PubMed Health⌕ Search

Biomedical subjects

M J Walland

Publications and source records attributed to M J Walland.

14 recordsLinked to original sources
PubMed2000

Diode laser cyclophotocoagulation: longer term follow up of a standardized treatment protocol.

BACKGROUND: Diode laser cyclophotocoagulation (cyclodiode) is gaining acceptance as a therapy for refractory or end-stage glaucoma. The aim of the study was to establish whether a reproducible dose-effect relationship exists following a single standardized cyclodiode treatment to lower intraocular pressure (IOP). METHODS: This paper reports results from a longer-term follow up of a trial involving the study of 30 patients with uncontrolled IOP and advanced glaucoma who were treated with a single episode of either a half or a full standardized dose of laser depending on clinical risk of phthisis and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. RESULTS: A lowering of IOP at the final follow up was achieved in 83% of patients, with a mean follow-up time of 21 months. For patients receiving a full standardized laser dose, preoperative IOP was 49.4 +/- 11.2 mmHg (mean +/- SD) and postoperative IOP was 28.5 +/- 20.0 mmHg (42% reduction); 45% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction > 30%. For the half treatment cases, the preoperative IOP was 29.4 +/- 4.3 mmHg (mean +/- SD) and the postoperative IOP was 18.3 +/- 10.0 mmHg (38% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Of 22 sighted eyes, nine (41%) recorded no change in vision; and nine (41%) lost and four (18%) gained vision. Hypotony was seen in 4/22 (18%) of full standardized laser dose cases. CONCLUSION: Longer follow-up times confirm that diode laser cyclophotocoagulation is a convenient and useful therapy in the control of IOP in end-stage glaucoma. Response of IOP to the laser therapy is highly variable, particularly in the neovascular glaucoma group, and it does not appear to be possible to predict an IOP outcome for an individual eye. Circumferential treatments in neovascular eyes should be avoided. Prospects for long-term vision retention in end-stage eyes are poor, perhaps due to progression of the underlying disease.

Ciliary Body↗
PubMed2000

"Cyclodiode".

Explore the source record for details and available documents.

Glaucoma↗
PubMed1998

Diode laser cyclophotocoagulation: dose-standardized therapy in end-stage glaucoma.

BACKGROUND: Ciliary body ablation in end-stage glaucoma has been widely performed with cryotherapy and neodymium:yttrium aluminium garnet (Nd:YAG) laser, both techniques frequently involving considerable pain and postoperative inflammation, with an unpredictable final intraocular pressure (IOP) and a significant risk of phthisis. Diode laser cyclophotocoagulation (cyclodiode laser) has recently been introduced in an attempt to avoid some of these problems. METHODS: Thirty patients with uncontrolled IOP and advanced glaucoma were divided on clinical grounds into two groups and were treated with either a half or a full standardized dose of laser (40 x 1500 mW for 1500 ms) and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. Success of IOP control was defined as IOP < 22 mmHg or a decrease in IOP of > 30%; preservation of visual acuity or control of pain in blind eyes was also assessed. RESULTS: A sustained lowering of IOP was achieved in 90% of patients, with a mean follow up of 10.4 months. For the full treatment cases (group A), mean (+/-SD) pre-operative and postoperative IOP was 49.4 +/- 11.2 and 25.8 +/- 17.7 mmHg, respectively (a 48% reduction); 55% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction of > 30%. For the half-treatment cases (group B). the mean pre-operative and postoperative IOP was 29.4 +/- 4.3 and 18.9 +/- 5.7 mmHg, respectively (a 36% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Neovascular glaucoma was present in 60% of patients; the full-treatment subgroup of these patients achieved a mean lowering of IOP of 58%. Of 22 sighted eyes, 11 (50%) recorded no change in vision; seven (32%) eyes lost and four (18%) eyes gained vision; pain control was achieved in six of eight blind eyes (75%). There was no significant postoperative inflammation, one case of hypotony and no suggestion to date of sympathetic ophthalmia. CONCLUSION: Diode laser cyclophotocoagulation appears to be simple, safe and is frequently successful in the control of IOP in end-stage glaucoma. Optimum dosage parameters remain to be determined.

Aged↗
PubMed1998

Diode laser cyclophotocoagulation: histopathology in two cases of clinical failure.

Diode laser photocoagulation is an alternative technique to Nd:YAG laser or cryotherapy in cycloablation. It may be more titratable with fewer local side effects. The effect is not, however, always maintained in the long term. The authors wished to establish histologic correlates with in vivo clinical outcomes of failure. Histologic findings in two cases of clinical failure of a single treatment with contact diode laser cyclophotocoagulation are presented. A recurrence of uncontrolled intraocular pressure (IOP) finally led to enucleation of the eyes 5 and 6 months after laser treatment. Histologic examination demonstrated preservation in both specimens of some ciliary processes outside the treatment zone, which was evidently over the pars plana in a case with a relatively low axial length. Persisting damage of treated ciliary processes was seen. Some efforts at ciliary epithelial regeneration were made in these, but in a disorganized and presumably nonfunctional fashion, so that a histologic explanation for the gradual postoperative rise in IOP was not evident. Diode laser cyclophotocoagulation may lower IOP by mechanisms other than destruction of ciliary epithelium. Reversal of a laser-induced increase in uveoscleral outflow may explain the gradual rise in IOP seen postoperatively in these two cases, given the ineffectual secretory epithelial regeneration in one case and the treatment over the pars plana in the other. Methods to enhance probe placement, such as ultrasound biomicroscopy, transillumination, or axial length measurement, may be useful to ensure that treatment is directed to the pars plicata. [Ophthalmic Surg Lasers 1998;29:852-856.] Cyclodestructive procedures have been likened to "duck hunting in the dark (without radar) since the 'shooter' sees neither the target nor the effect of the blast!" Although the use of Nd:YAG and semiconductor diode laser cyclophotocoagulation instead of cyclocryotherapy has progressively refined the caliber of the weapon and its titratability, aim in the placement of the destruction remains inexact. The assumption has generally been, however, that treatment must be directed to ablation of the ciliary epithelium to achieve a hypotensive effect. We present the histopathology from two cases of contact diode laser cyclophotocoagulation (DLCPC), both of which resulted in initially successful intraocular pressure (IOP) control, but which finally required enucleation for problems supervening on a recurrently raised IOP.

Aged↗
PubMed1995

Repair of Descemet's membrane detachment after intraocular surgery.

We repaired three unselected cases of Descemet's membrane detachment. A visually successful outcome was achieved in one case, an anatomically successful outcome in another, and no improvement in the last. We believe that large detachments should be repaired early rather than waiting for possible spontaneous reattachment, and we advocate sulfur hexafluoride fluid-gas exchange as the procedure of choice.

Aged↗
PubMed1995

Presumed ophthalmic herpes zoster after contralateral cataract extraction.

Herpes zoster ophthalmicus (HZO) may occur spontaneously, but can be precipitated by stress, trauma, debility or systemic illness. A case is here reported of Herpes zoster involving the contralateral eye, associated with a midline skin rash, following cataract extraction under local anaesthesia.

Aged↗
PubMed1994

Soft tissue infections after open lacrimal surgery.

BACKGROUND: Soft tissue infection after open lacrimal surgery is said to be uncommon. This study was designed to determine the rate of infection and the effect of early antibiotic prophylaxis after open lacrimal surgery. METHODS: Two consecutive patient groups undergoing open lacrimal surgery were studied by review of case notes: the first group (152 patients) did not receive antibiotic prophylaxis after surgery, and the second group (128 patients) did. RESULTS: Infection occurred in 2 of the 128 patients who were given prophylactic antibiotics (1.6%) and in 12 of the 152 patients who were not (7.9%; P < 0.02). Silicone intubation did not affect the infection rate, but patients who had sustained previous facial trauma did have a significantly increased rate of infection (P < 0.01). CONCLUSIONS: Soft tissue infection occurs in approximately 8% of patients after open lacrimal surgery. A 5-fold reduction in this rate can be achieved with routine administration of antibiotics after surgery. The use of silicone tubing does not increase the risk of infection.

Adolescent↗
PubMed1994

The effect of recurrent pterygium on corneal topography.

Pterygium is known to cause corneal topographic changes that can result in decreased visual acuity. We present a case of recurrent pterygium causing blurred vision and diplopia, and document the corneal topographic changes, showing astigmatism of 15 diopters induced by lateral gaze, prior to surgical excision.

Astigmatism↗
PubMed1994

Factors affecting the success rate of open lacrimal surgery.

Postoperative soft tissue infection may predispose to failure of open lacrimal surgical procedures. Using a retrospective analysis of 413 cases, the failure rates for primary and repeat surgery were 12.0% and 8.9% respectively (0.25 < p < 0.5). Postoperative soft tissue infection is associated with an increased risk of failure (p < 0.005); antibiotics decrease the rate of postoperative infection and may thus decrease the failure rate. Furthermore, antibiotic therapy decreases the rate of failure in cases after previous facial trauma. Curative antibiotic therapy for established postoperative infection is less effective than preventative therapy at improving the success rate after surgery. Previous trauma is also associated with a greater rate of failure (p < 0.02), possibly owing to the frequent canalicular problems in such patients. Silicone tubes appear to increase neither the rate of infection nor failure (p > 0.5). Trauma, acute dacryocystitis, and silicone tubes appear to act on outcome independently of each other.

Adolescent↗
PubMedDate not supplied

The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy.

Of 388 cases of dacryocystorhinostomy eligible for silicone intubation, intubation was used in 238 (61%) and not used in 150 (39%). The indications for intubation were canalicular disease or sac characteristics predisposing to failure. No significant difference was found in the rate of failure (.5 < P < 1.0) or soft-tissue infection (.25 < P < .5) for either primary or repeated surgery. Antibiotic prophylaxis did not alter these risks in relation to silicone intubation.

Cephalexin↗