Ophthalmology Review: A Case-Study Approach, Second Edition by renowned experts Kuldev Singh, William Smiddy, and Andrew Lee is a practical, case- based reference covering a wide array of common to ...serious ophthalmic conditions encountered in daily practice. The new edition reflects significant advances in ophthalmologic surgery and additional quick-reference material. The focus is on patient management problems and how to handle them and optimally manage the patient. A cadre of esteemed contributors discuss diagnostic methods, evaluation, contraindications, and patient management issues for a full spectrum of clinical disorders, with significant clinical pearls gleaned from hands-on expertise. A full spectrum of subspecialties are reflected in nearly 100 ophthalmology cases presented in 11 sections, encompassing the cornea and external disease, lens, glaucoma, retina, uveitis, tumors, posterior segment complications, ocular trauma, neuro-ophthalmology, pediatrics, and oculoplastic surgery. Each succinct case walks readers step by step through patient history, the examination, differential diagnoses, test interpretation, definitive diagnosis, medical and/or surgical management, rehabilitation, and follow up, with handy key point summaries. Key Features * Hundreds of tables, full-color images, and line drawings enhance clinical understanding * Presents patient management problems, focusing on diagnosis, problem-solving, and treatment * Disorders of the retina such as diabetic retinopathy, retinal vein and artery occlusion, AMD, myopic degeneration, chorioretinopathy, vitreous hemorrhage, and retinitis pigmentosa * Neuro-ophthalmologic conditions including optic neuritis, various types of nerve palsy, internuclear ophthalmoplegia, and anisocoria * Pediatric eye conditions -- from leukocoria and torticollis -- to optic nerve hypoplasia This is an essential exam review resource for ophthalmology residents... Its systematic approach provides an ideal teaching tool for ophthalmologists to use in courses and grand rounds.
Digital Palpation of Intraocular Pressure Birnbach, Charles D; Leen, Martha Motuz
Ophthalmic surgery, lasers & imaging retina,
09/1998, Letnik:
29, Številka:
9
Journal Article
Recenzirano
* BACKGROUND AND OBJECTIVE: Previous studies investigating the accuracy of digital palpation through the eyelids to estimate intraocular pressure (IOP) have shown disappointing results. In this ...study, the accuracy of digital assessment of IOP by palpation of the bare cornea is investigated.
* MATERIALS AND METHODS: The IOP of a cadaveric eye model was varied from 5 to 40 mm Hg in increments of 5 mm Hg. Two examiners, one experienced and one inexperienced, digitally palpated the corneas and estimated IOP. The results were compared before and after a 1-hour training session.
* RESULTS: Prior to the training session, the experienced examiner guessed correctly 46% of the time and was correct within 5 mm Hg 100% of the time. The inexperienced examiner guessed correctly 21% of the time and was within 5 mm Hg 62% of the time. After the training session, the experienced examiner's score did not significantly change, whereas the inexperienced examiner improved significantly (38% correct, 88% within 5 mm Hg, P = .05.)
* CONCLUSIONS: Digital assessment of IOP by palpation of bare cornea is accurate when performed by experienced individuals. A minimal amount of training using the eye model may improve one's accuracy.
Ophthalmic Surg Lasers 1998;29:754-757.
Purpose: To evaluate the long-term outcome of the Molteno implant drainage device using survival analysis.
Methods: A retrospective chart review was performed on 77 eyes of 71 patients that underwent ...Molteno implantation for intractable glaucoma unresponsive to conventional management from October 1984 to April 1990 at the University of Washington Eye Center and had at least 6 months of follow-up data. Success was defined as a postoperative intraocular pressure of 22 mmHg or lower with (qualified success) or without (complete success) glaucoma medications and no additional glaucoma surgery, phthisis, or loss of light perception.
Results: The median follow-up was 44 months (range, 6–107 months). Indications for Molteno implantation were aphakia/pseudophakia (n = 24), neovascular glaucoma (n = 20), uveitic glaucoma (n = 12), failed trabeculectomy (n = 9), traumatic glaucoma (n = 8), and congenital glaucoma (n = 4). The total success was 57% (23% complete; 34% qualified) at the last follow-up. Kaplan-Meier survival curves demonstrated a continuous and relatively linear attrition of success over at least 5 1/2 postoperative years. The uveitic glaucoma group had the highest success rate of 75%. Eyes with neovascular glaucoma failed significantly more frequently than those with uveitic glaucoma (P < 0.01). There was no significant difference in outcome based on sex, race, single versus double plate, anterior chamber versus posterior chamber tube placement, or two-stage versus single-stage surgery. Younger age was associated with a significantly higher failure rate after controlling for glaucoma category (P < 0.01).
Conclusion: The Molteno implant drainage device offers a reasonable long-term outcome in eyes with intractable glaucomas. However, an ongoing rate of failure, not unlike that seen after other filtration surgery, is to be expected.
To assess our patients' knowledge of glaucoma and to measure the effect of a brief education program on their understanding of glaucoma.
Patients attending glaucoma clinics at a university and a ...Veterans' Affairs hospital were randomized into two groups: "exposed" and "unexposed" to a simple education program of a video and brochures. Glaucoma knowledge was assessed twice by an oral questionnaire, at 2 weeks and 6 months after randomization plus or minus education.
Younger patients and those with more years of formal schooling knew more about glaucoma. Two weeks after the education program, the exposed group performed significantly better than did the unexposed group. Analysis of the results showed benefit from both brochures and video. This effect of education was not seen at retesting 6 months later.
Older patients and those with less formal education know less about glaucoma. A brief, simple education program can significantly improve levels of knowledge about glaucoma, even in a relatively well-informed population. However, patient education must be repeated to maintain a useful effect.
Postoperative hypotony is a common complication of glaucoma filtering surgery, particularly with adjunctive use of antifibrotic agents. Associated structural sequelae and reduced visual function may ...occur in some eyes, resulting in the low-pressure syndrome. Precautions may be taken intraoperatively and postoperatively to decrease the likelihood of hypotony. Sometimes, despite these measures, the low-pressure syndrome still can occur, the management of which can be difficult. When simple observation does not result in spontaneous resolution, several noninvasive and invasive techniques are available, targeted at the cause of low IOP.
To test whether a statistical method using a probability map could detect true changes in optic disc topography.
The average of three Glaucoma-Scope images (Ophthalmic Imaging Systems were used for ...analysis at each of two sessions. A Glaucoma-Scope probability map was constructed for each eye using statistical methods. The proportion of topographic locations with p values less than 0.05 on a modified two-sample t test (p-proportion) and the difference in the mean position of the disc (MPD) from two imaging sessions were calculated. Two pairs of stereoscopic disc photographs for 43 eyes with longitudinal follow-up were evaluated for change by four experienced glaucoma specialists masked to patient clinical information. Clinical change was considered to have occurred when the assessments of at least three of the four specialists were agreed on. The cutoff values for p-proportion and change in MPD that provided 95% specificity were calculated using a separate sample of 69 subjects who had serial images taken at two separate sessions on the same day, and thus showed no clinical change in the optic disc.
The cutoff values of 95% specificity for the p-proportion and the change in MPD were 18% and 25.1 microns, respectively. Of 43 eyes with longitudinal follow-up, 14 showed definite clinical change. Sensitivity of the p-proportion and change in MPD for detecting this change was 100% and 85.7%, respectively. For all 43 patients with longitudinal follow-up, the percent change in intraocular pressure (IOP) correlated strongly with both the p-proportion and the change in MPD.
Using data obtained with the Glaucoma-Scope, a statistical method based on probability mapping can be used to detect true changes in disc topography. The p-proportion was more sensitive than change in MPD in detecting clinical change in the study eyes. This statistical methodology may also be applicable for interpretation of data obtained with other optic disc analyzers.
Previous studies investigating the accuracy of digital palpation through the eyelids to estimate intraocular pressure (IOP) have shown disappointing results. In this study, the accuracy of digital ...assessment of IOP by palpation of the bare cornea is investigated.
The IOP of a cadaveric eye model was varied from 5 to 40 mm Hg in increments of 5 mm Hg. Two examiners, one experienced and one inexperienced, digitally palpated the corneas and estimated IOP. The results were compared before and after a 1-hour training session.
Prior to the training session, the experienced examiner guessed correctly 46% of the time and was correct within 5 mm Hg 100% of the time. The inexperienced examiner guessed correctly 21% of the time and was within 5 mm Hg 62% of the time. After the training session, the experienced examiner's score did not significantly (38% correct, 88% within 5 mm Hg, P = .05.
Digital assessment of IOP by palpation of bare cornea is accurate when performed by experienced individuals. A minimal amount of training using the eye model may improve one's accuracy.
OBJECTIVE To investigate the effect of intrableb autologous blood injection and diode laser bleb revision on cellular proliferation in filtration blebs of rabbits. METHODS Bilateral filtration ...surgery with mitomycin was performed on 19 white 2.5- to 3-kg New Zealand rabbits. Autologous blood injection (n=9) or diode laser bleb revision (n=10) was performed on blebs of right eyes (intervention eyes) on day 14 after filtration surgery. The blebs of the left eyes served as controls. Cellular proliferation was assessed by in vivo incorporation of 5-bromo-2‘-deoxyuridine (BrdU), after BrdU, 10 mg/kg, was injected via the ear vein on days 15, 16, and 18. The rabbits were euthanized on day 21. Conjunctival sections were stained with hematoxylin-eosin for total cell counts and with anti-BrdU antibody for counts of proliferating cells. The BrdU labeling index was calculated by dividing the mean proliferating cell count by the mean total cell count. RESULTS The BrdU labeling index was significantly increased in the blood-injected eyes as compared with the control eyes (P=.03). The BrdU labeling index was increased in the diode laser–revised eyes as compared with the control eyes, approaching significance (P=.06). Intraocular pressure increased significantly in the eyes that underwent bleb interventions in both groups from baseline and compared with the control eyes. CONCLUSIONS Intrableb autologous blood injection and diode laser bleb revision stimulate cellular proliferation in the rabbit filtration bleb, which may contribute to the rise in intraocular pressure observed clinically after these interventions.Arch Ophthalmol. 1999;117:77-83-->
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