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Biomedical subjects

C L Trempe

Publications and source records attributed to C L Trempe.

At least 55 records · Page 3Linked to original sources
PubMed1993

A comprehensive approach to biomicroscopic vitreous examination.

We recommend a biomicroscopic vitreous examination that combines an anterior vitreous examination done without using a neutralizing lens and a posterior vitreous examination using the high-power (low-magnification) double aspheric positive preset lens. When detailed observation of the posterior and peripheral vitreous are required, we also recommend the additional use of a low-power (high-magnification) double aspheric preset lens and the Goldmann three-mirror lens. Details of the anterior vitreous can be examined best without using a neutralizing lens and those of the posteror vitreous, by using the low-power double aspheric preset lens. The high-power double aspheric preset lens provides a wider field of view and more accessibility when the patient has small pupils and cataracts than the low-power double aspheric preset lens. The peripheral vitreous is best observed using a Goldmann three-mirror lens. We believe the method we describe can serve as a guide for a comprehensive clinical biomicroscopic vitreous examination.

Adolescent↗
PubMed1992

Fellow eyes in idiopathic macular hole cases.

The fellow eyes in 84 cases of unilateral idiopathic macular hole were studied retrospectively to determine prognoses and risk factors for this disorder. On initial examination, 15 of 84 eyes (18%) had a macular cystic lesion (group 1), 23 (27%) had a yellow spot in the fovea (group 2), and 46 (55%) had a normal macula (group 3). Of the 84 eyes, 58 (69%) had posterior vitreous attachment. During a mean follow up of 39 months, macular hole developed in 8 of 15 eyes (53%) in group 1, and in 6 of 23 eyes (26%) in group 2. However, a macular hole did not develop in eyes with posterior vitreous separation or a normal macula. Although the risk of developing a macular hole may have been overestimated in our study, posterior vitreous attachment and macular abnormalities may be important in predicting macular hole formation in the fellow eyes in idiopathic macular hole cases.

Aged↗
PubMed1991

Vitreous photography with a +90-diopter double aspheric preset lens vs the El Bayadi-Kajiura preset lens.

Two fundus lenses, a 90-diopter preset lens and a 58.6-diopter El Bayadi-Kajiura lens, were compared. The lenses were evaluated with regard to their optics, magnification, field of view, and photographic usefulness in photographing the posterior vitreous. The 90-diopter lens provided a wider field of view but lower magnification. Both lenses permitted high-quality vitreous photographs through the slit lamp, but the 90-diopter lens allowed photographs to be taken through small pupils and some lens opacities.

Aged↗
PubMed1991

Prognostic factors in idiopathic preretinal macular fibrosis.

We retrospectively studied 124 eyes with idiopathic preretinal macular fibrosis to assess the value of fluorescein angiography and vitreous examination for predicting the visual prognosis. During a mean follow-up period of 43 months (range, 12-14 months), the visual acuity of 33 eyes (27%) declined two or more lines from the initial value, although the appearance of the fibrosis remained unchanged in 114 cases (92%). At initial examination, 38 eyes (31%) showed fluorescein leakage into the macula; these eyes were more prone to further visual deterioration than were those without leakage (P less than 0.05). Of 14 eyes with partial vitreous detachment and vitreous traction to the fibrosis, 6 (43%) had a final visual acuity of 20/200 or worse; this proportion was significantly higher than that found either in eyes with no detachment or in those with complete vitreous detachment (P less than 0.05). The presence of fluorescein leakage and/or vitreous traction to the fibrosis may predict worse functional prognosis in eyes with idiopathic preretinal macular fibrosis.

Adult↗
PubMed1991

Comparative study of vitreoretinal relationships using biomicroscopy and ultrasound.

We prospectively studied 29 consecutive eyes with proliferative diabetic retinopathy that showed media clear enough to enable characterization of vitreoretinal relationships by biomicroscopy. Vitreoretinal relationships were also determined by contact B-scan ultrasound. With both techniques, these relationships were documented by photographs and drawings. Biomicroscopy showed complete posterior vitreous detachment (PVD) in 4 eyes (14%), partial PVD in 18 (62%), and no PVD in 7 (24%). Ultrasound examination revealed complete PVD in 4 eyes (14%), partial PVD in 19 (66%), and no PVD in 6 (21%). The results we obtained using ultrasound agreed significantly with those obtained by biomicroscopy [Cohen's kappa = 0.93, 95% confidence interval = (0.80, 1.06)]. Ultrasound detected vitreous changes more easily than biomicroscopy when mild media opacities were present and when the equatorial areas of the globe were examined. Results suggest that ultrasound is adequate to determine vitreoretinal relationships in eyes with clear media and that it is a good alternative to biomicroscopy in eyes with significant media opacities.

Adolescent↗
PubMed1991

[Prognosis of fellow eyes in idiopathic macular hole cases].

We studied contralateral eyes in 62 cases of unilateral idiopathic macular hole to determine their prognoses and risk factors for this disorder. At the initial examination, 11 of 62 eyes (18%) showed a macular cystic lesion, and 18 (29%) showed a yellow spot in the fovea. During a mean follow-up of 39 months, macular holes eventually developed in 6 of the 11 eyes (55%) with macular cystic lesion and in 4 of 18 eyes (22%) with a yellow spot. Macular holes, however, did not develop in eyes with vitreous separation in the fovea or with a normal macula. Moreover, the macular lesion apparently improved in 14 of 29 eyes (48%) with early stage macular holes. These fourteen eyes showed vitreous separation in the fovea at the initial examination or at the follow-up examination. Therefore, eyes with macular cystic lesions and without posterior vitreous separation are at high risk of a macular hole developing, although these eyes have a chance for improvement by spontaneous vitreous separation.

Fluorescein Angiography↗
PubMed1991

Role of the vitreous in posterior segment neovascularization in central retinal vein occlusion.

We retrospectively studied the relationship between the vitreous condition and the development of retinal or optic disc neovascularization in 60 eyes with central retinal vein occlusion associated with extensive retinal ischemia. At initial examination, 24 of 60 eyes (40%) with central retinal vein occlusion had complete posterior vitreous detachment, a prevalence significantly higher than in the fellow eyes. During a mean follow-up period of 43 months, 13 of 34 eyes (38%) without posterior vitreous detachment developed retinal or disc neovascularization, or both, but none of the 24 eyes with complete posterior vitreous detachment developed neovascularization (P less than .001). Our results suggest that central retinal vein occlusion may induce the development of posterior vitreous detachment, and that posterior vitreous detachment may play a role in protecting eyes with central retinal vein occlusion from posterior segment neovascularization.

Adult↗
PubMed1991

Image enhancement for the visually impaired. Simulations and experimental results.

Digital image enhancement has been proposed as an aid for the visually impaired. The capability of two enhancement techniques to improve recognition of images by patients with central scotoma or cataracts was evaluated using image-processing simulations and direct patient testing. Enhancements and simulations were based on measurements of contrast sensitivity loss for patients with macular disease. Contrast sensitivity loss was measured using Gabor-type localized stimuli and paradigms that are appropriate for analyzing form perception. The simulations using the contrast sensitivity data suggested that patients with moderate visual loss (20/70-20/200) may have difficulty recognizing faces and may benefit from enhancement by both of the techniques used. Ability to recognize celebrities from enhanced images improved for 39 of the 46 patients tested. The improvement was significant (P less than 0.05) for 16 of the 38 patients with central visual loss and for 3 of 8 patients with anterior segment media opacities tested. The simulations suggest that the benefits of image enhancement may be similar or even greater for recognition of other types of images.

Adult↗
PubMed1990

Risk of developing a macular hole.

We followed up 45 eyes with early-stage idiopathic macular hole (mean period, 32 months; range, 7 to 87 months) to investigate their prognoses, especially in relation to the vitreous condition. At initial examination, 18 eyes (40%) showed vitreous separation from the fovea, and 10 (22%) developed vitreous separation during follow-up. None of these 28 eyes progressed to a fully developed macular hole during follow-up. Moreover, the macular disease was apparently improved in 23 (82%) of these eyes. However, of the remaining 27 eyes without vitreous separation from the fovea, 10 eyes (37%) progressed to a fully developed macular hole. We speculate that early-stage macular hole could be reversed by spontaneous vitreous separation from the fovea, and this chance may be greater than the risk of true macular hole formation.

Aged↗
PubMed1990

Posterior vitreous detachment following panretinal laser photocoagulation.

A total of 30 eyes of 19 patients with type I diabetes, varying severity of retinopathy, and no posterior vitreous detachment (PVD) were studied clinically, and vitreous examination was performed by preset lens biomicroscopy. Follow-up was 4.0-7.5 years. A total of 15 eyes underwent panretinal laser photocoagulation (PRP) and 15 eyes were left untreated. The incidence of PVD was 8 of 15 353%) after PRP and 1 of 15 (7%) in untreated eyes (P less than 0.02). Minimal vitreous hemorrhage occurred in 4 of 7 treated eyes (57%) that did not develop PVD and in only 2 of 8 (25%) that did. In treated eyes with no history of vitreous hemorrhage, the incidence of PVD was 6/9 (67%); in treated eyes with minimal vitreous hemorrhage at any time, it was 2/6 (33%). In treated eyes, the presence of Diabetic Retinopathy Study (DRS) high-risk characteristics was equally frequent in eyes that developed PVD as in those that did not. These data suggest that PVD occurs following PRP, independent of the severity of diabetic retinopathy or prior vitreous hemorrhage.

Adult↗
PubMed1990

Role of posterior vitreous detachment in idiopathic macular holes.

The role of posterior vitreous detachment in the formation of idiopathic macular hole was evaluated in 310 eyes. The eyes were classified according to the stage of the initial macular pathology: group 1, macular cyst; group 2, early macular hole; and group 3, fully developed macular hole. The initial prevalence of posterior vitreous detachment was 0% (none of 15 eyes) in group 1, 6% (three of 50 eyes) in group 2, and 27% (67 of 245 eyes) in group 3. During the study, all 15 eyes in group 1 and all 43 eyes in group 2 for which data were obtained progressed to fully developed macular holes without the occurrence of posterior vitreous detachment. The findings strongly suggested that most idiopathic macular holes develop in the absence of posterior vitreous detachment and that the pathogenesis of the holes may be independent of the occurrence of posterior vitreous detachment.

Aged↗
PubMed1990

Posterior vitreous detachment and neovascularization in diabetic retinopathy.

The authors evaluated the effect of posterior vitreous detachment (PVD) in 172 eyes (114 patients) with nonproliferative diabetic retinopathy on the development of retinal or optic disc neovascularization. Patients were followed for more than 6 months after the initial vitreous examination (mean, 32 months). None of the patients 39 years of age or younger had PVD, but this condition became more prevalent thereafter with age. In 124 eyes of patients 40 years of age or older, neovascularization developed eventually in 20 (22%) of 93 eyes without PVD but in only 1 (3%) of 29 eyes with complete PVD (P less than 0.05). A vitreous examination was invaluable in predicting the development of retinal or optic disc neovascularization in diabetic patients 40 years of age or older.

Adolescent↗
PubMed1990

Vitreous changes and macular edema in central retinal vein occlusion.

The condition of the posterior vitreous was determined in 56 eyes with central retinal vein occlusion (CRVO). Using a life-table analysis, it was studied in 56 eyes. The incidence of posterior vitreous detachment (PVD) in the CRVO eyes at the first vitreous examination did not differ significantly from that in 64 age-matched control eyes. However, the incidence of PVD in CRVO eyes increased from 39.3% at the first vitreous examination to 58.5% after 6 months, and to 69.6% 1 year from the examination. The incidence of PVD in CRVO eyes during follow-up was statistically higher than that of the controls (P = .009). The incidence of PVD after the first vitreous examination was significantly higher in eyes with hemorrhagic retinopathy than in eyes with venous stasis retinopathy (P = .04). In the 34 eyes with macular edema, the edema lasted significantly longer in those with vitreomacular attachment (VMA) at the first examination than in those without VMA at this time (P = .02). VMA may play an important role in the pathogenesis and chronicity of macular edema in CRVO.

Adult↗
PubMed1989

Subretinal hemorrhage in atrophic age-related macular degeneration.

In eight eyes of eight patients we retrospectively studied the outcome of subretinal hemorrhage occurring in areas of atrophy of retinal pigment epithelium and choriocapillaris secondary to age-related macular degeneration. These patients were followed up for one to 20 months after the initial appearance of the hemorrhage. No subretinal new vessels were associated with these hemorrhages, which resolved over one to 15 months. Our findings indicated that hemorrhages occurring within areas of atrophy are not necessarily associated with subretinal new vessels, and that this type of hemorrhage has a good prognosis for resolution.

Age Factors↗
PubMed1989

Importance of the vitreous in young diabetics with macular edema.

The authors assessed retrospectively the clinical records of 80 patients (137 eyes) with diabetic retinopathy who were 50 years of age or younger and who had undergone a vitreous examination. The group comprised 53 patients (91 eyes) with macular edema and 27 patients (46 eyes) without macular edema. Vitreous studies using the El Bayadi-Kajiura lens determined whether the posterior vitreous was attached to the retina in the macula. Forty (42.1%) of 91 eyes in the edema group and none (0%) of the 46 eyes in the nonedema group had a detached posterior vitreous. This difference was statistically significant, indicating that young diabetic patients with macular edema have a significantly higher rate of posterior vitreous detachment than those without macular edema.

Adolescent↗
PubMed1989

Differences in contributory factors among hemicentral, central, and branch retinal vein occlusions.

Hemicentral retinal vein occlusion (HRVO) is an anatomic variant of central retinal vein occlusion (CRVO) and thus different from branch retinal vein occlusion (BRVO). Therefore, the risk factors for HRVO should be similar to those of CRVO and different from those of BRVO. To test this, the authors compared 15 demographic and clinical variables of 28 HRVO patients with those of 117 CRVO and 214 BRVO patients. Mean age of onset and sex ratio were not significantly different among the groups. Elevated erythrocyte sedimentation rate (ESR) (P = 0.019) and elevated intraocular pressure (IOP) (P = 0.025) were significantly more prevalent in the HRVO than the BRVO group. In addition, when the authors compared CRVO with BRVO, elevated ESR (P = 0.003), elevated IOP (P = 0.015), and positive purified protein derivative (PPD) (P = 0.003) were significantly more prevalent in the CRVO than the BRVO group, whereas hypertension (P = 0.03) and hyperopia (P = 0.008) were significantly more prevalent in the BRVO group. However, of the variables tested between HRVO and CRVO patients, no significant differences were found.

Adult↗
PubMed1989

Argon green laser treatment of peripapillary choroidal neovascular membranes.

Of 27 eyes with peripapillary choroidal neovascular membranes (PPCNM), 17 (63%) had age-related macular degeneration and ten (37%) were idiopathic. PPCNM were treated in 25 eyes using the monochromatic green argon laser. Two eyes were untreatable. After an average follow-up of 37.7 months, successful closure of the choroidal new vessels was obtained in 23 eyes (92%), and visual acuity was stabilized or improved in 20 (80%). Seven eyes (28%) had recurrences; in four, the new vessels extended into the macula. Post-treatment, three eyes ultimately had dry macular scars, and one had an exudative macular scar. Of these four eyes, only the one with a dry macular scar showed visual improvement. No treated cases showed arcuate scotoma.

Age Factors↗