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Biomedical subjects

W C Steinmann

Publications and source records attributed to W C Steinmann.

At least 19 recordsLinked to original sources
PubMed1992

Aqueous shunts. Molteno versus Schocket.

The authors conducted a multicenter, randomized, controlled trial to test whether the Schocket shunt with a larger shunt reservoir surface area would provide a lower final intraocular pressure than the double-plate Molteno implant. However, the Molteno implant produced a statistically lower intraocular pressure at 6 months compared with the Schocket shunt. Postoperative visual acuity, glaucoma medications, and complications were not statistically different.

Aqueous Humor↗
PubMed1992

Expert agreement in evaluating the optic disc for glaucoma.

The authors studied intraobserver and interobserver agreement, under monoscopic and stereoscopic conditions, in estimating vertical cup-to-disc ratios and in assessing whether a disc had glaucomatous damage. Six glaucoma experts evaluated 75 optic disc photographs under both viewing conditions. The experts also re-evaluated 25 photographs. Intraobserver agreement in estimating vertical cup-to disc ratios was high (median weighted kappa, 0.79). Interobserver agreement in estimating vertical cup-to-disc ratios was moderate (stereoscopic median weighted kappa, 0.67); individual experts differed by as much as 0.2 disc diameters (DD) monoscopically and 0.16 DD stereoscopically. The observers estimated larger vertical cup-to-disc ratios when evaluating the same discs under stereoscopic conditions than under monoscopic conditions. Intraobserver agreement in assessing glaucomatous disc damage was substantial (median kappa, 0.76). Interobserver agreement in assessing glaucomatous damage was moderate (stereoscopic median kappa, 0.50). This study confirms the ability of experts to reliably evaluate the optic disc within themselves and emphasizes the need for developing standardized methods for interobserver evaluation of the optic disc in glaucoma.

Adult↗
PubMed1992

Surgical and medical management of patients with narrow anterior chamber angles: comparative results.

We retrospectively reviewed case records of 70 patients (114 eyes) to assess long-term outcome of surgical and medical treatment of narrow anterior chamber angles. Fifty eyes had undergone a peripheral iridectomy, incisional or laser; 64 had been treated medically, without surgery. The two groups were not strictly comparable. (It is assumed but not proven that, since iridectomy was considered necessary in one group and not in the other, the surgically-treated patients were more seriously diseased.) Comparing clinical data obtained at the first visit with data obtained at the last visit, the eyes receiving iridectomies, as compared with those receiving medical treatment alone, showed a greater number of improved anterior chamber configurations (74% vs 28%), had a lower incidence of peripheral anterior synechiae (2% vs 10%), and required fewer glaucoma medications (30% fewer vs 10% fewer). The percentage of eyes with increased intraocular pressure was similar in both groups (36% vs 28%), as was the percentage of those with decreased visual field (17% vs 21%) and decreased visual acuity (66% vs 60%). No significant complications occurred in the eyes receiving laser iridectomies; however, one of the incisionally-treated eyes lost nine Snellen lines of vision.

Anterior Chamber↗
PubMed1991

Risk factors for hip fractures in men: a preliminary study.

Although hip fracture rates are higher in women than in men, for older men the lifetime risk of fractures of the femur is substantial. Very little is known about risk factors for hip fracture in men. A preliminary case control study was conducted comparing the medical charts of men with first hip fractures with two sets of age-matched controls. The major risk factors for hip fracture that emerged were preadmission ambulatory problems, confusion, heavy alcohol use, and low body mass. Although this study is limited to a medical chart review in a veteran population, these results confirm some of the known associations for hip fracture in women. Further studies in men are recommended.

Adult↗
PubMed1991

Use of trabeculectomy with postoperative 5-fluorouracil in patients requiring extremely low intraocular pressure levels to limit further glaucoma progression.

The authors conducted a randomized, controlled clinical trial to quantify the effect of 5-fluorouracil (5-FU) on filtration surgery. Both eyes of 17 patients with either bilateral low-tension glaucoma or advanced chronic open-angle glaucoma that would be expected to progress at intraocular pressures in the normal range were included. One eye received a full-thickness filtering procedure with a modified shell tamponade technique, and the other received a trabeculectomy with postoperative 5-FU. Follow-up was equal for both eyes and averaged 9.2 months. In eyes in the shell group, the average postoperative pressure was 10.94 mmHg, and in the 5-FU group it was 6.94 mmHg, (P = 0.0001). However, the postoperative visual acuity decrease was significantly greater in the 5-FU group (P less than 0.05). Choroidal detachments also were more frequent in the 5-FU group, but this was not statistically significant.

Aged↗
PubMed1991

The effects of postoperative corticosteroids on trabeculectomy and the clinical course of glaucoma: five-year follow-up study.

A randomized, prospective study on 68 eyes of 54 patients with progressive, uncontrolled, noninflammatory open-angle glaucoma showed that eyes that received topical prednisolone 1% had a lower intraocular pressure (IOP) 18 months following trabeculectomy than the eyes that received no prednisolone. The addition of systemic prednisone had no definite further effect. In the present study, we reevealuated 58 eyes of 45 of these patients 5 years after the time of initial surgery. The number of cases lost to follow up was similar in the steroid and the nonsteroid-treated groups. Mean IOP of the steroid-treated patients was 14.5 +/- 1.8 mm Hg, and of the nonsteroid-treated patients, 19.3 +/- 2.1 mm Hg. Visual field, optic disc, and IOP were stabilized in 94% of the steroid-treated cases and in 43% of the nonsteroid-treated cases. Thus, postoperative steroids significantly increased the success rate of trabeculectomy in these eyes, and the eyes with lower IOPs had a significantly better prognosis than those with higher IOPs.

Adult↗
PubMed1989

Reversible optic disk cupping and visual field improvement in adults with glaucoma.

To assess change over time in the optic disk and the associated change in visual field, we retrospectively reviewed perimetry results and optic disk photographs of adult patients treated for glaucoma. Three glaucoma specialists masked to the clinical course independently reviewed optic disk stereophotographs and visual fields taken before and after treatment. Each member of each pair of stereophotographs or perimetry results, which were presented in a random sequence, were graded as better, worse, or unchanged. Of the 75 eyes, 16 (21%) showed a reversal of optic disk cupping; 20 of the 63 visual fields (31%) were classified as improved. In six of 17 eyes (35%) with a change in the disk (better or worse), a corresponding change was also noted in the visual field. The frequency of improvement in optic disk and visual field appearance was significantly (P less than .05) associated with the degree of intraocular pressure reduction.

Adult↗
PubMed1989

Agreement between clinicians and an image analyzer in estimating cup-to-disc ratios.

We studied optic disc photographs of 35 eyes to determine the level of agreement between estimates of vertical and horizontal cup-to-disc ratios (CDRs) provided by two clinicians and estimates of these ratios obtained using an image analyzer. We also evaluated the agreement of each clinician with himself and with the other clinician to provide a relative standard by which to judge agreement between the clinicians and the image analyzer. Agreement between the clinicians and the image analyzer was moderate. Differences of more than 0.2 disc diameters (DD) between the CDR estimates of clinicians and those obtained using the image analyzer were limited to discs having small (CDR of 0.4 DD or lower) or very large (CDR of 0.9 DD or higher) cups. The clinicians' agreement with themselves and with each other was substantial to near perfect.

Adolescent↗
PubMed1989

Risk factors for the development of Tenon's capsule cysts after trabeculectomy.

Tenon's capsule cysts (TCCs) are a complication of glaucoma filtering surgery. They are frequently associated with substantial elevations in intraocular pressure (IOP) beginning 2 to 8 weeks postoperatively. To determine the incidence and possible risk factors for the development of TCCs, case records of all patients who received trabeculectomy over a 4-year period at the Wills Eye Hospital were reviewed. The incidence of TCCs was 28% in those who underwent trabeculectomy. Characteristics of patients after trabeculectomy in whom TCCs developed were compared with patients after trabeculectomy in whom TCCs did not develop. Both univariate and multivariate techniques were used to assess the association of characteristics associated with the development of TCCs. Factors associated with increased risk (P less than 0.05) were: history of prior TCCs, argon laser trabeculoplasty, male gender, and the use of preoperative sympathomimetics. The use of a compression shell was associated with decreased risk (P less than 0.05).

Adult↗
PubMed1989

Visual field change in low-tension glaucoma over a five-year follow-up.

There is some evidence that the nature and progression of disease in low-tension glaucoma may be distinct from other open-angle glaucomas. The authors assessed visual field change by retrospective case review of all patients treated for low-tension glaucoma by the Glaucoma Service, Wills Eye Hospital, for at least 5 years. Sixty-two glaucomatous eyes of 36 patients were identified. All eyes were treated medically and 40 (65%) underwent at least one surgical procedure. Twenty-eight eyes (47%) had initial field loss confined to a single hemi-field and in the remainder both hemi-fields were involved. Thirty of 57 eyes (53%) showed progression at 3 years and 38 (62%) of 57 had progressed by 5 years. A dense scotoma extending from the nasal periphery toward fixation was the most common visual field defect. The rate of field change in this population is significantly greater than in a cohort of primary open-angle glaucoma patients also seen at Wills Eye Hospital, but who had elevated intraocular pressures. Patterns of field loss and rate of progression in this low-tension glaucoma population suggest that the natural history of low-tension glaucoma differs from high-tension open-angle glaucoma.

Aged↗
PubMed1989

The effect of chronic miotic therapy on the results of posterior chamber intraocular lens implantation and trabeculectomy in patients with glaucoma.

We reviewed the charts of 18 patients (20 glaucomatous eyes) who had not used pilocarpine prior to undergoing trabeculectomy combined with or performed later with posterior chamber lens implantation. We then compared postoperative results and complications in these patients with those in 35 other patients (40 glaucomatous eyes) in two age- and stage-matched groups who had used pilocarpine prior to undergoing the same procedures. All patients had a minimum follow-up of 6 months. There was no significant difference between these groups in terms of postoperative intraocular pressure and required glaucoma medications. However, in the pilocarpine-treated groups, there was a significantly higher incidence of complications, especially intraocular lens capture (P less than 0.05), and of worse visual outcomes (P less than 0.01).

Aged↗
PubMed1989

A comparative evaluation of three methods of analyzing optic disc topography.

Topographical evaluations of the optic discs of 17 eyes obtained using a clinical planimeter, the Rodenstock video-ophthalmograph, and the IS 2000 image analyzer were compared. The parameters studied were vertical and horizontal cup-to-disc ratios, cup volumes, rim areas, disc areas, and rim area-to-disc area ratios. There was good correlation between the measurements obtained by the three methods (correlation coefficients ranged from 0.46 to 0.88). For various parameters, the correlations between clinical planimetry and image analysis were higher than either those between image analysis and video-ophthalmography, or those between clinical planimetry and video-ophthalmography. The mean horizontal cup-to-disc ratios and rim areas as measured by clinical planimetry were significantly higher than those measured by image analysis. Image analysis measured significantly higher disc area and rim areas and lower cup volumes than video-ophthalmography.

Aged↗
PubMed1988

Variability in digital analysis of optic disc topography.

We determined the magnitude of variability in optic disc topographical parameters on digital analysis of the optic disc using the IS 2000. The variability introduced by the system, the observer, the observer and patient, and by clinically different types of discs was assessed in the measurement of the vertical cup-to-disc ratio, horizontal cup-to-disc ratio, cup area-to-disc area, cup volume, neuroretinal rim area, and neuroretinal rim area-to-disc area. The system itself accounted for no variability. The variability introduced by one observer for the parameters ranged from 1% to 7%, and by one observer and patient from 1% to 28%. The variation among five observers ranged from 1% to 55%. Direct image acquisition (using video cameras) gave results that were no different from those obtained by digitizing the slides. Contrast-enhancement techniques did not decrease observer variability. A change in the flash intensity level at which optic disc images were acquired from 94.5 to 15.0 Watt-seconds introduced a variability of 3% to 21%. These results are less variable than those obtained on clinical observation and comparable to those of the Rodenstock image analyzer in evaluating these aspects of optic disc topography.

Adult↗
PubMed1988

Surgical therapy of chronic glaucoma in aphakia and pseudophakia.

Most glaucoma surgical procedures are less successful in aphakic or pseudophakic eyes. The authors reviewed 91 consecutive initial glaucoma procedures in aphakic patients from 1979 to 1986 to determine successful outcomes and complications. Success was defined as an intraocular pressure (IOP) of at least 30% below the preoperative value and less than 21 mmHg, less than 2 lines of Snellen acuity loss, and no further surgical intervention. At 9 months, success rates were: trabeculectomy, 4 of 15 patients; cyclodialysis, 3 of 20 patients; neodymium:YAG (Nd:YAG) cyclophotocoagulation, 1 of 8 patients; cyclocryotherapy, 9 of 22 patients; anterior chamber tube shunt (Schocket procedure), 3 of 6 patients; and argon laser trabeculoplasty, 2 of 20 patients. Severe complications included phthisis bulbi in 11% of cyclocryotherapy and severe visual loss in 20% with cyclodialysis and 14% with cyclocryotherapy. Results confirm the difficulty of surgical therapy in these patients.

Aged↗
PubMed1988

The clinical effectiveness of pneumococcal vaccine in the elderly.

The effectiveness of pneumococcal vaccine in the immunocompetent elderly remains controversial. We report the results of a multicenter, case-control study of 244 controls and 122 patients, aged 55 years and older, hospitalized during a 5-year period with pneumococcal bacteremia, meningitis, or other bacteriologically confirmed pneumococcal infection. Two controls per patient were matched on the basis of admission date, hospital records, and underlying diseases. All subjects were selected without knowledge of immunization status with pneumococcal vaccine, and were excluded if there was evidence for immunosuppression due to disease or iatrogenic causes. The clinical effectiveness of the vaccine was calculated to be 70% (95% confidence intervals [CI], 37% to 86%) in this population, based on a Mantel-Haenszel point estimate of the odds ratio of 0.30 (95% CI, 0.14% to 0.63%; P less than 0.005). The clinical effectiveness of pneumococcal vaccine in preventing pneumococcal infection in the immunocompetent elderly approximates the vaccine's effectiveness in the general immunocompetent population.

Aged↗
PubMed1987

Positional changes in the vasculature of the optic disk in glaucoma.

We analyzed 34 sets of optic disk photographs from 19 patients with glaucoma who had been followed up for ten years to evaluate changes in the position of the vasculature of the optic disks over time. Each photograph was analyzed by an image analyzer's edge-defining program for optic disk analysis and by three experienced clinicians. Image analysis of the blood vessels in 16 optic disks showed positional centrifugal shifts. The clinicians consistently noted changes in the appearance of seven optic disks. The difference between the results obtained using the image analyzer and those obtained by clinical observation was significant (P less than .05).

Adult↗
PubMed1987

Cysts of Tenon's capsule following filtration surgery. Medical management.

Cysts of Tenon's capsule (encapsulated blebs) developed postoperatively in 77 (13%) of 607 eyes that underwent filtration surgery between 1980 and mid-1985. The annual incidence was not uniform, increasing markedly throughout the period. Seventy-four eyes were treated with medical therapy only. At a mean follow-up of 19 months, the success rate for these eyes, defined as an intraocular pressure (IOP) of 21 mm Hg or less, was 92%. The three eyes that underwent surgical revision subsequently failed clinically by the study criteria. Those patients in whom cysts of Tenon's capsule developed were compared with an age-matched control group to assess for possible differences in long-term outcome. There was a significantly higher IOP in the Tenon's cyst group at one and three months after surgery, and an increased proportion of IOPs above 30 and 40 mm Hg. At a six-month and later follow-up, there was no significant difference in the mean IOP or in progression of visual field loss. Causative factors were sought for the development of these cysts of Tenon's capsule. Prior conjunctival surgery, or previous cyst formation in the other eye, were the significant risk factors noted.

Adolescent↗