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Biomedical subjects

M J Menage

Publications and source records attributed to M J Menage.

14 recordsLinked to original sources
PubMed1999

Acute angle closure glaucoma: an evaluation of a protocol for acute treatment.

PURPOSE: To report the use of a protocol for the treatment of acute angle closure glaucoma (AACG) and document its effectiveness. METHODS: Following a clinical audit, a formal protocol for the treatment of AACG was introduced in our department. Three and a half years later, the records of 63 consecutive patients were reviewed. A descriptive analysis was performed. RESULTS: At presentation the mean intraocular pressure (IOP) in the affected eye was 56 mmHg. The visual acuity was 6/60 or worse in 68% of patients. The mean duration to achieve adequate IOP control was 3 h (range 1-7 h) and 44% of the patients achieved this without the use of osmotic diuretics. None of the fellow eyes developed AACG prior to peripheral iridotomy. No further medical or surgical treatment was needed in 44%. Further topical treatment alone and surgical treatment were needed in 21% and 35% respectively. Following adequate IOP control, 76% had a visual acuity of 6/24 or better. All who had a final visual acuity of 6/60 or worse had significant non-glaucomatous pathology. At 6 months follow-up, 67% were treatment free and 65% had a normal optic disc. CONCLUSIONS: This study demonstrates that this treatment protocol provided comprehensive and explicit guidance on the emergency treatment of AACG. This resulted in rapid IOP control following presentation and eventual favourable outcome in most cases.

Acetazolamide↗
PubMed1999

The effect of once-daily latanoprost on intraocular pressure and pulsatile ocular blood flow in normal tension glaucoma.

PURPOSE: To determine the effect of once-daily 0.005% latanoprost on intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) in patients with normal tension glaucoma (NTG). METHODS: The diurnal IOP and sitting POBF were determined for 32 eyes of 19 NTG patients after a washout period. The subjects were treated with 0.005% latanoprost for 3-4 weeks and the measurements repeated. Statistical analysis was performed using the Wilcoxon signed rank test. RESULTS: Median IOP before and after treatment were 19 and 15 mmHg respectively (p < 0.001). The IOP reduction correlated with the initial IOP before treatment (p < 0.01) and was accompanied by an increase in median POBF from 656 to 796 microliters/min (p < 0.001). CONCLUSIONS: Once-daily treatment with 0.005% latanoprost provides a significant and stable IOP reduction in the majority of NTG patients after short-term treatment. This is accompanied by a significant increase in POBF.

Administration, Topical↗
PubMed1998

Modification of trabeculectomy with single-dose intraoperative 5-Fluorouracil application.

PURPOSE: To assess the outcome of trabeculectomy supplemented with intraoperative 5-Fluorouracil (5 FU) application in glaucoma patients. METHODS: A prospective non-randomized case series of 76 eyes of 76 consecutive patients who underwent trabeculectomy with intraoperative sponge 5 FU (25 mg/ml). Minimum follow-up was 6 months. There were 31 eyes in the low-risk group and 45 eyes in the high-risk group. The reduction in intraocular pressure (IOP) and any treatment complications were noted. RESULTS: The mean preoperative IOP was 28+/-7.72 mm Hg. The mean final postoperative IOP was 16.8+/-6.1 mm Hg. The average number of glaucoma medications required dropped from 1.8+/-0.8 preoperatively to 0.4+/-0.8 after the operation (p<0.001). Cumulative success rates (IOP less than 21 mm Hg) for all eyes were 93% and 81% at 6 and 12 months, respectively. There was no difference in outcome between the low- and high-risk groups if criteria for success were an IOP of less than 21 mm Hg or an IOP of less than 21 mm Hg and an IOP reduction of 30%. However, if success is defined as an IOP of 15 mm Hg or less and a 30% fall in IOP, then the low-risk group had significantly longer survival times than the high-risk group (p=0.033, log-rank test). Transient punctate keratitis and corneal epithelial defect were each observed in only 1 eye. Other serious complications include rapid progression of cataract in 2 eyes, endophthalmitis in 1 eye and hypotonic maculopathy after subsequent cataract extraction in 1 eye. CONCLUSION: Single dose intraoperative 5 FU appears to be a safe and useful adjunct to trabeculectomy. IOPs in the low teens were achieved in a greater proportion of low-risk eyes than high-risk eyes.

Antimetabolites↗
PubMed1998

The correlation of the visual field with scanning laser ophthalmoscope measurements in glaucoma.

PURPOSE: To assess the relationship between Humphrey visual field data and optic disc topographical data collected by the Heidelberg Retina Tomograph (HRT) scanning laser ophthalmoscope in chronic glaucoma patients. METHODS: The mean deviation (MD) and corrected pattern standard deviation (CPSD) from Humphrey visual fields of 106 eyes of 106 patients with glaucoma were analysed for correlation with the multiple topographical measures calculated by the HRT. RESULTS: Significant correlations were found between MD of the visual field and several optic disc measurements. These included neuroretinal rim volume, mean nerve fibre layer thickness and cross-sectional area, and the cup shape measure. CPSD correlated significantly only with mean nerve fibre layer cross-sectional area. This pattern was common to the whole circumference of the disc with the exception of the directly temporal segment. CONCLUSION: Optic disc topography performed by HRT reflects the optic disc pathology in correlation with perimetry.

Aged↗
PubMed1998

Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium.

The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. All received a mixture of 5 ml 2% lignocaine with 1:200,000 adrenaline, 5 ml 0.75% bupivacaine and 150 IU hyaluronidase with either 0.9% saline 0.25 ml (group A, n = 30) or vecuronium bromide 0.25 ml (0.5 mg) (group B, n = 30). Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.

Aged↗
PubMed1997

Phacoemulsification trabeculectomy compared to other methods of combined cataract and glaucoma surgery.

PURPOSE: To compare three methods of combined cataract extraction and glaucoma surgery. METHODS: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing phacoemulsification and trabeculectomy. RESULTS: Ninety-one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP < 22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P < 0.001). CONCLUSION: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.

Aged↗
PubMed1995

The Bristol Shared Care Glaucoma Study: study design.

The purpose of this study was the evaluation of community based optometric monitoring of stable glaucoma patients and glaucoma suspects compared to the routine Hospital Eye Services (HES) monitoring. Four hundred and five subjects were recruited from routine outpatient clinics at the Bristol Eye Hospital. All eligible participants were seen in the routine hospital clinic and then within two months were given a 'Gold Standard Assessment' (GSA) by an independent research team. Participants then visited one of 12 glaucoma-trained optometrists, for a standard battery of tests. Randomisation resulted in 204 subjects being allocated to community care, with reviews on a six monthly basis, with 201 who remained a control group within the hospital. Referral criteria were established to enable optometric detection of apparent glaucomatous progression. A questionnaire was used to assess patient satisfaction with both care types. Additionally a cost analysis exercise was performed.

Community Health Services↗
PubMed1992

Prevalence of glaucoma. The Beaver Dam Eye Study.

PURPOSE: The purpose of this study is to determine the prevalence of glaucoma in the population participating in the Beaver Dam Eye Study (n = 4926). METHODS: All subjects were examined according to standard protocols, which included applanation tonometry, examination of the anterior chamber, perimetry, grading of fundus photographs of the optic disc, and a medical history interview. Visual field, cup-to-disc ratio, and intraocular pressure (IOP) criteria were used to define the presence of open-angle glaucoma. Definite open-angle glaucoma was defined by the presence of any two or all three of the following: abnormal visual field, large or asymmetric cup-to-disc ratio, high IOP. RESULTS: The overall prevalence of definite open-angle glaucoma was 2.1%. The prevalence increased with age from 0.9% in people 43 to 54 years of age to 4.7% in people 75 years of age or older. There was no significant effect of sex after adjusting for age. Of the 104 cases of definite open-angle glaucoma, 33 had IOPs less than 22 mmHg in the involved eye. Hemorrhage on the optic disc was found in 46 people; 2 of these had glaucoma. Narrow-angle glaucoma was rare, with two definite cases in the population. CONCLUSION: The prevalence of open-angle glaucoma in Beaver Dam is similar to that in other white populations. Findings from this study re-emphasize the notion that estimates of glaucoma prevalence should be based on assessing multiple risk indicators.

Adult↗
PubMed1991

Use of leeches in a case of severe periorbital haematoma.

A case of severe penetrating eye injury and resulting periorbital haematoma is described. Leeches applied to the eyelids enabled examination of the globe to be carried out and improved the surgical approach. Leeches provide a speedy and efficient means of reducing a periorbital haematoma.

Animals↗
PubMed1990

Antiviral drug sensitivity in ocular herpes simplex virus infection.

Thirty-nine herpes simplex virus (HSV) isolates were assayed for their sensitivity to 10 different antiviral agents. Of these 39 HSV isolates 10 were cultured from recipient buttons obtained at penetrating keratoplasty in patients with inactive stromal scarring due to recurrent herpetic keratitis, 25 were cultured from patients with conjunctival and ulcerative ocular infections, and the remaining four were laboratory strains with known drug sensitivity patterns, thus providing controls for the experiment. All but one of the 35 clinical isolates of HSV were type 1 and all were sensitive to the 10 antiviral agents. A single type 2 isolate from a young man with recurrent conjunctivitis proved to be resistant to a number of the antiviral agents. Since many of the clinical isolates had been exposed to multiple and protracted antiviral drug treatment, it is suggested that antiviral drug resistance in type 1 HSV ocular infection is not a significant problem.

Antiviral Agents↗
PubMed1988

Severe herpetic keratitis. II. The costs associated with penetrating keratoplasty.

We report a study on 100 patients with severe herpetic keratitis. Overall, one in three of the study group required a penetrating keratoplasty (PK). These patients required a mean of 18 days as an inpatient and 15 outpatient visits in the year the PK was performed; these figures fell to 1 inpatient day and 8 outpatient visits in the second year after surgery. The financial cost of such therapy is discussed.

Ambulatory Care↗