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Biomedical subjects

M F Lieberman

Publications and source records attributed to M F Lieberman.

At least 19 recordsLinked to original sources
PubMed2000

Glaucoma screening using the scanning laser polarimeter.

PURPOSE: To determine the ability of scanning laser polarimetry (GDx Nerve Fiber Analyzer; Laser Diagnostic Technologies, Inc., San Diego, CA) to separate normal eyes and those considered likely to have glaucoma in a public glaucoma screening. METHODS: A 2-day public glaucoma screening program was held at two different institutions. Each subject underwent ophthalmologic examination, Humphrey perimetry (24-2 Fastpac program), and imaging using scanning laser polarimetry (GDx) in each eye for allocation into a diagnostic category: normal, ocular hypertensive, glaucoma suspect, or glaucoma. Results from the normal and glaucoma groups were analyzed, using modulation parameters calculated from a measurement band located 1.8 disc diameters from the disc, and selected parameters provided automatically by GDx software. Receiver operating characteristic curves were used to depict the sensitivity/specificity relationship at different GDx parameter cutoff levels. RESULTS: Of 200 subjects, 197 were classified; 122 were classified as normal, 23 were classified with ocular hypertension, 30 were classified as glaucoma suspects, and 22 were classified with definite glaucoma. Three subjects had ocular diseases other than glaucoma. The maximum area under the receiver operating characteristic curve for modulation parameters was 0.935, and for the GDx software parameters was 0.901. CONCLUSIONS: Scanning laser polarimetry may be useful in glaucoma screening.

Diagnostic Techniques, Ophthalmological↗
PubMed1999

Screening for glaucoma with frequency-doubling technology and Damato campimetry.

OBJECTIVE: To assess frequency-doubling technology (FDT) perimetry (Humphrey Systems, San Leandro, Calif) and Damato campimetry (Precision Vision, Villa Park, Ill) for detecting glaucoma in a public glaucoma screening. METHODS: A 2-day public glaucoma screening was held at 2 different institutions. Each subject underwent 2 visual field screening tests (Damato campimetry and FDT perimetry in screening mode), an ophthalmologic examination, and Humphrey perimetry (24-2 FASTPAC) for each eye. Eyes were divided into 4 categories: normal, ocular hypertensive, glaucoma suspect, and definite glaucoma. The sensitivity and specificity of FDT perimetry and Damato campimetry for detecting glaucoma were estimated with receiver operating characteristic curves. RESULTS: Among 240 subjects who underwent FDT, the number identified as normal, ocular hypertensive, glaucoma suspect, and definite glaucoma was 151, 28, 35, and 26, respectively; among 175 subjects who underwent Damato campimetry, the numbers for the same groups were 118, 19, 19, and 19, respectively. The areas under the receiver operating characteristic curve for FDT perimetry and Damato campimetry were 0.925 and 0.883, respectively. The optimal sensitivity and specificity for FDT perimetry were 92% and 93%, while those for Damato campimetry were 53% and 90%, respectively. The average test time was 1 minute and 3 minutes per eye for FDT perimetry and Damato campimetry, respectively. CONCLUSION: Frequency-doubling technology perimetry was superior to Damato campimetry in this screening for glaucoma.

California↗
PubMed1997

Late onset of sequential multifocal bleb leaks after glaucoma filtration surgery with 5-fluorouracil and mitomycin C.

PURPOSE: To describe the late onset of sequential multifocal bleb leaks as a postoperative complication after filtering surgery with antimetabolites. MATERIALS: Retrospectively, 385 consecutive eyes (304 patients) undergoing trabeculectomy with 5-flurouracil (5-FU) or mitomycin C (MMC) from 1989 to 1994 were reviewed. Eyes with filtration bleb leak occurring 6 months or more after trabeculectomy were analyzed, and clinical characteristics of the filtration bleb, response to treatment, and bleb histopathology from eyes undergoing bleb excision were analyzed. RESULTS: In seven (1.8%) of 385 consecutive eyes from 304 patients undergoing glaucoma filtration surgery with 5-FU or MMC, repetitive bleb leaks in different locations of the bleb were observed from 9 to 44 months (mean, 20.4 months) after the procedure. One hundred ninety-three eyes (50%) were treated with 5-FU and the remaining eyes, with MMC. All eyes had transparent, avascular, lobular, cystic blebs. Bleb leaks occurred in five eyes treated postoperatively with subconjunctival 5-FU and in two eyes in which MMC was used intraoperatively. Three eyes (all treated with 5-FU) required surgical excision, and four eyes healed with soft contact lens, cyanoacrylate glue, or intrableb injection of autologous blood. Histopathology of the bleb leak sites demonstrated focal epithelial thinning and interruption with subjacent hypocellularity and stromal collagen degeneration. CONCLUSION: Late sequential multifocal bleb leaks may occur after glaucoma filtration surgery with administration of antimetabolites (5-FU or MMC) and are associated with epithelial break-down, hypocellularity, and stromal collagen necrosis in the filtration bleb.

Aged↗
PubMed1997

Midterm follow-up results of combined phacoemulsification, lens implantation, and mitomycin-C trabeculectomy procedure.

PURPOSE: This study evaluates the visual, refractive, perimetric, and intraocular pressure (IOP) results following combined phacoemulsification, lens implantation, and trabeculectomy with mitomycin-C. METHODS: Twenty-nine consecutive eyes of 26 patients with cataract and glaucoma that had undergone combined phacoemulsification, posterior chamber lens implantation, and limbus-based trabeculectomy with mitomycin-C applied after the cataract removal and trabeculectomy had a minimal follow-up time of 12 months (mean follow-up 20 +/- 6.3 months). Each eye was evaluated for visual acuity, corneal astigmatism, IOP, bleb persistence, optic nerve stability, visual field status, and complications. Goldmann visual fields were assessed by a semi-quantitative method and threshold static perimetry by statistical indices of diffuse damage (mean deviation) and focal loss (corrected pattern standard deviation). The preoperative and postoperative results were compared by Student's t-test. RESULTS: All eyes that were free of pre-existing macular disease demonstrated significant improvement in visual acuity by at least 4.5 lines of Snellen acuity. Postoperative astigmatism was negligible (0.29 diopters). The average IOP reduction was 6.5 mm Hg, with the one year or more average of 13.4 mm Hg on virtually no antiglaucoma medicines (0.2 +/- 0.5). Functioning filtering blebs persisted in 86% of eyes. Of 11 patients tested with pre- and postoperative Goldmann perimetry, only two showed visual field defect progression despite IOPs < 15 mm Hg. Of the 12 eyes with pre- and postoperative static threshold perimetry, the mean deviation deteriorated in nine eyes (p = 0.003). The corrected pattern standard deviation changes were not statistically significant (p = 0.69). Complications (including two cases of late-onset endophthalmitis) were comparable with other studies reporting filtration surgery with adjunctive antimetabolites. We detected no untoward effects of applying the mitomycin at the end of the procedure rather than at the beginning. CONCLUSIONS: The combined procedure technique that we describe appears to be effective at restoring visual acuity and significantly reducing IOP. Nevertheless, many visual fields showed continued, diffuse glaucomatous progression in the year or two following surgery and the development of late endophthalmitis in two eyes is a concern.

Aged↗
PubMed1996

Evaluation of optic disc measurements with the glaucoma-scope.

PURPOSE: We evaluated the Glaucoma-Scope's ability to acquire images of the optic disc, the reproducibility of its analysis, and the comparison between it and expert evaluation. METHODS: One hundred and sixty-eight patients with satisfactory standard fundus photography were referred for Glaucoma-Scope analysis. Characteristics of eyes in which Glaucoma-Scope analysis could not be obtained were evaluated. Eight glaucoma patients (15 eyes) were quantitatively evaluated: inter- and intraobserver reproducibility of the Glaucoma-Scope analyses were calculated utilizing weighted Kappa index of agreement and coefficient of variation. The Glaucoma-Scope cup-to-disc ratio was calculated from the gray scale analysis and compared to the ratio as evaluated by a glaucoma expert. RESULTS: Glaucoma-Scope analysis was not achieved in 14% of a total of 336 eyes of 168 patients. The conditions associated with the inability to obtain a satisfactory image were hyperpigmented fundi, pseudophakia, aphakia, corneal opacities, cataract, and contact lenses. The quantitative analysis of the 15 patients showed small inter- and intraobserver means of the coefficient of variation (0.136 +/- 0.023 and 0.129 +/- 0.016) and SD (0.063 +/- 0.0056 and 0.064 +/- 0.0077) and moderate-substantial intra- and interobserver agreement (weighted K = 0.427 +/- 0.1 and 0.61 +/- 0.14, respectively). Significant disagreement (weighted K = -0.11, p = 0.0023) was found between Glaucoma-Scope (mean 0.52 +/- 0.064) and expert's evaluations (0.673) of the cup-to-disc ratio. CONCLUSIONS: The inter- and intraobserver reliability and low variation of the Glaucoma-Scope readings indicates moderate to substantial reproducibility for detecting changes in optic disc's topography under selected conditions. However, eyes with moderate cataract, aphakia, pseudophakia, mild corneal opacity, darkly pigmented fundi or myopia were inconsistently analyzable. In a small group of randomly selected eyes there was very low agreement between the glaucoma expert's evaluation of the optic disc and that of the Glaucoma-Scope. These findings raise questions about the usefulness of the instrument as a diagnostic tool for glaucoma but show promise for detecting change when good images are possible.

Diagnostic Imaging↗
PubMed1994

Technique for determining glaucomatous visual field progression by using animation graphics.

The first two visual field examinations of each of 16 glaucoma suspects and 16 glaucoma patients, who were followed up for a median of 7.46 years with seven examinations, were averaged. Three-dimensional color-coded images of the visual field were then generated. After correcting for test-retest variability, the images, as well as additional interpolated images, were aligned and presented in rapid succession to create an animation sequence. Five glaucoma specialists trained themselves to classify the visual fields as either progressing or not progressing. The interobserver and intraobserver agreement rates were then calculated. Perfect agreement (100% concordance) between the observers was obtained for 18 (56.3%) subjects, and at least 80% concordance was obtained for 27 (84.4%) subjects. Of the eight sequences that were repeated to test intraobserver agreement, four of the five observers had a value of at least 87.5%.

Adult↗
PubMed1992

Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil.

Long-term success in trabeculectomy has been enhanced in recent years by postoperative subconjunctival 5-fluorouracil injections and intraoperative mitomycin C applications. During 1990 and 1991, after trabeculectomy with a small scleral flap (2 x 3 mm) augmented by antimetabolite therapy, hypotonous maculopathy developed in eight eyes of six patients. The maculopathy was characterized by loss in visual acuity, retinal striae, and choroidal folds without evidence of vascular leakage. The average loss in visual acuity was four Snellen lines. Visual acuity did not return to preoperative levels even when the hypotony could be reversed. Reversing the hypotony with various strategies aimed at stimulating subconjunctival scarring has been relatively ineffective. During that same period, an additional seven eyes in six patients had prolonged hypotony but without development of maculopathy. Features common to patients who developed maculopathy included age (mean age, 46 years; range, 32 to 60 years) and myopia (mean, -7.5 diopters; range, -0.75 to -11.75 diopters). The patients with hypotony but no maculopathy were older (mean age, 73 years; range, 63 to 82 years) and were closer to emmetropia (mean, -1.11 diopters; range, +1.50 to -9.00 diopters). The means of the ages and refractive errors were statistically significantly different in the two groups (P = .007 and .04, respectively). Trabeculectomy with adjunctive antifibrosis therapy should be used with caution in young myopic patients.

Adult↗
PubMed1989

Internal suture occlusion of the Molteno glaucoma implant for the prevention of postoperative hypotony.

The Molteno glaucoma drainage implant procedure is useful for managing refractory glaucoma, but a significant concern has been the avoidance of postoperative hypotony due to temporary excessive filtration. We have developed a method of temporarily closing the translimbal tube with an internally-placed occluding suture (4-0 or 5-0 chromic). Seven to 12 days later this suture was removed, without surgery, in an outpatient setting. We have used this method on 30 patients. The advantages are that postoperative hypotony is reduced, and the Molteno drainage implant can be inserted in a single operation.

Drainage↗
PubMed1983

Complications of laser trabeculoplasty.

Laser trabeculoplasty (LTP) is a relatively new procedure requiring evaluation for long-term effectiveness and associated complications. The authors review some 300 LTPs and identify complications. Among the most serious are transient or persistent rise in intraocular pressure, iritis, and progression of visual field loss. The authors recommend LTP as an alternative to glaucoma surgery in selected patients not controlled by medications.

Glaucoma↗
PubMed1983

Laser trabeculoplasty and the glaucomas.

A standard 100-spot laser trabeculoplasty was applied to 137 eyes of 109 presurgical patients with a variety of primary, secondary, and postsurgical glaucomas. Average follow-up was 15.3 months. Laser therapy was most successful in eyes without prior surgery (chronic open-angle glaucoma (COAG), pseudoexfoliation, pigmentary dispersion) or with only one prior operation (iridectomy, trabeculectomy, or intracapsular cataract extraction). The mean range for pressure reduction was 6 to 12 mmHg. Failures were frequently seen in eyes with angle recession, uveitis, or more than one operation. Visual field deterioration was seen in 11% of successful COAG eyes. Asymmetric responses in bilaterally treated COAG patients were seen half the time. A drift downward of 5 mmHg or more at six months after laser reversed itself by 12 months in approximately one out of eight eyes from various categories.

Adult↗
PubMed1978

Hypoplasia of the optic nerve.

Premorbid ophthalmoscopic and histopathologic findings were correlated in a case of bilateral optic nerve hypoplasia in a 9-month-old infant with bilateral hydranencephaly. The double-ring sign was due to an extension of retina and retinal pigment epithelium (RPE) over the outer portion of the lamina cribrosa. The outer ring was the junction between sclera and lamina cribrosa, and the inner ring was the termination of the RPE. The center of the inner ring was the hypoplastic nerve head, which appeared whitish because of fibroglial tissue surrounding the central retinal vessels where they entered the optic nerve head. We speculate that an in utero vascular insult, after the third month of development, led to cystic cavitation of the anterior cerebral hemispheres, with subsequent retrograde degeneration of developing retinal ganglion cells.

Abnormalities, Multiple↗
PubMed1978

Embolic ischemic optic neuropathy.

On examining the postmortem enucleated eyes of a 68-year-old man, we found the left eye had focal infarction 3 mm behind the lamina cribrosa caused by thromboembolic compromise of three discrete pial and pial-derived arterioles. The optic nerve had been destroyed focally, whereas the retinal and choroidal tissue supplied by a similarly occluded vessel had been preserved. We diagnosed nonarteritis ischemic optic neuropathy.

Aged↗
PubMed1976

Histologic studies of the vasculature of the anterior optic nerve.

Thirty-one normal human anterior optic nerves were studied in thin serial sections and their vessels stained by standard histologic stains and a new modification of the silver reticulin stain. The retrolaminar cribrosa was profusely supplied by centripetal and longitudinal vessels of pial origin; small branches of the central retinal artery were also seen. Longitudinal continuity of small vessels extended from the retrolaminar nerve to the retinal surface. This system freely anastomosed with three transverse systems; a significant anteriolar input from short posterior ciliary arteries in the sclera to the lamina cribrosa; smaller short posterior ciliary branches and occasional choroidal capillaries to the prelaminar portion; and branches derived from the central retinal artery in and around the disk. Vessels entering the prelaminar region at the level of the choroid were mainly derived from scleral branches of short posterior ciliary vessels entering through the border tissue of Elschnig, rather than from choroidal branches of ciliary arteries. Venous drainage for the anterior optic nerve was primarily through the central retinal vein, although alternate smaller paths to surrounding tissues were also identified.

Choroid↗