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Biomedical subjects

G S Schwartz

Publications and source records attributed to G S Schwartz.

15 recordsLinked to original sources
PubMed2001

Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis.

A 45-year-old man was struck in the left eye by the edge of a paper shopping bag 3 weeks after having laser in situ keratomileusis (LASIK). The injury resulted in partial displacement of the LASIK flap. The patient developed diffuse lamellar keratitis (DLK) the day after the flap was repositioned. By day 4, visual acuity diminished to 20/60. By day 9, the clinical evidence of the DLK had resolved, and by day 15, uncorrected visual acuity was 20/20. Eye trauma 3 weeks after LASIK can result in displacement of the LASIK flap, and DLK can develop following flap replacement. Long-term anatomic and visual results are usually good.

Corneal Stroma↗
PubMed2000

Oral acyclovir for the management of herpes simplex virus keratitis in children.

PURPOSE: To evaluate the use of oral acyclovir in pediatric patients with herpes simplex virus (HSV) keratitis. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven pediatric patients seen at the University of Minnesota Hospitals and Clinics with herpes simplex virus (HSV) infectious epithelial keratitis between January 1992 and October 1998. Patient ages ranged from 6 weeks to 5 years at time of presentation with a median of 1.7 and mean of 1.9 years. INTERVENTION: All patients received oral acyclovir; six of seven patients also received topical antiviral medications. Three of seven patients had topical antiviral therapy fail before being placed on oral acyclovir, and the remaining four patients were placed on oral acyclovir primarily. RESULTS: All patients showed resolution of HSV infectious epithelial keratitis. Three patients have been maintained on prophylactic dosage of oral acyclovir because of recurrent disease or because they have been chronically treated with topical corticosteroids for immune stromal keratitis. All patients tolerated acyclovir well, and there were no adverse reactions. CONCLUSIONS: Oral acyclovir is useful in treating HSV infectious epithelial keratitis in pediatric patients. It is beneficial in treating infectious epithelial keratitis and prophylactically either while treating with topical corticosteroids for immune stromal keratitis or for preventing recurrent infectious epithelial keratitis.

Acyclovir↗
PubMed1999

Keratolimbal allograft: recommendations for tissue procurement and preparation by eye banks, and standard surgical technique.

PURPOSE: To facilitate increased use of keratolimbal allograft transplantation (KLAL) for severe ocular surface disease (OSD) by informing clinicians and eye banks of differences in tissue requirements and preparation for the procedure and to describe the surgical technique of KLAL transplantation. METHODS: The protocol of the Minnesota Lions Eye Bank is described for procuring and preparing tissue for KLAL transplantation. The surgical technique is described in detail. RESULTS: Over the last several years, we have modified our eye-banking procedures as well as our surgical technique to improve the success of KLAL transplantation. CONCLUSION: KLAL transplantation for patients with severe ocular-surface disease is an important management option. Success is influenced by the ability to obtain appropriate tissue; this requires clinicians and eye banks to expand current procurement guidelines.

Cell Transplantation↗
PubMed1999

Classification of herpes simplex virus keratitis.

PURPOSE: We propose a nomenclature for classification of herpes simplex virus (HSV) keratitis. We hope that a more consistent classification system will lead to a better understanding of the disease processes, thus resulting in improved diagnosis, treatment, and patient outcomes. METHODS: A review of the literature was performed to evaluate current HSV classification systems. These systems were evaluated in the context of both current clinical and basic science studies and our own clinical observations. RESULTS: The proposed classification system is based on the anatomy and pathophysiology of the specific presentations of HSV keratitis. Anatomically, the primary level of corneal involvement, whether epithelium, stroma, or endothelium, must be elucidated. Pathophysiologically, the cause of the inflammation. whether immunologic, infectious, or neurotrophic, must be determined. There are four major categories of HSV keratitis. (1) Infectious epithelial keratitis, which is made up of cornea vesicles, dendritic ulcer, geographic ulcer, and marginal ulcer. (2) Neurotrophic keratopathy, which includes punctate epithelial erosions and neurotrophic ulcer. (3) Stromal keratitis, which is subdivided into necrotizing stromal keratitis and immune stromal keratitis. (4) Endotheliitis, which has three clinical presentations: disciform, diffuse, and linear. CONCLUSION: We believe that by categorizing cases of HSV keratitis by their primary anatomic and pathophysiologic etiologic characteristics, clinicians can better understand and therefore treat all types of HSV keratitis. The four main categories of HSV keratitis are infectious epithelial keratitis, neurotrophic keratopathy, stromal keratitis, and endotheliitis. Each of these is subdivided to more specific clinical presentations.

Cornea↗
PubMed1998

Iatrogenic limbal stem cell deficiency.

PURPOSE: To describe a group of patients with limbal stem cell (SC) deficiency without prior diagnosis of a specific disease entity known to be causative of SC deficiency. METHODS: We performed a retrospective review of the records of all patients with ocular surface disease seen at the University of Minnesota between 1987 and 1996. Patients were categorized according to origin of limbal deficiency. Patients who did not have a specific diagnosis previously described as being causative of limbal deficiency were analyzed. Risk factors, clinical findings, and sequelae were evaluated. RESULTS: Fourteen eyes of 12 patients with SC deficiency not caused by a known diagnosis were described. All eyes had prior ocular surgery involving the corneoscleral limbus. Eleven eyes had been receiving long-term topical medications, and all eyes had concurrent external disease such as pterygium, keratoconjunctivitis sicca, rosacea, herpes simplex virus keratitis, or aphakic or pseudophakic corneal edema. All eyes had superior quadrants affected, corresponding to areas of prior limbal surgery. Sequelae of disease included corneal scarring and neovascularization, with seven eyes having visual acuity of 20/150 or worse. CONCLUSION: Because the epitheliopathy started peripherally and extended centrally in all patients, we believe it represents an SC deficiency. The fact that all patients were affected superiorly, at sites of a prior limbal surgical incision, points to surgical trauma to the SC as the likely major etiologic factor for the deficiency. The surgical trauma to the limbal SC probably made these cells more susceptible to damage from other external disease influences and toxicity from long-term topical medications. Because the SC deficiency is the result of prior ocular surgery and long-term topical medications, we propose the term "iatrogenic limbal stem cell deficiency."

Adult↗
PubMed1998

Etiology of immune stromal (interstitial) keratitis.

PURPOSE: We compared the etiologies of immune stromal keratitis (ISK), also known as interstitial keratitis (IK), in a recent group of patients with active and inactive ISK. METHODS: We reviewed the charts of 97 patients seen in the cornea clinic at the University of Minnesota from 1985 through 1994. Fifty-five patients were classified as having active ISK, defined by stromal inflammation without ulceration within 1 year of presentation. Forty-two patients were identified as having inactive ISK, defined by evidence of past stromal inflammation including stromal scarring, stromal thinning, ghost vessels, and reduplication of Descemet's membrane without active inflammation for the 1 year before presentation. We determined the etiology of the ISK by careful review of the patient's ocular examination, as well as medical and laboratory workup. Patients were labeled with the diagnosis of idiopathic ISK if no identifiable etiology was found. RESULTS: Herpes simplex virus (HSV) accounted for 71.4% of unilateral active ISK. Idiopathic accounted for 14.3%, and varicella-zoster virus accounted for 8.6% in this group. HSV was the etiologic factor of 50.0% of inactive unilateral cases, whereas 33.3% were idiopathic. Sixty percent of cases of bilateral, active ISK were from idiopathic causes. Syphilis was the cause of 48.5% of bilateral inactive cases. In this group, 33.3% were from idiopathic causes. CONCLUSION: Although syphilis has been recognized for many years as the cause of 90% of cases of ISK, this is no longer true. We demonstrated that active ISK is most commonly caused by HSV or is idiopathic and that, although syphilis is the leading cause of inactive, bilateral ISK, it is responsible for only 18.6% of total cases.

Antibodies, Antinuclear↗
PubMed1997

Iatrogenic limbal stem cell deficiency.

PURPOSE: To describe a group of patients with limbal stem cell (SC) deficiency without prior diagnosis of a specific disease entity known to be causative of SC deficiency. METHODS: We performed a retrospective review of the records of all patients with ocular surface disease presenting to the University of Minnesota between 1987 and 1996. Patients were categorized according to etiology of limbal deficiency. Patients who did not have a specific diagnosis previously described as being causative for limbal deficiency were analyzed. Risk factors, clinical findings and sequelae were evaluated. RESULTS: Eight eyes of six patients with stem cell deficiency not secondary to a known diagnosis were described. All eyes had prior ocular surgery involving the corneoscleral limbus. Six eyes had been on chronic topical medications and all eyes had concurrent external disease such as pterygium, keratoconjunctivitis sicca, rosacea or herpes simplex virus keratitis. All eyes had superior quadrants affected corresponding to areas of prior limbal surgery. Sequelae of disease included corneal scarring and neo-vascularization, and five eyes had with visual acuity of 20/200 or worse. CONCLUSIONS: Because the epitheliopathy started peripherally and extended centrally in all patients, we feel it represents a stem cell deficiency. The fact that all patients were affected superiorly, at sites of a prior limbal surgical incision, points to surgical trauma to the SC as the likely major etiologic factor for the deficiency. The surgical trauma to the limbal SC probably made these cells more susceptible to damage from other external disease influences and toxicity from chronic topical medications. Because the stem cell deficiency is secondary to prior ocular surgery and chronic topical medications, we propose the term "iatrogenic limbal stem cell deficiency".

Adult↗
PubMed1996

Diagnosis and treatment of an ophthalmic artery occlusion during an intralesional injection of corticosteroid into an eyelid capillary hemangioma.

PURPOSE: To demonstrate the usefulness of simultaneous indirect ophthalmoscopy in the diagnosis and treatment of embolization of the ocular circulation during intralesional injection of corticosteroids into capillary hemangiomas. METHODS: A 4-month-old infant had an ophthalmic artery occlusion during an intralesional injection of corticosteroids into a right upper eyelid capillary hemangioma. The injection was discontinued immediately and a paracentesis was performed. Fluorescein angiography was performed 20 minutes and three weeks after the ophthalmic artery occlusion. RESULTS: Fluorescein angiography after the paracentesis showed delayed retinal and choroidal filling and large areas of retinal and choroidal ischemia. Three weeks after treatment, the angiographic abnormalities had resolved, and the retinal and choroidal circulations were normal. Twenty-eight months after treatment, the visual acuity was 20/20 in each eye. CONCLUSION: Ophthalmic artery occlusion can occur during intralesional injection of corticosteroids into capillary hemangiomas. Simultaneous indirect ophthalmoscopy allows the surgeon to discontinue the injection and provide treatment to allow for the best possible visual outcome after this complication.

Anti-Inflammatory Agents↗
PubMed1995

Induction of ligneous conjunctivitis by conjunctival surgery.

PURPOSE/METHODS: A woman with ligneous conjunctivitis of the left upper eyelid underwent conjunctival autograft transplant from the left lower to the upper eyelid. The disease in the upper eyelid persisted, and the previously healthy lower eyelid developed ligneous conjunctivitis at the autograft donor site. RESULTS/CONCLUSIONS: The conjunctivitis was aggressively treated with multiple surgical debridements and topical and oral medications, including topical cyclosporine. The conjunctivitis slowly resolved over the course of seven months, with the longest persistence in the upper eyelid at the junction between the original tissue and the autograft. We conclude that the conjunctival transplant surgery worsened ligneous conjunctivitis in this patient's upper eyelid and induced it in her lower eyelid.

Adult↗
PubMed1989

Disseminated fat necrosis: a rehabilitation challenge.

Disseminated fat necrosis (DFN) is a rare complication of pancreatic disease characterized by subcutaneous nodules, visceral effusions, osseous intramedullary fat necrosis, and arthritis. The rehabilitation of a 33-year-old patient with DFN is described here. The patient had a history of alcoholic pancreatitis for which she underwent a subtotal pancreatectomy. Three months later she developed subcutaneous nodules and migratory polyarthralgias. The diagnosis of DFN as the etiology of her arthritis was confirmed by synovial fluid analysis; in addition, magnetic resonance imaging of her long bones revealed multiple marrow infarcts. She was nonambulatory and required assistance with transfers because of severe joint pain. Treatment included local ice, prednisone, methadone, instruction on joint preservation and proper body mechanics, and ambulation with weight-bearing as tolerated with an assistive device. At the patient's discharge, her joint inflammation was clinically improved but not resolved, and she was independent in transfers and ambulation with a walker for short distances. Despite ongoing inflammation, functional improvement was accomplished through a rehabilitation program emphasizing partial weight-bearing ambulation rather than strengthening exercises.

Adult↗
PubMed1980

Volumetric changes in cells during freezing and thawing.

A thermodynamic model is presented to describe the combined freezing and thawing process for living cells. Continuous changes in the cell volume are predicted according to the thermal protocol imposed on the system. Experimental verification of the model is sought by monitoring continuously the volume of cells as frozen on a cryomicroscope. The volumes of individual cells are measured from sequential photomicrographs by a computerized image analysis technique. The model and experimental data are in quite close agreement for the freezing process, but upon thawing the experimentally measured volumes consistently increased much more rapidly than predicted by the model. The model can be made to conform to the data by accounting for a substantial influx of electrolyte to the cell at subfreezing temperatures.

Cell Membrane↗