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Biomedical subjects

Dov Weinberger

Publications and source records attributed to Dov Weinberger.

At least 19 recordsLinked to original sources
PubMed2007

Pneumatic displacement of submacular hemorrhage due to age-related macular degeneration.

PURPOSE: Subretinal hemorrhage is one of the most serious complications of exudative age-related macular degeneration (AMD). Treatment with vitreous surgery with or without plasminogen activator, fluid-gas exchange, or perfluorocarbon yields only a small improvement in visual acuity. PATIENTS AND METHODS: The files of 24 patients with submacular hemorrhage secondary to AMD who were treated by injection of perfluoropropane gas (C(3)F(8)) (11 patients) or sulfur hexafluoride (SF(6)) (13 patients) were reviewed for visual acuity before and after the procedure and time of treatment from onset of symptoms. RESULTS: For the whole sample, pneumatic displacement led to a statistically significant improvement in mean visual acuity (p = 0.015). A significant difference between pre- and postoperative visual acuity was found for the patients treated with SF(6) (p = 0.034), but not for the patients treated with C(3)F(8) (p = 0.245). CONCLUSION: The use of gas injection to displace submacular hemorrhage can significantly improve visual acuity.

Aged↗
PubMed2006

Intravitreal voriconazole for the treatment of endogenous Aspergillus endophthalmitis.

OBJECTIVE: To describe the first use of intravitreal voriconazole in a human eye for the treatment of Aspergillus endophthalmitis. DESIGN: Interventional case report. PATIENT: A 22-year-old woman receiving immunosuppressive agents 5 weeks after lung transplantation who presented with blurred vision and redness in the right eye. INTERVENTIONS: Intravitreal injection of voriconazole (100 microg/0.1 ml) with pars plana vitrectomy, given after isolation of A. terreus in the vitreous sample. Previous treatment modalities, including vitrectomy with repeated intravitreal amphotericin B and systemic voriconazole, failed to prevent deterioration. MAIN OUTCOME MEASURES: Visual acuity (VA) and ocular inflammation. RESULTS: Significant improvement was observed in VA (to 6/15) and in ocular inflammatory reaction. The patient recovered with no evidence of systemic fungal infection. CONCLUSION: Intravitreal voriconazole may be used as an adjunct to systemic treatment in patients with Aspergillus endophthalmitis. Further clinical studies are needed to determine how often this approach can safely treat this condition.

Adult↗
PubMed2006

Insulinlike growth factor I affects ocular development: a study of untreated and treated patients with Laron syndrome.

OBJECTIVE: To evaluate the ocular dimensions in patients with primary growth hormone receptor insensitivity (Laron syndrome [LS]) and to study the effect of supplemental insulinlike growth factor I (IGF-I) on ocular growth. DESIGN: Retrospective case series. PARTICIPANTS: Twelve patients with LS, 8 untreated (LS group) and 4 treated (LS-T group) with supplemental IGF-I, and 30 healthy controls. METHODS: Ocular dimensions and refraction were measured, and a full ophthalmologic examination was performed. MAIN OUTCOME MEASURES: Differences in the average ocular dimension data among IGF-I-treated patients, untreated ones, and controls. RESULTS: The average axial length of eyes in the LS group was 21.94 mm (standard deviation [SD], 0.81). Corresponding values for the LS-T and control group eyes were 22.53 mm (SD, 1.74) and 23.20 mm (SD, 1.35) respectively. The average anterior chamber depth of eyes in the LS group was 2.55 mm (SD, 0.26). Corresponding values for eyes in the LS-T and control groups were 3.48 mm (SD, 0.09) and 3.84 mm (SD, 0.16) respectively. The average lens thickness of eyes in the LS group was 4.56 mm (SD, 0.36). Corresponding values for the LS-T and control groups were 3.77 mm (SD, 0.23) and 3.51 mm (SD, 0.25), respectively. The average corneal curvature of eyes in the LS group was 46.9 diopters (D) (SD, 2.32). Corresponding values for the LS-T and control groups were 47.6 D (SD, 2.83) and 44.4 D (SD, 1.5), respectively. CONCLUSIONS: Insulinlike growth factor I seems to be an important regulator of ocular growth as documented in patients with primary growth hormone insensitivity. The mechanism of this observation should be investigated further.

Adolescent↗
PubMed2006

Fibrin glue as a suture substitute: histological evaluation of trabeculectomy in rabbit eyes.

PURPOSE: To describe the outcome of the use of fibrin adhesive (Quixil) in penetrating trabeculectomy in a rabbit model. METHODS: Fibrin adhesive was used experimentally to attach the conjunctiva and the scleral flap in two groups of 17 New Zealand albino adult rabbits (34 eyes). In the first experiment (20 eyes), the fibrin adhesive was used to reattach the tissue after conjunctival peritomy and scleral flap only in 14 eyes (experiment I). In 6 eyes (controls), the conjunctiva was attached with nylon sutures. In the second experiment (14 eyes), the fibrin adhesive was used after conjunctival peritomy, scleral flap, and penetrating trabeculectomy in 8 eyes (experiment II). In a control group of 6 eyes, nylon sutures were used to attach the scleral flap and the conjunctiva after penetrating trabeculectomy. Biomicroscopy and histopathological examinations were performed on postoperative days 1, 3, 7, 14, 21, and 30. Intraocular pressure was measured before and after surgery in the second experiment. Main outcome measures are histological presence of adhesive in the tissue, degree of capillary congestion, inflammatory reaction, collagen density [scar formation] and clinical (IOP measurements before and after surgery, conjunctival chemosis, anterior chamber reaction, presence of filtering bleb and wound leakage). RESULTS: In experiments I and II, the adhesive was well identified histologically in the tissue as an amorphic eosinophilic substance for up to day 3 and nearly disappeared by day 7. An acute inflammatory reaction was noted for up to 14 days, which converted to chronic inflammation with collagen deposits and scar formation by day 30. Similar inflammatory reaction was observed in the control group. The adhesive had no adverse effects on ocular tissue compared with sutures. One eye in experiment II demonstrated wound dehiscence. Intraocular pressure dropped from 17.35 mmHg preoperatively to 8.28 mmHg on postoperative day 1 in experiment II, and from 17.2 mmHg to 11.5 mmHg in the controls. No significant change in intraocular pressure was noted in experiment I. CONCLUSIONS: The fibrin adhesive had no adverse effects on ocular tissue compared with sutures. It might serve as an effective substitute for conjunctival and scleral wound closure in trabeculectomy surgery.

Animals↗
PubMed2006

Pterygium surgery: fibrin glue versus Vicryl sutures for conjunctival closure.

PURPOSE: To compare the short-term results of conjunctival closure in pterygium surgery using fibrin adhesive versus Vicryl sutures with respect to operative time, postoperative ocular signs and symptoms, and overall patient satisfaction. METHODS: A comparative prospective randomized clinical trial was performed in 65 patients (65 eyes) with primary nasal pterygium. Surgery in all patients consisted of the bare sclera technique combined with intraoperative mitomycin C. Patients were randomized to undergo conjunctival closure with a fibrin tissue adhesive (Quixil; n = 39) or 8-0 Vicryl absorbable interrupted sutures (n = 26). Clinical assessment was performed on days 1, 3, 10, and 21 after surgery. Patients completed a questionnaire at each follow-up visit, grading pain, discomfort, and satisfaction with the procedure. The groups were compared for operative time, ocular signs and symptoms, and overall satisfaction. RESULTS: Average operative time was 16 minutes (range, 14-16 minutes) in the fibrin glue group and 20 minutes (range, 20-29 minutes) in the Vicryl suture group (P < 0.05). Significantly less pain, photophobia, foreign body sensation, irritation, epiphora, itching, local hyperemia, conjunctival chemosis, and dry eye were noted in the subjects treated with glue than in controls (P < 0.05). There were no complications during the 3-week follow-up period in the glue-treated patients. One of the patients in the suture group had a medically treatable corneal delle. CONCLUSION: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient symptoms, pain, and discomfort. A longer follow-up is needed to evaluate the influence of fibrin glue on rate of recurrence and long-term complications.

Adult↗
PubMed2006

[Goblet cell distribution and epithelial cell morphology in pterygium].

BACKGROUND: Studies conducted to date on the distribution density of goblet cells and epithelial cell morphology in pterygium have yielded contradictory findings. OBJECTIVE: To evaluate the density of goblet cells in pterygium and possible correlation between clinical and demographic features and goblet cell distribution. METHODS: The methodology involved retrospective case series. The study sample included 45 consecutive patients undergoing bare sclera operation. Biopsy specimens were examined under light microscopy. The goblet cells were counted in four fields under X480 magnification and determined by the density range. Demographic features were evaluated for every patient. The relationships between elastosis, inflammation, congestion of blood vessels and the density range in goblet cell count were determined. RESULTS: Distribution density of goblet cells was found to be homogenous among cases. In 16 cases (35%) the count showed more than 120 cells in a field, while in 13 cases (30%) the authors calculated under 15 cells in a field. In 27 cases (60%) there was a high rate of elastosis. In only 3 cases (6.6%) the authors found mild dysplasia of the epithelium. There was a low rate of congestion of blood vessels in only 5 cases (11%). In all cases inflammation was found. There was no significant correlation found with all demographic parameters evaluated. CONCLUSION: There is a high rate of difference in the distribution and density of goblet cells in pterygia, without any correlation with demographic and clinical features listed. There is a variable elastosis rate, significant congestion of blood vessels and a low rate of dysplasia. All cases presented with chronic inflammatory reaction.

Adult↗
PubMed2006

The relationship between diabetic retinopathy, glycemic control, risk factor indicators and patient education.

BACKGROUND: Hyperglycemia, high blood pressure and hypercholesterolemia are risk factors for diabetic retinopathy and vision loss in diabetic patients. OBJECTIVES: To evaluate risk factors in patients treated for diabetic retinopathy in our hospital clinic and assess patients' awareness of the impact of glycemic control; and to compare the findings with those in patients followed in a community clinic. METHODS: We performed a cross-sectional comparative study that included 178 consecutive patients with type 2 diabetes mellitus treated in the Retinal Vascular Service of Rabin Medical Center from 1 September to 31 December 2004, and 107 consecutive patients with type 2 diabetes mellitus examined in a community clinic during the same period. A questionnaire was completed; the main outcome measures were glycemic and risk factor control and their correlation with diabetic retinopathy and visual acuity. RESULTS: Although only 43% of the patients had heard of HbA1c, 98% of them had undergone this analysis, with a mean level of 8.2% (SD 1.9) in the hospital patients and 7.7% (SD 1.6) in the community patients (P= 0.01, t-test). HbA1c was lower in hospital patients who were aware of the test. Correlations were found for visual acuity, diabetic retinopathy and laser treatment with HbA1c < or = 7%, cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg. CONCLUSIONS: Since our study and previous reports have shown that HbA1c level < or = 7%, serum cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg are associated with better preservation of vision in patients with type 2 diabetes mellitus, we propose that the ophthalmologist has a role in educating patients about glucose, lipid and blood pressure control as part of the treatment of diabetic retinopathy.

Aged↗
PubMed2006

Estimation of prevalence and incidence rates and causes of blindness in Israel, 1998-2003.

BACKGROUND: The prevalence and incidence of blindness in Israel appear to be comparable to other western countries. Comparisons are difficult because of different definitions of blindness, and the uniqueness of the Israeli Registry of the Blind. OBJECTIVE: To characterize the population who were registered as Blind in Israel in the years 1998-2003 and estimate the prevalence and incidence of blindness by age and causes of blindness. METHODS: A retrospective review of the annual report of the national Registry of the Blind in Israel between 1998 and 2003 identified 21,585 blind persons who received a certificate for blindness. Blind persons are identified by ophthalmologists throughout Israel and referred to the Registry of the Blind if they have a visual acuity of 3/60 or worse, or a visual field loss of <20 degrees in their better eye. This report includes prevalence data on 21,585 persons enrolled in this review still alive and living in Israel in 2003. We estimated the prevalence rate of blindness nationwide and the incidence rate for each cause of blindness for every year. RESULTS: The main leading causes of blindness in Israel in 1998 were (in percent of the total number of newly registered patients): age-related macular degeneration (20.1%), glaucoma (13.8%), myopic maculopathy (12%), cataract (10.4%), diabetic retinopathy and maculopathy (10.1%), and optic atrophy (7.9%), and in 2003, 28%, 11.8%, 7.4%, 6.5%, 14.4% and 6.5% respectively. CONCLUSIONS: The results indicate that the incidence of age-related macular degeneration, diabetic retinopathy and maculopathy in Israel is increasing, while that of glaucoma, myopic maculopthy, optic atrophy and cataract is decreasing.

Adolescent↗
PubMed2005

Ocular injury in children from exploding microwaved eggs.

PURPOSE: To report an ocular injury caused by exploding microwave-cooked eggs. DESIGN: Case reports. METHODS: Two children exposed to exploding microwaved eggs were examined for facial burns and ocular trauma. RESULTS: One patient sustained mild corneal epithelial damage in both eyes and eyelid burn, which were treated conservatively. The other, injured in the same event, had symblepharon and moderate keratopathy requiring intensive lysis. CONCLUSIONS: Physicians should be alerted to the potential risk of vision-threatening ocular injury from exploding microwaved foods, and the public should be educated not to cook eggs in microwave ovens.

Blast Injuries↗
PubMed2005

Combined rectus muscle transposition with posterior fixation sutures for the treatment of double-elevator palsy.

PURPOSE: To evaluate the surgical and functional results of full horizontal tendon rectus muscle transposition to the superior rectus (SR) insertion, augmented by posterior fixation sutures, in patients with double-elevator palsy (DEP). DESIGN: Retrospective nonconcurrent interventional comparative case series. PARTICIPANTS: Fourteen consecutive patients with DEP. INTERVENTION: Six patients treated for DEP by vertical transposition of the horizontal muscles to the SR insertion (Knapp procedure) were compared with 8 patients treated by the Knapp procedure combined with fixation of the transposed muscles to the sclera, adjacent to the SR, with nonabsorbable sutures. MAIN OUTCOME MEASURES: Postoperative ocular alignment, ductions, binocular functions, and rate of reoperation. RESULTS: Ocular deviation: Mean distance and near deviations decreased by 84% and 83%, respectively (P = 0.012), in the augmented-surgery group versus 48% and 47%, respectively (P = 0.03), in the standard-surgery group. Duction: Mean elevation deficiency in abduction and adduction improved by 64% and 65%, respectively (P = 0.01), in the augmented surgery group versus 42% and 55% (P = 0.02) in the standard group. Binocular functions: 3 patients (37%), all in the study group, gained binocular function. Reoperation was required in 5 patients (83.3%) in the control group. The difference in postoperative improvement between the groups was statistically significant for all 4 parameters. No postoperative complications or duction anomalies were observed during the follow-up period of 15.4 months (standard deviation, 5.5). CONCLUSIONS: The augmented Knapp procedure with superior posterior fixation suture is the preferred surgical treatment for patients with DEP. Its use in this series avoided the need for multiple surgeries on other extraocular muscles.

Child↗
PubMed2005

Full vertical rectus muscle transposition combined with medial posterior fixation sutures for patients with adduction deficiency.

PURPOSE: To compare the surgical and functional results of full tendon rectus muscle transposition to the medial rectus muscle augmented with posterior medial fixation sutures in patients with adduction deficiency (ADD) and Duane's syndrome type 2. DESIGN: Retrospective nonconcurrent interventional comparative case series. PARTICIPANTS: Twelve consecutive patients with ADD and Duane's syndrome type 2. INTERVENTIONS: Six patients treated by the full tendon rectus muscle transposition procedure alone were compared with 6 patients treated by the full tendon rectus muscle transposition combined with posterior medial fixation sutures. MAIN OUTCOME MEASURES: Postoperative ocular alignment, duction improvement, binocular functions, and reoperation. RESULTS: In the augmented surgery group, mean distance and near deviation decreased by 74.5% and 74%, respectively, versus 56% and 59%, respectively, in the control group (P = 0.007 and 0.02, between-group comparison for distance and near deviation, respectively). Mean duction improved in 73% of the study group compared with 52% of controls (P = 0.025). No postoperative complications or duction anomalies were observed during follow-up in the entire cohort; reoperation was needed in 1 patient in the study group and in all 6 patients in the control group. CONCLUSIONS: The augmented full vertical rectus muscle procedure is a beneficial surgical approach for patients with ADD and Duane's retraction syndrome type 2, reducing the need for multiple extraocular muscle surgery.

Abducens Nerve Diseases↗
PubMed2005

Competitive quenching: a possible novel approach in protecting RPE cells from damage during PDT.

PURPOSE: The purpose of this study is to demonstrate feasibility of using our novel concept, termed competitive quenching, for protecting the choroidal extravascular compartment and retinal pigment epithelium (RPE) from verteporfin (VP)-induced phototoxicity using hypericin. Furthermore, we aim to achieve partitioning of the quencher, hypericin, in the extravascular space and VP within the microvascular compartment of the chorio-retinal complex in vivo. METHODS: We protect RPE cells from damage inflicted by photoactivated VP by introducing hypericin into these cells prior to photosensitization to quench the photosensitizing activity of VP. Cell protection levels were measured by MTT and Hemacolor viability assays. Wavelength range used for VP photoexcitation (700 +/- 40 nm) excludes the absorption range of hypericin, preventing the latter from photoactivation. Pharmacokinetic conditions, in which hypericin spreads throughout the choroidal and retinal extravascular space while VP is confined to the vasculature, are delineated using double-fluorescence imaging. RESULTS: Cell viability increased 3- to 5-fold when 10-20 microM hypericin were present in RPE cells during photosensitization with 0.1-0.5 microM VP. VP fluorescence intensity was unchanged by the presence of hypericin in the cells. Hypericin administered intravenously to rats was confined to the choroidal vasculature after 15 min to 2 hr. Subsequently, hypericin partitioned to the choroidal and retinal extravascular space. VP administered at this time was confined to the microvasculature. CONCLUSIONS: RPE and choroid may potentially be protected by compartmentalizing hypericin to the extravascular compartment while VP administered shortly before photosensitization is confined to the microvasculature. Adverse photodynamic therapy (PDT) damage to choroidal tissues adjacent to neovasculature targeted for photoablation have the potential of being prevented by competitive quenching with hypericin.

Animals↗
PubMed2005

Airbag-induced bilateral corneal graft dehiscence.

PURPOSE: To report a case of bilateral corneal graft dehiscence caused by blunt trauma. METHODS: Case report of bilateral simultaneous corneal graft dehiscence with expulsion of the lens and iris as a result of airbag-induced trauma. RESULTS: Both corneal buttons were resutured, the prolapsed iris tissue was repositioned in the right eye, and anterior vitrectomy was performed bilaterally. Topical and systemic antibiotics, topical steroids, cycloplegic agents, and antiglaucoma drugs were initiated. Repeated B-scan ultrasound examinations demonstrated an attached retina in both eyes. Three weeks after admission, the right eye was reoperated for removal of remnant lens material and additional anterior vitrectomy. The patient was fitted with polycarbonate spectacles with an optical correction of +8 in both eyes. Visual acuity improved to 20/200 and 0.5/60 in the right and left eyes, respectively. The right corneal graft regained transparency, but the left one remained hazy. CONCLUSION: Airbag deployment during motor vehicle collisions is a significant cause of ocular morbidity. The reported risk of airbag-related eye injury is 2.5% for any eye injury and 0.4% for severe eye injury. Patients undergoing corneal surgery should be counseled about the weakness of the donor-recipient interface and should consider wearing protective glasses.

Accidents, Traffic↗
PubMed2005

Preoperative injection of mitomycin C in combined pterygium and cataract surgery.

PURPOSE: To evaluate the safety and efficacy of a preoperative injection of mitomycin C (MMC) in combined pterygium and cataract surgery. METHODS: This was a prospective, nonrandomized, interventional trial. Thirty-nine patients with cataract and pterygium enrolled in a prospective, nonrandomized trial. All patients underwent combined pterygium and cataract surgery. Twenty-seven received a single 0.1-mL injection of 0.15 mg/mL MMC into the pterygium head 4 weeks before surgery and 12 did not. Patients were followed for 12 to 23 months postoperatively. Recurrence of pterygium, side effects, and complications of MMC were recorded. RESULTS: Recurrent pterygium developed in none of the patients treated with MMC preoperatively and in 5 of the nontreated patients. Two patients in the pretreated group had allergic conjunctivitis immediately after MMC injection. No other local eye complications or adverse systemic reactions were recorded. CONCLUSIONS: Preoperative injection of MMC into the head of the pterygium 4 weeks prior to combined pterygium and cataract surgery resulted in no recurrence and no serious complications up to 12 to 23 months of follow-up postoperatively. This procedure may be recommended to save time and cost and to prevent the possible side effects of MMC when administered topically at the time of cataract surgery. Further follow-up and additional studies will be needed to determine the long-term safety and efficacy.

Cataract Extraction↗
PubMed2005

Ocular growth in premature infants conceived by in vitro fertilization versus natural conception.

PURPOSE: To evaluate the possible effect of in vitro fertilization (IVF) on early development of the eye in premature infants. METHODS: Biometric and keratometric values, intraocular pressure, and retinal vascular status were assessed in a cohort of 133 premature infants. These values were compared between premature infants conceived by IVF or naturally, and the relationship between these parameters and postconceptional age and weight at examination were evaluated. RESULTS: The sample consisted of 133 premature infants, 62 (46.6%) born by IVF and 71 (53.4%) by natural conception. Postconceptional age at examination was 28 to 46 weeks. In both groups, axial length, anterior chamber depth, and corneal radius correlated with the postconceptional age and weight at examination and followed a linear growth pattern. Lens thickness changed very slightly. The rate of retinal vascularization correlated with the postconceptional age as well. No correlation was found between intraocular pressure and corrected age or weight at examination. There was no difference between the study and control groups in any of the biometric or keratometric parameters or in intraocular pressure, according to two-way analysis of variance. CONCLUSIONS: IVF apparently does not affect early ocular growth, intraocular pressure, changes in corneal curvature, or retinal vascularization in premature infants. These findings may aid ophthalmologists in assessing ocular dimensions in this patient population.

Biometry↗
PubMed2005

T1799A BRAF mutations in conjunctival melanocytic lesions.

PURPOSE: To gain a better understanding of the molecular events leading to the development of conjunctival melanocytic lesions and conjunctival melanoma, this study was conducted to investigate the presence of T1799A BRAF oncogenic mutation in these lesions. METHODS: Forty-eight surgically excised conjunctival melanocytic lesions from 48 patients were examined for the presence of the BRAF T1799A mutation. Twenty-eight lesions were conjunctival nevi, of which 20 were excised from children younger than 18 years. Fifteen lesions were conjunctival primary acquired melanosis (PAM; 11 without atypia and 4 with atypia) and five were conjunctival melanomas. To detect the BRAF T1799A mutation, both a newly developed kit (Mutector; TrimGen, Sparks, MD) and direct DNA sequence analysis of exon 15 after PCR amplification were used. RESULTS: The T1799A BRAF mutation was identified in 14 of 28 (50%) conjunctival nevi analyzed, but in none of the 15 conjunctival PAMs, with and without atypia. The T1799A BRAF mutation was identified in two of the five (40%) conjunctival melanomas. There was no difference in the BRAF mutation detected in conjunctival nevi in children or adults, as the BRAF mutation was detected in 50%. CONCLUSIONS: The results showed that conjunctival nevi, similar to skin nevi, have a high frequency of oncogenic BRAF mutations. Furthermore, the results suggest that the oncogenic event leading to BRAF mutations affect only conjunctival nevi and not conjunctival PAM. The clinical significance of these observations remains to be determined.

Adolescent↗