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Biomedical subjects

C Enger

Publications and source records attributed to C Enger.

At least 55 records · Page 3Linked to original sources
PubMed1994

The context and consequences of ocular injuries from air guns.

There is little available information on the context of air-gun inflicted ocular injuries. To address this need, we performed a systematic telephone survey of victims of severe air-gun ocular injuries, collected between January 1986 and August 1992, through the auspices of the National Eye Trauma System and the Alabama Eye Injury Registry. One hundred forty interviews were completed with injury victims or their parents. Pump-action rifles with BB ammunition were the most common weapons. Victims and shooters were predominantly male (91% and 89%, respectively) and their mean age was 13 years. Of the injuries, 95% were inflicted by individuals known to the victim; 40% of these were relatives. People were the intended targets in 45% of the injuries. Ricochets accounted for 26% of the injuries. Of those victims with penetrating injuries, 84% had visual acuity less than 20/200 despite numerous surgical attempts. Adults were present at the scene of the injury in only 11% of the incidents, implying that unrestricted access to these weapons by children is likely the principal risk factor for injury.

Adolescent↗
PubMed1994

Foveomacular dystrophy.

We reviewed the clinical records of 47 patients (92 eyes) at the Wilmer Institute in whom foveomacular dystrophy had been diagnosed between 1977 and 1990 to determine reasons for initial examination, long-term visual prognosis, and the factors associated with visual loss. From each clinical record, we obtained the patient's age at the time first seen, symptoms, initial and final visual acuity, lesion size and appearance, and results of fluorescein angiography, electroretinography, and electro-oculography. The most common reasons for examination were decreased visual acuity in 25 of the 47 patients (53%), metamorphopsia in six (13%), referral for diagnosis in seven (15%), and misdiagnosis of age-related macular degeneration in seven (15%). Over an average follow-up period of 5.0 years, in 29 patients (56 eyes), visual acuity changed less than two lines in 41 eyes and decreased greater than or equal to two lines in 15 eyes. In most patients with foveomacular dystrophy, visual acuity appears to remain relatively stable.

Adult↗
PubMed1994

Functional status and quality of life measurement among ophthalmic patients.

OBJECTIVES: Assessment of the relationship between visual function and functional status/quality of life in clinical research involving patients with eye disease by investigating whether the scores of four existing functional status/quality of life patient questionnaires are sensitive to differences in visual acuity and studying whether selected subscales of the questionnaires provide similar information concerning the relationship between functional status/quality of life and visual acuity as do the respective full-length questionnaires. DESIGN, SETTING, PARTICIPANTS: Case patients consisted of 86 consecutive patients seen at The Wilmer Ophthalmological Institute Retinal Vascular Center, Baltimore, Md. Controls consisted of 51 individuals with normal visual acuity and no known ocular disease and were frequency-matched to the case patients by age (+/- 5 years), sex, and race. Subjects were interviewed in person using each of the following questionnaires: the Sickness Impact Profile, the vision-specific Sickness Impact Profile, the Community Disability Scale, and the General Health Questionnaire. RESULTS: Scores of all four questionnaires and their subscales were significantly associated with visual acuity. The vision-specific Sickness Impact Profile and the Community Disability Scale were independently significant predictors of visual acuity. Regression analysis revealed that in our study, selected subscales of the respective full-length questionnaires were able to demonstrate the association between vision and functional status/quality of life. CONCLUSIONS: Ophthalmic patients are at high risk for decreased functional status/quality of life. Subscales of existing questionnaires potentially may be substituted for the full-length questionnaires, thereby increasing the efficiency of functional status/quality of life measurement in such patients.

Aged↗
PubMed1994

Risk factors for the development of glaucomatous visual field loss in ocular hypertension.

OBJECTIVE: To detect characteristics of persons with ocular hypertension that are associated with a higher risk of future glaucomatous field loss. METHODS: Annual examinations of the optic disc, nerve fiber layer, and visual field in 647 persons with bilateral intraocular pressure higher than 21 mmHg and initially normal visual field test results with the Goldmann perimeter. RESULTS: Sixty-eight persons developed a field defect on two consecutive Goldmann visual field tests in at least one eye, while 579 others retained normal fields. Moderate or severe nerve fiber layer atrophy at baseline was associated with a seven to eight times greater risk of development of visual field loss. Attributes that were significantly associated with the incidence of field loss included older age, larger cup-disc ratio, smaller rim-disc area ratio, larger cup asymmetry, presence of disc crescent, and higher intraocular pressure. Characteristics found not to be associated with incidence were gender, race, hypertension, diabetes, refractive error, family history of glaucoma, smoking or alcohol drinking history, and disc area. CONCLUSIONS: Increasing nerve fiber layer atrophy judged by a semiquantitative grading system was associated with increasing risk of development of visual field loss among persons with ocular hypertension. The relationship of the development of field loss to race, myopia, family history of glaucoma, and medical history are more complex than has been presumed.

Adult↗
PubMed1994

Local intramural drug delivery using an infusion balloon following angioplasty in normal and atherosclerotic vessels.

Local intramural delivery of various pharmacologic agents following angioplasty has been proposed as a means of reducing restenosis. This study tested whether local intramural delivery of aqueous solutions using an infusion balloon could be accomplished safely in normal vessels and whether such infusion was safe following standard angioplasty in diseased vessels. Infusion of aqueous agents into normal canine arteries had no adverse effect. Infusion of several aqueous agents (< or = 4 cc at 4 atm) into diseased swine iliac arteries following balloon angioplasty did not worsen existing or create new dissections. Histologically, infusion treated vessels did not differ in either model from vessels treated with angioplasty alone. We conclude that local intramural drug infusion does not create new, or worsen existing, dissections produced during standard balloon angioplasty in diseased vessels.

Angioplasty, Balloon, Coronary↗
PubMed1994

Effects of early and late treatment with anti-CD4 monoclonal antibody on autoimmune disease in MRL/MP-lpr/lpr mice.

MRL/Mp-lpr/lpr (MRL/lpr) mice spontaneously develop a systemic autoimmune disease, characterized by vasculitis, lymphadenopathy, glomerulonephritis, and autoantibody formation, with target organ inflammatory lesions composed largely of CD4+ (helper) T cells. Previous reports have demonstrated that anti-CD4 monoclonal antibody (mAb) treatment of MRL/lpr mice from 1 to 5 months of age resulted in a dramatic reduction in both the frequency and the severity of autoimmune disease. In order to investigate the effects of early, short-course and late, short-course anti-CD4 mAb therapy on the autoimmune disease in MRL/lpr mice, groups of 12 to 15 animals were treated with weekly intraperitoneal injections according to one of four regimens: (i) anti-CD4 mAb from age 1 to 5 months (continuous treatment); (ii) anti-CD4 mAb from age 1 to 3 months (early treatment); (iii) anti-CD4 mAb from age 3 to 5 months (late treatment); and (iv) either normal saline or rat immunoglobulin (control treatment). Continuous treatment resulted in a dramatic reduction of both frequency and severity of the autoimmune disease, as demonstrated histologically and serologically. Early treatment also resulted in a significant reduction in autoimmune disease, while late treatment had little effect. Glomerulonephritis was detected in none of the animals in the continuously treated group (P < 0.05), 38% of those in the early-treated group (P = < 0.05), 92% of the late-treated group, and 100% of controls. The titer of antinuclear antibodies, of anti-dsDNA antibodies, and total immunoglobulin levels were all significantly reduced in the continuous-treatment and early-treatment groups, but not in the late-treatment group. Murine antibodies to rat anti-CD4 mAb were present in the late-treatment group. These results indicate that early short-course anti-CD4 mAb treatment of MRL/lpr mice is effective in ameliorating the autoimmune disease in this model, while late-treatment is ineffective, probably due to the induction of antibody directed against anti-CD4 mAb itself.

Animals↗
PubMed1994

Improved visual results after surgical repair of cytomegalovirus-related retinal detachments.

PURPOSE: This study was conducted to determine whether visual outcomes have improved after repair of retinal detachments (RDs) associated with cytomegalovirus (CMV) retinitis, and, if so, whether factors such as earlier intervention and changes in surgical technique have led to these results. METHODS: The authors performed a retrospective review of 35 eyes in 30 immunocompromised patients with CMV retinitis and RD who underwent pars plana vitrectomy with the use of silicone oil injection. Visual and anatomic results in eyes treated between January 1991 and April 1992 (group 1) were compared with eyes treated before January 1991 (group 2). Follow-up was limited due to patient mortality; median follow-up was 4.1 months in group 1 and 2.5 months in group 2. RESULTS: Best-attained postoperative visual acuities were better for group 1 than group 2 eyes, with 71% of group 1 eyes attaining visual acuity of 20/200 or better compared with 17% of group 2 eyes (chi-square1 trend = 12.3; P < 0.001). A similar result was found among eyes with macula-off detachments. Ambulatory visual acuity of 5/200 or better was achieved in 86% of group 1 versus 33% of group 2 eyes. There was a longer interval between diagnosis and surgery in group 2 compared with group 1 (7 versus 3 days); scleral buckling in conjunction with pars plana vitrectomy and silicone oil injection was used in more group 1 eyes. CONCLUSION: Earlier intervention, absence of preoperative optic atrophy, and macular CMV correlate with better postoperative visual acuity results. Pars plana vitrectomy combined with silicone oil for eyes with macula-off RDs can result in improved visual acuity.

Adult↗
PubMed1993

Bone marrow transplantation and cataract development.

OBJECTIVES: To evaluate risk factors for the development of posterior subcapsular cataract following bone marrow transplantation (BMT) and the results of patients undergoing cataract extraction. DESIGN: Retrospective case-control study. SETTING: Tertiary referral center. PATIENTS: Three hundred sixty-six patients (59% male, 41% female) undergoing BMT at one institution who survived for at least 1 month and underwent full ophthalmologic examination. Risk factors were then compared between patients who developed posterior subcapsular cataract and those who did not. INTERVENTION: Cataract surgery in six eyes of four patients. MAIN OUTCOME MEASURE: Formation of posterior subcapsular cataract. Data were obtained on all patients for type of BMT, pretransplantation regimen, underlying malignancy, demographic background, complications of BMT, and medications. RESULTS: Forty (10.9%) of 366 patients developed posterior subcapsular cataract. By univariate analysis, cataract formation was associated with total body irradiation, chronic graft-vs-host disease, the use of allogeneic bone marrow, and the total dose and duration of corticosteroid therapy. Multivariate analysis revealed that the total dose and duration of corticosteroid therapy were the most important risk factors, while total body irradiation was not a statistically significant risk factor. Cataract surgery was performed in six eyes of four patients, all of whom developed visual acuities of 20/40 or better. CONCLUSION: Posterior subcapsular cataract following BMT is uncommon and rarely requires surgery. Total dose and duration of corticosteroid therapy are the most important risk factors for development of cataract, but total body irradiation is not a statistically significant risk factor.

Adolescent↗
PubMed1993

Corneal thickness changes after high-risk penetrating keratoplasty. Collaborative Corneal Transplantation Study Group.

OBJECTIVE: To determine whether ultrasonic measurements of corneal thickness are of prognostic value after high-risk penetrating keratoplasty. DESIGN: A prospective, multicenter, randomized trial. PATIENTS: Four hundred fifty patients at high risk for graft failure because of previous immunologic graft failure or because of two or more quadrants of stromal vascularization. Patients underwent surgery and were treated according to a specific protocol and observed at frequent intervals. INTERVENTION: At each postoperative visit, ultrasonic measurement of central corneal thickness was performed and the corneal status was determined by biomicroscopic examination. MAIN OUTCOME MEASURE: Graft failure owing to immunologic or nonimmunologic causes. RESULTS: Corneal thickness stabilized by 3 months at a median thickness of 0.54 mm. The range of corneal thicknesses in patients with corneal grafts judged to be clear was large. In 49% of eyes, development of an allograft reaction episode was accompanied by an increase in corneal thickness of at least 10%; the greater the increase in thickness, the more likely the graft would fail. Clear grafts with central thicknesses of 0.59 mm or greater at 1, 3, or 6 months had a much greater risk of failure than those with thicknesses of less than 0.59 mm. CONCLUSION: Corneal thickness measurements after high-risk penetrating keratoplasty are of prognostic value.

Cornea↗
PubMed1993

Age-related macular degeneration histopathologic studies. The 1992 Lorenz E. Zimmerman Lecture.

BACKGROUND: Delineation of the morphologic aspects of age-related macular degeneration (ARMD) is helpful in correlation with the clinical features and may contribute to understanding the pathogenesis. METHODS: All eyes on file in the Eye Pathology Laboratory, Wilmer Institute, with the known features of ARMD were analyzed according to age, sex, and race. Methods included routine sections in the macula, stepped-serial and serial sections, and electron microscopy and two-dimensional reconstruction in selected cases. RESULTS: There were 760 eyes with ARMD from 450 patients. Only 5.3% of these patients were black. Nodular drusen were observed in 6.2% of eyes (n = 47), basal laminar deposits in 54.7%, basal linear deposits in 27.6%, neovascularization in 38.2%, and disciform scars in 40.8%. Three types of soft drusen were identified and were observed in 28.0%. The mean diameter of the disciform scar was 3.73 mm, and mean thickness was 0.27 mm. In disciform scars greater than 0.2 mm in thickness, only approximately 25% of the surface of the scar had some remaining photoreceptor cells. Serous or hemorrhagic detachments were observed in 10.4% of eyes. Retinal pigment epithelial (RPE) atrophy without disciform scars was observed in 24.6% of eyes. Areolar atrophy was the most common feature observed in eyes of black patients. CONCLUSION: This comprehensive histopathologic evaluation provides the tabulation of the various morphologic features of ARMD. Basal laminar deposit and basal linear deposit, but not nodular drusen, are important positive associations with choroidal neovascularization, disciform scarring, and visual loss. Preservation of photoreceptor cells was seen only over disciform scars 0.2 mm thickness or less.

Adult↗
PubMed1992

Reformulation and drop size of apraclonidine hydrochloride.

We performed a prospective, double-masked, placebo-controlled, six-period, cross-over study in which normal subjects were randomly assigned to treatment and compared three different formulations of apraclonidine hydrochloride (the present commercially available formulation, and formulations with hydroxypropylmethylcellulose or lysolecithin). We also evaluated the efficacy of a 16-microliters and 30-microliters drop size. The magnitude and duration of decrease in intraocular pressure was comparable for all formulations. Most subjects tolerated all formulations well with only a few reporting any side effects. The best-tolerated formulation was 0.5% apraclonidine hydrochloride delivered with a 16-microliters drop size. Dry mouth developed frequently with the commercially available 1% apraclonidine solution. Blurred vision complicated the use of the formulation containing hydroxypropylmethylcellulose. Both dry mouth (P less than .05) and blurred vision (P = .004) were statistically significant side effects.

Adrenergic alpha-Agonists↗
PubMed1991

Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker.

We evaluated the occurrence or progression of nuclear sclerosis of the crystalline lens in 100 eyes after vitrectomy for removal of idiopathic epiretinal membranes causing macular pucker. The follow-up period ranged from six to 99 months (average, 29 months). Visually significant nuclear sclerosis was present preoperatively in three of the operated on eyes and four of the fellow eyes. The rate of occurrence or progression of visually significant nuclear sclerosis was far greater in the operated on eyes (P less than .0001). Of 100 patients, 80 operated on eyes and 24 fellow eyes had visually significant nuclear sclerosis or had undergone previous cataract extraction at the conclusion of the study. Different concentrations of glucose in the intraocular irrigating solution did not affect occurrence of later nuclear sclerosis. Patients older than 50 years of age had a far greater incidence of later nuclear sclerosis than patients younger than 50 years of age (P = .0003). Nuclear sclerosis may be caused by altered lens metabolism after removal of part of the vitreous gel, since nuclear sclerosis also occurs in other conditions associated with vitreous liquefaction.

Adolescent↗
PubMed1991

A new method for documenting lens opacities.

We tested an anterior segment camera and digital analyzer on 32 eyes of 22 patients to determine whether its measurement of lens opacities correlated with measurements obtained by a standardized clinical grading system. The lenses were graded clinically for nuclear opacity, nuclear color, cortical opacity, and posterior subcapsular opacity. The lenses were then photographed and analyzed with this new device, and the results were compared. The camera system showed good reproducibility. Its results correlated well with the clinical gradings for nuclear capacity (P = .001) and cortical opacity (P = .001) but less well with posterior subcapsular opacity (P = .3), although there were only seven eyes with posterior subcapsular opacities. This camera system could help document and follow up lens opacity with more accuracy and reproducibility than has been previously possible.

Cataract↗
PubMed1991

Retinal detachments in patients with cytomegalovirus retinitis.

Retinal detachments are a recognized complication of cytomegalovirus retinitis. In a series of 145 patients with cytomegalovirus retinitis, 38 (26%) developed retinal detachments. The cumulative probability of a retinal detachment 1 year after the diagnosis of cytomegalovirus retinitis was 50%. Detachments were associated with increased size of the cytomegalovirus lesion and with lesions extending anteriorly up to the ora serrata. Treatment with an anticytomegalovirus drug appeared to delay the time to detachment. Median survival time after the diagnosis of retinal detachment was 9 months. In our study, vitrectomy with silicone oil as the initial surgical procedure was the most effective approach. Successful anatomic reattachment of the retina was achieved in 70% of patients undergoing this procedure. Despite the success of surgery, the visual outcome was disappointing, with only 20% of eyes achieving a final visual acuity of 5/200 or better.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Prevalence of lens opacities in surgical and general populations.

The distribution and prevalence of lens opacities were examined and compared among three general population-based groups and a group that underwent cataract surgery. The population-based groups comprised subjects from the Framingham Eye Survey, the National Health and Nutrition Examination Survey, and the study of watermen in Maryland. Comparison among these groups revealed similar frequencies of lens opacities among age groups, with slightly higher rates for older individuals in the watermen study population. Comparison between the watermen and the surgical groups revealed that, of lenses with opacities, posterior subcapsular cataracts were present in a far greater percentage of surgery cases (60.6%) than in general population cases (5.3%). These findings confirm the generally held clinical belief that posterior subcapsular opacities are disproportionally represented in the surgical population and suggest that they cause more significant visual disability than do other types of cataracts.

Adult↗
PubMed1991

Natural history of corneal astigmatism after cataract surgery.

Little information on the natural course of corneal astigmatism following cataract surgery exists. We report a prospective, computerized analysis of postoperative astigmatism, based on keratometry measurements, of 137 cases of extracapsular cataract extraction with intraocular lens implantation performed by one surgeon. No sutures were cut postoperatively. Surgery induced 1.44 diopters (D) of with-the-rule astigmatism at one month, which declined at a rate of 0.77 D and 0.35 D per month for the next two months, respectively, with a more gradual decline thereafter. The mean surgically induced astigmatism at the last postoperative visit ranged from 0.29 D at six months (minimum follow-up) to 1.23 D at 48 months; both were against-the-rule. Mean follow-up was 28.92 months. These findings may be technique specific and suggest that (1) corneal curvature continues to change slowly even two to four years postoperatively; (2) most patients develop against-the-rule astigmatism, thus more with-the-rule astigmatism is desirable in the early postoperative period; (3) selective suture removal is necessary only when significantly more than 3.00 D of surgically induced with-the-rule astigmatism is present.

Aged↗
PubMed1991

Computerized tomography in the evaluation of penetrating ocular injuries.

An evaluation was made of the cases of 80 consecutive patients (82 eyes) who underwent acute surgical intervention for penetrating eye injuries. Of these cases, 46 patients had computerized tomography (CT) of the orbit performed in addition to routine preoperative ophthalmic examination. Eyes with more severe injuries and eyes in which the posterior segment was not visualized on the preoperative ophthalmic examination were more likely to undergo CT evaluation. CT scanning frequently demonstrated posterior segment pathology not observable by ophthalmic examination. The following CT findings were associated with poor visual or anatomic outcome: (1) posterior segment hemorrhage; (2) vitreous space distortion; and (3) lens disruption. This study suggests that CT scanning may provide useful information as to the nature and extent of injury in cases of penetrating ocular trauma.

Adolescent↗