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Biomedical subjects

R L Stamper

Publications and source records attributed to R L Stamper.

At least 19 recordsLinked to original sources
PubMed1992

Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil.

Long-term success in trabeculectomy has been enhanced in recent years by postoperative subconjunctival 5-fluorouracil injections and intraoperative mitomycin C applications. During 1990 and 1991, after trabeculectomy with a small scleral flap (2 x 3 mm) augmented by antimetabolite therapy, hypotonous maculopathy developed in eight eyes of six patients. The maculopathy was characterized by loss in visual acuity, retinal striae, and choroidal folds without evidence of vascular leakage. The average loss in visual acuity was four Snellen lines. Visual acuity did not return to preoperative levels even when the hypotony could be reversed. Reversing the hypotony with various strategies aimed at stimulating subconjunctival scarring has been relatively ineffective. During that same period, an additional seven eyes in six patients had prolonged hypotony but without development of maculopathy. Features common to patients who developed maculopathy included age (mean age, 46 years; range, 32 to 60 years) and myopia (mean, -7.5 diopters; range, -0.75 to -11.75 diopters). The patients with hypotony but no maculopathy were older (mean age, 73 years; range, 63 to 82 years) and were closer to emmetropia (mean, -1.11 diopters; range, +1.50 to -9.00 diopters). The means of the ages and refractive errors were statistically significantly different in the two groups (P = .007 and .04, respectively). Trabeculectomy with adjunctive antifibrosis therapy should be used with caution in young myopic patients.

Adult↗
PubMed1992

Acute ptosis secondary to contact lens wear.

Ocular ptosis secondary to the wearing of rigid contact lenses has been reported. Generally this ptosis is not of the classical variety, and appears to be an edematous or inflammatory response of the lid to the presence of the lens. We report a case of acute ptosis secondary to rigid lens wear in a patient who had undergone cataract surgery. The patient had been a contact lens wearer before surgery, and developed the relative ptosis postsurgically in the nonoperated eye. The ptosis resolved without any form of intervention other than ceasing to wear the contact lens. We feel that in cases where rigid lens wear is discontinued unilaterally for any reason, and a relative ptosis is noted, it should be given time to resolve before any therapeutic regimen is considered.

Acute Disease↗
PubMed1990

Needle revision with and without 5-fluorouracil for the treatment of failed filtering blebs.

Twelve patients with failed or failing filtering blebs were treated by transconjunctival needle revision of the bleb. Seven of these received 5-fluorouracil as an adjunct. Intraocular pressure decreased from 31.3 +/- 8.8 mm Hg (range, 20 to 47 mm Hg) to 17.0 +/- 3.7 mm Hg (range, 8 to 22 mm Hg). The length of follow-up ranged from two to 31 months. The results in 11 of 12 patients (91.6%) were satisfactory, defined by an intraocular pressure of 22 mm Hg or less, with or without antiglaucoma medications, and requiring no subsequent procedures for control of intraocular pressure. The success rates and overall pressure lowering effect of the seven patients receiving and the five patients not receiving 5-fluorouracil were similar. However, most patients receiving 5-fluorouracil were thought to be at higher risk for surgical failure. Complications of needle revision were minor and resolved without sequelae. We advocate the consideration of transconjunctival needle revision with or without the use of 5-fluorouracil as a useful therapeutic modality in the management of the failed or failing filtering bleb.

Adult↗
PubMed1990

Effect of intraocular aspiration of sodium hyaluronate on postoperative intraocular pressure.

A prospective, randomized, masked study was conducted to evaluate whether intraocular aspiration of sodium hyaluronate used in cataract surgery influenced postoperative intraocular pressure (IOP). Ninety-nine patients (105 eyes) underwent uncomplicated extracapsular extractions with posterior chamber intraocular lens implantation using 1% sodium hyaluronate (AMVISC). In 53 eyes, sodium hyaluronate was aspirated from the anterior chamber prior to wound closure. Sodium hyaluronate was left in the anterior chamber of 52 eyes. The IOP of 33 of the patients was measured 4 hours after surgery. No significant difference was found between the pressure in the eyes from which the sodium hyaluronate had been aspirated and the pressure in those from which it had not. The IOP of all the patients was measured on the first postoperative day. The mean 24 hours after surgery was 23.4 mm Hg in the aspirated eyes and 23.1 mm Hg in the not-aspirated group. Thirteen eyes in the aspirated group and 14 in the not-aspirated group had pressures above 30 mm Hg during the first 24 hours after surgery. There were no significant differences in visual outcome, patient discomfort, corneal clarity, anterior chamber inflammation, or subsequent IOPs during 3 months postoperative examination. Aspiration of sodium hyaluronate at the end of cataract surgery does not appear to significantly reduce either the incidence or the degree of postoperative pressure elevations.

Aged↗
PubMed1989

Intraocular lens data.

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Catalogs, Commercial as Topic↗
PubMed1989

Psychophysical changes in glaucoma.

Chronic glaucoma has been thought to spare the central vision until quite late in the disease process. This assumption is based on the use of the relatively insensitive Snellen chart to measure central vision and the relatively sensitive kinetic and static perimetry to measure the peripheral vision. In recent years, new measures of visual function have been utilized to assess patients with glaucomatous damage. Sensitive methods of measuring central visual function such as color vision, contrast sensitivity (both spatial and temporal), and macular light sensitivity have demonstrated defects early in the glaucomatous process - sometimes even before perimetry is affected. Since these visual functions are largely mediated by macular fibers, central vision may be affected earlier and more frequently in glaucoma than previously believed. Studies of both the nerve fiber layer of the retina and of quantitative light sense perimetry suggest that glaucomatous damage may occur diffusely across the population of nerve fibers, focally in the arcuate portion of the nerve fiber layer, or in both places. Color vision, contrast sensitivity and macular light sense appear to correlate with the diffuse type of nerve fiber layer damage. The exact utility of the psychophysical tests that assess central visual function for the clinical management of glaucoma has not yet been demonstrated. More work is needed to determine which tests are most useful, what parameters are most efficient, and what the diagnostic and prognostic significance of abnormal values may be. However, the studies of color vision, contrast sensitivity and macular light sensitivity have led to a better understanding of how glaucoma affects visual function.

Color Perception↗
PubMed1987

Chemotactic activity in aqueous humor from patients with anterior uveitis.

Anterior uveitis, inflammation of the iris or ciliary body of the eye, may be associated with a variety of systemic diseases. Although a leukocytic infiltrate is characteristic of anterior uveitis, few studies have sought to detect factors in aqueous humor that could attract neutrophils or monocytes into the anterior chamber. Using modified Boyden chambers, we found that a 5% concentration of aqueous humor from patients with anterior uveal inflammation induced monocyte movement comparable to optimal or near-optimal concentrations of C (complement)5a or platelet-derived growth factor. Aqueous humor from patients with anterior uveitis induced significantly more monocyte migration than did aqueous humor from two sets of controls (either patients undergoing cataract extraction or patients with posterior uveitis). "Checkerboard" or gradient analysis indicated that a majority of inflammatory disease samples induced monocyte chemotaxis (directed migration) while the control aqueous humor consistently induced chemokinesis (stimulated random migration) (P less than 0.02). Despite their ability to induce monocyte migration, samples tended to induce minimal neutrophil migration with the exception of aqueous humor that was obtained from one patient with acute anterior disease. This sample induced marked chemokinesis. Identification of chemotactic activity may clarify the pathogenesis of uveitis and the characterization of leukocyte migration factors in aqueous humor may help define subsets of anterior uveal inflammation.

Aqueous Humor↗
PubMed1985

The corneal endothelium and Descemet's membrane in the iridocorneal endothelial syndrome.

A 39-year-old woman with progressive left unilateral glaucoma associated with corneal edema, iris changes, and peripheral anterior synechia formation underwent a left trabeculectomy and iridectomy in an attempt to control the intraocular pressure. Shortly after surgery the edema worsened despite low intraocular pressure measurements. A repeat trabeculectomy combined with a full thickness keratoplasty was performed 11/2 years later. The posterior corneal surface was found to be covered by a partially doubled layer of endothelial cells with ultrastructural features resembling epithelium. Similar cells were not noted on the surface of the initial trabecular meshwork and iris specimens, but were seen on the surface of the specimens obtained at the second trabeculectomy. The anterior and middle portions of Descemet's membrane, formed during perinatal and early adult life, appeared normal, but its posterior portion appeared abnormal. The ultrastructural changes in the endothelial cells and the abnormalities observed in Descemet's membrane suggest that the endothelial cells were initially normal but subsequently acquired epithelial-like features as they degenerated and proliferated. The continued presence of corneal edema despite the hypercellularity of the endothelium suggests that the proliferating cells were permeable to aqueous.

Adult↗
PubMed1985

Intraocular lens data.

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Catalogs, Commercial as Topic↗
PubMed1978

The effect of calcium dobesilate on nonproliferative diabetic retinopathy: a controlled study.

Two independent, double-masked, controlled studies were made to evaluate the efficacy of calcium dobesilate for the treatment of nonproliferative diabetic retinopathy. Forty-two patients underwent a six-month crossover evaluation while receiving calcium dobesilate (750 mg per day) and placebo in random order. Thirty-six patients received calcium dobesilate (1,000 mg per day) or placebo for one year. Evaluation by clinical examination, fluorescein angiography, angiography, and fundus photography failed to demonstrate any beneficial effect of calcium dobesilate.

Adult↗