Biomedical subjects

M J Lynn

Publications and source records attributed to M J Lynn.

At least 19 recordsLinked to original sources

PubMed2006

Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID.

The WASID trial showed no advantage of warfarin over aspirin for preventing the primary endpoint of ischemic stroke, brain hemorrhage, or vascular death. In analyses of selected subgroups, there was no definite benefit from warfarin. Warfarin reduced the risk of the primary endpoint among patients with basilar artery stenosis, but there was no reduction in stroke in the basilar artery territory or benefit for vertebral artery stenosis or posterior circulation disease in general.

Aged↗

PubMed2006

Natural history of homonymous hemianopia.

OBJECTIVE: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). METHODS: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. RESULTS: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60% chance of improvement for cases tested within 1 month after injury that decreased to about 20% for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. CONCLUSION: Spontaneous improvement of homonymous hemianopia is seen in at least 50% of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient's ability to perform visual field testing reliably.

Adolescent↗

PubMed2006

Homonymous hemianopias: clinical-anatomic correlations in 904 cases.

OBJECTIVE: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). BACKGROUND: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations. METHODS: The authors reviewed medical records of all patients with HH seen in their service between 1989 and 2004. Demographic characteristics, characteristics of visual field defects, causes of visual field defects, neuroradiologic definition of lesion location, and associated neurologic deficits were recorded. RESULTS: A total of 904 HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH (62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%), partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407 HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123, 13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Every type of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia, was found in all lesion locations along the retrochiasmal visual pathways. CONCLUSION: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.

Adolescent↗

PubMed2006

Longitudinal changes in the spherical equivalent refractive error of children with accommodative esotropia.

AIM: To assess the longitudinal changes in the spherical equivalent (SE) refractive errors of children with accommodative esotropia as a function of the age when glasses were prescribed. METHODS: Refractive errors were followed longitudinally for 126 children with accommodative esotropia for a mean of 4.4 (SD 2.5) years. Cycloplegic refractions were performed using an autorefractor for older children and retinoscopy for younger children. The refractive data were analysed for three groups of children based on their age at the time spectacles were prescribed. RESULTS: The initial SE refractive error was age dependent (<2 years, 5.1 (1.9) D; 2-<4 years, 4.2 (1.9) D; 4-8 years, 3.8 (1.7) D). Children in all age groups had an initial increase in their SE refractive error, followed by a later decrease; however, the greatest decrease occurred in the patients in the oldest age group. The SE refractive error peaked 1 year after spectacles were prescribed for the children 4-8 years of age versus 6 years after spectacles were prescribed for the children less than 2 years of age. CONCLUSION: Longitudinal changes in SE refractive error for children with accommodative esotropia vary as a function of their age when spectacle wear is initiated.

Accommodation, Ocular↗

PubMed2002

Autonomic dysfunction in Parkinson's disease: a comprehensive symptom survey.

BACKGROUND: Autonomic dysfunction occurs in Parkinson's disease (PD), but few studies have addressed it in a comprehensive manner. METHODS: Autonomic symptoms were evaluated by a questionnaire in sixty-eight subjects (44 patients and 24 controls). RESULTS: PD patients experienced higher frequency and severity of autonomic dysfunction. When all autonomic symptoms were pooled into an aggregate score, differences between patients and controls were highly statistically significant (p<0.0001). 'Increased salivation', 'frequency of dysphagia', decreased 'BM (bowel movement) frequency', i.e. constipation, and 'orthostatic dizziness' were more frequent in PD patients (p<0.05). A prediction model to determine the predictors of autonomic dysfunction was unsuccessful. CONCLUSION: Differences in the prevalence of autonomic symptoms in PD and non-parkinsonian controls are apparent from this study.

Aged↗

PubMed2001

Neuro-ophthalmic manifestations of head trauma.

OBJECTIVE: To describe the neuro-ophthalmic findings in a group of patients with head trauma. MATERIALS AND METHODS: A retrospective chart review of all patients given a diagnosis code of head trauma in the neuroophthalmology unit at Emory University between 1991 and 1999. RESULTS: A total of 326 consecutive patients were reviewed (203 [63%] men and 123 [37.0%] women). Age ranged from 2 to 86 years, with a mean of 30 years. Motor vehicle accident was the most common cause of head trauma, occurring in 195 (59.8%) patients. An abnormal neuro-ophthalmic examination was noted in 185 of 326 patients (56.7%). Loss of consciousness was not associated with any outcome, but the presence of a neuroimaging abnormality, particularly intracranial hemorrhage, was significantly associated with specific neuroophthalmic deficits. CONCLUSIONS: Head trauma causes a number of neuroophthalmic manifestations. The afferent and efferent pathways are vulnerable to traumatic injury, although the efferent system is more commonly affected. Loss of consciousness may not be a reliable predictor of specific neuro-ophthalmic outcomes, but neuroimaging abnormalities may.

Adolescent↗

PubMed2000

Redox state of glutathione in human plasma.

Thiol and disulfide forms of glutathione (GSH) and cysteine (Cys) were measured in plasma from 24 healthy individuals aged 25-35 and redox potential values (E(h)) for thiol/disulfide couples were calculated using the Nernst equation. Although the concentration of GSH (2.8 +/- 0.9 microM) was much greater than that of GSSG (0.14 +/- 0.04 microM), the redox potential of the GSSG/2GSH pool (-137 +/- 9 mV) was considerably more oxidized than values for tissues and cultured cells (-185 to -258 mV). This indicates that a rapid oxidation of GSH occurs upon release into plasma. The difference in values between individuals was remarkably small, suggesting that the rates of reduction and oxidation in the plasma are closely balanced to maintain this redox potential. The redox potential for the Cys and cystine (CySS) pool (-80 +/- 9 mV) was 57 mV more oxidized, showing that the GSSG/2GSH and the CySS/2Cys pools are not in redox equilibrium in the plasma. Potentials for thiol/disulfide couples involving CysGly were intermediate between the values for these couples. Regression analyses showed that the redox potentials for the different thiol/disulfide couples within individuals were correlated, with the E(h) for CySS-mono-Gly/(Cys. CysGly) providing the best correlation with other low molecular weight pools as well as protein disulfides of GSH, CysGly and Cys. These results suggest that E(h) values for GSSG/2GSH and CySS-mono-Gly/(Cys. CysGly) may provide useful means to quantitatively express the oxidant/antioxidant balance in clinical and epidemiologic studies.

Adult↗

PubMed2000

Neoadjuvant interferon alfa-2b treatment in a murine model for metastatic ocular melanoma: a preliminary study.

OBJECTIVES: To investigate the treatment of metastasis from uveal melanoma and to test the effect of interferon (IFN) alfa-2b in a murine model. METHODS: The B16-LS9 tissue culture melanoma cells were inoculated into the posterior intraocular compartment of 3 groups of C57BL/6 mice. The inoculated eyes were enucleated at 9 days and the mice were euthanized at 26 days after inoculation; the site and number of metastases were determined using standard histologic techniques. Group 1 was the control group; group 2 was given 20,000 international units (IU) of IFN alfa-2b intramuscularly 12 hours before enucleation, and group 3 received daily injections of 20,000 IU of IFN alfa-2b intramuscularly starting 4 days before enucleation. RESULTS: Pulmonary metastases were detected in 57%, 33%, and 0% of groups 1, 2, and 3, respectively; hepatic micrometastases were detected only in group 1. These results showed a significant decrease in hepatic metastases in mice receiving IFN alfa-2b vs controls (P =.005). CONCLUSION: Treatment with IFN alfa-2b results in decreased hepatic metastases from intraocular melanoma in a murine model. Arch Ophthalmol. 2000;118:1085-1089

Animals↗

PubMed2000

Stages of improvement in visual fields after pituitary tumor resection.

PURPOSE: To use static threshold perimetry to examine the stages of improvement and the potential for late improvement of visual fields after surgical resection of pituitary adenomas causing visual loss from compression of the anterior visual pathways. METHODS: Retrospective review of charts of patients with pituitary tumors and abnormal static threshold perimetry before or soon after treatment who had subsequent visual fields. Quantification of the visual field mean deviation overall, superotemporally, and inferotemporally was performed and compared between visits. Postoperative visits were considered in five time periods: visit 1 (surgery to 1 week), visit 2 (1 month to 4 months), visit 3 (6 months to 1 year), visit 4 (2 years), and visit 5 (3 or more years). RESULTS: Sixty-two patients were included (33 men and 29 women; mean age 54 years [SD +/- 15 years; range, 22 to 83 years]). At visit 1, the relative improvement of the overall mean deviation for the right eye was 30.8% (P =.01) and for the left eye was 13.7% (P =.3067). At visit 2, the relative improvement of the overall mean deviation for the right eye was 30. 4% (P =.0142) and for the left eye was 32.6% (P =.0092). At visits 1 and 2, the inferotemporal quadrants were the quadrants with greatest improvement (visit 1, right eye, 37.8% [P =.0082]; visit 2, left eye, 30.8% [P =.0074]). At visits 3, 4, and 5, an overall trend toward mild improvement was observed with statistical significance only for the inferotemporal quadrant of the left eye from visit 2 to visit 3, which improved 19.7% (P =.0270). CONCLUSION: The pattern of recovery of visual function after decompression of the anterior visual pathways suggests at least three phases of improvement. The early fast phase (surgery to 1 week) of improvement may lead to normalization of visual fields in some individuals. The early slow phase (1 month to 4 months) is the period of most notable improvement. A late phase (6 months to 3 years) of mild improvement does not appear significant overall but may be marked in some individuals. Each of these phases may have one or more mechanisms underlying the observed improvement.

Adenoma↗

PubMed2000

Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy.

PURPOSE: To compare the visual outcome and refractive status of children with primary congenital glaucoma who underwent 360 degrees trabeculotomy or goniotomy as an initial surgical procedure. METHODS: This retrospective study describes 24 eyes (15 patients) with primary congenital glaucoma that underwent 360 degrees trabeculotomy as the initial procedure and 40 eyes (23 patients) that underwent goniotomy as the initial procedure. Inclusion criteria were: (1) diagnosis of primary congenital glaucoma and initial angle surgery before 1 year of age, (2) no other ocular or systemic diseases, (3) 360 degrees trabeculotomy or goniotomy as the first surgical procedure, and (4) ability to obtain an Allen or Snellen visual acuity. A postoperative vision of 20/50 or better was considered good. Surgical success was defined as an intraocular pressure (IOP) less than 22 mm Hg with or without medication and without evidence of a progressive optic neuropathy. RESULTS: The IOP was successfully controlled in 92% of eyes in the trabeculotomy group and in 58% of eyes in the goniotomy group (P =.004). Of eyes in the trabeculotomy group, 79% had vision of 20/50 or better compared with 53% in the goniotomy group (P =.03). High myopia was more prevalent in the goniotomy group, but this difference was not statistically significant (P =.16). A poor visual outcome was associated with failure of the angle surgery or poor compliance with follow-up and amblyopia therapy. CONCLUSION: For primary congenital glaucoma, 360 degrees trabeculotomy is a highly effective procedure that results in excellent pressure control and is at least as successful as multiple standard procedures. In this study, 360 degrees trabeculotomy resulted in better vision than what is reported in the literature for standard angle procedures.

Anterior Chamber↗

PubMed2000

A standardized method for measuring intracranial arterial stenosis.

BACKGROUND AND PURPOSE: Atherosclerosis of the major intracranial arteries is an important cause of ischemic stroke. We established measurement criteria to assess percent stenosis of a major intracranial artery (carotid, middle cerebral, vertebral, basilar) and determined the interobserver/intraobserver agreements and interclass/intraclass correlations of these measurements. METHODS: We defined percent stenosis of an intracranial artery as follows: percent stenosis = [(1 - (D(stenosis)/D(normal)))] x 100, where D(stenosis) = the diameter of the artery at the site of the most severe stenosis and D(normal) = the diameter of the proximal normal artery. If the proximal segment was diseased, contingency sites were chosen to measure D(normal): distal artery (second choice), feeding artery (third choice). Using a hand-held digital caliper, three neuroradiologists independently measured D(stenosis) and D(normal) of 24 stenotic intracranial arteries. Each observer repeated the readings 4 weeks later. We determined how frequently two observers' measurements of percent stenosis of each of the 24 diseased arteries differed by 10% or less. RESULTS: Among the three pairs of observers, interobserver agreements were 88% (observer 1 versus observer 2), 79% (observer 1 versus observer 3), 75% (observer 2 versus observer 3) for the first reading and were 75% (observer 1 versus observer 2), 100% (observer 1 versus observer 3), and 71% (observer 2 versus observer 3) for the second reading. Intraobserver agreement for each of the observers was 88%, 83%, and 100%. Interclass correlation was 85% (first reading) and 87% (second reading). Intraclass correlation was 92% (first and second readings combined). CONCLUSION: This method shows good interobserver and intraobserver agreements for the measurement of intracranial stenosis of a major artery. If validated in subsequent studies, this method may serve as a standard for the measurement of percent stenosis of an intracranial artery.

Arterial Occlusive Diseases↗

PubMed1999

Long-term results of corneal graft survival in infants and children with peters anomaly.

OBJECTIVE: To determine the long-term results of corneal graft survival after penetrating keratoplasty for Peters anomaly and to identify risk factors for graft failure. DESIGN: Noncontrolled interventional case series: a single-center retrospective review of a consecutive surgical series. PARTICIPANTS: The records of all children 12 years of age or younger who underwent penetrating keratoplasty for Peters anomaly between January 1971 and December 1992 were reviewed. All study eyes had completed a minimum of 3 years of follow-up from the date of first keratoplasty and had undergone most of their corneal surgery at Emory University. INTERVENTION: Characteristics of the recipient, the eye, the donor, and the surgical procedure were analyzed for their influence on survival of the first graft. Survival probabilities were estimated using the Kaplan-Meier method. Multivariate regression analysis was performed to estimate relative risks and adjusted survival probabilities. MAIN OUTCOME MEASURE: Graft clarity. RESULTS: One hundred forty-four penetrating keratoplasties were performed in 72 eyes of 47 patients. The median age at first keratoplasty was 4.4 months. The median follow-up was 11.1 years. Fifty-four percent of eyes received one graft, 18% received two grafts, and 28% received three or more grafts. The overall probability of maintaining a clear first graft was 56% at 6 months, 49% at 12 months, 44% at 3 years, and 35% at 10 years. The probability of second or subsequent grafts surviving for 3 years was less than 10%. Thirty-nine percent of eyes had a clear graft at the time of review; 36% of eyes had a clear first graft. Multivariate analysis identified disease severity, donor cornea size, coexisting central nervous system abnormalities, and quadrants of anterior synechiae as the strongest risk factors for graft failure. Supplemental multivariate analysis, restricted to observable preoperative variables, identified stromal vessels, total limbal opacification, and preoperative glaucoma as independent preoperative predictors of graft failure. Allograft rejection was the most frequently identified cause of graft failure. Major complications after keratoplasty were phthisis, retinal detachment, cataract, and glaucoma. CONCLUSIONS: The overall long-term probability of maintaining a clear graft after initial penetrating keratoplasty for Peters anomaly is 35% +/- 0.06%, with subsequent grafts rarely surviving. Eyes with severe disease, larger donor corneas, coexisting central nervous system abnormalities, and anterior synechiae have significantly poorer outcomes than eyes without these factors. These data should be carefully considered before recommending corneal transplantation for Peters anomaly, particularly after previous graft failure.

Anterior Eye Segment↗

PubMed1999

Diurnal fluctuations in corneal topography 10 years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study.

PURPOSE: To correlate clinically observed fluctuations in manifest refraction, visual acuity, keratometry, and intraocular pressure (IOP) with changes in the anterior corneal surface as measured by videokeratography in patients 10 years after radial keratotomy (RK). SETTING: Four clinical centers in the United States that participated in the Prospective Evaluation of Radial Keratotomy (PERK) study. METHODS: Thirty-two eyes of 20 PERK patients who noted diurnal fluctuations in vision had clinical examination and videokeratography (TMS-1, Computed Anatomy Inc.) in the morning and evening of the same day a mean of 10.3 years (range 7.8 to 11.7 years) after RK. The videokeratographs were analyzed in terms of various indexes generated by custom-designed software. Morning-to-evening changes in the means of the various clinical and videokeratographic values were assessed using pairwise methods. RESULTS: The mean increase in myopia was 0.36 diopters (D) +/- 0.58 (SD) from morning to evening (P < .01). Analysis of the videokeratographs showed a corresponding increase in average corneal power (ACP), reflecting a steepening of 0.52 +/- 0.45 D (P < .001). The change in ACP was correlated with a change in the manifest spherical equivalent refraction (R = 0.39, P = .03) and a change in best spectacle-corrected visual acuity (R = 0.38, P = .03) over the same period. Similarly, simulated keratometry (SimK) readings correlated with the change in the manifest spherical equivalent refraction (R = 0.38, P = .03 for SimK1; R = 0.37, P = .35 for SimK2; R = 0.4, P = .02 for average SimK), although the standard clinical keratometric data did not (P = .26 for K1, P = .11 for K2, and P = .09 for the mean K). The elevation depression magnitude, a measure of the low-frequency irregularities of the cornea, showed a decrease of 0.32 +/- 1.59, which also correlated with the change in the manifest spherical equivalent refraction (R = 0.37, P = .04). Intraocular pressure tended to decrease from morning to evening (mean change of -0.97 +/- 3.29 mm Hg), but the difference was not significant. Variations in IOP in individual patients, however, were correlated with changes in the manifest spherical equivalent refraction (R = 0.37, P = .04). CONCLUSIONS: Diurnal fluctuations in corneal topographic indexes can be used to evaluate the diurnal fluctuations in refraction and visual acuity after RK. The study findings provide statistical support for the idea that IOP contributes to the diurnal fluctuation in visual acuity after RK.

Adult↗

PubMed1999

Depletion of NK cell activity results in growth of hepatic micrometastases in a murine ocular melanoma model.

PURPOSE: To study the role of natural killer (NK) cells in growth of spontaneous hepatic metastasis in a murine intraocular melanoma model. METHODS: Tissue culture B16-LS9 melanoma cells were analyzed by flow cytometry for MHC class I expression of all haplotypes and inoculated into the posterior compartment (PC) of one eye of C57BL6 mice. The eyes were enucleated at 12 days post-inoculation and histologically examined for tumor growth. One group of mice (n = 10) were given intraperitoneal injections of anti-asialo GM1 for NK cell depletion post-enucleation and a second group of mice (n = 9) served as controls. The mice were sacrificed at 24 days post-inoculation and necropsies were performed to determine the number and size of metastasis. RESULTS: The B16-LS9 cells failed to express MHC class I antigen. Tumor grew in the PC of all eyes and metastasized to the lungs and livers of all mice, with the average number of hepatic micrometastases greater in the NK depleted group versus the control group (p =.009). There was no significant difference in the average number of pulmonary metastases in the treated versus the control group (p =.072). Hepatic metastases grew to an average diameter of 600 microm in diameter in two NK depleted mice. CONCLUSIONS: NK depletion in this model of metastatic ocular melanoma results in increased number and growth of hepatic micrometastases.

Animals↗

PubMed1998

Optic neuritis in African Americans.

OBJECTIVE: To describe the clinical profile of demyelinating optic neuritis in African Americans. METHODS: The medical records of all patients with a diagnosis of optic neuritis examined at the Neuro-Ophthalmology Unit at the Emory University Eye Center (Emory) and at the Grady Memorial Hospital Eye Clinic (Grady), Atlanta, Ga, between 1989 and 1996 were retrospectively reviewed. PATIENTS: African American and white patients, aged 15 through 55 years, with a single initial episode of acute optic neuritis of unknown or demyelinative origin were included in the study. Study patients included 23 African American patients and 56 white patients examined at Emory as well as 10 African American patients examined at Grady. RESULTS: There were no significant differences among the African American study patients, the white study patients, and patients from the Optic Neuritis Treatment Trial (ONTT) regarding sex (P=.36), age (P=.73), or the presence of disc edema (P=.40), lesions found on magnetic resonance imaging (P=.43), or multiple sclerosis (P=.54) at the onset of an initial episode of optic neuritis. The Emory African American patients presented with more frequent severe visual loss (13 [93%] of 14 patients with a visual acuity < or =20/200) compared with Emory white patients (12 [39%] of 31 patients; P=.002) and with ONTT patients (161 [36%] of 448 patients; P<.001). At follow-up examination of at least 1 year, Emory African American patients had worse vision (9 [39%] of 23 patients <20/40, and 4 [17%] of 23 patients < or =20/200) compared with Emory white patients (5 [8%] of 63 patients <20/40, P=.001; 3 [5%] of 63 patients < or =20/200, P=.08), and with ONTT patients (29 [7%] of 409 patients <20/ 40, P=.0001; 12 [3%] of 409 patients < or =20/200, P=.01). Compared with ONTT patients, the Emory African American patients combined with the Grady African American patients had more frequent severe visual loss (visual acuity < or =20/200) at presentation (18 [90%] of 20 patients vs 161 [36%] of 448 patients; P<.001) and at follow-up examination of at least 1 year (6 [18%] of 33 patients vs 12 [3%] of 409 patients; P=.002). Seven (58%) of 12 African American patients with multiple sclerosis had a "neuromyelitis optica" presentation defined by the presence of neurological deficits limited to the optic nerves and spinal cord. CONCLUSIONS: The African American study patients with a single episode of demyelinating optic neuritis had visual acuities more severely affected at onset and after 1 year of follow-up compared with the white study patients and with patients in the ONTT. In the African American patients, multiple sclerosis occurred most frequently in a "neuromyelitis optica" form.

Acute Disease↗

PubMed1998

Trabeculectomy with adjunctive mitomycin C in pediatric glaucoma.

PURPOSE: To determine the safety and efficacy of trabeculectomy with adjunctive mitomycin C in patients 17 years of age or younger, and to identify risk factors for failure of this surgical technique. METHODS: Retrospective review of consecutive cases of pediatric glaucoma that underwent mitomycin C augmented trabeculectomy between January 1991 and December 1995. Forty-nine patients (60 eyes) with a mean age of 7.6 years (range, 6 weeks to 17.6 years) were identified and followed up until repeat glaucoma surgery, or after a minimum of 6 months. Success was defined as intraocular pressure control of 22 mm Hg or less with or without topical glaucoma control medication, no evidence of glaucoma progression, no further glaucoma surgery necessary, and no visually devastating complication. RESULTS: Cumulative probabilities of success +/- SD for 49 eyes (one eye per patient) were 67% +/- 13% at 12 months and 59% +/- 15% at 24 months. Multivariate regression analysis yielded the following characteristics as significantly increased risk for failure: age of less than 1 year at time of surgery (risk ratio, 5.6; confidence interval, 2.1 to 14.7; P = .0005), and aphakia (risk ratio, 2.7; confidence interval, 1.1 to 6.9; P = .0364). Shallow anterior chamber (17 [28%] of 60 eyes) and serous choroidal detachment (13 [22%] of 60 eyes) were the most common complications. Four (11%) of 38 eyes with obtainable Snellen acuity were noted to have a decrease in best-corrected visual acuity of more than 2 Snellen lines or loss of light perception. In 5 (8%) of 60 eyes bleb-related endophthalmitis was noted. CONCLUSIONS: Trabeculectomy with adjunctive mitomycin C is generally effective for the treatment of pediatric glaucoma, especially in phakic children over 1 year of age. However, late-onset bleb-related endophthalmitis is a substantial risk in this patient population.

Adolescent↗

PubMed1997

Effect of intraocular irrigating solutions on the viability of cultured retinal vascular endothelial cells.

PURPOSE: To compare the abilities of balanced salt solution, BSS Plus and Hartmann's lactated Ringer's (HLR) solution to maintain the viability of retinal vascular endothelial cells (RVEC) in vitro. METHODS: Cultured retinal vascular endothelial cells were suspended in each irrigating solution for four hours. Viability was determined by trypan blue exclusion at 30 minute intervals. Regression analysis was used to determine the rate of viability loss. Additional studies were performed to determine the effectiveness of lactate in maintaining cell viability. RESULTS: Retinal vascular endothelial cells lost viability at a greater rate (p < 0.001) in BSS (8.7%/hr) compared with BSS Plus (3.3%/hr). Cells in Hartmann's lactated Ringer's lost viability at a significantly lower rate (4.4%/hr) than retinal vascular endothelial cells in lactate-free Hartmann's lactated Ringer's solution (8.4%/hr). Lactate was as effective as glucose in preserving RVEC viability. By comparison, the viability of corneal endothelial cells was not effectively maintained by lactate. For these cells, BSS Plus was clearly superior to Hartmann's lactated Ringer's solution in maintaining viability. CONCLUSIONS: BSS Plus and Hartmann's lactated Ringer's solution are both superior to balanced salt solution in maintaining retinal vascular endothelial cell viability. For retinal vascular endothelial cells, Hartmann's lactated Ringer's solution preserves cell viability as well as BSS Plus, since the retinal vascular endothelial cells, unlike corneal endothelial cells, can apparently utilize lactate as an energy source.

Animals↗

PubMed1996

Anterior vs posterior intraocular melanoma. Metastatic differences in a murine model.

OBJECTIVE: To study differences in metastatic rate of anterior vs posterior ocular melanoma in a murine model. METHODS: Thirty-eight 12-week-old C57BL6 mice were inoculated into the anterior chamber (AC) or posterior compartment (PC) of the right eye with 5 x 10(5) tissue culture Queens melanoma cells per 5 microL. The right eye was enucleated 14 days after inoculation, and the animal was killed 28 days after inoculation and a necropsy was performed. The eye was evaluated for the presence of melanoma and the mean of the 10 largest nucleoli in tumor cells. Eyes with orbital invasion of the melanoma were excluded. The number of metastases was determined at necropsy. RESULTS: Melanomas grew in 30 of 38 eyes. After exclusion of 9 eyes with orbital invasion of tumor, melanoma was found in 12 mice in the AC group and 9 mice in the PC group. The metastatic rate was significantly lower for AC tumors (33%) than for PC tumors (89%) (P = .02). All AC tumors that metastasized to lungs also metastasized to ipsilateral cervical lymph nodes, and no PC tumors metastasized to ipsilateral cervical lymph nodes. The median number of pulmonary metastases per tumor was significantly smaller for AC tumors than for PC tumors (P = .01) There was a median of 0 metastases (range, 0-14) per AC tumor and 4 metastases (range, 0-38) per PC tumor. CONCLUSION: Posterior ocular melanoma metastasizes more often than anterior ocular melanoma in this murine model.

Animals↗