Biomedical subjects

Daniel F Martin

Publications and source records attributed to Daniel F Martin.

14 recordsLinked to original sources

PubMed2005

Three cases of large retinal capillary hemangiomas treated with verteporfin and photodynamic therapy.

OBJECTIVE: To investigate the efficacy of verteporfin and photodynamic therapy in the treatment of large retinal capillary hemangiomas. METHODS: Case reports of 3 patients with large retinal capillary hemangiomas treated with photodynamic therapy using verteporfin. Standard verteporfin dosages (6 mg/m(2) of body surface area) were given. Both standard and modified photodynamic protocols were followed. Modified protocols included shorter verteporfin infusion times and longer light exposure times. RESULTS: Pretreatment best-corrected Snellen visual acuity of the 3 affected eyes were 20/100, 20/50, and 2/200, respectively. All cases had associated exudative retinal detachments involving the macula. Cases 1 and 2 were classic endophytic retinal capillary hemangiomas. Case 3 was a reactive retinal capillary hemangioma. Case 1 had 2 photodynamic therapy treatments, and after 8 months, visual acuity improved to 20/40. Two years after initiating photodynamic therapy, the visual acuity was 20/30 and there was no reperfusion of the hemangioma. Case 2 had 3 photodynamic therapy treatments. The hemangioma was fibrotic, and 20 months after initiating photodynamic therapy visual acuity improved to 20/30. Case 3 had 1 treatment, 11 weeks later and visual acuity improved to 20/400. Four months after treatment, visual acuity returned to counting fingers because of tractional elevation of the macula as the capillary hemangioma fibrosed. Vitrectomy surgery was performed, and choroidal and retinal neovascularization was discovered. Three months after vitrectomy visual acuity was 20/400. In cases 1 and 2, the capillary hemangioma ultimately regressed, and the exudative detachment resolved. CONCLUSIONS: Verteporfin and photodynamic therapy were effective in achieving closure of large retinal capillary hemangiomas. In all cases, the hemangioma underwent fibrosis with consequent macular puckering due to retinal traction. In all cases, the visual acuity improved.

Adolescent↗

PubMed2005

Pathological findings in eyes with the ganciclovir implant.

OBJECTIVE: To examine the pathologic findings of eyes treated with ganciclovir implants. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Thirty-three eyes from 19 AIDS patients with ganciclovir implants. METHODS: Pathologic specimens collected from 1993 through 1999 at the National Eye Institute were reviewed. Thirty-three eyes from 19 patients were identified with ganciclovir implants. The submitted eyes then were sectioned through the implant site and stained with hematoxylin and eosin, periodic acid-Schiff, and other special stains when needed. Medical records, including operative and postoperative notes, were reviewed carefully. MAIN OUTCOME MEASURE: Light microscopic findings at and around the site of implantation. RESULTS: Scars of surgical perforation were present in all eyes. Fibrous ingrowth developed from the implant site into the vitreous in 32 of the 33 eyes. Vitreous hemorrhage was present in 18 of the 33 eyes. Poor wound apposition was found in 2 of the 33 eyes, both of which had undergone multiple procedures. Foreign body giant cell reactions were observed in most of the eyes related to suture material. Thirty-two of the 37 implant sites were located within the pars plana, whereas the other 5 were either on the border of the pars plana and pars plicata (n = 4) or within the pars plicata (n = 1). Hyalinization, atrophic changes of the ciliary body in the area of implantation, or both were observed in 18 eyes. CONCLUSIONS: The ganciclovir implant is well tolerated within the eye. Fibrous ingrowth is present in most eyes and seems to be a benign occurrence because of its limited extension. Microscopic vitreous hemorrhage is present in many eyes, especially those that underwent multiple procedures. Poor wound apposition occurred rarely and was found only in eyes that had undergone multiple procedures.

AIDS-Related Opportunistic Infections↗

PubMed2005

Pegaptanib sodium.

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Aptamers, Nucleotide↗

PubMed2004

Emergence of drug-resistant cytomegalovirus retinitis in the contralateral eyes of patients with AIDS treated with ganciclovir.

The purpose of the present study was to examine the emergence of ganciclovir-resistant virus in the contralateral eyes of patients who received treatment for cytomegalovirus retinitis with either a ganciclovir implant plus oral placebo, a ganciclovir implant plus oral ganciclovir, or intravenous (iv) ganciclovir. Viral DNA was amplified from vitreous specimens and was assayed for UL97 and UL54 resistance mutations. Resistant viral genotypes were found in the contralateral eyes of 0 of 28 patients treated with a ganciclovir implant plus oral placebo, in 5 of 23 patients treated with a ganciclovir implant plus oral ganciclovir, and in 1 of 6 patients treated with iv ganciclovir. All resistance mutations were in codons 591, 592, or 594 of the UL97 gene. Treatment of unilateral cytomegalovirus retinitis with systemic ganciclovir decreases the risk of development of secondary sites of infection, but, in contralateral eyes that develop retinitis, this approach to treatment is associated with a higher prevalence of drug resistance, compared with treatment with the ganciclovir implant alone (P=.023; Fisher's exact test).

AIDS-Related Opportunistic Infections↗

PubMed2004

Hypopyon uveitis and relapsing polychondritis: a report of 2 patients and review of autoimmune hypopyon uveitis.

OBJECTIVE: To report hypopyon uveitis as an ophthalmic finding associated with relapsing polychondritis. DESIGN: Interventional case reports. PARTICIPANTS: Two patients with hypopyon uveitis as a manifestation of relapsing polychondritis. METHODS: Complete ocular and systemic examinations as well as chart reviews were performed for 2 patients with hypopyon uveitis as a manifestation of relapsing polychondritis at presentation. MAIN OUTCOME MEASUREMENTS: Clinical observation and response to treatment in 2 patients with hypopyon uveitis secondary to relapsing polychondritis. RESULTS: A 70-year-old white male had unilateral hypopyon uveitis accompanied by a migratory polyarthralgia at presentation. Fifteen months later, he sought treatment for chondritis of the right auricle and was diagnosed with relapsing polychondritis. A 42-year-old white female with known relapsing polychondritis had bilateral hypopyon uveitis at presentation during a systemic relapse. Both patients had resolution of the hypopyon with topical and systemic steroids. CONCLUSIONS: Relapsing polychondritis should be considered in the differential diagnosis of sterile hypopyon uveitis. Steroids and systemic immunosuppression can be used to treat the uveitis.

Adult↗

PubMed2004

Primary intraocular lymphoma: clinical, cytologic, and flow cytometric analysis.

PURPOSE: To compare cytologic with flow cytometric results of vitreous biopsy specimens obtained to rule out primary intraocular lymphoma (PIOL). STUDY DESIGN: Prospective noncomparative case series. PARTICIPANTS: Patients suspected of having PIOL who underwent vitreous biopsy were evaluated. METHODS: Patients underwent a standard 3-port vitrectomy and vitreous biopsy to rule out PIOL. Each undiluted specimen was split, and half was prepared for cytologic evaluation with the collodion bag method; the other half was submitted for flow cytometric immunophenotyping (FCI). The diluted specimen was processed as a cell block for cytology. MAIN OUTCOME MEASURES: Final diagnosis based on cytology and FCI. RESULTS: Ten of 14 patients had sufficient specimens for both cytologic and FCI evaluation. Three patients had chronic inflammation confirmed by both methods. Six patients had large cell lymphoma identified by both cytology and FCI. Two of those 6 patients initially had insufficient specimen for FCI. One patient had large cell lymphoma diagnosed cytologically that was initially negative for a clonal population by FCI. All lymphomas were B-cell type. CONCLUSIONS: Cytologic evaluation is an accurate diagnostic technique to evaluate for PIOL. FCI is useful for immunophenotyping PIOL. Multiple biopsies may be required to achieve a diagnosis.

Adult↗

PubMed2004

Complications of ganciclovir implant surgery in patients with cytomegalovirus retinitis: the Ganciclovir Cidofovir Cytomegalovirus Retinitis Trial.

PURPOSE: To describe the complications of ganciclovir implant surgery in patients with cytomegalovirus retinitis. METHODS: Prospective data collection within the context of a randomized, controlled clinical trial, comparing a regimen of the ganciclovir implant plus oral ganciclovir to one of intravenous cidofovir for the treatment of cytomegalovirus retinitis in patients with AIDS. Adverse events were compared for patients undergoing implant surgery in the following groups: primary versus replacement implant surgery, inpatient versus outpatient surgery, and general versus local anesthesia. RESULTS: Fifty-six eyes of 42 patients underwent a total of 74 ganciclovir implant surgeries. Vitreous hemorrhage was the most common adverse event, occurring in 10% of eyes undergoing surgery with local anesthesia but in no eyes undergoing surgery with general anesthesia. All vitreous hemorrhages resolved within 60 days. Patients in the general anesthesia and inpatient surgery groups tended to have a lower risk of complications in the first 30 days than did patients in the local anesthesia and outpatient surgery groups, but no differences in the complication rate were found after 60 days. Visual acuity was similar among these different groups. There were no cases of endophthalmitis. CONCLUSION: Ganciclovir implant surgery in patients with AIDS and cytomegalovirus retinitis was associated with a low risk of serious complications in the first 60 days after surgery. Vitreous hemorrhage was the most commonly observed complication and resolved in all cases.

AIDS-Related Opportunistic Infections↗

PubMed2003

Genotypic analysis of cytomegalovirus retinitis poorly responsive to intravenous ganciclovir but responsive to the ganciclovir implant.

PURPOSE: To determine whether cytomegalovirus (CMV) retinitis that responded poorly to intravenous ganciclovir therapy but responded to the ganciclovir implant was caused by virus with resistance mutations in the viral UL97 and UL54 genes. DESIGN: Retrospective chart review and laboratory-based experimental study. METHODS: Regions of the CMV UL97 and UL54 were amplified from the vitreous and analyzed for resistant mutations by a combination of DNA sequencing and restriction digestion. Vitreous from patients with AIDS and retinal infections other than CMV retinitis served as negative controls. RESULTS: We amplified all target regions of UL97 DNA and most target regions of UL54 DNA from eight eyes with CMV retinitis. In one eye we found a ganciclovir resistance mutation at base 1781 of the UL97 gene, predicting an alanine to valine mutation at codon 594. In a second eye we found a ganciclovir resistance mutation at base 2960 of the UL54 gene, predicting an alanine to glycine mutation at codon 987. In two additional eyes, both from patients with bilateral retinitis, we found UL54 mutations that are likely to confer resistance to ganciclovir but have not been previously described. In both of these patients the UL54 genotype differed between the two diseased eyes. CONCLUSIONS: Failure to control CMV retinitis with intravenous ganciclovir does not necessarily imply infection with a virus having a known mutation that confers drug resistance. The ganciclovir implant can be an effective therapy for CMV retinitis caused by virus with certain UL97 and UL54 resistance mutations. Cytomegalovirus UL54 genotypes can differ between eyes in patients with bilateral retinitis.

AIDS-Related Opportunistic Infections↗

PubMed2003

Endophthalmitis after ganciclovir implant in patients with AIDS and cytomegalovirus retinitis.

PURPOSE: To describe the incidence, clinical course, and outcomes of endophthalmitis in patients treated with a ganciclovir implant. DESIGN: Retrospective review of cases identified from a clinical survey. METHODS: Cases of endophthalmitis were identified from a survey of 30 clinical practices known to treat a large number of patients with cytomegalovirus retinitis. RESULTS: Twenty-four cases of endophthalmitis were identified from 5185 implants performed (incidence, 0.46%). Final visual acuity ranged from 20/20 to no light perception, with 50% (12/24) seeing light perception or worse. Vitreous cultures revealed Staphylococcus epidermidis in 29% (7/24) of patients, whereas other gram-positive organisms were responsible in 42% (10/24) of cases. In the remaining 29% (7/24) of cases, no organisms were cultured; these cases exhibited a better visual outcome (P =.007). Six of the eight late-onset cases were associated with wound problems such as implant strut or suture exposure. There was no significant relationship between implant removal and final visual acuity. CONCLUSIONS: Endophthalmitis is an infrequent but potentially devastating complication associated with placement of a ganciclovir implant.

AIDS-Related Opportunistic Infections↗

PubMed2003

Magnetic resonance imaging abnormalities in cat-scratch disease encephalopathy.

A 23-year-old woman who presented with a branch retinal artery occlusion followed by encephalopathy showed, by brain magnetic resonance imaging, a nonenhancing lesion in the right parietal gray matter with normal diffusion-weighted imaging. Of 64 reported cases of cat-scratch encephalopathy with documented neuroimaging findings, only 12 (18.8%) have had abnormal imaging findings. The abnormalities have included cerebral white matter lesions, basal ganglia and thalamic lesions, and multifocal lesions in immunocompromised patients, but no gray matter lesions similar to those in this patient. The variety of neuroimaging findings supports multiple pathophysiologic mechanisms of central nervous system involvement in this disorder.

Adult↗

PubMed2002

A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis.

BACKGROUND: Valganciclovir is an orally administered prodrug that is rapidly hydrolyzed to ganciclovir. We compared the effects of oral valganciclovir with those of intravenous ganciclovir as induction therapy for newly diagnosed cytomegalovirus retinitis in 160 patients with the acquired immunodeficiency syndrome (AIDS). METHODS: The primary end point was photographically determined progression of cytomegalovirus retinitis within four weeks after the initiation of treatment. Secondary end points included the achievement of a prospectively defined satisfactory response to induction therapy and the time to progression of cytomegalovirus retinitis. After four weeks, all patients received valganciclovir as maintenance therapy. RESULTS: Eighty patients were randomly assigned to each treatment group. Of the patients who could be evaluated, 7 of 70 assigned to intravenous ganciclovir (10.0 percent) and 7 of 71 assigned to oral valganciclovir (9.9 percent) had progression of cytomegalovirus retinitis during the first four weeks (difference in proportions, 0.1 percentage point; 95 percent confidence interval, -9.7 to 10.0). Forty-seven of 61 patients (77.0 percent) assigned to intravenous ganciclovir and 46 of 64 (71.9 percent) assigned to valganciclovir had a satisfactory response to induction therapy (difference in proportions, 5.2 percentage points; 95 percent confidence interval, -20.4 to 10.1). The median times to progression of retinitis were 125 days in the group assigned to intravenous ganciclovir and 160 days in the group assigned to oral valganciclovir. The mean values for the area under the curve for the ganciclovir dosage interval were similar at both induction doses and maintenance doses. The frequency and severity of adverse events were similar in the two treatment groups. CONCLUSIONS: Orally administered valganciclovir appears to be as effective as intravenous ganciclovir for induction treatment and is convenient and effective for the long-term management of cytomegalovirus retinitis in patients with AIDS.

AIDS-Related Opportunistic Infections↗

PubMed2002

Effects of enzymatic sterilization detergents on the corneal endothelium.

OBJECTIVE: To evaluate the potential of enzymatic detergents to cause endothelial damage and anterior segment inflammation. METHODS: Paired rabbit corneas were mounted in an in vitro specular microscope. Endothelia were perfused either with the sterile irrigating solution BSS Plus (Alcon Laboratories Inc, Ft Worth, Tex) (control) or 0.1%, 0.4%, or 1.0% Medline Enzymatic Detergent (Medline Industries Inc, Mundelein, Ill) in BSS Plus. Swelling rates were determined by regression analysis. Human endothelia were perfused using 1.56% detergent. All corneas were fixed for scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Endothelial permeability was determined following perfusion of 0.78% detergent. Finally, in vivo intracameral injections with 1.56% or 3.9% detergent were performed to evaluate clinical changes and to correlate with histopathologic analysis. RESULTS: Dose-related corneal swelling rates were observed. Digital specular micrographs revealed greater endothelial cell damage when perfused with 1.0% detergent. The TEM of endothelia exposed to 1.0% solutions demonstrated abnormal vacuolization and dilated extracellular spaces, which manifested as an increased corneal permeability to 3 to 4 times that of controls. Human corneas swelled comparably to rabbit corneas but demonstrated increased sensitivity when evaluated by TEM and SEM. Histopathologic analysis after intracameral injection revealed thickened corneas with fewer endothelial cells and irises with increased inflammatory and fibrinous responses compared with controls. CONCLUSIONS: Medline Enzymatic Detergent causes a dose-dependent corneal swelling, ultrastructural damage, increased corneal permeability, and increased inflammatory response in the iris after intracameral injection. CLINICAL RELEVANCE: Failure to adequately rinse the detergent from surgical instruments may result in corneal edema and intraocular inflammation.

Animals↗

PubMed2002

Retinal pigment epithelial changes after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling.

PURPOSE: To report the results of macular hole surgery using indocyanine green to improve visualization and facilitate peeling of the internal limiting membrane. METHODS: A retrospective noncomparative review of a consecutive series of 22 patients (22 eyes) who underwent macular hole repair using indocyanine green to facilitate visualization of the internal limiting membrane was performed. One patient was excluded because of a history of a rhegmatogenous retinal detachment. All patients underwent a three-port pars plana vitrectomy with internal limiting membrane peeling. Indocyanine green (0.1% solution) was used to assist in the visualization of the internal limiting membrane. The main outcome measures were postoperative visual acuity, macular hole status, and postoperative retinal pigment epithelial changes. RESULTS: In 21 eyes, the median preoperative best-corrected visual acuity was 20/200 (range, 20/60 to counting fingers at 5 feet). The median postoperative visual acuity was 20/400 (range, 20/60-1/200) with an average follow-up of 13 weeks. The macular hole was closed in 18 eyes (86%) at the most recent follow-up. Ten eyes were found to have atrophic retinal pigment epithelium changes in the area of the previous macular hole. CONCLUSIONS: Indocyanine green assists in visualization of the internal limiting membrane in macular hole surgery. In our series, 10 eyes had unusual atrophic changes in the retinal pigment epithelium at the site of the previous macular hole, or in the area where the indocyanine green solution would have had direct access to the bare retinal pigment epithelium cells. Although the use of indocyanine green improves visualization and assists with peeling of the internal limiting membrane, the safety and potential toxicity of indocyanine green to the retinal pigment epithelium require further investigation.

Aged↗

PubMed2002

Anterior chamber infiltrates associated with systemic lymphoma: report of two cases and review of the literature.

PURPOSE: To describe the clinicopathologic features of two patients with systemic lymphoma who developed anterior chamber (AC) infiltrates of lymphoma cells. DESIGN: Two case reports and literature review. METHODS: The clinical and pathologic findings in two patients with AC infiltrates secondary to systemic B-cell lymphoma are reviewed. MAIN OUTCOME MEASUREMENTS: Clinical observation and cytologic/flow cytometric examination of the infiltrate after AC aspiration. RESULTS: One patient presented with uveal infiltration, an exudative retinal detachment and an AC infiltrate. Systemic evaluation revealed a follicular lymphoma involving several groups of lymph nodes. The second patient with a known history of abdominal lymphoma was found to have blurred vision, photophobia and an AC infiltrate. Flow cytometric analysis of the AC infiltrate in both patients showed phenotypes consistent with the patients' systemic lymphomas. CONCLUSIONS: A pseudohypopyon in an adult may represent either the initial manifestation or a later complication of systemic lymphoma, similar to what has been reported in acute leukemia.

Abdominal Neoplasms↗