Biomedical subjects
Patrick J Bowers
Publications and source records attributed to Patrick J Bowers.
Angle-closure glaucoma after discontinuing donepezil hydrochloride (Aricept).
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Acute angle-closure glaucoma caused by vitreous prolapse after neodymium:YAG posterior capsulotomy.
We report the second known case of acute angle-closure glaucoma from vitreous prolapse after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in a patient with a posterior chamber intraocular lens (IOL). This is the first reported case to result in corneal decompensation that required penetrating keratoplasty. The rare complication of vitreous prolapse was unusual in this patient because of the presence of a posterior chamber IOL, a small 4.0 mm capsulotomy opening, and low (26 mJ) Nd:YAG laser energy.
Long-term graft survival after penetrating keratoplasty.
PURPOSE: To determine long-term graft survival rates and causes of secondary graft failures for a large series of penetrating keratoplasties (PKPs). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Longitudinal review of 3992 consecutive eyes that underwent PKP at a large tertiary care referral center from 1982 through 1996. Data were collected retrospectively from August 1982 through December 1988 and prospectively thereafter. INTERVENTION: Three thousand six hundred forty primary grafts and 352 regrafts. MAIN OUTCOME MEASURES: Corneal graft survival and etiology of graft failures. Patients were evaluated preoperatively and at 1, 3, 6, 9, 12, 18, and 24 months after transplant, then at yearly intervals. RESULTS: Mean recipient age was 67 years (range, 1-98 years). The predominant indications for PKP were pseudophakic bullous keratopathy (32%) and Fuchs' dystrophy (23%). Graft failure occurred in 10% (385) of the eyes. The most common causes of secondary graft failure were endothelial failure (29%) or immunologic endothelial rejection (27%). Survival of first time grafts was 90% at 5 years and 82% at 10 years. Initial regrafts had significantly lower 5-year and 10-year survival rates, 53% and 41%, respectively. The highest 5-year and 10-year survival rates were noted in primary grafts for eyes with a preoperative diagnosis of keratoconus (97% and 92%, respectively), or Fuchs' dystrophy (97% and 90%, respectively). Primary grafts for aphakic bullous keratopathy without intraocular lens placement had the lowest 5-year survival rate, 70%. CONCLUSIONS: The 5-year and 10-year survival rates in this series demonstrate that PKP is a safe and effective treatment for the corneal diseases commonly transplanted in the United States. However, endothelial failure and immunologic graft rejection were persistent risks over the long term, supporting the need for continued patient follow-up. Regrafts, aphakic eyes without intraocular lens placement at the time of transplant, and corneas with deep stromal vascularization had reduced graft survival rates. Pseudophakic bullous keratopathy grafts with a retained posterior chamber intraocular lens were at increased risk of endothelial failure compared with primary grafts done for other causes or compared with pseudophakic bullous keratopathy grafts done with intraocular lens exchange.
Superficial keratectomy with mitomycin-C for the treatment of Salzmann's nodules.
PURPOSE: To evaluate the success of treatment and prevention of recurrence of Salzmann's nodules by superficial keratectomy with intraoperative mitomycin-C (MMC). SETTING: Price Vision Group, Indianapolis, Indiana, USA. METHODS: This retrospective consecutive case series comprised 30 eyes of 25 patients who had superficial keratectomy with MMC between January 1997 and June 2000 at a large tertiary-care center. RESULTS: Twenty-four patients reported improvement in their symptoms. The remaining patient lost 1 line of visual acuity. Ninety-seven percent of eyes maintained or improved best corrected visual acuity. No patient had a recurrence of Salzmann's nodular degeneration over a mean follow-up of 28 months +/- 15 (SD) (range 4.0 days to 4.1 years). CONCLUSION: Superficial keratectomy with MMC appears to be a valid and safe method for treating and preventing the recurrence of Salzmann's nodular degeneration.
Outcomes of laser in situ keratomileusis in a Refractive Surgery fellowship program.
PURPOSE: The purpose of this study was to document the learning curve and evaluate the success of laser in situ keratomileusis (LASIK) performed by fellows in a Cornea/External Disease and Refractive fellowship program. METHODS: Two surgeons performed LASIK within a fellowship training program between July 2000 and August 2001. A retrospective review was conducted to determine the visual outcomes and operative complications from this non-comparative case series of 755 consecutive eyes. All LASIK procedures were performed using a Bausch & Lomb Technolas 217A laser and the Bausch & Lomb Hansatome or the Automated Corneal Shaper microkeratome. All eyes were evaluated for operative complications. Visual acuity was reported with a minimum of 1 month follow-up. RESULTS: Data analysis revealed that uncorrected visual acuity of 20/40 or better was attained in 99.4% of treated eyes, and 20/20 or better in 77.2%. With both eyes open, 100% of patients saw 20/30 or better, 94% saw 20/20 or better, 70% saw 20/15 or better, and 5.5% saw 20/10. Flap related complications occurred in 7 of 755 eyes (0.9%) and all were successfully treated. Forty-two eyes (5.6%) were lost to follow-up prior to the 1-month examination and were excluded from analysis of visual acuity. CONCLUSIONS: Favorable operative and visual acuity 1-month results in 755 eyes after LASIK with the Bausch & Lomb Technolas 217A laser were in part due to a well organized system of education, patient examination, execution of surgery, and postoperative care. A team approach was essential.