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Biomedical subjects

A R Frederick

Publications and source records attributed to A R Frederick.

At least 19 recordsLinked to original sources
PubMed1999

Visual and surgical outcomes of retinal detachment following macular hole repair.

OBJECTIVE: To characterize 20 cases of retinal detachment (RD) following surgical repair of macular holes. METHODS: Retrospective review of 20 eyes in 16 patients (4 patients [25%] had bilateral macular hole repairs with subsequent RD) who developed RD in the same eye in which surgical repair of a macular hole had been performed. RESULTS: Twenty detachments in 16 patients were reviewed. The average duration between macular hole repair and presentation of RD was 5.5 weeks. The inferior retina was involved more frequently than the superior retina. A total of 76% of all breaks were located inferiorly. Ten of the 20 eyes were asymptomatic at the time the detachment was diagnosed. Of the 20 eyes, 19 underwent surgical repair, all with anatomic reattachment. At final follow-up, the macular hole was closed in all 20 eyes, and 60% of the patients had final visual acuity improved by 2 lines or more over that before their macular hole repair. CONCLUSION: Retinal detachment is a complication of macular hole surgery. These detachments tend to occur within the first 2 months of follow-up, and have a high success rate of anatomic reattachment with surgery. The occurrence of RD does not preclude improved final visual acuity.

Aged↗
PubMed1998

Evolution of a full-thickness macular hole.

PURPOSE: To illustrate succinctly the various stages of macular hole formation. METHOD: We photodocumented the evolution of a full-thickness macular hole in a patient who refused surgery. RESULTS: A 60-year-old woman, who had had difficulty reading for 3 months, was initially examined with a stage 1B macular hole in her right eye that progressed to stage 2 over a 6-month period and then to stage 3, 2 years after initial examination. CONCLUSIONS: This case demonstrates vividly and succinctly the development of a full-thickness macular hole from stage 1B to stage 3 and provides a unique opportunity to study carefully in a single eye the sequential progression of this important retinal disorder.

Disease Progression↗
PubMed1998

Exudative retinal detachment in X-linked retinoschisis.

X-linked retinoschisis is a vitreoretinal dystrophy characterized by foveal and peripheral retinoschisis in the nerve fiber layer. Although many associated peripheral retinal findings have been reported, few reports have described massive exudative retinal detachments in patients with X-linked retinoschisis. The authors report the unusual occurrence of Coats'-like exudative retinopathy in two patients with X-linked retinoschisis. Both patients had peripheral massive exudative retinal detachments.

Adult↗
PubMed1997

Acute progressive multifocal Best's disease in a 61-year-old man.

PURPOSE: To report acute progressive multifocal Best's disease in patients in their seventh decade. METHOD: We report one such case. RESULTS: We examined a 61-year-old man with strikingly symmetric, 1-disk diameter serous retinal detachments involving each fovea. Fluorescein angiography was unremarkable, with no dye leakage. Electrophysiologic testing confirmed the diagnosis. Visual acuity decreased, and within 1 month, the size and number of lesions rapidly increased. Three months later, the lesions quickly evolved to the classic vitelliform stage. CONCLUSION: This well-documented case expands the spectrum of findings in multifocal Best's disease.

Acute Disease↗
PubMed1996

Postvitrectomy positioning complicated by ulnar nerve palsy.

PURPOSE: Ulnar nerve palsy is an unusual complication of postvitrectomy positioning. METHOD: We report two such cases. RESULTS: Both patients developed ulnar nerve palsy after maintaining a face-down position for 2 to 4 weeks after vitrectomy with intraocular perfluoro-octane. The neuropathy resolved in one patient after he was instructed to avoid prolonged pressure on his flexed elbows, whereas the other patient ultimately required surgical decompression of the nerve at the elbow. CONCLUSION: Ulnar nerve palsy can result from postvitrectomy positioning associated with prolonged direct pressure on the ulnar nerve or compression of the ulnar nerve via flexion of the elbow.

Adult↗
PubMed1995

Choroidal and retinal detachment in antineutrophil cytoplasmic antibody-positive scleritis.

PURPOSE/METHODS: A 72-year-old woman with antineutrophil cytoplasmic antibody-positive vasculitis had a combined detachment of the choroid and retina. This unique initial manifestation was also associated with systemic and orbital manifestations, including brow ptosis, dacryoadenitis, and pneumonitis. RESULTS/CONCLUSIONS: This patient underwent vitrectomy for removal of a dense vitreitis and responded well to systemic cyclophosphamide. This case demonstrates that antineutrophil cytoplasmic antibody testing is useful for the diagnosis and treatment of Wegener's granulomatosis and microscopic polyarteritis-associated scleritis. The distinction between these two entities is often difficult to make.

Aged↗
PubMed1995

Posterior segment complications after vitrectomy for macular hole.

PURPOSE: The purpose of this study is to assess the rate of posterior segment complications after vitreous surgery for macular holes and to evaluate the effect of such complications on final visual outcome. METHODS: The authors reviewed retrospectively all cases of vitreous surgery for macular holes performed between June 1990 and October 1993. Among 98 patients with a followup of 3 months or more, all patients with posterior segment complications during the postoperative course were identified. The rate of complications was compared with that seen after vitreous surgery for macular pucker performed by the same surgeons. RESULTS: Posterior segment complications were noted in 23 (23%) of 98 patients. These included peripheral retinal breaks (3%), rhegmatogenous retinal detachment from a peripheral retinal break (14%), enlargement of the hole (2%), late reopening of the hole (2%), retinal pigment epithelium loss under the hole (1%), photic toxicity (1%), and endophthalmitis (1%). In 40% of these eyes, the final visual acuity was two lines or more below preoperative visual acuity. When compared with the macular pucker group, the rate of posterior segment complications, in particular the rate of peripheral retinal tears and detachments, was significantly higher (P < or = 0.05). CONCLUSIONS: The authors conclude that visually significant posterior segment complications may occur after vitrectomy for macular hole, and the rate of these complications appears to be higher than expected.

Adult↗
PubMed1994

Streptokinase-induced Tenon's hemorrhage after retinal detachment surgery.

PURPOSE/METHODS: We studied a case in which a streptokinase-induced Tenon's hemorrhage developed after retinal detachment surgery. The patient received intravenous streptokinase for myocardial infarction two hours after pars plana vitrectomy and encircling scleral buckling surgery. RESULTS/CONCLUSIONS: A Tenon's hemorrhage with an orbital compartment syndrome developed in the patient's left eye, and he underwent lateral canthotomy and inferior cantholysis. Symptoms of the compartment syndrome resolved and final visual acuity was 20/40. Although there are potential ocular-related side effects to thrombolytic therapy, there has been no permanent ocular morbidity reported after thrombolytic-related hemorrhage. We recommend not to defer such life-saving therapy after ocular surgery.

Eye Hemorrhage↗
PubMed1993

Posterior retinal folds following vitreoretinal surgery.

The authors conducted a retrospective review of 32 patients with posterior retinal folds following retinal reattachment surgery. Twenty-eight of these patients underwent combined pars plana vitrectomy, fluid-air exchange with either internal drainage through a preexisting retinal break or external drainage of subretinal fluid, and scleral buckle. We believe these drainage techniques resulted in incomplete elimination of subretinal fluid, with resultant sequestration of fluid at the dependent border between attached and detached retina. Metamorphopsia and decreased visual acuity were noted in patients with folds involving the macula. The likelihood of fold formation may be greatly reduced by internal drainage through a posterior retinotomy combined with more complete removal of slowly gravitating fluid as it flows dependently to the drainage site.

Adult↗
PubMed1993

Endophthalmitis caused by the coagulase-negative staphylococci. 2. Factors influencing presentation after cataract surgery.

PURPOSE: This study, comprising 60 patients with coagulase-negative staphylococcal endophthalmitis which occurred after cataract surgery, was designed to define the variation in disease presentation and visual outcome and to evaluate statistically the role of the primary surgery and its management. METHODS: An intensive evaluation of microbiological, inpatient, outpatient, and cataract surgery charts was made retrospectively using a standardized protocol. The predictive value of surgical, iatrogenic, and clinical factors was analyzed for their influence on defined aspects of the disease pattern and of the visual results using multiple regression models, via a stepwise technique. RESULTS: There was commonly a significant asymptomatic latent period after cataract surgery. The median diagnostic delay was 7 days; 22% of patients presented after 2 weeks and 12% after 1 month. Symptoms progressed longer than 3 days in 25% of patients. Ten percent had no pain. Clinical variation proved largely unrelated to cataract surgery events and postoperative management; bacterial factors were implicated. Good visual outcome was associated statistically with intensive topical corticosteroid in the symptomatic period, but was negatively associated with operative subconjunctival corticosteroid. CONCLUSIONS: The clinical variation in cases of postoperative coagulase-negative staphylococcal endophthalmitis poses particular problems for diagnosis in the outpatient setting. Surgical and perioperative events (except corticosteroid use) probably can be disregarded in studies of endophthalmitis management.

Adult↗
PubMed1993

Endophthalmitis caused by the coagulase-negative staphylococci. 1. Disease spectrum and outcome.

PURPOSE: The coagulase-negative staphylococci are the most common causes of postoperative endophthalmitis. This study investigates the variability in the disease spectrum and visual outcome of coagulase-negative staphylococcal endophthalmitis in a large, single-center series. METHODS: Ninety consecutive cases of coagulase-negative staphylococcal endophthalmitis were investigated retrospectively from two time periods, 1978 to 1982 and 1985 to 1987, separated by a transitional period in cataract surgery technique. Using a detailed protocol, inpatient, outpatient, and microbiologic records were analyzed. Six-month visual acuity results were obtained. RESULTS: Diagnosis frequently was delayed, often suspected only after hypopyon development. Thirty-seven percent of patients presented more than 1 week after the inoculating event, and 13% presented after more than 1 month. Variable asymptomatic intervals and gradually worsening inflammatory prodromes are noted. Painless endophthalmitis occurred in 16%. Non-epidermidis infections comprised 28%. With vitrectomy/intraocular antibiotic management, 38% and 68% achieved visual acuities of 20/50 and 20/400, respectively. Overall, 10% of patients developed late retinal detachments. This occurred in only 4% of patients, with endophthalmitis occurring after cataract surgery. CONCLUSION: Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmitis in which the coagulase-negative staphylococci play a prominent role.

Adult↗
PubMed1993

The appearance of stippled retinal pigment epithelial detachments. A sign of occult choroidal neovascularization in age-related macular degeneration.

The clinical source of 62 eyes that had been coded for macular degeneration and fibrovascular retinal pigment epithelial (RPE) detachment on fluorescein angiography was reviewed; 17 eyes had signs of a choroidal neovascular membrane (CNVM) at initial examination, and 30 eyes developed a definite CNVM during follow-up examination. Thus, 47 of the 62 eyes (76%) developed a CNVM in association with fibrovascular RPE detachments. Features of fibrovascular RPE detachments include: 1) focal, tiny hyperfluorescent spots at the level of the RPE arising in the mid and late frames of the angiogram, which do not correspond to drusen or foci of depigmentation (stippled hyperfluorescence); 2) intensification of these spots in the later stages of the angiogram; 3) slight enlargement of the spots in the late frames of the angiogram; 4) occasional presence of scant overlying subretinal fluid; and 5) minimal elevation of the RPE. Fibrovascular RPE detachments appear to be a distinct form of an RPE detachment. It is concluded that this sign is associated with a high risk of developing a frank CNVM and is thus a reliable indicator of occult neovascularization.

Aged↗