Ophthalmol Clin North Am
· 2005 Sep · PMID 16055002
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Although surgery remains the definitive treatment for congenital and other childhood glaucomas, medical therapy can be effective in lowering intraocular pressure as a temporizing measure before surgery or as long-term ad...Although surgery remains the definitive treatment for congenital and other childhood glaucomas, medical therapy can be effective in lowering intraocular pressure as a temporizing measure before surgery or as long-term adjunctive treatment in disease refractory to surgical measures. Carbonic anhydrase inhibitors, beta-blockers, cholinergic drugs, and the prostaglandin-related drugs all play an effective role in pediatric glaucoma management. The usefulness and safety profile of the adrenergic agonists and the osmotic agents are less well established. In medically treating the pediatric patient or the pregnant woman for glaucoma, the clinician must be mindful of the possibility of adverse effects and be prepared to alter or terminate treatment if needed.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16055001
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Nonpenetrating glaucoma surgery continues to evolve and improve. New technical refinements and increased experience among its practitioners have led to improved efficacy and longer duration of filter survival. These refi...Nonpenetrating glaucoma surgery continues to evolve and improve. New technical refinements and increased experience among its practitioners have led to improved efficacy and longer duration of filter survival. These refinements include the use of intraoperative and postoperative antimetabolites, adjunctive space-maintaining devices, and postoperative yttrium-aluminum-garnet laser goniopuncture. Deep sclerectomy and viscocanalostomy vary significantly in their surgical approaches and mechanisms of aqueous outflow. An understanding of the microanatomy of the aqueous outflow structures is necessary to gain surgical access to Schlemm's canal and to augment aqueous outflow surgically through the trabecular meshwork. Indications and contraindications for nonpenetrating glaucoma surgery are discussed.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16055000
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Approximately, one fifth of primary congenital glaucoma patients fail primary surgery. Also, some pediatric glaucomas respond poorly to goniotomy or trabeculectomy. In these situations, clinicians often choose trabeculec...Approximately, one fifth of primary congenital glaucoma patients fail primary surgery. Also, some pediatric glaucomas respond poorly to goniotomy or trabeculectomy. In these situations, clinicians often choose trabeculectomy with mitomycin-C or a drainage implant as a surgical treatment. Glaucoma drainage device implantation is a useful option in refractory patients. When other surgical treatments have a poor prognosis for success, prior conventional surgery fails, or significant conjunctival scarring precludes filtration surgery, glaucoma drainage implant may effectively control intraocular pressure. Patients often require adjunctive glaucoma medications after surgery and may develop complications. Most of these complications, however, are reversible or resolve spontaneously, and most are not associated with vision loss.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054999
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Uveitic glaucoma can pose some of the most challenging management problems faced by the ophthalmologist. A better understanding of the pathogenesis of glaucoma associated with ocular inflammatory disease is an important...Uveitic glaucoma can pose some of the most challenging management problems faced by the ophthalmologist. A better understanding of the pathogenesis of glaucoma associated with ocular inflammatory disease is an important key to making appropriate therapeutic decisions. This article provides an update on recent advances in understanding the epidemiology and pathogenesis of uveitic glaucoma, as well as developments in the diagnosis and management of this condition.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054998
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Selective laser trabeculoplasty (SLT) has been shown to be safe, well tolerated, and effective in intraocular pressure (IOP) reduction as therapy in several forms of open-angle glaucoma. The preservation of trabecular me...Selective laser trabeculoplasty (SLT) has been shown to be safe, well tolerated, and effective in intraocular pressure (IOP) reduction as therapy in several forms of open-angle glaucoma. The preservation of trabecular meshwork (TM) architecture and the demonstrated efficacy in lowering IOP make SLT a reasonable and safe alternative to argon laser trabeculoplasty (ALT). SLT may also be effective for cases of failed ALT and is a procedure that may also be repeatable, unlike ALT. SLT is also a simple technique for an ophthalmologist to learn as the large spot size eliminates the need to locate a particular zone of treatment on the TM. SLT has been demonstrated to be effective as primary treatment for open angle glaucoma and can be an effective adjunct in the early treatment of glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or who are noncompliant with their glaucoma medications, without interfering with the success of future surgery.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054997
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Prescribing medical treatment for glaucoma requires a complex decision-making process that involves the patient, the severity of the disease, the therapeutic options available, and their potential side effects. Lowering...Prescribing medical treatment for glaucoma requires a complex decision-making process that involves the patient, the severity of the disease, the therapeutic options available, and their potential side effects. Lowering intraocular pressure, a known risk factor for progression, has been the mainstay of glaucoma treatment. Most patients who are first diagnosed with glaucoma in the United States are started on topical medications. As our understanding of the disease changes and newer treatments become available, glaucoma therapies may need to be reassessed and changed if necessary.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054996
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Various cellular and molecular mechanisms that may lead to apoptotic cell death of retinal ganglion cells in glaucoma are discussed. These cellular mechanisms include neurotrophic factor deprivation, ischemia, glial cell...Various cellular and molecular mechanisms that may lead to apoptotic cell death of retinal ganglion cells in glaucoma are discussed. These cellular mechanisms include neurotrophic factor deprivation, ischemia, glial cell activation, glutamate excitotoxicity, and abnormal immune response. Based on experimental and clinical evidence, the rationale for various neuroprotective strategies is described.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054995
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Primary angle closure glaucoma is a common cause of visual loss worldwide. Gonioscopy and other current methods of assessment of the anatomy of the anterior segment relevant to the diagnosis of this disease, such as ultr...Primary angle closure glaucoma is a common cause of visual loss worldwide. Gonioscopy and other current methods of assessment of the anatomy of the anterior segment relevant to the diagnosis of this disease, such as ultrasound biomicroscopy, have significant limitations. Anterior segment optical coherence tomography, with its rapid, noncontact, and high-resolution image acquisition, seems to be a promising tool for the evaluation of the anterior chamber angle configuration, including changes induced by illumination and laser peripheral iridotomy. It has the potential for use as a rapid screening tool for detection of occludable angles. Ongoing clinical studies should help to evaluate its efficacy in this regard.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054994
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This article provides a basis for understanding modern visual field analysis techniques. It describes some of these tests, including their advantages and disadvantages, and the settings in which different tests might be...This article provides a basis for understanding modern visual field analysis techniques. It describes some of these tests, including their advantages and disadvantages, and the settings in which different tests might be used most successfully. It also includes an examination of the value of visual field assessment from a public health standpoint with particular attention paid to morbidity, cost/benefit ratios, and quality of life correlations.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054993
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Glaucoma is the most common chronic optic neuropathy. Although traditionally considered a disease of elevated intraocular pressure, it is now clear that glaucoma is primarily a distinctive optic neuropathy. This article...Glaucoma is the most common chronic optic neuropathy. Although traditionally considered a disease of elevated intraocular pressure, it is now clear that glaucoma is primarily a distinctive optic neuropathy. This article discusses the distinctive features of glaucoma: disk morphology, visual field patterns, and disease progression. The primary goal is to distinguish glaucoma from other optic neuropathies and, in so doing, to suggest some hypotheses for its etiology.
Harris A, Rechtman E, Siesky B
… +3 more, Jonescu-Cuypers C, McCranor L, Garzozi HJ
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054992
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Many theories have surfaced regarding the exact mechanisms behind glaucomatous damage, but the complex nature of the disease and the inaccessibility of the internal structures of the human eye have limited current knowle...Many theories have surfaced regarding the exact mechanisms behind glaucomatous damage, but the complex nature of the disease and the inaccessibility of the internal structures of the human eye have limited current knowledge. Increased intraocular pressure is the risk factor most often associated with glaucomatous optic neuropathy; ischemic insult to the optic nerve has also been suggested as a possible cause of cellular damage. The aim of this review is to cover the possible role of optic nerve head hemodynamics in the pathogenesis of glaucoma.
Ophthalmol Clin North Am
· 2005 Sep · PMID 16054991
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Glaucoma is a common blinding disease worldwide. Most forms of the disease are inherited in some way. The identification of genes responsible for glaucoma will lead to insights into the underlying biochemical defects as...Glaucoma is a common blinding disease worldwide. Most forms of the disease are inherited in some way. The identification of genes responsible for glaucoma will lead to insights into the underlying biochemical defects as well as provide the basis for new methods of diagnosis and therapy. Glaucoma patients who are identified early and treated appropriately have the best chance of maintaining useful sight.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935295
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Combinations of in-office and home care treatment modalities are effective in the improvement and maintenance of photodamaged skin. A regimen of daily internal supplementation and application of topical products will pro...Combinations of in-office and home care treatment modalities are effective in the improvement and maintenance of photodamaged skin. A regimen of daily internal supplementation and application of topical products will prolong and enhance the effects of noninvasive and surgical procedures.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935294
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This article discusses follicular unit transplantation for male and female pattern hair loss and restoring eyebrows.This article discusses follicular unit transplantation for male and female pattern hair loss and restoring eyebrows.
Gladstone GJ, Myint S, Black EH
… +2 more, Brazzo BG, Nesi FA
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935293
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A multitude of techniques exists for facelift surgery (rhytidectomy). These techniques range from simple skin undermining to complex procedures involving superficial musculoaponeurotic system (SMAS) manipulation and subp...A multitude of techniques exists for facelift surgery (rhytidectomy). These techniques range from simple skin undermining to complex procedures involving superficial musculoaponeurotic system (SMAS) manipulation and subperiosteal dissection. Most surgeons agree that some type of modification of the SMAS is necessary to achieve an acceptable result. The technique presented herein involves developing a relatively large skin flap, tightening the SMAS, and redraping the skin.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935292
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In today's active society and demanding workplace, patients are frequently searching for less invasive procedures with diminished morbidity and more rapid healing to address their cosmetic concerns. The goal of face-lift...In today's active society and demanding workplace, patients are frequently searching for less invasive procedures with diminished morbidity and more rapid healing to address their cosmetic concerns. The goal of face-lift surgery is to reverse the effects of aging by removing excess skin of the lower face and neck with concomitant repositioning of the deeper ptotic tissues. Recent advances in understanding facial anatomy and aging have resulted in the development of new procedures that can achieve these goals with more limited surgery. As increasingly younger patients present for early restorative procedures, it is imperative that surgeons have alternative options within their armamentarium to achieve success. This article reviews the current trends in face-lift surgery, particularly the small incision face-lift.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935291
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This article discusses endoscopic foreheadplasty for rejuvenation of the aging face.This article discusses endoscopic foreheadplasty for rejuvenation of the aging face.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935290
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The traditional lower lid blepharoplasty highlighted by fat removal and excision of excess skin via a transcutaneous approach has been replaced by a reconstructive blepharoplasty involving minimal fat removal, sculpting,...The traditional lower lid blepharoplasty highlighted by fat removal and excision of excess skin via a transcutaneous approach has been replaced by a reconstructive blepharoplasty involving minimal fat removal, sculpting, or fat repositioning. Simultaneous application of chemical peels, microdermabrasion, or laser resurfacing procedures is an acceptable alternative to skin excision when there is minimal skin redundancy. This article reviews the anatomic changes in the lower eyelid that occur as a result of aging and addresses reconstructive techniques for rejuvenation of the lower eyelid.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935289
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Cosmetic upper eyelid blepharoplasty is not a procedure comprising skin and fat resection only. Efficient and effective functional repair of the upper lid requires brow stabilization or elevation, levator aponeurotic rep...Cosmetic upper eyelid blepharoplasty is not a procedure comprising skin and fat resection only. Efficient and effective functional repair of the upper lid requires brow stabilization or elevation, levator aponeurotic repair, lacrimal gland suspension, and cutaneous laser resurfacing when necessary.
Ophthalmol Clin North Am
· 2005 Jun · PMID 15935288
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This article provides an overview of upper eyelid anatomy and racial variations, functional indications in upper lid blepharoplasty, and various surgical techniques.This article provides an overview of upper eyelid anatomy and racial variations, functional indications in upper lid blepharoplasty, and various surgical techniques.