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Biomedical subjects

W A Franks

Publications and source records attributed to W A Franks.

15 recordsLinked to original sources
PubMed1992

Clinical risk factors for failure in glaucoma tube surgery. A comparison of three tube designs.

We studied a cohort of 165 eyes that had undergone tube implant surgery for glaucoma, with a minimum follow-up of 12 months (range, 12 to 72 months). Of the 57 cases (34.5%) in which surgery failed to control intraocular pressure (less than 22 mm Hg), 15 (26%) occurred by 3 months, 36 (63%) by 12 months, and 46 (80%) by 24 months. Cox regression modeling was used to evaluate independent risk factors in the absence of additional therapy. The use of a two-piece (anterior chamber-to-encircling band) tube system was associated with a 2.4 times higher risk of failure (P less than .001) compared with a one-piece system. Neovascular glaucoma was associated with a 2.1 times higher risk of failure (P less than .037) than other types of glaucoma. Late failure of tube implant surgery is common and there is a steady attrition rate over a 2-year follow-up period.

Adult↗
PubMed1992

Four-quadrant local anaesthesia technique for vitreoretinal surgery.

We report our experience of a recently described local anaesthetic technique which seeks to avoid risk of perforation of the globe, damage to the optic nerve, or injection into the subarachnoid space, whilst providing prolonged and reliable anaesthesia. A prospective series of 19 patients who underwent vitreoretinal surgery using this technique were compared with 19 patients who had retrobulbar anaesthesia for cataract extraction. The vitreoretinal group had excellent akinesia and very good anaesthesia, allowing prolonged retinal reattachment surgery lasting up to 3 hours. Patient evaluation of discomfort or pain experienced in the two groups was assessed using a visual analogue pain score chart. The pain scores for the two groups were not significantly different (p = 0.03) and 16 of 19 patients in each group (84%) experienced only slight pain or less. Satisfaction with local anaesthesia, in both groups, was also assessed by asking patients which method of anaesthesia they would prefer if future surgery were to be performed. In the vitreoretinal group, 18 of 19 patients expressed a preference for local anaesthesia and in the cataract group 17 ot 19 also favoured local anaesthesia. The vitreoretinal patients' median pain score was 0 compared with 1 for the cataract patients. This study demonstrates that local anaesthesia provides pain relief for vitreoretinal surgery which is comparable to the experience of patients undergoing cataract surgery by retrobulbar anaesthesia. The technique described can provide successful local anaesthesia for vitreoretinal procedures. The success of this technique for pain relief and akinesia calls for a reappraisal of the number of patients suitable for vitreoretinal surgery under local anaesthesia.

Anesthesia, Local↗
PubMed1992

Cytokines in human intraocular inflammation.

The presence of interleukin 6 (IL-6), interleukin 1 (IL-1), interleukin 2 (IL-2) and tumour necrosis factor (TNF) was investigated in vitreous and aqueous aspirates from eyes undergoing vitrectomy for the treatment of different inflammatory conditions. Cadaveric vitreous from 10 normal subjects were used as controls. IL-6 was observed in 5 specimens from eyes with idiopathic uveitis (range = 26-264 pg/ml), in 2 specimens from eyes with uveitis complicated with retinal detachment (28 and 279 pg/ml, respectively), in 6 samples from eyes with diabetic retinopathy (range = 5-480 pg/ml), in one sample from an eye with phacolytic glaucoma (1190 pg/ml) and in one specimen from an eye with Behçet's disease (366 pg/ml). Although IL-1 was detected in 80% of all the samples investigated, concentrations of this cytokine greater than 3 pg/ml were only observed in 2 specimens from eyes with uveitis (5 and 20 pg/ml, respectively) and 2 samples from eyes with diabetic retinopathy (3 and 31 pg/ml, respectively). TNF was present in 3 specimens from eyes with uveitis (range = 2-24 pg/ml) and 1 sample from eyes with diabetic retinopathy (4 pg/ml), but was not detected in the eyes with phacolytic glaucoma or Behçet's disease. IL-2 (less than 0.1 U/ml) was detected in one sample from an eye with uveitis, one specimen from an eye with uveitis complicated with retinal detachment and 2 samples from eyes with diabetic retinopathy. None of the cytokines measured were detected in any of the control vitreous. The present observations suggest that cytokines, particularly IL-6 and IL-1, may act as local amplification signals in pathological processes associated with chronic eye inflammation.

Aqueous Humor↗
PubMed1991

Cytokines in proliferative vitreoretinopathy.

This study determined the presence of interleukin 1 (IL-1), interleukin 6 (IL-6), tumour necrosis factor alpha (TNF alpha), tumour necrosis factor beta (TNF beta), interferon gamma (IFN gamma), transforming growth factor beta 2 (TGF beta 2) and fibroblast proliferation activity (FPA) in vitreous aspirates from eyes undergoing vitrectomy for the treatment of retinal detachment complicated by proliferative vitreoretinopathy (PVR) or uncomplicated retinal detachment (RD). Cadaveric vitreous from normal subjects were used as controls. The results showed that IL-1 and IL-6 predominated in vitreous from eyes with PVR or RD, and that concentrations of IL-6 greater than 20 pg/ml were more frequently found in PVR than in RD (p = 0.031) or control specimens (p = 0.006). Low levels of TNF alpha were observed in 4/18 eyes with PVR, 1/15 eyes with RD and 1/15 control vitreous, and small concentrations of TNF alpha were seen in 3/18 eyes with PVR, 1/15 eyes with RD and 2/15 control vitreous. IFN gamma was detected in 12/18 eyes with PVR, but only in 5/15 eyes with RD (p = 0.048) and 6/15 control specimens. TGF beta 2 was present in all vitreous samples at concentrations ranging from 100 to 4,500 pg/ml with no significant differences among the three groups. Control vitreous possessed the greatest FPA when compared with vitreous from eyes with PVR (p = 0.031) or RD (p = 0.048). These observations provide further evidence that cytokine-mediated pathways of inflammation are involved in the pathogenesis of PVR and point to the possible involvement of IL-1, IL-6 and IFN gamma in cellular interactions leading to chronicity.

Antigens, Neoplasm↗
PubMed1991

Removal of silicone oil--rewards and penalties.

Silicone oil is a useful tool in retinal reattachment surgery in selected cases, but complications, particularly cataract, glaucoma and keratopathy, have led to worries about its use for prolonged internal tamponade. Removal of silicone oil has been recommended to preempt or reverse these complications. A retrospective review of 120 eyes in which temporary silicone oil tamponade had been employed is presented. One hundred and twelve eyes were examined six months and two years after removal of silicone oil. Retinal redetachment occurred in 21 eyes (19%). Cataract formation was delayed by early removal of silicone oil, but after two years the majority of eyes had undergone surgery for cataract or had developed lens opacities. Removal of silicone oil was ineffective in reversing an established pressure rise in nearly all cases. Three phakic eyes developed glaucoma after removal of silicone oil but no new cases occurred in phakic eyes in the two years following silicone oil removal. Keratopathy was uncommon and was arrested and occasionally reversed by silicone oil removal. Visual acuities improved in the majority of eyes after removal of silicone oil.

Adult↗
PubMed1991

Complications of 5--fluorouracil after trabeculectomy.

Trabeculectomy has a very high success rate, however, certain eyes are known to be at high risk of failure due to scarring of the conjunctival bleb. Such eyes include those with a previous failed filter, eyes with glaucoma secondary to uveitis and neovascularisation and the eyes of children and young adults. Trabeculectomy is generally accepted to have less successful results in patients of African race although good results are reported from some centres. The effectiveness of treatment with 5-fluorouracil in improving the results of trabeculectomy has been established in a number of pilot studies and clinical trials. Early studies used 100 mg of 5-fluorouracil in divided doses. Serious complications were recorded and lower dose regimes have been advised to improve the safety of the technique. Similar success in improving the chance of success to trabeculectomy has been found with doses of 40 mg with a lower incidence of side effects. We report complications associated with the use of 5-fluorouracil in a total dose of 50 mg in a group of 49 eyes undergoing trabeculectomy and postoperative 5-fluorouracil and describe the previously unreported increased incidence of thin cystic blebs in these eyes.

Adolescent↗
PubMed1991

Perforation of the globe--a complication of peribulbar anaesthesia.

Peribulbar anaesthesia has been recommended as a safer alternative to retrobulbar anaesthesia. We report a case of perforation of the globe sustained during peribulbar anaesthesia which resulted in blindness. Orbital injections are potentially dangerous, be they peribulbar or retrobulbar. To minimise the risk, short, blunt needles are advocated for the peribulbar route.

Aged↗
PubMed1990

Injection of perfluoropropane gas to prevent hypotony in eyes undergoing tube implant surgery.

Hypotony after fistulizing surgery is common, and most cases resolve without complications. Occasionally, a flat anterior chamber in phakic or pseudophakic eyes may lead to corneal decompensation or cataract formation. In aphakic eyes that have undergone previous vitreous surgery, flat anterior chambers will not develop, but large choroidal detachments and delayed suprachoroidal hemorrhage may occur while the eye is soft. To maintain intraocular pressure (IOP) in the early postoperative period, the authors used a technique to seal the drainage tube with a Vicryl tie, combined with injection of sodium hyaluronate, sulfur hexafluoride (SF6), or perfluoropropane (C3F8), perioperatively in 28 eyes undergoing glaucoma tube implant surgery. Eight eyes were treated with injection of sodium hyaluronate, 8 with SF6, and 12 eyes with C3F8. Hypotony was significantly less frequent in eyes treated with C3F8 compared with sodium hyaluronate (P less than 0.05). Mean IOP was significantly higher for eyes treated with C3F8 injection compared with sodium hyaluronate for the first 4 days after surgery (P less than 0.05).

Adolescent↗
PubMed1990

Leber's hereditary optic neuropathy in women.

Four women, from three families, are presented who developed severe bilateral optic nerve disease. A diagnosis of Leber's hereditary optic neuropathy (LHON) was made when male family members became affected. The disease ran a similar course in men and women with severe and permanent reduction in vision. Two women had been told that they suffered from multiple sclerosis. With recent advances in diagnostic techniques it should be possible to distinguish between these two conditions. Although LHON may be underdiagnosed in women, there does seem to be a male preponderance of the disease in most European pedigrees. Recent work supports the assumption that LHON is transmitted via cytoplasmic DNA; however, this does not explain why men are more likely to be affected, nor why only a minority of those carrying the defect develop the disease.

Adolescent↗
PubMed1990

Secondary angle closure in association with pseudoexfoliation of the lens capsule.

Two cases of pseudoexfoliation of the lens capsule are presented in which unilateral shallowing of the anterior chamber caused an acute rise in intraocular pressure. Both patients were elderly women. In one case anterior chamber shallowing was precipitated by administration of pilocarpine and the second followed central retinal vein occlusion. We suggest that pseudoexfoliation of the lens capsule weakened the zonule allowing forward shift to the lens and secondary angle closure.

Aged↗
PubMed1990

Oculokinetic perimetry for the assessment of visual fields.

The visual fields of 13 children aged 7 to 16 (mean 10.7 years) were assessed by oculokinetic perimetry (OKP), a technique where the field of vision is tested at reading distance using a simple chart, and the results compared with conventional Goldmann perimetry. Cooperation with testing was greater for OKP than Goldmann perimetry and in some cases OKP was better correlated with clinical findings. The advantages of visual field assessment by OKP for children are the close proximity of observer and child, the absence of the requirement for prolonged fixation, and the inexpensiveness and portability of the testing equipment. The disadvantages are movements of the head, with variability in the distance from the target, and the limitation to the central 25 degrees of the visual field.

Adolescent↗
PubMed1990

Intraocular gas injection in the treatment of cornea-lens touch and choroidal effusion following fistulizing surgery.

Five eyes with large choroidal detachments and flat anterior chambers following fistulizing surgery were treated with injection of perfluoropropane into the anterior chamber. In all cases the choroidal detachments resolved within 4 days, without the need for drainage. Three phakic eyes developed anterior capsular opacification in the area of contact between the gas bubble and the anterior capsule. Injection of perfluoropropane is recommended as a simple and effective approach to the management of choroidal detachments with flat anterior chamber in pseudophakic eyes and in cataractous phakic eyes.

Aged↗