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Biomedical subjects

A K Vine

Publications and source records attributed to A K Vine.

At least 19 recordsLinked to original sources
PubMed1997

Atypical, severe toxoplasmic retinochoroiditis in elderly patients.

BACKGROUND: The diagnosis of toxoplasmic retinochoroiditis is based primarily on characteristic ocular findings, with supportive serologic evidence. Clinical recognition of atypical presentations is critical for timely antiparasitic drug therapy. METHODS: Case histories were reviewed for seven presumed immunocompetent elderly patients with atypically severe (multifocal or diffuse or both) toxoplasmic retinochoroiditis. Three cases initially were misdiagnosed as acute retinal necrosis syndrome. The correct diagnosis was confirmed in each case by response to antiparasitic drug therapy, polymerase chain reaction studies of intraocular specimens, or histopathologic analysis. RESULTS: The patients ranged in age from 69 to 82 years (median, 74 years). Only three patients had intercurrent medical conditions that may be associated with subtle immune dysfunction (diabetes mellitus and hepatitis C). The extensive necrotizing retinochoroiditis in each patient was nonhemorrhagic and not associated with occlusive retinal arteritis. Despite prompt response to antiparasitic drug therapy, prolonged treatment usually was required, and four patients had retinitis reactivation after discontinuing treatment. Significant visual loss accompanied the infection in most eyes. CONCLUSION: Toxoplasmosis should be considered as a cause of multifocal or diffuse necrotizing retinitis or both in elderly patients. Older patients may be more susceptible to severe ocular Toxoplasma infections because of age-related decline in cell-mediated immunity and chronic underlying diseases.

Aged↗
PubMed1996

Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study.

PURPOSE: To determine the microbiologic spectrum and antibiotic susceptibilities of infecting organisms in postoperative endophthalmitis and to evaluate the effects of operative factors on the microbiologic spectrum. METHODS: Patients with bacterial endophthalmitis presenting within six weeks of cataract extraction or secondary intraocular lens implantation (IOL) were evaluated. Cultures and Gram stains were performed on intraocular specimens and susceptibility tests on the isolates. RESULTS: Confirmed microbiologic growth was demonstrated from intraocular specimens from 291 of 420 patients (69.3%). Gram-positive bacteria were isolated from 274 patients (94.2%) with confirmed growth and gram-negative bacteria from 19 (6.5%). Two hundred twenty-six of the 323 isolates obtained (70.0%) were gram-positive, coagulase-negative micrococci, 32 (9.9%) Staphylococcus aureus, 29 (9.0%) Streptococcus species, seven (2.2%) Enterococcus species, ten (3.1%) miscellaneous gram-positive species, and 19 (5.9%) gram-negative species. All gram-positive isolates tested were susceptible to vancomycin. Seventeen gram-negative isolates (89%) were susceptible to both amikacin and ceftazidime and two (11%) were resistant to both. Anterior chamber or secondary IOL implantations were associated with higher rates of infection with gram-positives other than coagulase-negative micrococci than were posterior chamber IOL implantations (P = .022) or primary cataract extractions (P = .024). CONCLUSIONS: Gram-positive, coagulase-negative micrococci predominated in this series. Vancomycin was active against all gram-positive isolates tested. Amikacin and ceftazidime showed equivalent activity against gram-negative isolates. Secondary or anterior chamber lens implantations were associated with a possible spectrum shift toward gram-positive organisms other than the coagulase-negative micrococci.

Anti-Bacterial Agents↗
PubMed1996

Thrombin in the management of full thickness macular holes.

PURPOSE: As thrombin is a known stimulator of retinal glial and pigment epithelial cells, we performed a pilot study to evaluate the use of thrombin as adjunctive mitogen therapy in vitreous surgery for full-thickness macular holes. METHODS: Macular hole surgery was performed on 25 eyes of 24 consecutive patients with stage II, III, or IV macular holes. After removal of the posterior hyaloid, peeling of epiretinal membranes, and fluid-air exchange, 0.05 mL or 0.1 mL of thrombin (100 units/ mL) was placed over the macular hole. After infusion of a gas tamponade, the patient's head was kept in a supine position for 1 hour, and then was kept in a prone position for approximately 2 weeks. RESULTS: Closure of the macular hole with one procedure was achieved in 80% of the eyes. Sixty-five percent of the eyes with a closed macular hole achieved a visual acuity of 20/40 or better. Postoperative inflammation was present in all eyes, and a small hypopyon developed in 28% of the eyes. CONCLUSION: Thrombin therapy failed to markedly increase the success rate of macular hole surgery.

Aged↗
PubMed1995

Choroidal blastomycosis. A report of two cases.

PURPOSE: To review the presentation and course of choroidal blastomycosis, a rare chorioretinal mycotic infection, which results from disseminated blastomycosis. METHODS: Two cases of disseminated blastomycosis with ocular infection limited to the choroid are presented. Each patient was diagnosed through biopsy of skin lesions demonstrating the characteristic histologic features and the budding yeast. RESULTS: Systemic evaluation revealed extensive disseminated disease with involvement of the eye, lung, skin, bone and joint, central nervous system, and genitourinary system. Both patients were successfully treated with intravenous amphotericin B with elimination of ocular and systemic disease. CONCLUSION: Although rare, blastomycosis can result in choroidal mycotic infection in immune competent individuals. Tissue biopsy to confirm the diagnosis and extensive systemic evaluation are required.

Adult↗
PubMed1994

Retinal vasculitis.

Explore the source record for details and available documents.

Arterial Occlusive Diseases↗
PubMed1993

Cytogenetic analysis of posterior uveal melanoma.

Cytogenetic analysis was performed on short-term cultures of primary tumor samples from seven patients with posterior uveal melanoma. Informative data were obtained from four patients, all of whom had a near-diploid chromosomal number and clonal chromosomal alterations. Analysis of one patient's tumor revealed monosomy 3 as the only cytogenetically distinguishable aberration. Trisomies of chromosome 8 and i(8)(q10) were detected in two other patients in combination with monosomy of chromosome 3. The fourth patient's karyotype displayed two different translocations. One translocation, der(6)t(6;8)(q12;q13.1), resulted in the over-representation of 8q13.1-->qter and a partial monosomy of 6q12-->qter; the other translocation, der(9)t(6;9)(p12;p23), produced a partial trisomy of 6p12-->pter and a partial monosomy of 9p23-->pter. These results support the view that the recurring pattern of chromosomal rearrangements in ocular melanoma is unique from that associated with cutaneous malignant melanoma. Furthermore, these results help confirm that chromosomes 3, 6, and 8 are nonrandomly altered in ocular melanoma.

Adult↗
PubMed1992

Severe periphlebitis, peripheral retinal ischemia, and preretinal neovascularization in patients with multiple sclerosis.

Two patients with definite multiple sclerosis and marked retinal periphlebitis developed occlusive peripheral retinal vasculitis, which resulted in peripheral retinal ischemia and peripheral retinal neovascularization. Results of investigation for other causes of peripheral proliferative retinopathies were negative in both patients although one patient had a positive anticardiolipin antibody. Both patients have been followed up for over seven years and have maintained good visual acuity with mild regression of the preretinal neovascularization without laser intervention. An analysis of these two cases and six other reported cases indicates that severe periphlebitis can evolve into occlusive peripheral vasculitis, which results in peripheral retinal neovascularization in patients with multiple sclerosis.

Adult↗
PubMed1991

Diffuse infiltrating retinoblastoma.

The authors describe two children who presented with atypical posterior uveitis and who were subsequently diagnosed as having diffuse infiltrating retinoblastoma. A review of these two cases and 26 previously published cases was performed to assess the epidemiology, presenting signs, and usefulness of diagnostic tests. In contrast to typical retinoblastoma, results of histologic analysis showed that only 4 of the 28 cases with infiltrating lesions contained calcium. Computed tomography scans and ultrasonography were not particularly helpful and many eyes required an anterior chamber paracentesis to establish the correct diagnosis. A systematic approach to the diagnosis of diffuse infiltrating retinoblastoma is presented.

Child↗
PubMed1990

Progression of diabetic retinopathy after pancreas transplantation. The University of Michigan Pancreas Transplant Evaluation Committee.

The progression of diabetic retinopathy after combined pancreatic and kidney transplantation was studied in eight patients for 12 to 49 months. Four patients who had rapid pancreatic graft failure constituted a control group for comparison with four patients who retained functioning grafts. Using Fisher's exact probability test, the authors found no posttransplantation difference between the two groups in visual acuity lost, severity of diabetic macular edema, extent of capillary closure, progression of preretinal gliosis, development of disc or preretinal neovascularization, or worsening of the severity of the retinopathy. Achievement of normoglycemia by pancreatic transplantation is not effective in halting the progression of diabetic retinopathy in patients who already have severe diabetic microangiopathy joined the current follow-up.

Adult↗
PubMed1989

A new inexpensive customized plaque for choroidal melanoma iodine-125 plaque therapy.

The authors have developed a new inexpensive precious metal alloy plaque for use in customized iodine-125 plaque therapy. Each plaque is formed from two flat circular gold/palladium foils which are used in dental crown work. Using a simple manual mechanism, the two forms are stamped over a customized acrylic die shaped to the dimensions of the tumor base plus a 2-mm margin. Completed plaques consist of a back wall, a 2-mm side wall, and a 1.5-mm wide lip with holes for suture placement. Advantages include: simple construction from inexpensive components, customized shape, and iodine seeds that are readily visible on plane radiographs.

Brachytherapy↗
PubMed1988

Recombinant tissue plasminogen activator to lyse experimentally induced retinal arterial thrombi.

We evaluated the efficacy of intravenously administered recombinant tissue plasminogen activator to lyse laser-induced arterial thrombi in the stroke-prone, spontaneously hypertensive rat model. The arterial thrombi were confirmed histologically, and assessed by color photographs and fluorescein angiography before and after intravenous tissue plasminogen activator or saline therapy. Experimental animals received tissue plasminogen activator (1 mg/kg of body weight) given intravenously over one hour, and control animals received similar volumes of normal saline. Tissue plasminogen activator was effective in lysing experimental retinal arterial thrombi.

Animals↗
PubMed1988

Ocular complications associated with retrobulbar injections.

The authors describe six complications, of retrobulbar injections documented by fundus photography and fluorescein angiography. These include (1) injection of corticosteroid into the posterior ciliary arterial circulation resulting in emboli in the vasculature of the choroid and the optic nerve head; (2) injection of corticosteroid into the ophthalmic artery resulting in emboli in both the choroidal and retinal circulations; (3) presumed injection of lidocaine and air into the optic nerve sheath adjacent to the globe with extension anteriorly into the subretinal space and the space between the posterior vitreous and the internal limiting membrane; (4) occlusion of the central retinal artery without an associated retrobulbar hemorrhage; (5) trauma to and partial injection of lidocaine in the central retinal artery with embolization into the retinal circulation; and (6) presumed injection of lidocaine into the optic nerve sheath producing a combined central retinal vein and artery occlusion. Alternative techniques that might decrease the incidence of complications associated with retrobulbar injections are discussed.

Adult↗
PubMed1988

Massive bilateral retinal vascular occlusion secondary to thrombotic thrombocytopenic purpura.

An 18-year-old woman developed sudden diffuse bilateral retinal vascular occlusive disease secondary to thrombotic thrombocytopenic purpura. This microangiopathic disease resulted in massive bilateral capillary closure and severe visual loss. Visual loss occurred while responding to therapy for this immune-mediated disease. This report is the first description of extensive retinal vascular occlusion in thrombotic thrombocytopenic purpura.

Adolescent↗
PubMed1987

Hydroxychloroquine therapy in massive total doses without retinal toxicity.

To assess the relationship between hydroxychloroquine retinal toxicity and total dose, we selectively reviewed the histories of patients who had received an additive dose exceeding 1,000 g. No retinopathy was found in nine patients treated with massive total hydroxychloroquine doses ranging from 1,054 to 3,923 g. Eight of these patients were taking recommended daily doses of 400 mg/day or less and showed no evidence of toxicity. The remaining patient treated with 600 mg/day showed evidence of preretinopathy in one eye.

Adult↗