Biomedical subjects

R H West

Publications and source records attributed to R H West.

11 recordsLinked to original sources

PubMed1992

Creeping angle-closure glaucoma. The influence of iridotomy and iridectomy.

In 16 patients (30 eyes) with creeping angle-closure glaucoma YAG laser iridotomy or surgical iridectomy was performed as part of treatment. The initial characteristics of the affected eyes (refractive state, intraocular pressure, anterior chamber depth, iris contour, gonioscopic features, extent and severity of synechia formation and result of dark-room testing in six eyes) are recorded, and also the influence on these features of iridotomy or iridectomy. Intraocular pressure was reduced on average by 2.46 mmHg (1.72 mmHg in non-trabeculectomised eyes) (P less than 0.02), and anterior chambers deepened on average by 0.05 mm (P less than 0.05). Extension of peripheral anterior synechiae was recorded in nine eyes.

Adult↗

PubMed1992

The effect of topical corticosteroids on laser-induced peripheral anterior synechiae.

PURPOSE: To assess the influence of different topical steroid agents and a non-corticosteroid medication after Argon laser trabeculoplasty (ALT) on the development of peripheral anterior synechiae (PAS) and the reduction of intraocular pressure (IOP). METHOD: In two separate prospective, randomised, group-controlled studies, topical fluorometholone 0.1% (FML Liquifilm) was compared with dexamethasone 0.1% (Maxidex) (Study A), or naphazoline hydrochloride 0.1% (Albalon) (Study B) after ALT for chronic open-angle glaucoma, with particular reference to the formation of PAS and the IOP response. RESULTS: In Study A (N = 109) eyes treated with Maxidex had a significantly higher incidence of PAS than those treated with FML - 45% compared with 22%, P < 0.05 (normal deviate test). In Study B (N = 75) the incidence of PAS was equal in eyes treated with FML or Albalon (23%). In the two studies combined (N = 184), the development of PAS was associated with a significantly lower mean response of IOP to ALT - 1.47 mmHg compared with 3.22 mmHg, 0.01 < P < 0.05 (Student t-test). CONCLUSION: The incidence of PAS after ALT is significantly higher with the post-laser use of Maxidex than with FML, and is the same for Albalon as for FML. The therapeutic benefit of ALT is significantly reduced if PAS develop.

Administration, Topical↗

PubMed1991

Ocular surface and lacrimal disturbances in chronic graft-versus-host disease: the role of conjunctival biopsy.

Forty-four patients (21 male, 23 female) were studied following bone marrow transplantation (BMT): 40 after allogeneic, one after syngeneic and three after autologous transplantation. Diffuse punctate conjunctival and corneal epitheliopathy was seen in 27 (61%), reduced or disordered tear film in 26 (59%), acquired lacrimal outflow obstruction in three (7%) and posterior subcapsular lens opacities in five (12%) patients. Conjunctival histology showed abnormal features, including those of graft-versus-host disease (GVHD) in 41 patients. Of these, 28 (64%) had clinical and laboratory features of GVHD and six patients with no systemic evidence of GVHD had conjunctival histology specific for GVHD. We conclude that after BMT, subclinical changes of GVHD are very common in the periocular tissues and may be universal in long-term survivors following allogeneic BMT. Some minor conjunctival changes are more likely to be due to the primary disease or the transplant conditioning regimen. Conjunctival biopsy is useful in demonstrating low-grade GVHD or GVHD confined to the ocular structures and may be diagnostic in some cases.

Adolescent↗

PubMed1988

Acute primary ischemic iris atrophy.

Five patients are described with acute primary ischemic iris atrophy with almost complete loss of the normal radial vessels of the iris and fine microneovascularization. The atrophy of the iris was marked with a thin atrophic stroma, widely dilated pupil, and extensive loss of pigment from the posterior surface of the iris. The condition is of unknown etiology but occlusion of the greater vascular circle of the iris is possible. Iris angiography showed an almost total loss of the radial vessels of the iris with some patchy microneovascularization. In recent cases, the onset was acute and all patients had a raised intraocular pressure (IOP) except one who had already undergone a drainage operation. There was an accompanying low-grade uveitis or cyclitis in the chronic stage in all cases. The condition was unilateral and the posterior segment of the eye was normal so that good visual function was possible if the accompanying cataract and glaucoma were appropriately managed.

Acute Disease↗

PubMed1988

Argon laser trabeculoplasty five years on.

The results of argon laser trabeculoplasty (ALT) in a series of 252 patients are presented with follow-up of up to five years. The procedure is effective in chronic open-angle glaucoma (COAG), ocular hypertension and pseudoexfoliative (PXF) glaucoma. Most cases were treated initially over 180 degrees of the angle and repeat treatment of the remaining 180 degrees usually resulted in an additional fall in IOP which was maintained at two, three and four year follow-up with only a small number of these retreated cases having no fall on later follow-up. ALT was not very effective in further lowering IOP in eyes with IOP controlled to a low level before treatment or in low tension glaucoma. It was effective in most of a number of miscellaneous glaucomas including pigmentary glaucoma. Apart from the immediate high rise in IOP the main complication was a late high rise in IOP which was serious in degree and appeared mainly in PXF but also in two cases of ocular hypertension. The presence of a concomitant fall in IOP in the fellow untreated eye is important and probably due to better compliance with treatment. Almost all cases required medical treatment for glaucoma which could not be ceased after ALT. ALT should be seen as an adjunct to, but not a substitute for, medical treatment.

Adult↗

PubMed1987

Betaxolol eye drops as a safe medication to lower intraocular pressure.

Betaxolol, a cardioselective beta 1-adrenergic antagonist, was used in a clinical trial in nine patients with glaucoma and chronic obstructive airways disease to assess its patient acceptance, and its effect on intraocular pressure, respiratory function, corneal and tear function. Betaxolol was well tolerated by all patients with no adverse symptoms. It significantly lowered intraocular pressure (p = 0.03) with no significant change in respiratory function (forced expiratory volume in one second (FEV1), mean mid expiratory flow rate (MMEFR) and vital capacity). Although there was a tendency to decreased wetting with Schirmer 1, decreased break-up time and increased corneal staining with Rose Bengal, this was not statistically significant in this small series. We confirmed the previously reported efficacy and safety of betaxolol in patients with glaucoma and airways disease with satisfactory patient acceptance.

Adrenergic beta-Antagonists↗

PubMed1987

Therapeutic response interactions between timolol maleate and dipivefrin hydrochloride.

Twenty-one patients on long-term treatment with topical timolol maleate and dipivefrin hydrochloride were studied to assess the effect of each agent when used in combined therapy. The two agents are partially additive in most patients, but the relative contribution of each agent varies widely in individual patients and in separate diagnostic categories.

Aged↗

PubMed1986

The risks of precipitating acute angle-closure glaucoma with the clinical use of mydriatic agents.

The risks of precipitating acute angle-closure glaucoma is always present when eyes have shallow anterior chambers, and early recognition of angle-closure glaucoma is important to prevent permanent loss of vision. Two groups of patients with acute angle-closure glaucoma are presented: in the first the attack was immediately preceded by the use of a mydriatic agent and in the second a mydriatic agent had been used previously without incident but the patient later presented with a spontaneous acute attack. A shallow anterior chamber, and in particular inequality of anterior chamber depths of greater than 0.2 mm, were important indicators of susceptibility to angle closure, which is more common in women than in men. Where there is a risk of angle closure, tropicamide 0.5% appears to be the safest mydriatic agent and should be followed by the administration of a miotic agent in susceptible individuals. The need to carry out a peripheral iridectomy in the other eye is stressed, irrespective of the age of the patient. A case of acute glaucoma after the use of oral drops that contained belladonna for nasal allergy further highlights the risks of the use of systemic mydriatic agents in susceptible individuals.

Acute Disease↗

PubMed1979

Ocular involvement in scleroderma.

Thirty-eight patients with scleroderma (progressive systemic sclerosis) without renal failure were subjected to detailed clinical ophthalmic assessment. Abnormalities were frequent. However, many of these, including lens opacities, vitreous frosting, and arteriosclerotic changes, were considered to be age-related, and there were various incidental changes. Posterior subcapsular lens opacities in one patient were probably corticosteroid-induced. Changes related to scleroderma included eyelid abnormalities (stiffness or tightness in 11, telangiectasia in 8), deficient tear secretion (14 cases), and conjunctival abnormalities (injection 19 cases, vascular sludging 27 cases). Iris light reflux (6 cases) was possibly related to scleroderma. The changes related to scleroderma occurred in the 3 types classified according to the extent of skin involvement.

Adult↗

PubMed1976

Traumatic hyphaema: a general hospital experience.

A series of fifty consecutive patients admitted to the Alfred Hospital with a primary diagnosis of traumatic hyphaema is analysed with respect to causation, size of bleed at admission, treatment, complications and ultimate visual result. The need to examine carefully the eyes of all patients presenting with a history of motor vehible accident is stressed.

Adolescent↗

PubMed1976

Visual failure during replacement therapy in primary hypothyroidism with pituitary enlargement.

A 34-year-old woman with longstanding untreated thyroprivic hypothyroidism and pituitary enlargement is reported here in whom visual failure coincided with thyroid hormone replacement. Visual fields were normal after 30 years untreated hypothyroidism, but severe concentric field constriction developed during the first 6 months of therapy and was relieved by hypophysectomy. Plasma TSH and prolactin remained elevated during 10 months replacement therapy, but both were suppressed by preoperative hyperreplacement with T3 and T4. The paradoxical pressure symptoms suggest imbalance between pituitary TSH content and TSH release during treatment with thyroid hormone; a finding previously reported in animal studies. This sequence suggests that patients with known pituitary enlargement secondary to thyroid hypofunction should be observed for pressure symptoms during thyroid hormone treatment.

Adult↗