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Biomedical subjects

D M Fastenberg

Publications and source records attributed to D M Fastenberg.

8 recordsLinked to original sources

Management of dislocated nuclear fragments after phacoemulsification.

We examined 13 patients referred for management of dislocated lens fragments after phacoemulsification. Ocular findings included corneal decompensation, glaucoma, inflammation, and retinal tears and detachments. Eleven of the 13 patients underwent vitrectomy with removal of lens fragments. Surgical indications included the presence of large lens fragments, uncontrolled glaucoma, persistent and severe inflammation, and retinal detachment. Better visual acuity was observed in patients who had smaller lens fragments or when vitrectomy was delayed to allow medical treatment of intraocular inflammation and glaucoma. The results indicate that nucleus dislocation during phacoemulsification is an important visual complication, with seven of the 13 patients having a final visual acuity of 20/80 or less.

Adrenal Cortex Hormones

Vitrectomy retinotomy aspiration biopsy of choroidal tumors.

We used an investigational technique for the biopsy of intraocular tumors to aid in the diagnosis of three choroidal tumors. A three-port trans-pars plana vitrectomy was performed in conjunction with retinotomy, tumor biopsy, endophotocoagulation, and air-fluid exchange. Vitrectomy was used to decrease the amount of traction secondary to retained vitreous after intraocular surgery. Retinotomy sites were chosen under microscopic control to avoid large caliber retinal vessels. Then a modified tumor-aspiration technique, together with endophotocoagulation and aspiration of intraoperative vitreous hemorrhages, provided an opportunity to sample tumor tissue continually at varied depths. We have added standard vitreous surgery concepts, techniques, and instrumentation to produce vitrectomy retinotomy aspiration biopsy of choroidal tumors.

Adenocarcinoma

Intraocular radiation blocking.

Iodine-based liquid radiographic contrast agents were placed in normal and tumor-bearing (Greene strain) rabbit eyes to evaluate their ability to block iodine-125 radiation. This experiment required the procedures of tumor implantation, vitrectomy, air-fluid exchange, and 125I plaque and thermoluminescent dosimetry (TLD) chip implantation. The authors quantified the amount of radiation attenuation provided by intraocularly placed contrast agents with in vivo dosimetry. After intraocular insertion of a blocking agent or sham blocker (saline) insertion, episcleral 125I plaques were placed across the eye from episcleral TLD dosimeters. This showed that radiation attenuation occurred after blocker insertion compared with the saline controls. Then computed tomographic imaging techniques were used to describe the relatively rapid transit time of the aqueous-based iohexol compared with the slow transit time of the oil-like iophendylate. Lastly, seven nontumor-bearing eyes were primarily examined for blocking agent-related ocular toxicity. Although it was noted that iophendylate induced intraocular inflammation and retinal degeneration, all iohexol-treated eyes were similar to the control eyes at 7 and 31 days of follow-up. Although our study suggests that intraocular radiopaque materials can be used to shield normal ocular structures during 125I plaque irradiation, a mechanism to keep these materials from exiting the eye must be devised before clinical application.

Animals

Management of macular puckers associated with retinal angiomas.

Monocular visual loss in four patients was caused by epiretinal macular membranes associated with peripheral retinal capillary angiomas or angioma-like lesions. Three patients had solitary vascular lesions and one had two discrete vascular lesions. All patients were in good health, with no evidence of the von Hippel-Lindau syndrome. In three patients, spontaneous peeling of the macular membranes and visual improvement occurred 2 to 6 months after obliteration of the angioma-like lesions with cryotherapy (two patients), or cryotherapy combined with argon laser (one patient). The fourth patient underwent a vitrectomy 8 months after the macular pucker had failed to respond to treatment of the vascular lesion.

Adolescent

Peripheral retinal neovascularization in birdshot retinochoroidopathy.

A 69-year-old black woman had ocular findings consistent with birdshot retinochoroidopathy; these included cream-colored depigmented spots at the level of the retinal pigment epithelium and vitreitis. She also had peripheral retinal neovascularization with localized vitreous hemorrhage. There were no laboratory or systemic findings consistent with other disease entities.

Aged

Bacillus Calmette-Guerin (BCG) endophthalmitis.

A patient who had been treated for metastatic bladder carcinoma with bacillus Calmette-Guerin (BCG) vaccine subsequently developed bilateral visual loss secondary to an infiltrative retinitis and vitreitis. Although assumed to have candida endophthalmitis, vitrectomy demonstrated mycobacterium bovis. The patient was placed on systemic anti-tuberculous therapy, and there was noted to be a reduction in retinal lesions prior to his death. This is the first report in the literature documenting endogenous endophthalmitis after BCG usage.

Aged

Macular pucker and retinal angioma.

A 44-year-old white female had a macular pucker associated with a peripheral retinal capillary angioma. Following successful destruction of the angioma with cryotherapy, the macular pucker regressed and visual acuity returned to normal. This is the first report documenting the regression of a macular pucker following successful treatment of a peripheral retinal angioma.

Adult