R P Wilson

Thomas Jefferson University, Philadelphia, Pennsylvania, United States

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Publications (28)98.81 Total impact

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    ABSTRACT: To evaluate and compare the outcome of functioning filtration surgery followed by cataract surgery with posterior intraocular lens implantation by both phacoemulsification and extracapsular cataract extraction (ECCE) techniques in glaucomatous eyes. We retrospectively evaluated the clinical course of 77 eyes (68 patients) that after successful trabeculectomy, underwent cataract surgery by either phacoemulsification or ECCE techniques. We determined the frequency of partial and absolute failure following cataract surgery by either phacoemulsification or ECCE in eyes with functioning trabeculectomies. Partial failure of intraocular pressure (IOP), control after cataract extraction was defined as the need for an increased number of antiglaucoma medications or argon laser trabeculoplasty to maintain IOP < or =21mm Hg. Complete failure of IOP control after cataract surgery was defined as an IOP >21 mm Hg on at least two consecutive measurements one or more weeks apart or the performance of additional filtration surgery. Failure rates were calculated using the Kaplan-Meier actuarial method. Failure rates between phacoemulsification and ECCE subgroups were compared using the log rank test. The probability of partial failure by the third postoperative year after cataract surgery was 39.5% in the phacoemulsification subgroup and 37.3% in the ECCE subgroup. This small difference is not statistically significant (P = 0.48). The probability of complete failure by the fourth postoperative year after cataract surgery was 12.0% in the phacoemulsification subgroup and 12.5% in the ECCE subgroup. This difference is also not statistically significant (P = 0.77). At the 6-month follow-up visit, visual acuity of both groups improved one or more lines in 87.0% of patients, and worsened one or more lines in 3.9% of patients. Sixty-one percent achieved visual acuity of 20/40 or better. The most frequent complication was posterior capsular opacification requiring laser capsulotomy that occurred in 31.2% of patients. Cataract extraction by either phacoemulsification or ECCE following trabeculectomy surgery may be associated with a partial loss of the previously functioning filter and the need for more antiglaucoma medications to control IOP.
    No preview · Article · Nov 2000 · Ophthalmic surgery and lasers
  • M R. Moster · S. Kansal · M. Gomes · C M. Schmidt · R P. Wilson

    No preview · Article · Feb 2000 · Journal of Glaucoma
  • S Sudesh · E J Cohen · C J Rapuano · R P Wilson

    No preview · Article · May 1999 · Archives of Ophthalmology
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    ABSTRACT: To report the long-term outcome of ten patients with iridocorneal endothelial (ICE) syndrome who underwent aqueous shunt surgery for uncontrolled glaucoma. Noncomparative, retrospective case series. The authors reviewed charts of ten patients with ICE syndrome-related glaucoma who underwent aqueous shunt surgery at one institution between 1987 and 1996. Intraocular pressure (IOP), number of glaucoma medications, and further surgical interventions were measured. With a median follow-up of 55 months, four eyes had adequate IOP control (IOP <21 mm Hg) with one or two medications after the initial aqueous shunt surgery. An additional three eyes achieved adequate IOP control after one or more tube repositionings or revisions of the initial aqueous shunt. In this series, the aqueous shunt surgery most often failed because of blocking of the tube ostium by iris, ICE membrane, or membrane-induced tube migration. Aqueous shunt surgery appears to be an effective method for IOP lowering in some eyes with ICE syndrome-related glaucoma when medical treatment or conventional filtration surgeries fail, but additional glaucoma procedures and/or aqueous shunt revisions and tube repositionings are not uncommon.
    No preview · Article · May 1999 · Ophthalmology
  • A Azuara-Blanco · R P Wilson · R C Eagle · P A Rafferty
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    ABSTRACT: We describe a patient with Chandler's syndrome variant of the iridocorneal endothelial syndrome in whom ectopic Descemet's membrane was found intraoperatively on the anterior surface of the lens. Initially, the membrane was confused with the anterior lens capsule during extracapsular cataract extraction, leading to the performance of a pseudocapsulorrhexis. Electron microscopy disclosed that the epilenticular membrane was composed of multiple layers of abnormal basement membrane consistent with the iridocorneal endothelial syndrome.
    No preview · Article · Apr 1999 · Archives of Ophthalmology
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    A Azuara-Blanco · R P Wilson

    Preview · Article · Dec 1998 · British Journal of Ophthalmology
  • A Azuara-Blanco · M R Moster · R P Wilson · C M Schmidt
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    ABSTRACT: To evaluate the outcome of Baerveldt implantation with adjunctive mitomycin-C in cases of complicated glaucoma. The authors reviewed the charts of all patients who had undergone Baerveldt implantation with mitomycin-C between January 1993 and March 1995. Success was defined before data collection as an intraocular pressure (IOP) between 5 and 21 mm Hg, with or without medications. The success rate was calculated using the Kaplan-Meier actuarial method. Twenty-nine patients were identified. The mean preoperative IOP was 33.6 mm Hg, with an average of 2.0 antiglaucoma medications. The probability of success at 6 and 12 months for patients who received mitomycin-C during Baerveldt implantation was 82.4% and 73.3%, respectively. Choroidal effusion with a flat anterior chamber (10.3%), corneal edema (6.8%), and conjunctival erosion (6.8%) were the most frequent complications. In this retrospective series of complicated glaucoma, the implantation of a Baerveldt drainage device with adjunctive mitomycin-C had a satisfactory outcome. The complications encountered and the clinical efficacy were comparable to those of previously reported series in which mitomycin-C was not used.
    No preview · Article · Jan 1998 · Ophthalmic surgery and lasers
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    Full-text · Article · Dec 1997 · British Journal of Ophthalmology
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    ABSTRACT: To determine the frequency of encapsulated blebs after guarded filtration procedures with mitomycin-C. The authors reviewed the charts of all patients who had undergone a guarded filtration procedure with mitomycin-C. There were 235 patients (283 cases) who had more than 1 month of follow-up. An encapsulated bleb developed in 7 eyes (2.47%) of 6 patients. Identification of bleb encapsulation occurred at a mean follow-up time of 29.7 +/- 14.6 days after surgery. The mean intraocular pressure at that point was 24.2 +/- 13.5 mm Hg in the affected eyes. Three eyes were treated medically, and needling was performed in 4 eyes. There is a low frequency of encapsulated bleb formation after guarded filtration procedures with adjunctive mitomycin-C.
    No preview · Article · Nov 1997 · Ophthalmic surgery and lasers
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    ABSTRACT: The management of coexistent corneal disease and uncontrolled glaucoma continues to be a challenging clinical situation. The purpose of this study is to evaluate the results of combined penetrating keratoplasty and trabeculectomy with mitomycin-C. A retrospective study was undertaken to review the records of nine patients who had corneal edema and high intraocular pressure managed by simultaneous penetrating keratoplasty and trabeculectomy with mitomycin-C. The nine patients had an average pre-operative intraocular pressure of 26 mm Hg (range 17 to 41 mm Hg) and associated corneal edema. The average postoperative intraocular pressure at last follow-up was 19 mm Hg (range 5 to 53 mm Hg). Three patients needed additional procedures. Six of nine patients had intraocular pressures judged to be adequately controlled (11 +/- 5 mm Hg, range 5 to 18 mm Hg) throughout the postoperative period (average follow-up 16 months). Grafts remained clear in seven patients. The grafts failed in two cases in which additional glaucoma surgery was necessary. Combined penetrating keratoplasty and trabeculectomy with mitomycin-C should be considered for selected patients with uncontrolled glaucoma and corneal disease who have sufficient conjunctiva for a filtering procedure.
    No preview · Article · Dec 1996 · Ophthalmic surgery and lasers
  • M S Fineman · L J Katz · R P Wilson

    No preview · Article · Sep 1996 · Archives of Ophthalmology
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    ABSTRACT: To evaluate the effect of the chronic use of apraclonidine 0.5% on the intraocular pressure (IOP) of patients with glaucoma; also, to study the side effect profile of this drug when used chronically. All patients who had uncontrolled IOP, who were either already on glaucoma medications, or who were intolerant of other glaucoma medications were enrolled. A total of 185 patients were started on apraclonidine 0.5% two to three times a day in one eye. Follow up extended to 35 weeks. The mean difference in IOP between treated and control eyes was 2.1 (SD 5.0) mm Hg. A similar IOP lowering effect was obtained comparing IOP difference from baseline in the treated eye only. By the end of the follow up period, 46% of patients were still on the medication. The drug was stopped in 23% of patients because of side effects and in 31% of patients because of failure to lower IOP significantly.
    Full-text · Article · Apr 1996 · British Journal of Ophthalmology
  • Y Oh · L J Katz · G L Spaeth · R P Wilson
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    ABSTRACT: To study risk factors for the development of encapsulated filtering bleb, especially the effect of surgical glove powder and 5-fluorouracil on the development of encapsulated blebs. One hundred forty-eight patients who underwent trabeculectomy were prospectively studied. After patient of each surgeon were divided into two subgroups of 5-fluorouracil versus no 5-fluorouracil, each subgroup was then randomized for powder versus powder-free surgical gloves. All patients were followed for at least 2 months (mean, 3.5 months; range, 2-10 months). The overall incidence of encapsulated bleb was 11.2% when an encapsulated bleb was defined by clinical characteristics with a peak intraocular pressure of 26 mmHg or higher. The group that received 5-fluorouracil had a lower incidence of encapsulated blebs despite a higher rate of previous surgeries, whereas the group with powdered gloves had increased incidence. The subgroup in which powder-free gloves were used in conjunction with postoperative injections of 5-fluorouracil had the lowest incidence of encapsulated blebs (2.6%) compared with the other subgroups (12.0%-17.9%) (P = 0.01). Combined use of powder-free surgical gloves and 5-fluorouracil may reduce the incidence of encapsulated bleb.
    No preview · Article · May 1994 · Ophthalmology
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    V P Costa · M R Moster · R P Wilson · C M Schmidt · S Gandham · M Smith
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    ABSTRACT: The charts were reviewed of all patients who underwent primary trabeculectomies (group 1) or combined procedures (phacoemulsification + intraocular lens implantation + trabeculectomy--group 2) and received intraoperative mitomycin C (0.4 mg/ml) between 1991 and 1992 at Wills Eye Hospital. A total of 54 eyes of 54 patients were included: 39 in group 1 and 15 in group 2. Intraocular pressure was controlled successfully in 97.4% of eyes in group 1 (mean follow up 6.7 months), and in 93.3% in group 2 (mean follow up 6.8 months). Main complications included choroidal detachment (n = 15), shallow anterior chamber (n = 9), cataract formation (n = 8), and hypotony maculopathy (n = 3). The use of mitomycin C in primary trabeculectomies and combined procedures is associated with high success rates. However, it may be associated with unacceptable risks of vision threatening complications related to excessive filtration.
    Full-text · Article · Dec 1993 · British Journal of Ophthalmology
  • V P Costa · R P Wilson · M R Moster · C M Schmidt · S Gandham
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    ABSTRACT: Intraoperative mitomycin C has been shown to be highly effective in increasing the success rate of glaucoma filtration surgery. Between October 1991 and June 1992, 169 eyes of 156 patients underwent filtration procedures with intraoperative mitomycin C. In the postoperative period, five eyes (2.9%) developed hypotony maculopathy, characterized by disc edema, vascular tortuosity, and chorioretinal folds in the macular area. Cryotherapy was applied to three eyes, and was effective in reversing the hypotony in two of them. However, the visual prognosis was poor: after a mean follow up of 5.3 months (range, 3.5 to 8 months), visual acuity returned to preoperative levels in one case. Hypotony maculopathy may develop after glaucoma filtration surgery with intraoperative mitomycin C. We suggest restricting the indication of its adjunctive use to eyes with poor surgical prognosis or those in which a very low intraocular pressure is desired. The use of extra sutures (which can be sectioned by laser) or releasable sutures to prevent excessive filtration in the postoperative period also is advisable.
    No preview · Article · Jul 1993 · Ophthalmic surgery
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    ABSTRACT: CDI is showing continued promise as a reliable, reproducible method to assess the hemodynamics of a variety of ophthalmic diseases in which vascular perfusion abnormalities are suspect. Moreover, some patients with advanced POAG appears to have abnormalities of the vasculature of the retrobulbar circulation that is corrected by trabeculectomy. Continued CDI clinical correlations with longitudinal studies are now required to elucidate the significance of this technology and these results for individual patients.
    Preview · Article · Feb 1993 · Transactions of the American Ophthalmological Society
  • R P Wilson · L Cantor · L J Katz · C M Schmidt · W C Steinmann · S Allee
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    ABSTRACT: 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.
    No preview · Article · Jun 1992 · Ophthalmology
  • G F Schwartz · W C Steinmann · G L Spaeth · R P Wilson
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    ABSTRACT: 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.
    No preview · Article · Mar 1992 · Ophthalmic surgery
  • R P Wilson · M R Moster
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    ABSTRACT: In 1977, C. William Simcoe developed the anterior chamber-retaining suture as a means of preventing intraocular lens-cornea touch during intraocular lens manipulation, penetrating keratoplasty, and following filtration surgery. Though seldom remembered today, Simcoe's innovation safely and effectively insures corneal well-being following increasingly complex modern filtration and shunt procedures. The use of a combination of double-armed 9-0 nylon suture and anterior chamber-bridging straight needles simplifies placement.
    No preview · Article · Oct 1990 · Ophthalmic surgery
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    ABSTRACT: Nd:YAG laser cyclophotocoagulation (CPC) of the ciliary body is a promising cyclodestructive treatment for the management of refractory glaucoma following penetrating keratoplasty. Twenty-eight eyes (27 patients) were treated between August 1985 and September 1987 and followed 6 to 24 months (median, 18 months). The mean intraocular pressure (IOP) was initially 39 mm Hg (range, 30 to 70 mm Hg) on maximally tolerated medications. The Lasag Microrupter 2 was used in the free-running thermal mode with a mean pulse energy of 4.13 J. The laser was retrofocused 3.6 mm from the conjunctival surface and 30 to 50 applications per treatment (mean, 37.5) were given 2 to 3 mm from the limbus for 360 degrees (71%) or 180 degrees (29%). Multiple treatments were necessary in 13 eyes (46%). After CPC, IOP fell to 22 mm Hg or below in 18 eyes (64%) at 3 months, in 20 of 27 eyes (74%) at 6 months, and in 16 to 24 eyes (67%) at 1 year. Inadequate IOP control in four of 28 eyes necessitated cyclocryotherapy in three patients and a Schocket procedure in one other. Of the 14 clear pre-CPC grafts six (43%) became edematous during follow-up. All of the failed grafts had undergone multiple CPCs.
    No preview · Article · Nov 1989 · Ophthalmic surgery

Publication Stats

587 Citations
98.81 Total Impact Points


  • 1996-1999
    • Thomas Jefferson University
      Philadelphia, Pennsylvania, United States
  • 1986-1999
    • Wills Eye Institute
      Filadelfia, Pennsylvania, United States
  • 1987
    • University of Florida
      • Department of Ophthalmology
      Gainesville, Florida, United States