Reversible glaucomatous disc change.
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Glaucoma↗
Biomedical subjects
R J Simmons
Publications and source records attributed to R J Simmons.
Congenital heart disease, parental stress, and infant-mother relationships.
The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infant-mother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well.
Adult↗
The shell tamponade technique for glaucoma filtration surgery.
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Bandages↗
Bandage contact lens augmentation of 5-fluorouracil treatment in glaucoma filtration surgery.
The use of 5-Fluorouracil (5-FU) to inhibit scarring following filtration surgery has been hampered by corneal epithelial defects and their accompanying inflammation. This toxicity, which occurs during the crucial period in which the risk of bleb failure is highest, has previously been a relative contraindication to further 5-FU use. We have found the early placement of a therapeutic bandage contact lens permits extended administration of 5-FU during this period, minimizing discomfort and inflammation as well as enhancing bleb survival.
Aged↗
Angle-closure glaucoma in nanophthalmos.
Two patients had nanophthalmos with uveal effusion and angle-closure glaucoma. They were treated with a method based on the use of the laser, not only to perform iridotomy but to shrink the iris stroma, which appears to open the anterior chamber angle even without iridotomy. Additionally, we introduced three factors that may be diagnostic of nanophthalmos.
Choroid↗
Scanning electron microscopy of trabeculectomy specimens in open-angle glaucoma.
We examined trabeculectomy specimens obtained at the time of surgery for inadequately controlled open-angle glaucoma by scanning electron microscopy. Of the 50 specimens ten included a broad area of the trabecular meshwork. In these ten specimens the meshwork was obscured by material. We believe the degree of occlusion was significant in these specimens, which would lead to obstruction of aqueous outflow. No similar material was found in control specimens from persons of similar age.
Aged↗
Glaucoma associated with precipitates on the trabecular meshwork.
Precipitates on the trabecular meshwork may be the only sign of ocular inflammation. Fourteen patients who had glaucoma associated with precipitates on the trabecular meshwork and minimal or no other signs of ocular inflammation did not respond to usual antiglaucoma therapy. Treatment with topical steroids eliminated the precipitates and lowered the intraocular pressure. Careful gonioscopy is the key to accurate diagnosis.
Acetazolamide↗
A modified cyclodialysis spatula.
A cyclodialysis spatula specifically designed for glaucoma surgery is presented which facilitates the performance of the cyclodialysis procedure alone or in combination with cataract extraction and decreases the chance of inadvertent damage to the eye.
Glaucoma↗
Shell tamponade in filtering surgery for glaucoma.
The glaucoma shell tamponade technique in filtering surgery for glaucoma is a technique for (1) decreasing the incidence of flat anterior chamber and choroidal separation postoperatively, (2) promoting the development of a low diffuse filtration area, and (3) increasing the possibility of achieving very low resulting postoperative pressure. The glaucoma shell technique is applicable to all types of filtration procedures, including conventional filtering procedures utilizing no scleral flap and those utilizing a scleral flap, such as trabeculectomy. It can be used at surgery or can be applied in the postoperative period to deal with flat or shallow anterior chambers immediately at the time of onset. The shell tamponade technique can be utilized to aid in the management of some cases of leaking bleb in the early postoperative period or in the late postoperative period. The technique for operative and postoperative use of the glaucoma shell tamponade technique and its closely related pressure dressing is a demanding and exacting art. Because the technique increases the possibility of very low resulting tensions, its use should be considered especially for cases in which very low pressures are desired, such as some cases of extremely advanced cupping and field loss and low-tension glaucoma.
Anterior Chamber↗
The essential iris atrophies.
We studied 82 cases of essential iris atrophy. The findings support some traditional concepts of this complex spectrum of disorders, but conflict with others. Corneal abnormality appeared early and may be the primary disorder. A corneal endothelial disturbance was present in 55% of cases and corneal edema was present in 50%. Peripheral anterior synechiae occurred in all but one of the cases studied by gonioscopy. The pupil was distorted in 71% of the cases and was usually pulled in the direction of the most prominent synechia. The iris was stretched with stromal atrophy in 71%. Iris holes occurred in 33%. The degree of corneal and iris changes occurred as a spectrum of disorders. The prognosis for most patients with essential iris atrophy is slow progression with eventual involvement of vision because of corneal edema, secondary glaucoma, or both. Treatment of increased IOP was required in 77% of our cases, and 44% required surgical intervention.
Adolescent↗
Progress in glaucoma.
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Anniversaries and Special Events↗
Glaucoma occurring after closed vitrectomy.
Six of 20 eyes developed postoperative glaucoma within two to ten days after closed vitrectomy for vitreous hemorrhage. Intraocular pressure was greater than 40mm Hg in all six eyes, and three developed pressure greater than 60 mm Hg. Intraocular pressure in four eyes was controlled with medical antiglaucoma therapy and two eyes required anterior chamber irrigation. Six months postoperatively three of the eyes had normal pressures, one was hypotonous, and two developed increased intraocular pressure secondary to angle neovascularization. Three of the 14 eyes that did not develop glaucoma developed a cellular accumulation in the anterior chamber. The glaucoma was caused mainly by obstruction of the trabecular meshwork by degenerated red blood cells known as ghost cells. The cells may be identified by phase-contrast examination of anterior chamber aspirates. Glaucoma can be prevented through irrigation of the vitreous cavity at the time of vitrectomy ensuring that no cells and debris are left behind to migrate into the anterior chamber and obstruct the trabecular meshwork. This type of glaucoma is caused mainly by ghost cells, whereas hemolytic glaucoma is caused mainly by macrophages and red blood cell debris.
Eye Diseases↗
Iris nodules in essential iris atrophy.
Seven cases are reported, believed to be the first in the literature, in which iris nodules are verified in the complete spectrum of essential iris atrophies. This feature appears late in the course of the disease as small yellow nodules that progressively increase in number and gradually become dark brown. The differential diagnosis of multiple iris nodules includes neurofibromatosis, melanomas, inflammatory nodules, and developmental anomalies such as iridocorneal dysgenesis.
Adult↗
Urinary calculus during methazolamide therapy.
A 68-year-old white man with Paget's disease and open-angle glaucoma was treated with methazolamide, 50 to 100 mg three times daily. Ten months after the medication was initiated he developed ureteral colic and a calcium oxalate stone was surgically removed. Three months after the drug was reinstituted the patient passed three calcium phosphate stones. This suggested a casual relationship between methazolamide and stone formation, although renal calculi also complicate Paget's disease and acetazolamide had been administered briefly.
Acetazolamide↗
Ghost cells as a cause of glaucoma.
Clinical and investigative evidence indicated a glaucoma caused mainly by degenerated red blood cells, or ghost cells. These ghost cells, with altered shape, color, and pliability, accumulated in the vitreous cavity after hemorrhage. Following disruption of the anterior hyaloid face, they passed into the anterior chamber and caused severe glaucoma. In the anterior chamber, the tiny, khakicolored cells, circulating slowly, were frequently mistaken for white blood cells. They covered the trabecular meshwork or filled the inferior angle with a pathognomonic khaki-colored layer. They were identified by phase-contrast microscopic examination of anterior chamber aspirates. The decreased pliability of these degenerated cells seemed to account for their inability to pass easily through the human trabecular meshwork and, therefore, to cause severe glaucoma.
Aged↗
Combined cyclodialysis and cataract extraction.
Combined cyclodialysis and cataract extraction was performed on 78 eyes in a consecutive series of 26 years duration. This operation was performed on eyes with severe glaucoma, inadequately controlled on maximum medical therapy, and with a cataract needing extraction. Glaucoma types included open-angle, angle-closure with peripheral anterior synechias, combined open-angle and angle-closure, and secondary to uveitis. Seventy of the 78 eyes had follow-up of six months or more and the results in these 70 eyes were analyzed. In thirteen percent of the eyes in this study the postoperative intraocular pressure was the same or higher than the preoperative level, or reductions of intraocular pressure were not clinically significant. Eighty-seven percent (61 eyes) had a clinically significant lowering of intraocular pressure following the combined procedure. Thirty-nine percent (27 eyes) of the 70 eyes in this study had a tension of 0-14 mm Hg, and 44% (31 eyes) had a tension of 15-20 mm Hg. Intraocular pressure was improved significantly more often in patients over 60 years of age. Resulting intraocular pressures of 14 mm Hg or less were more likely when the cyclodialysis was performed in the lower quadrant. The results of the combined procedure were not significantly influenced by the type of glaucoma involved or by a history of previous glaucoma surgery. Bleeding was a frequent complication, but was not related to resulting intraocular pressure. Other complications were rare. We conclude that combining cyclodialysis with cataract extraction is safe and effective, and is a suitable procedure when there is need for surgery to relieve severe glaucoma, along with a need for cataract extraction.
Adolescent↗
The vitreous in glaucoma.
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Anterior Chamber↗
Goniophotocoagulation for neovascular glaucoma.
A new treatment, goniophotocoagulation, for neovascularization of the anterior chamber angle has been applied with the argon laser to 21 eyes of 20 patients. Three of the eyes had neovascularization related to central retinal vein occlusion. In the other 18 eyes the neovascularization was related to diabetic retinopathy. A specific protocol has been followed since January 1973. The results so far indicate that closure of the angle and progression of the usual chain of pathologic events in neovascular glaucoma were prevented in 10 (77%) of the 13 eyes having an average follow-up of 22 months. We believe that goniophotocoagulation of the angle deserves more extensive, judicious, and carefully monitored clinical use. Our results suggest that this new technique is safe and reasonably effective in preventing progressive neovascularization of the angle, synechial closure, and severe nonvascular glaucoma.
Anterior Chamber↗