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Biomedical subjects

A S Kimmel

Publications and source records attributed to A S Kimmel.

18 recordsLinked to original sources
PubMed1989

Idiopathic premacular gliosis in children and adolescents.

We treated three patients under 20 years of age who had idiopathic premacular gliosis, a disorder found primarily in patients older than 50 years of age. Initial visual acuity ranged from 20/20 to 20/50, remained unchanged in one patient, improved in one patient, and decreased in one patient. Final visual acuity ranged from 20/15 to 20/500 with an average follow-up of 60 months (range, ten to 102 months). Included in this series is a 6-year-old boy with idiopathic premacular gliosis. Children and adolescents with idiopathic premacular gliosis may develop progressive visual loss to a level where vitrectomy should be considered.

Adult↗
PubMed1989

Progressive capillary nonperfusion in temporal branch retinal vein obstruction.

We studied 31 eyes with nonischemic temporal branch retinal vein obstruction (TBRVO) of six months' duration or less. Each eye had an initial and at least one follow-up fluorescein angiogram according to the clinical course. Five eyes had sufficient additional capillary nonperfusion by angiography to warrant reclassification into the ischemic category. This conversion to an ischemic TBRVO pattern was documented as early as one month and as late as 14 months (average 5.2 months) after initial evaluation. Males dominated the progressive group (P less than 0.005); age, sex, initial visual acuity, and associated medical and ocular conditions were not significantly different between progressive and nonprogressive eyes (P greater than 0.05). A nonischemic TBRVO may convert to an ischemic pattern, placing these eyes at increased risk for the subsequent development of neovascular complications.

Aged↗
PubMed1989

Unilateral proliferative sickle retinopathy: a model for photocoagulation in the proliferative retinopathies.

We present a case report of a patient with unilateral proliferative sickle retinopathy who progressed to intractable vitreous hemorrhage, traction retinal detachment, and severe loss of vision after unsuccessful vitrectomy surgery. The patient's other eye had chronic uveitis resulting in widespread destruction of the retinal tissue, and subsequently the eye did not have any evidence of neovascularization. This observation is consistent with those seen in proliferative diabetic retinopathy where retinal damage from high myopia, trauma, or other cause typically protects that eye from the advanced stages of diabetic retinopathy. As in this case, the eye with long-standing uveitis did not have proliferative sickle retinopathy.

Aged↗
PubMed1989

Temporal branch retinal vein obstruction masquerading as a retinal arterial macroaneurysm: the Bonet sign.

We present the case report of a patient with a hemorrhage at an arteriovenous crossing which was erroneously interpreted as being an arterial macroaneurysm. Shortly thereafter, the typical appearance of a temporal branch retinal vein obstruction was evident indicating that the hemorrhage was an early sign of the venous obstruction. This sign (the Bonet sign) should alert the clinician to this disorder so that the correct diagnosis and recommendations for patient care can be undertaken.

Aged↗
PubMed1988

Central retinal-artery occlusion in proliferative sickle-cell retinopathy after retrobulbar injection.

Central retinal-artery obstruction (CRAO) is a devastating complication after retrobulbar anesthesia, a procedure which was previously recommended routinely to immobilize the eye and reduce discomfort during laser surgery. Recent developments in treatment technique, involving scatter laser applications given over several sessions with smaller spot sizes and shorter durations, have virtually eliminated the need for retrobulbar injections and the risks of retrobulbar hemorrhage, which can cause increased intraocular pressure and culminate in closure of the arterial circulation. We present the case of a patient with proliferative sickle retinopathy who sustained such a complication after direct photocoagulation treatment of sea-fans elsewhere and offer alternative treatment techniques which we have used for the past ten years that eliminate this hazard.

Adult↗
PubMed1987

Proliferative sickle cell retinopathy under age 20: a review.

Of the 256 sickle patients with hemaglobinopathies SC, SS and S-thal referred to the Wills Eye Hospital Retina Vascular Service from 1966 through 1983, 64 (50%) of the 128 males and 71 (55%) of the 128 females were less than 20 years old. Proliferative sickle retinopathy (PSR) was documented by fluorescein angiography in five of the males (8%) and two of the females (3%) under age 20. Included in this series is a 13-year-old black girl with homozygous sickle cell anemia (HbSS), to our knowledge the youngest reported case of PSR in an SS patient. This report emphasizes the importance of ophthalmic examinations in teenage sickle patients to detect and treat proliferative disease.

Adolescent↗
PubMed1986

Peripheral circumferential retinal scatter photocoagulation for the treatment of proliferative sickle retinopathy. An update.

Forty-four patients (70 eyes, 220 sea fans) with proliferative sickle retinopathy (PSR) received peripheral circumferential retinal scatter photocoagulation (PCRP) to the peripheral zones of retinal capillary nonperfusion. With an average follow-up of 3.3 years, 33% of preexisting sea fans regressed completely, 46% regressed partially, 19% remained stable, and 2% showed progression. De novo neovascularization developed after treatment in only one eye (1.4%). Ninety-five percent of patients treated had a final visual acuity of 20/30 or better and only one patient (2%) developed a nonresolving vitreous hemorrhage requiring vitrectomy surgery. These results confirm the authors' previous report and continue to compare favorably to the natural history of PSR in which de novo lesions developed in 58%, and 12% of eyes ended with a visual acuity of 20/200 or less. PCRP seems preferable to other techniques in reducing the risk of nonresolving vitreous hemorrhage and/or traction retinal detachment, although randomized controlled studies are needed to conclusively assess the safety and efficacy of this strategy in treating PSR.

Adolescent↗
PubMed1986

Proliferative sickle retinopathy and neovascularization of the disc: regression following treatment with peripheral retinal scatter laser photocoagulation.

Proliferative sickle retinopathy (PSR) is usually described as a peripheral neovascular tuft in a "sea fan" like configuration. While neovascularization of the disc (NVD) is a common finding in proliferative diabetic retinopathy (PDR), to our knowledge only one other case has been reported of NVD in an S-C patient in the absence of other contributing conditions. PSR has been shown to regress after treating hypoxic peripheral retina with peripheral circumferential retinal scatter photocoagulation (PCRSP). The following is a case report of an S-C patient with PSR and NVD/NVR which was originally treated elsewhere with scatter argon laser photocoagulation from the vascular arcades to just behind the equator. The peripheral "sea fan" and NVD did not regress. PCRSP to the zone of peripheral ischemia was then performed, and regression of the NVD and peripheral "sea fan" was achieved. This case illustrates the importance of concentrating laser treatment to the zones of retinal ischemia to achieve regression of associated neovascularization.

Anemia, Sickle Cell↗
PubMed1986

Temporal branch retinal vein obstruction: a review.

Two hundred forty-six eyes with temporal branch retinal vein obstruction (TBRVO) were studied prospectively. Of the 85 eyes not receiving laser treatment, 35 (41%) presented with greater than or equal to 20/50 vision and 89% remained in this group; whereas, 29 eyes (34%) presented with less than or equal to 20/200 vision and only 17% improved. Of the 161 eyes receiving laser, 40 (25%) had greater than or equal to 20/50 vision pre-treatment and 75% remained in this group; whereas, 64 eyes (40%) had less than or equal to 20/200 vision pre-treatment and 50% improved. The average final VA (20/70 vs 20/100), risk of developing neovascularization in ischemic TBRVO (3% vs 34%) and risk of vitreous hemorrhage in proliferative TBRVO (10% vs 57%) were all significantly better in treated eyes (p less than or equal to 0.01).

Aged↗
PubMed1985

Diabetic retinopathy under age 20. A review of 71 cases.

A review of the fluorescein angiograms on 4547 diabetic patients with clinically suspected retinopathy was performed. Although only 26 (1%) of the 2013 males and 45 (2%) of the 2534 females were less than 20 years old (71 patients total), proliferative diabetic retinopathy (PDR) was diagnosed in 14 females (31%) and 4 males (15%). The youngest patient, a 13-year-old boy with diabetes for eight years, presented with severe proliferative diabetic retinopathy in both eyes as documented angiographically. He showed no evidence of other systemic complications of diabetes. A review of the literature revealed one other case of proliferative diabetic retinopathy in a patient this young; a 13-year-old girl who was nephrotic and hypertensive upon presentation. This study emphasizes the importance of having prepubescent and teenage diabetics examined for the presence of retinopathy.

Adolescent↗