Hospitals without eye surgery: are minimum standards of care being met for patients with ocular injury?
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Emergency Medical Services↗
Biomedical subjects
C E Margo
Publications and source records attributed to C E Margo.
Capsular bag distention syndrome after combined cataract-lens implant surgery and Ahmed valve implantation.
PURPOSE: To describe the capsular bag distention syndrome after combined cataract extraction with posterior lens implant and aqueous drainage device. METHODS: Case report. RESULTS: A persistently shallow anterior chamber and low intraocular pressure developed after combined cataract extraction with posterior chamber lens implant and Ahmed aqueous drainage device. An optically empty space between the lens implant and posterior capsule was detected 18 days after surgery. The anterior chamber deepened within minutes after Nd:YAG posterior capsulotomy. CONCLUSION: The capsular bag distention syndrome needs to be included in the differential diagnosis of shallow anterior chamber with low intraocular pressure after combined cataract extraction and glaucoma valve implant surgery.
Aged↗
Pseudoadenomatous hyperplasia of the conjunctiva.
PURPOSE: To describe the clinical and pathologic features of three patients with pseudoadenomatous hyperplasia of the conjunctiva. DESIGN: Observational case series with clinicopathologic correlation. METHODS: Case reports and clinical histories and examination of three biopsy specimens. MAIN OUTCOME MEASURES AND RESULTS: Pseudoglandular hyperplasia of the conjunctiva was associated with chronic inflammation, including eosinophils, in two patients, and squamous epithelial hyperplasia in a third. The pseudoglands are lined by varying proportions of squamous epithelium and goblet cells. CONCLUSIONS: Pseudoglandular hyperplasia of the conjunctiva can mimic a well-differentiated mucoepidermoid carcinoma. Awareness of this entity may help to prevent misdiagnosis and unnecessary surgery.
Administration, Topical↗
When is surgery research? Towards an operational definition of human research.
The distinction between clinical practice and surgical research may seem trivial, but this distinction can become a complex issue when innovative surgeries are substituted for standard care without patient knowledge. Neither the novelty nor the risk of a new surgical procedure adequately defines surgical research. Some institutions tacitly allow the use of new surgical procedures in series of patients without informing individuals that they are participating in a scientific study, as long as no written protocol or hypothesis exists. Institutions can justify this practice by viewing human research in narrow terms as an activity outlined in a formal protocol. Application of limited definitions, however, erodes patients' rights and risks losing public confidence in how biomedical research is conducted. I propose an operational definition of human research also be recognised. Enforcing more rigid and less ambiguous guidelines of human research may curtail enrolment into some studies, but it will also protect patients from being used as subjects without their knowledge.
Attitude to Health↗
Comparison of different biomaterials for glaucoma drainage devices: part 2.
BACKGROUND: Inflammation associated with biomaterials may contribute to the failure of glaucoma drainage devices. OBJECTIVE: To compare the inflammatory reaction associated with the insertion of Krupin silicone, Molteno polypropylene, and Acrosof end plates in the subconjunctival space of rabbits. METHODS: Similar-sized glaucoma end plates made of 3 different biomaterials were sutured to the sclera in the superotemporal quadrant of the rabbit eye. Thirty eyes of 15 albino New Zealand rabbits were randomly assigned to the 3 groups. Conjunctival vascular hyperemia was graded in a masked fashion among the 3 groups. At the end of 3 weeks, the enucleated eyes were examined histologically and by scanning electron microscopy. RESULTS: Molteno polypropylene was associated with more inflammation both in clinical observations and based on histological grading. Silicone and Acrosof were associated with less intense inflammation. One polypropylene end plate was extruded on day 21. CONCLUSIONS: Polypropylene appears to be more inflammatory than silicone. Flexible biomaterials appear to be less inflammatory than rigid ones. CLINICAL RELEVANCE: Bleb failure following glaucoma drainage device implantation could be related to the biomaterial-associated inflammation. Choosing a biomaterial with the least inflammatory potential might enhance the success rate of the glaucoma drainage device. Arch Ophthalmol. 2000;118:1081-1084
Animals↗
Mycobacterium chelonae conjunctivitis and scleritis following vitrectomy.
The atypical, or nontuberculous, mycobacteria are opportunistic pathogens that usually cause infection following accidental trauma or surgery. These organisms are ubiquitous in nature but have been found with increasing frequency in other environments that include medical offices and surgical suites. Management of atypical mycobacterial ocular infections can be difficult because in vitro antibiotic activity does not always correlate with in vivo efficacy and because normal immune defenses against mycobacteria may work too slowly to prevent irreversible damage to infected ocular tissues. This report describes a patient who developed a severe ocular infection due to Mycobacterium chelonae after vitrectomy. Despite eradication of the infection, the eye became blind and painful. Arch Ophthalmol. 2000;118:1125-1128
Aged↗
Choroidal neovascular membranes: reproducibility of angiographic interpretation.
PURPOSE: To determine interobserver agreement for classifying choroidal neovascular membranes in age-related macular degeneration. METHODS: Six fluorescein angiograms of choroidal neovascular membranes were interpreted by 21 retina specialists. Reliability was measured by percent agreement and kappa coefficient. RESULTS: Interobserver agreement of membrane types ranged from perfect concordance for a small, classic membrane to near-random classification for a complex pattern. Mean kappa coefficient was.64. Interobserver agreement of membrane size was most variable for intermediate size lesions (mean kappa coefficient =.40). CONCLUSION: Fluorescein angiographic interpretation of choroidal neovascular membrane type and size can vary considerably. Interobserver agreement is better for membrane type than for membrane size.
Choroidal Neovascularization↗
Pathologic findings in late endophthalmitis after glaucoma filtering surgery.
OBJECTIVE: To report the clinicopathologic features of four eyes enucleated for late-onset bleb-related endophthalmitis. STUDY DESIGN: Retrospective case series. MATERIALS: Four enucleated eyes. METHODS: The clinical and histopathologic features of four patients who underwent enucleation for late-onset endophthalmitis after glaucoma filtering surgery were reviewed. RESULTS: The eyes were enucleated for endophthalmitis one to five years after trabeculectomy. Two of the four eyes had trabeculectomy with adjunctive mitomycin-C. All four eyes had streptococci cultured from the aqueous and/or vitreous. Common pathologic features included inflammation involving the anterior segment, lens and choroid. One eye exhibited focal granulomatous uveitis. CONCLUSIONS: Late-onset endophthalmitis after glaucoma filtering surgery is often due to streptococcal species and rapidly progresses over a few days. Phacoanaphylaxis with associated granulomatous uveitis may contribute to the poor prognosis in this setting.
Aged↗
Primary malignancies of the thyroid: epidemiologic analysis of the Florida Cancer Data System registry.
PURPOSE: Descriptive epidemiology of thyroid cancer in Florida. METHODS: The Florida Cancer Data System (FCDS) registry was used to identify patients with the different histologic subtypes of thyroid cancer occurring in Florida from 1981 through 1993. RESULTS: The FCDS recorded 5746 primary malignancies of the thyroid. The average annual incidence of all types of thyroid cancer was 37.0 cases/1,000,000 population. One type of thyroid cancer (papillary carcinoma) accounted for the overall increase during the 13 years of this study. There was no difference in incidence based on Hispanic ethnicity, but the incidence in Blacks was half that of Whites, and Blacks showed less advanced disease at the time of diagnosis. CONCLUSIONS: The increase in incidence of only one histologic type of thyroid cancer suggests that the increasing rate is not an artifact related to the utilization of new diagnostic technologies. The lower incidence and tendency to have less advanced thyroid cancer in Blacks would indicate that racial differences in thyroid cancer are not likely explained by socioeconomic factors such as access to medical care. A substantial amount of the difference in incidence between Whites and Blacks is explained by differences in age distribution.
Adult↗
Comparison of different biomaterials for glaucoma drainage devices.
OBJECTIVES: To compare the inflammatory reaction associated with the insertion of silicone and polypropylene endplates and endplates made of a new biocompatible polymer, Vivathane, in the rabbit subconjunctival space. METHODS: Similar-sized endplates made of 3 different biomaterials were sutured to the sclera in the superotemporal quadrant of the rabbit eye. Thirty eyes of 15 albino New Zealand rabbits were randomly assigned to the 3 groups. Conjunctival vascular hyperemia was graded in a masked fashion among groups. At the end of 3 weeks, the enucleated eyes were examined histologically and using scanning electron microscopy. RESULTS: Polypropylene and Vivathane were associated with significantly more inflammation in clinical observations and based on histological grading. Silicone was associated with the least amount of inflammation. Three polypropylene and 1 Vivathane plate were extruded between the second and third week. CONCLUSIONS: Silicone is the most inert of the 3 materials tested. Inflammation associated with biomaterials may contribute to the failure of the glaucoma drainage devices. CLINICAL RELEVANCE: Bleb inflammation may be related to the biomaterial being used as the endplate. Endplates should be handled carefully during surgery to avoid creating rough spots.
Animals↗
Indeterminate melanocytic proliferations of the conjunctiva.
OBJECTIVE: To test the hypothesis that a subset of conjunctival melanocytic proliferations exists that cannot be reproducibly classified as benign, malignant, or indeterminate. METHODS: Three groups of excisional biopsy specimens of conjunctival melanocytic proliferations were evaluated by a panel of 5 ophthalmic pathologists. These groups included lesions that we considered to represent benign (group 1 [n = 5]), malignant (group 2 [n = 5]), and indeterminate melanocytic proliferations (group 3 [n = 5]). The panel classified the same sections in all 3 groups in a randomized, masked fashion, first without and then with a clinical history of patient age, sex, and race. The kappa statistic was used to quantify the degree of agreement among observers. RESULTS: There was strong concordance among the panel members for both group 1 (benign [kappa = 0.76]) and group 2 (malignant [kappa = 0.70]) melanocytic proliferations. There was no concordance of the panel for group 3 (indeterminate) lesions (kappa = -0.045). The concordance for groups 1 and 2 and lack of concordance for group 3 lesions were independent of knowledge of clinical history of age, sex, and race. CONCLUSION: A subset of melanocytic proliferations of the conjunctiva exists that cannot be reproducibly classified by pathologists as benign, malignant, or indeterminate.
Adult↗
Adverse periocular reaction after blood transfusion.
PURPOSE: To describe a patient with an acute conjunctival and periocular reaction after blood transfusion. METHODS: Case report and literature review. RESULTS: A 67-year-old woman sustained a self-limited periocular reaction characterized by bilateral turgescence and redness of the conjunctiva and eyelids after blood transfusion. More than 100 similar reactions of this type have been reported by the Centers for Disease Control and Prevention. CONCLUSIONS: The cause of this periocular transfusion reaction is unclear, but this type of reaction is being investigated by the Centers for Disease Control and Prevention. This case suggests that mild transfusion complications, even if unusual, may be under-reported.
Aged↗
Eyelid tumors: accuracy of clinical diagnosis.
PURPOSE: To determine the accuracy, specificity, and sensitivity of the clinical diagnosis of malignant tumor of the eyelid. METHOD: Analysis of consecutively submitted biopsy specimens of the eyelid for 1 year to a regional ophthalmic pathology laboratory. RESULTS: Agreement was noted between clinical and histopathologic diagnoses on 72 (84%) of 86 eyelid biopsy specimens received over 12 months. Ten (11.6%) clinical diagnoses of suspected malignant eyelid tumor showed benign skin conditions, and four (4.6%) clinical diagnoses of presumed benign conditions proved to be malignant. CONCLUSIONS: The clinical assessment of eyelid malignancy by ophthalmologists is reasonably good when evaluated in terms of sensitivity (87.5%) and specificity (81.5%) of diagnosis. Lesions giving rise to the false-negative diagnosis of malignancy tend to be nodules with unremarkable surface features.
Biopsy↗
A pseudoepidemic of postoperative scleritis due to misdiagnosis.
OBJECTIVE: To describe a pseudoepidemic of infectious scleritis following eye surgery. METHODS: Retrospective cohort study with selected procedural and laboratory investigations. RESULTS: Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found. The clinical findings, when carefully reviewed, were consistent with poor surgical-wound closure. CONCLUSIONS: The art of clinical diagnosis involves the subjective interpretation of clinical history, physical findings, and laboratory results. A repeated error in the interpretation of clinical findings can simulate an outbreak of disease. Clinicians may be reluctant to concede misdiagnosis.
Adult↗
Choroidal metastasis from adenocarcinoma of the parotid gland.
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Adenocarcinoma↗
Indeterminate melanocytic proliferations of the conjunctiva.
PURPOSE: The purpose of this study is to test the hypothesis that a subset of conjunctival melanocytic proliferations exists that cannot be reproducibly classified as benign, malignant, or indeterminate. METHODS: Three groups of excisional biopsy specimens of conjunctival melanocytic proliferations were evaluated by 5 ophthalmic pathologists. These groups included lesions that were considered by the authors to represent benign (Group 1, n = 5), malignant (Group 2, n = 5) and indeterminate melanocytic proliferations (Group 3, n = 5). The panel classified the same sections in all 3 groups in a randomized, masked fashion, first without and then with a clinical history of patient age, sex and race. The kappa statistic (k) was used to quantify the degree of agreement among observers. RESULTS: There was strong concordance among the panel for both Group 1 (benign, k = 0.76) and Group 2 (malignant, k = 0.70) melanocytic proliferations. There was no concordance of the panel for Group 3 (indeterminate) lesions (k = -0.045). The concordance for Groups 1 and 2 and lack of concordance for Group 3 lesions were independent of knowledge of clinical history of age, sex, and race. CONCLUSIONS: A subset of melanocytic proliferations of the conjunctiva exists that cannot be reproducibly classified by pathologists as benign, malignant, or indeterminate.
Adult↗
Malignant tumors of the eyelid: a population-based study of non-basal cell and non-squamous cell malignant neoplasms.
OBJECTIVE: To determine the relative frequencies, average annual incidences, and patient characteristics of non-basal cell and non-squamous cell malignant neoplasms of the eyelid in a defined geographic population. DESIGN AND SETTING: A retrospective study using the Florida Cancer Data System to identify malignant tumors of the eyelid, except for basal cell and squamous cell carcinomas, from 1981 through 1994. Cases were limited to persons who resided within Florida. MAIN OUTCOME MEASURE: Incidence of histologically confirmed malignant eyelid tumors. RESULTS: Two hundred six primary malignant eyelid tumors were identified. The 3 most common, in order of frequency, were melanoma, sebaceous carcinoma, and lymphoma. The median age at diagnosis for all patients was 73 years. Only 3 of the 206 malignant neoplasms occurred in blacks. The annual incidence of eyelid melanoma and sebaceous carcinoma in whites older than 20 years was 0.6 and 0.5 per million, respectively. Kaposi sarcoma was the most common type of mesenchymal tumor. Eleven different histologic types of lymphoma were found in the eyelid. Only 2 of 27 lymphomas had T-cell lineage. CONCLUSIONS: Malignant tumors of the eyelid other than basal cell and squamous cell carcinoma are uncommon and usually occur in elderly white persons. Primary eyelid tumors of any type are rare in blacks. The risk of a non-basal cell and non-squamous cell malignant neoplasm of the eyelid in Florida is 6.4 times greater for whites than for blacks (95% confidence interval [CI], 2.1-20.2). A variety of B-cell lymphomas can be manifested as primary eyelid tumors.
Adenocarcinoma, Sebaceous↗
Choroidal melanoma and neurofibromatosis type 1.
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Aged↗