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Biomedical subjects

Gregg T Kokame

Publications and source records attributed to Gregg T Kokame.

11 recordsLinked to original sources
PubMed2004

Retinal capillary angioma in familial exudative vitreoretinopathy treated with photodynamic therapy.

PURPOSE: To report a case of familial exudative vitreoretinopathy with a retinal capillary angioma and persistent macular exudation treated with photodynamic therapy. DESIGN: Interventional case report. METHODS: A 39-year-old woman with familial exudative vitreoretinopathy presented with an intraretinal capillary angioma temporally with persistent macular exudation despite previous vitrectomy and thermal laser. Photodynamic therapy to the retinal angioma was performed. RESULTS: Three months after photodynamic therapy, vision was stable at 20/200 with a reduction in lesion size on B-scan ultrasonography and no leakage on fluorescein angiography. With 10 months of follow-up there was no recurrence of leakage. CONCLUSION: Retinal capillary angioma may be present in association with familial exudative vitreoretinopathy, and photodynamic therapy may provide a good alternative treatment to decrease exudation.

Adult↗
PubMed2004

In-the-bag intraocular lens dislocation.

PURPOSE: To describe the presenting characteristics and management alternatives of posterior chamber intraocular lens (PC-IOL) dislocation secondary to dehiscence of the zonules supporting the capsular bag. DESIGN: Observational case series. METHODS: Multicenter retrospective analysis of the surgical treatment and predisposing factors associated with 25 eyes of 22 patients with dislocation of the PC-IOL encased within the capsular bag secondary to dehiscence of the zonules supporting the capsular bag. RESULTS: The dislocated in-the-bag PC-IOL was replaced with an anterior chamber intraocular lens in 60% or repositioned/exchanged and scleral fixated in 40% of eyes. Associated conditions included pseudoexfoliation syndrome 44%, uveitis 16%, and trauma 16%. There was no identifiable cause in 24% of eyes. CONCLUSIONS: In-the-bag PC-IOL dislocations are an unusual, sometimes bilateral, late complication of cataract surgery that can be managed by exchange with an anterior chamber intraocular lens or by PC-IOL repositioning or replacement with scleral fixation. The most common associated condition was pseudoexfoliation.

Aged↗
PubMed2004

Scleral fixation of dislocated posterior chamber intraocular lenses: Temporary haptic externalization through a clear corneal incision.

PURPOSE: To report the results of managing dislocated posterior chamber intraocular lenses (PC IOLs) by externalizing the haptics through a clear corneal incision. SETTING: The Retina Center at Pali Momi, Aiea, Hawaii, USA. METHODS: This retrospective consecutive series comprised cases in which a dislocated PC IOL was managed with pars plana vitrectomy. With this method, the dislocated PC IOL is retrieved and stabilized in the anterior chamber. The haptic is externalized through a clear corneal incision for suture knot placement and then reinserted. A scleral fixation suture is placed 1.25 mm posterior to the limbus under a scleral flap. RESULTS: The study included 14 eyes of 14 patients with a minimum follow-up of 6 months (median 15.4 months). There were 2 subluxated PC IOLs, 11 posteriorly dislocated PC IOLs, and 1 in-the-bag IOL dislocation. Postoperative vision and/or visual symptoms were stable or improved in 86% of eyes. Two eyes had worse vision caused by conditions not related to surgery including chronic cystoid macular edema from latanoprost use and optic atrophy. All IOLs were well fixated and stable, although 1 eye with asymmetric haptics had a slightly tilted IOL. CONCLUSIONS: Dislocated PC IOL management by externalizing the haptic through a clear corneal incision stabilized the IOL in the anterior chamber, minimized intraocular operative manipulations, and allowed easier placement of the opposite haptic over residual capsule, if available. Stable fixation was achieved without dislocation or IOL-related complications recurring.

Aged↗
PubMed2004

Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage.

PURPOSE: To describe the clinical features and to present results of new diagnostic methods to help define the cause of the clinical syndrome of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH). DESIGN: Retrospective review of patients with IHAPSH at presentation seen in 3 centers in Hawaii and Japan. METHODS: We analyzed data including patient demographics, presenting symptoms, initial and final visual acuities, biomicroscopic findings, fundus photographs, and results of available ancillary testing, including fluorescein angiography, B-scan ultrasonography, and optical coherence tomography. RESULTS: There were 10 eyes of 9 patients (7 female and 2 male, 8 Asian and 1 white) aged 14 to 79 years. All patients experienced an acute onset of visual symptoms. Eight eyes had mild to severe myopia (-2.50 diopters [D] to -9.50 D), and 8 eyes had a tilted disc. Hemorrhage within the disc and adjacent subretinal hemorrhage were located nasally in 6 eyes, superiorly in 2 eyes, and temporally in 2 eyes. Vitreous hemorrhage was noted in 6 of 10 eyes. Posterior vitreous evaluation by biomicroscopy (10 eyes), by B-scan ultrasonography (4 eyes), and by optical coherence tomography (2 eyes) revealed no evidence of vitreopapillary traction, except for a follow-up optical coherence tomography in 1 eye showing localized vitreoretinal separation with residual attachment to the optic disc 10 months after presentation. Fluorescein angiography showed mild disc staining in 4 of 8 eyes. Hemorrhage spontaneously resolved within 1 to 7 months, and there were no recurrent hemorrhages with an average follow-up of 13.5 months (range, 2-31 months). Visual acuities maintained or improved to 20/25 or better in 8 eyes. The other 2 eyes had unrelated poor vision. CONCLUSIONS: Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is more common in myopic eyes and spontaneously resolves without treatment. The unique structural architecture of the elevated nasal edge of the myopic tilted disc and the choroidal blood supply of the prelaminar optic nerve may predispose patients to bleeding from the optic discs, which may be spontaneous or may be precipitated by acute disc edema, Valsalva maneuver, or vitreopapillary traction.

Adolescent↗
PubMed2003

Peripapillary detachment in pathologic myopia.

OBJECTIVE: To describe peripapillary detachment in pathologic myopia (PDPM), a newly recognized fundus lesion. DESIGN: Retrospective medical record review. METHODS: We evaluated a series of myopic eyes that had a yellow-orange elevation of the retina and retinal pigment epithelium at the inferior border of the myopic conus. RESULTS: Twenty eyes of 15 patients were identified during a 17-year period to have characteristic findings of PDPM. The mean age of the patients was 58 years. They were followed up for an average of 6 years. The mean spherical equivalent correction was -11.00 diopters (D) (range, -6.00 to -16.00 D). The mean axial length was 27.4 mm (range, 25.3-28.9 mm). In each case, ophthalmic coherence tomographic examination showed a localized detachment of the retinal pigment epithelium and retina corresponding to the PDPM lesion. During the follow-up period, the lesion remained stable in all cases except for 1. No apparent negative effect on visual function was noted. CONCLUSIONS: Peripapillary detachment in pathologic myopia is an asymptomatic, yellow-orange peripapillary detachment of the retinal pigment epithelium and retina in pathologic myopia. Recognition of this lesion is important to distinguish it from other fundus pathologic conditions, such as tumors or choroidal neovascularization, which require further investigation and treatment.

Adult↗
PubMed2002

Management options for early stages of acutely symptomatic macular holes.

PURPOSE: To evaluate management options for acutely symptomatic stage I macular holes, and vitrectomy with intraocular gas tamponade for advanced stage I macular holes. METHODS: Retrospective noncomparative study. SETTING: Clinical practice. STUDY POPULATION: Acutely symptomatic stage I macular holes. MANAGEMENT OPTIONS: (I) spontaneous resolution with observation -7 eyes; (II) stage I holes developing poor visual acuity of 20/50 or worse during observation -9 eyes undergoing pars plana vitrectomy, posterior vitreous separation, fluid -20% sulfur hexafluoride gas exchange; (III) stage I holes acutely progressing to stage II or III during observation -9 eyes with vitrectomy, posterior vitreous separation, membrane peel, fluid -18% perfluoropropane gas exchange. MAIN OUTCOME MEASURES: visual acuity of 20/40 of better, prevention, or closure of macular hole. RESULTS: Spontaneous resolution developed in 7 eyes with 20/40 or better vision (group I). 8/9 eyes undergoing vitrectomy for advanced stage I holes (group II) did not progress and recovered 20/40 or better vision. 1/9 recovered 20/40 vision after further surgery. 9/9 eyes following acute progression to full-thickness holes (group III) had closed macular holes with recovery of 20/40 vision after vitrectomy. CONCLUSIONS: Stage I macular holes can initially be observed. However, excellent visual and surgical results can be obtained in stage I holes with poor vision, or with acute progression to full-thickness holes.

Acute Disease↗
PubMed2002

Spontaneous reopening of a spontaneously closed macular hole.

PURPOSE: To report a case of spontaneous reopening after spontaneous closure of a full-thickness macular hole. METHODS: Observational case report. Retrospective clinical practice case review. RESULTS: A 57-year-old man with a full-thickness macular hole in his left eye developed spontaneous closure for 1.5 years with improved vision, followed by spontaneous reopening of the hole with loss of vision. Surgical repair resulted in repeat closure and recovery of 20/20 visual acuity. CONCLUSION: Spontaneous reopening, which occasionally occurs after surgical closure of macular holes, can also occur after spontaneous closure of a macular hole.

Fluorocarbons↗
PubMedDate not supplied

Subretinal surgery for peripapillary subretinal neovascular membranes.

PURPOSE: To report the results of surgical removal of extrafoveal peripapillary subretinal neovascular membranes (PSRNVMs) for elderly patients in whom visual acuity was threatened or affected by subretinal fluid, subretinal hemorrhage, subretinal exudate, or PSRNVM growth toward the fovea. METHODS: Retrospective review of six eyes of six patients undergoing subretinal surgical removal of PSRNVMs via pars plana vitrectomy. RESULTS: PSRNVMs were successfully removed in six eyes of six patients with initial preservation of foveal function. The preoperative Snellen visual acuity ranged from 20/40 to counting fingers, and the best postoperative visual acuity ranged from 20/25 to 20/40. The final visual acuity with a mean follow-up of 3 years (range, 6-63 months) was stable or improved in 83% (5 eyes) of cases, ranging from 20/25 to 20/80. Early recurrence of PSRNVM was noted only in 1 eye (17%) at 1 month after surgery and was successfully treated with laser photocoagulation. Late recurrence of choroidal neovascularization developed after 3 years in two eyes. Cataract developed in three of four phakic eyes. CONCLUSION: PSRNVMs sparing the central fovea in elderly patients can be successfully removed surgically with initial preservation of foveal function and with a low rate of early recurrence.

Aged↗