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Biomedical subjects

A J Brucker

Publications and source records attributed to A J Brucker.

At least 19 recordsLinked to original sources
PubMed2001

Familial primary pulmonary hypertension and associated ocular findings.

BACKGROUND: Familial primary pulmonary hypertension (PPH) is a rare, fatal, autosomal dominant disease that results in right heart failure from idiopathic obliteration of the pulmonary arteries. Patients develop stagnation of venous blood flow and elevated venous pressure. METHODS: The authors retrospectively reviewed the clinical records of three patients diagnosed with PPH that was confirmed on the basis of physical examination, chest X-ray, electrocardiogram, and echocardiogram. Cardiac catheterization excluded cardiac shunt and other secondary causes of pulmonary hypertension. RESULTS: Two patients presented with a clinical picture resembling venous stasis retinopathy, and one with bilateral choroidal detachments. Two patients had delayed choroidal filling on fluorescein angiography, which was confirmed in one patient with indocyanine green videoangiography. CONCLUSIONS: Elevated venous pressure found in PPH is responsible for the delayed choroidal perfusion and the reduced venous blood outflow. This explains the clinical findings of venous stasis retinopathy and choroidal detachments seen in these patients.

Adult↗
PubMed2000

One-year outcomes of panretinal photocoagulation in proliferative diabetic retinopathy.

PURPOSE: To describe the clinical features and complications of diabetic retinopathy, visual acuity, and number of repeat treatments after panretinal photocoagulation for proliferative diabetic retinopathy in a tertiary care center. METHODS: A cohort study was conducted with data collection from medical records of patients undergoing panretinal photocoagulation between 1985 and 1995 at the Scheie Eye Institute; 297 eyes of 186 patients were eligible for study. RESULTS: The presence of neovascularization of the disk at baseline, an earlier onset of diabetes, and a shorter duration of disease before panretinal photocoagulation were the strongest risk factors for needing an additional panretinal photocoagulation treatment. Sixty-two percent of eyes with poor visual acuity (< or =20/200) at baseline still had poor visual acuity at 1 year, and 76% with good visual acuity (> or =20/40) at baseline maintained good visual acuity at 1 year. Poor vision at baseline was the only risk factor for having poor vision at 1 year. Vitreous hemorrhage was present in 44% of eyes at baseline. New vitreous hemorrhage developed in 37% of eyes during the first year after panretinal photocoagulation. A traction retinal detachment was present in 4% of eyes at baseline and newly developed in 6% of eyes during follow-up. A repeat panretinal photocoagulation treatment was performed in 39% of eyes after initial treatment. A vitrectomy was performed in 10% of eyes from baseline through the 1-year follow-up visit. CONCLUSIONS: The data from this study are useful for counseling patients with respect to likely visual outcome, possibility of major complications from proliferative diabetic retinopathy, and the chance of undergoing additional laser treatment after panretinal photocoagulation.

Adolescent↗
PubMed2000

Choroidal white lesions as an early manifestation of sarcoidosis.

PURPOSE: To describe the natural history of a series of patients with fine white choroidal lesions and uveitis of previously unknown cause. METHODS: A retrospective chart review of 11 patients with chronic uveitis and multiple, small (50-100 microm), peripheral white lesions of the choroid was performed using a standardized questionnaire form. RESULTS: Ten of 11 patients were white women with an average age of 62 years. Seven of 11 patients had panuveitis; 4 of 11 patients had vitritis; and 6 of 11 patients had cystoid macular edema. Choroidal white lesions were bilateral in all but one patient. Seven of 11 patients were followed up for more than 1 year. During a 12- to 173-month follow-up (mean, 94 months), these patients showed coalescence and atrophy of the white lesions. Initial systemic examination for the cause of the uveitis and white choroidal lesions was negative in all seven patients. With long-term follow-up, sarcoidosis was diagnosed in five of the seven patients followed for more than 1 year. CONCLUSIONS: The pattern of inflammatory white choroidal lesions distributed in the peripheral retina that atrophy and coalesce with time and that are associated with uveitis in middle-aged white women may represent an early form of sarcoidosis.

Adrenal Cortex Hormones↗
PubMed1999

Venous collateral remodeling in a patient with posttraumatic glaucoma.

PURPOSE: To photographically document venous collateral development, remodeling, and regression in a patient with traumatic glaucoma. METHODS: Consecutive fundus photographs were evaluated, labeled, and correlated with the clinical history of a patient with unilateral posttraumatic glaucoma. RESULTS: This report photographically documents the appearance, remodeling, and subsequent disappearance of collateral vessels from venous occlusion on the surface of the optic disk in an eye with increased intraocular pressure and progressive glaucomatous cupping. CONCLUSIONS: Asymptomatic chronic obstruction of a branch retinal vein on the optic disk may cause venous collaterals to develop in the absence of retinal hemorrhages or other signs of venous occlusive disease. Increased intraocular pressure, arteriolarsclerosis, and glaucomatous cupping are risk factors for these occlusions.

Collateral Circulation↗
PubMed1998

Foveolar choroidal blood flow in age-related macular degeneration.

PURPOSE: To compare measurements of the foveolar choroidal blood circulation in subjects with nonexudative, age-related macular degeneration (AMD) with those of control subjects. METHODS: Laser Doppler flowmetry was used to assess relative choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) in the center of the fovea. Measurements were obtained in 20 eyes of 20 subjects with 10 or more large drusen, visual acuity of 20/32 or better, and no evidence of choroidal neovascularization. Findings obtained in these subjects were compared with those of 10 eyes of 10 age- and blood pressure-matched control subjects with no large drusen. Foveolar choroidal blood flow measurements were obtained by asking the study participants to fixate on a probing laser beam. RESULTS: No significant differences in average age, blood pressure, or intraocular pressure were observed between subjects with AMD and control subjects. In subjects with AMD, average ChBVol was 0.24 +/- 0.08 (+/- 1 SD) arbitrary units (AU); this value was 33% lower than that of control subjects (0.36 +/- 0.11 AU; two-tailed, independent Student's t-test, P = 0.005). Average ChBVel, conversely, was not significantly different from normal (0.44 +/- 0.07 AU) in subjects with AMD (0.44 +/- 0.10 AU). Average ChBFlow in subjects with AMD (8.7 +/- 3.1 AU) was 37% lower than that of control subjects (13.7 +/- 3.5 AU) (P = 0.0005). Average blood flow pulsatility was 6% higher in subjects with AMD (0.71 +/- 0.15) than in control subjects (0.66 +/- 0.14), but this difference was not statistically significant (P = 0.42). CONCLUSIONS: Average ChBFlow in the nonexudative stages of AMD is lower than that of age-matched controls, and the effect is caused mainly by a decrease in ChBVol. Further studies are needed to elucidate whether decreased ChBFlow plays a role in the development of choroidal neovascularization, and whether ChBFlow measurements may help identify subjects with AMD at risk for developing choroidal neovascularization.

Aged↗
PubMed1997

Experimental pseudomonal posttraumatic endophthalmitis in a swine model. Treatment with ceftazidime, amikacin, and imipenem.

PURPOSE: To compare the intravitreal efficacy of three separately administered antibiotics (imipenem, ceftazidime, and amikacin) in limiting the intraocular inflammation and tissue destruction caused by posttraumatic pseudomonal endophthalmitis. METHODS: Thirty-three Yorkshire pigs each received a surgically induced scleral injury to the right eye. After repair, each eye was injected with 22,000 colony-forming units of live Pseudomonas aeruginosa. Pigs then were randomly grouped into a natural-history-of-infection group in which no treatment was given (n = 9) or into groups treated with the following: intravitreal imipenem (n = 6), ceftazidime (n = 6), amikacin (n = 6), or normal saline (n = 6). Pigs then were observed clinically for 18-24 hours after surgery and enucleated for histopathologic examination. RESULTS: Clinical examinations revealed significantly less posterior segment inflammation in pigs treated with amikacin and imipenem than in pigs in the natural history or saline control groups, based on the Wilcoxon rank sum test (P < .05). Histopathologic examinations showed similar results, with less intraocular inflammation and retinal destruction in pigs treated with amikacin and imipenem, whereas the inflammation in pigs treated with ceftazidime did not differ significantly from that in control pigs. CONCLUSION: Intravitreal antibiotic treatment with imipenem or amikacin appears to limit intraocular inflammation and retinal tissue damage when given early in the course of posttraumatic pseudomonal endopthalmitis. Results with ceftazidime are less conclusive.

Amikacin↗
PubMed1997

Branch retinal vein occlusion. Axial length and other risk factors.

OBJECTIVE: To determine the association between axial length, as a measurement of hyperopia, and branch retinal vein occlusion and to determine the clinical characteristics and other risk factors of patients with branch retinal vein occlusion. METHODS: A case-control study was performed using 36 patients with branch retinal vein occlusion and 36 age- and sex-matched control patients selected from a list of subjects who had undergone cataract extraction. RESULTS: There was essentially no difference in axial length between patients the disorder and control patients (23.55 mm versus 23.62 mm; P = 0.79). Although the intraocular pressure (IOP) among control eyes was somewhat higher than that in branch retinal vein occlusion eyes, the difference was not statistically significant (P = 0.32). Systemic hypertension was more common in patients with branch retinal vein occlusion (53%) than in control patients (42%) but the difference was not statistically significant (P = 0.35). Chronic open-angle glaucoma was present in 14% of patients with branch retinal vein occlusion and 22% of control patients (P = 0.37), but this difference was not statistically significant. Diabetes mellitus was two times more common in controls (28%) than in patients with branch retinal vein occlusion (14%). This difference, however, also did not reach statistical significance (P = 0.13). CONCLUSIONS: Hyperopia as measured by axial length is not a risk factor for branch retinal vein occlusion. This study provides evidence that hypertension is a risk factor for branch retinal vein occlusion and that chronic open-angle glaucoma and diabetes mellitus are not risk factors for branch retinal vein occlusion.

Adult↗
PubMed1996

Management of postoperative Acremonium endophthalmitis.

PURPOSE: Four patients presented after cataract surgery with delayed-onset endophthalmitis caused by Acremonium kiliense with in vitro sensitivity to amphotericin B. In all patients, ocular infection was recalcitrant to single-dose intravitreous amphotericin B injection. The authors reviewed the management of endophthalmitis caused by A. kiliense and presented treatment recommendations. METHODS: The authors retrospectively evaluated a cluster of four patients with delayed-onset postoperative endophthalmitis after phacoemulsification with posterior chamber intraocular lens implantation. All patients underwent vitreous sampling, intravitreous injection of amphotericin B, and systemic administration of fluconazole. Pars plana vitrectomy was performed in all patients for management of either primary (1 eye) or persistent infection (3 eyes). Two patients with persistent infection also underwent surgical explanation of their posterior chamber intraocular lens. RESULTS: Worsening infection developed in three of three eyes that underwent vitreous aspiration with intravitreous injection 5 micrograms amphotericin B. These patients subsequently responded to vitrectomy followed by additional intravitreous amphotericin B injection. One eye underwent primary vitrectomy and intravitreous injection of 7.5 micrograms amphotericin B. Although treatment of the initial infection was successful, fungal keratitis developed in this patient 3 months after presentation. Visual outcome was variable, ranging from visual acuity of 20/25 to no light perception with follow-up of 2 years. Epidemiologic investigation suggested a common environmental source for the A. kiliense organisms. CONCLUSIONS: Single-dose administration of intravitreous amphotericin B was inadequate treatment for fungal endophthalmitis caused by A. kiliense. Vitrectomy with repeated intravitreous administration of amphotericin B may be necessary to eradicate intraocular function caused by this organism.

Acremonium↗
PubMed1996

Vitrectomy in eyes with peripheral retinal angioma associated with traction macular detachment.

PURPOSE: Peripheral angiomas have been associated with epiretinal membranes and traction retinal detachment. The authors investigated the timing, results, and complications of vitreous surgery to remove the retinal traction and treat the peripheral vascular tumor. METHODS: The authors reviewed the results of ten eyes that had undergone vitrectomy for macular pucker and/or traction retinal detachment. These eyes had either preoperative or intraoperative treatment of the peripheral tumor. RESULTS: Patients were followed 4 to 95 months. Six eyes had nonfamilial peripheral acquired retinal hemangioma, three had von Hippel angiomas, and one had multiple large peripheral retinal angiomas associated with extensive retinal telangiectasis. Four eyes received cryotherapy and/or laser photocoagulation 2 to 3 months before surgery. In the remaining six eyes, initial treatment to the peripheral angioma was performed at the time of vitreous surgery. At final follow-up, all eyes were attached without retinal traction. Vision improved in all eyes; six (60%) achieved 20/50 or better visual acuity. Complications included recurrent epiretinal membrane (n=3); nonregressed angiomas (n=3); increased nuclear sclerosis (n=2); and retinal detachment (n=1). CONCLUSION: Vitreous surgery, when applied to epiretinal membranes or traction retinal detachments associated with peripheral vascular tumors, has a good chance of improving vision. Treatment of the hemangioma, before or during vitrectomy, usually results in tumor regression.

Adult↗
PubMed1995

Macular pseudohypopyon from secondary syphilis.

PURPOSE/METHODS: Acute syphilitic posterior placoid chorioretinitis causes visual loss in patients with secondary syphilis. The condition is characterized by vitreitis and large, yellow placoid lesions in the macula. We examined a patient with syphilis who had a serious retinal detachment and an exudative fluid meniscus (pseudohypopyon). RESULTS/CONCLUSIONS: Visual recovery and complete resolution of the chorioretinal lesion occurred after intravenous penicillin therapy. Secondary syphilis should be considered in the differential diagnosis of any patient with a macular pseudohypopyon.

Chorioretinitis↗
PubMed1995

Macular epiretinal membrane formation and treated retinal breaks.

PURPOSE: We sought to determine the incidence of macular epiretinal membrane formation in eyes treated for retinal breaks after three different modalities of treatment: laser photocoagulation, cryotherapy, or both. METHODS: We reviewed the charts of 262 consecutive patients with a diagnosis of retinal tears and included 205 patients who had more than six months of follow-up. RESULTS: One hundred ninety-five patients were treated. One hundred seventy of these patients had retinal breaks in one eye and 25 patients had breaks in both eyes, for a total of 220 treated eyes. Cryopexy was applied in 125 eyes, laser retinopexy in 73 eyes, and both modalities in 22 eyes. Macular epiretinal membranes developed in a total of 26 eyes: 12 in the cryopexy group, ten in the laser-treated group, and four in the dual modality group. No statistically significant difference, at a level of P < or = .01, was seen in the rate of epiretinal membrane formation between the different treatment modalities. No statistically significant difference, at a level of P < or = .01, was seen in the rate of epiretinal membrane formation in the presence or absence of vitreous hemorrhage or in the type of precedent retinal break. CONCLUSIONS: After treatment of retinal breaks with laser photocoagulation and cryotherapy, no statistically significant difference in the incidence of macular epiretinal membrane formation was demonstrated.

Adolescent↗
PubMed1995

Strict control of glycaemia: effects on blood flow in the large retinal vessels and in the macular microcirculation.

AIMS: The purpose of this study was to investigate the effect of instituting strict diabetic glycaemic control on the retinal macular microcirculation and to compare this effect with that observed in the main retinal veins. METHODS: In 28 insulin dependent diabetic patients with poor glycaemic control a regimen of strict diabetic control, consisting of four daily insulin injections was instituted and maintained for 6 months. Retinal haemodynamics were investigated in the macular microcirculation by the blue field simulation technique and in the major retinal veins by a combination of bidirectional laser Doppler velocimetry and monochromatic fundus photography. Progression of diabetic retinopathy was assessed from fundus photographs taken at baseline and at the end of the study. RESULTS: Institution of strict diabetic control resulted in a significant increase in leucocyte velocity in the macular circulation (p = 0.013). No significant difference in this increase was observed between eyes that showed progression (n = 8) and no progression (n = 20) of retinopathy during the study. Significant correlations were found between relative changes over time of blood flow measured in the main retinal veins and relative changes of leucocyte velocity determined in the macular microcirculation at 2 months (p = 0.008) and 6 months (p = 0.001) but not at 5 days (p = 0.49). In the eight eyes that showed progression of retinopathy, the product of leucocyte velocity and density at baseline was significantly higher than normal (p < 0.05). During the length of this study, this product was also significantly higher in the eight eyes that showed retinopathy progression than in the 20 eyes that did not show progression (p = 0.005). CONCLUSION: Our results suggest that increased flow in the macular microcirculation may be associated with progression of retinopathy, thus supporting the hypothesis that increased blood flow may play a role in the development of diabetic microangiopathy. Although there are correlations between the changes detected in the macular microcirculation and those measured in the main retinal vessels, there are also differences which need to be further investigated in order to better understand pathogenetic mechanisms.

Adolescent↗
PubMed1995

Effects of adenosine on ocular blood flow.

PURPOSE: To determine the effect of intravascular adenosine on blood flow in the ocular fundus and to examine indirectly whether the blood-brain barrier to adenosine, which exists in the cerebrovasculature of the cat, is present in the eye of this animal. METHODS: The noninvasive techniques of laser Doppler flowmetry and velocimetry along with fundus photography were used to measure the change in optic nerve head and choroidal and retinal blood flow during intravenous infusions of 0.18 and 0.6 mg/kg per minute of adenosine. RESULTS: Infusions of adenosine induced significant increases in choroidal blood flow (60% with 0.6 mg/kg per minute) but not in optic nerve head or retinal blood flows. CONCLUSIONS: The lack of effect of intravenously infused adenosine on the optic nerve and retinal circulations is most likely caused by the tight junctions in the vessels of these vascular beds, which prevent adenosine from reaching its receptors. Perivascular adenosine in the choroid most likely accounts for the increase in blood flow in this tissue.

Adenosine↗