Biomedical subjects
Publications and source records attributed to E Bartov.
A 68-year-old woman with blurred vision had a foveal spot of fluorescein leakage that later was found to be a transient leakage. The clinical picture resembled central serous chorioretinopathy, a rare diagnosis in older patients. Other possible diagnoses (e.g., subretinal neovascular membrane or epiretinal membrane) are discussed as is the need for laser treatment.
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We treated two patients in whom silicone oil pupillary block developed despite a patent inferior iridectomy. The clinical characteristics of this complication were a deep anterior chamber, specular reflexes from the iris surface, identification by biomicroscopy of aqueous trapped inferiorly in the vitreous cavity, and no convection currents in the anterior chamber. This complication may be prevented by early face-down positioning of the patient after the operation, and the avoidance of large, centrally located, inferior iridectomies. We recommend that the iridectomy be placed peripherally no larger than 2 mm and propose a new technique for breaking the silicone oil block, which was clearly successful in one of the patients.
Chorioretinal production of prostaglandin type E2 (PGE2) as well as changes in vitreal protein and PGE2 concentrations were studied following retinal irradiation with low-power laser energy that caused ophthalmoscopically invisible ("subthreshold") laser burns. This was compared with changes following ophthalmoscopically visible ("suprathreshold") laser burns. Our results demonstrate that with in eyes exposed to the lower-power levels, the enhancement in vitreal PGE2 concentration persisted for a longer period and was more pronounced than in eyes exposed to the suprathreshold levels (a 3-fold and a 2-fold increase above baseline values, respectively). Protein leakage into the vitreous was noted only in the suprathreshold group, indicating a blood-retinal barrier (BRB) disruption. The findings of persistent, excessive PGE2 vitreal levels with no protein leakage in the subthreshold group suggest a possible anti-inflammatory role for PGE2 following low-power laser exposure.
Laser irradiation of the eye is a widely used therapeutic measure in various ocular disorders. We investigated in laser-treated rabbits' eyes the changes in prostaglandin E2 (PGE2) levels of the tissue affected by the laser (the retina/choroid) and of its adjacent vitreous over a two-week period. The parameters studied were; PGE2 in vitro production by the retina/choroid, as well as PGE2 and protein levels in the vitreous, the latter indicative of a break in the blood retinal barrier (BRB). The effect of noncoherent light exposure used for illumination, and that of the mechanical manipulation involved (sham exposure) were also studied. Following laser exposure vitreal PGE2 levels were increased two-fold above baseline (days three and 14), whereas light exposure resulted in a single peak. PGE2 in vitro production by the retina/choroid in the laser-exposed group was elevated throughout the observation period, peaking twice (days 3 and 14), in the light-exposed group the enhanced production was evident during a shorter period, whereas in the sham group it remained unchanged from baseline. An elevation in vitreal protein levels to above baseline levels occurred in both the laser- and, to a lesser degree, in the noncoherent light-exposed groups, but not in the sham group. Our study demonstrated an enhanced PGE2 in vitro production by retina/choroid of laser-exposed eyes, which might be attributable to the additive effect of the laser induced trauma, and the noncoherent light photochemical changes; the clinical significance of the recurrent increase in vitreal PGE2 levels in laser-treated eyes might be related to its anti-inflammatory properties.
An inexpensive instrument for rapid intraoperative or postoperative evaluation of corneal astigmatism is presented. Its ease of use and availability make it an ideal adjunct to cataract and corneal surgical procedures in which minimal postoperative astigmatism is desired.
We present a case of anterior migration of a solid silicone band through a lateral rectus muscle. In this patient the action of the lateral rectus was preserved, and this is demonstrated photographically. The possible reasons for this rare complication and the possible mechanism by which lateral rectus activity remained intact are explained.
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Two cases of a brother and a sister with characteristic manifestations of Vogt-Koyanagi-Harada syndrome are presented. To the best of our knowledge, this is the first report of a typical appearance of Vogt-Koyanagi-Harada syndrome in two siblings.
Late infection of filtering blebs and endophthalmitis are hazardous complications of glaucoma filtering surgery frequently associated with bleb failure and loss of functional vision. To determine possible risk factors for the development of these complications, characteristics of nine eyes of nine patients after filtering surgery in whom late endophthalmitis developed were compared with those in patients who had received a comparable operation at the same time in whom endophthalmitis did not develop. An average of 7.7 +/- 6.2 years (range, 6 months to 18 years) elapsed between the time of the filtering procedure and the initial appearance of endophthalmitis. Factors associated with increased risk were: increased axial length, thin and leaky bleb, conjunctivitis, upper respiratory infection, and the winter season.
The protruding ends of sutures used to secure the ends of the silicone rubber band placed during many retinal surgical procedures may cause postsurgical irritation, since with presently used suturing techniques, the knot of the suture remains on top of the band, facing the conjunctiva. We describe a suturing technique which, by inverting the band when suturing its ends and then allowing the band to return to its original position, places the knot on the undersurface of the band, against the sclera. Thus, no protruding suture ends are left facing the conjunctiva and the irritation resulting from such a protrusion is averted.
Among the complications associated with pterygium surgery, scleral perforation is mentioned in cases where subconjunctival tissue must be separated from the sclera. We present a case in which such a perforation and consequent suturing resulted in an intravitreous migration of a suture. We believe this is the first report of such a complication following pterygium surgery.
To evaluate the penetration of ciprofloxacin, a new wide-spectrum oral antibiotic, into the vitreous, ciprofloxacin was administered orally to 21 patients who were scheduled to undergo vitreal surgery. Seven patients received 750 mg ciprofloxacin 4 hr before surgery (group I), seven patients received this dose 8 hr before surgery (group II), and seven patients received two 750-mg doses of oral ciprofloxacin every 12 hr. The last dose was administered 12 hr before surgery (group III). Vitreous and blood samples were collected simultaneously and assayed for ciprofloxacin concentrations by bioassay and high-performance liquid chromatography.
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The prevalence of capsular opacification was studied in a group of patients who had extracapsular cataract extraction from 1978 to 1980 by one surgeon. In 94 eyes the follow-up was longer than four years. Capsular opacification developed in 41% of these eyes. In 72% of the eyes with opacification the diagnosis was made more than two years after surgery. In the patients who were operated on during 1980, capsular opacification appeared later and less frequently than in those operated on during 1978. Although the difference was not statistically significant, it probably reflects improved technique and more meticulous cleaning of residual cortex. Patients younger than 40 years had a higher prevalence of capsular opacification (70%) than those older than 40 years (37%). Pseudophakic and aphakic patients had a similar prevalence--47.6% and 39.7%, respectively.