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Biomedical subjects

H D Gilbert

Publications and source records attributed to H D Gilbert.

16 recordsLinked to original sources
PubMed2000

Familial spastic paraplegia and maculopathy with juxtafoveolar retinal telangiectasis and subretinal neovascularization.

PURPOSE: To describe a previously unreported condition involving familial spastic paraplegia and a peculiar type of maculopathy. METHODS: Two pairs of siblings were studied. All four cases underwent serial clinical examinations, fundus photography, and fluorescein angiography. Two siblings had extensive investigations. RESULTS: Characteristics of the four cases include spastic paraplegia diagnosed in the first decade of life and visual loss at about age 9 due to a maculopathy with an abnormal vascular complex. In the early stages, parafoveal dilatation of the capillary network was noted. The later stages were characterized by cystic macular degeneration, and seven of eight eyes developed fibrovascular scars with retinochoroidal anastomoses, pigment migration, and atrophic changes. In two siblings, electro-oculographic findings were subnormal, whereas results of electroretinography, magnetic resonance imaging of the brain and spinal cord, and metabolic and karyotype studies were normal. These siblings were an Indonesian girl and boy; the other siblings were white males. There was no consanguinity of the parents and family history was unremarkable. CONCLUSIONS: This study suggests that the two pairs of siblings have an identical familial and probably recessive disorder with neurodegenerative changes that have caused paraplegia and a peculiar maculopathy associated with anomalous retinal vascular complexes, retinochoroidal anastomoses, and subretinal neovascularization.

Adolescent↗
PubMed1996

Lensectomy, vitrectomy indications, and techniques in cataract surgery.

Removal of a cataract during a vitrectomy can be performed to improve visualization for the surgeon or to facilitate visual rehabilitation for the patient. Because aphakic eyeglasses or contact lenses are often poor options to correct aphakia, placement of an intraocular lens during or after a vitrectomy is becoming increasingly common. A cataractous lens can be removed by pars plana lensectomy, phacoemulsification, or extracapsular cataract extraction. Options for intraocular lens placement include no intraocular lens, anterior chamber lens or sutured posterior capsular lens in the absence of capsular support, "in-the-bag" posterior capsular lens, or sulcus-fixated posterior capsular lens. This article reviews the current indications and techniques for cataract removal with or without intraocular lens placement in patients undergoing vitrectomy.

Cataract Extraction↗
PubMed1994

Results of surgical treatment of recent-onset full-thickness idiopathic macular holes.

OBJECTIVE: To investigate whether the visual prognosis after macular hole surgery was different between recent and older holes and to evaluate preoperative characteristics and variations in surgical technique that may influence outcome. DESIGN: The medical charts of all our patients who underwent surgery for a full-thickness macular hole were retrospectively reviewed. PATIENTS: Forty-eight eyes of 48 patients in the "early" group (symptoms < or = 6 months), and 20 eyes of 19 patients in the "late" group (symptoms > 6 months). INTERVENTION: Vitrectomy, separation of the posterior hyaloid, gas tamponade, and instructions to be face down for 1 week. Most patients had epiretinal membrane dissection. MAIN OUTCOME MEASURES: The early and late groups were compared regarding anatomic and visual outcomes. In the early group we evaluated the effect on outcome of the stage of the hole, intraocular tamponade, membrane dissection, and travel distance. RESULTS: Median postoperative visual acuity in the early group was 20/40 at 3, 6, and 12 months. Fifteen (56%) of 27 patients gained at least three lines of vision at 12 months. Anatomic success was seen with one operation in 75% (36/48), and with two operations in 87.5% (42/48). Stage 2 holes had a final anatomic success rate of 94.4%. Of respondents to an informal survey, 63.4% (26/41) believed that vision was greatly improved, and 70.3% (26/37) said that they would definitely choose surgery again. In the late group, median postoperative visual acuity was 20/100 at 6 months, compared with 20/142 preoperatively. Closure of the hole with one operation was seen in 60% (12/20) of the patients in the late group. CONCLUSIONS: Surgery in patients with recent macular holes has a better prognosis for visual rehabilitation than with older holes and appears to be considered beneficial by most patients.

Aged↗
PubMed1992

Clinicopathologic study of idiopathic macular pucker in children and young adults.

Clinically significant idiopathic macular pucker was observed in 11 patients aged 30 years or younger. In these patients, the tissue was well defined and fibrous in appearance, in contrast to the thin, cellophane appearance that is typical of macular pucker in elderly patients. Vitrectomy and epiretinal membrane peeling were performed in each case. Visual acuity improved after surgery in seven cases and worsened in one case, and follow-up data was not obtained in three cases. Recurrent membranes were noted in four cases, two of which detached spontaneously. Ultrastructural studies were performed on the removed specimens in each case. Myofibroblasts, myoblastic differentiation of retinal pigment epithelial cells and fibrous astrocytes, and new collagen formation were more common than in idiopathic macular pucker in older patients. The clinical and ultrastructural features of juvenile macular pucker reflect more rapidly changing, contractile tissue compared with the usually more quiescent features in series involving older patients.

Adolescent↗
PubMed1985

Cowden's disease (multiple hamartoma syndrome).

A case report of Cowden's disease has been presented along with a discussion of its multiple system involvement. Its association with thyroid and breast malignancy make its differentiation from other or similar disease entities vital.

Facial Neoplasms↗
PubMed1983

Evaluation of osteogenesis following immediate and delayed reimplantation of frozen autogenous mandibular bone.

A follow-up study of the feasibility of delayed reimplantation of frozen autogenous mandibles after ablative surgery for oral carcinomas with mandibular involvement was performed. Fifteen young adult mongrel dogs were used and evaluated clinically, bacteriologically, radiographically, histologically, and by radionuclide imaging. The animals were divided into two groups according to whether they underwent immediate or delayed reimplantation. These were subdivided into those who received grafts with and without autogenous marrow augmentation. The results were positive and suggested clinical evaluation. Twelve patients had undergone delayed reimplantation along with marrow augmentation over the past 3 years. Again, the results are most promising and we believe that, with further refinement, this technique will offer a new and acceptable modality for facial reconstruction in the cancer patient.

Animals↗
PubMed1980

Unusual presentation of acute ocular toxoplasmosis.

Two unusual cases of ocular toxoplasmosis are presented. A 24 year old woman developed retinal and optic nerve neovascularization in conjunction with acute ocular toxoplasmosis. The neovascularization regressed with resolution of the inflammation. The possibility of retinal ischemia or inflammation alone as an etiology are discussed. A 19 year old woman developed optic nerve edema and a marked decrease in vision associated with a nasal toxoplasma lesion and a macular star. With resolution of the process, optic atrophy developed but visual acuity returned to normal. Optic nerve edema and atrophy were felt to result from diffuse inflammation, but not from focal involvement in the nerve itself with the organism.

Adult↗
PubMed1979

Surgical management of macular pucker after retinal reattachment surgery.

We used vitrectomy techniques to remove epiretinal membranes that caused reduced visual acuity in 13 consecutive eyes with macular pucker after otherwise successful retinal reattachment surgery. A technically successful result with visual improvement was achieved in each case. An iatrogenic retinal tear (successfully repaired) occurred in one eye, and recurrent retinal detachment requiring an additional operation occurred postoperatively in two eyes. Despite such risks, and that the best postoperative visual acuity achieved was 6/9 (20/30), the use of vitrectomy methods in removal of epiretinal membranes in selected cases of macular pucker can provide significant improvement in vision.

Adult↗
PubMed1979

Ultrastructure of epiretinal membranes causing macular pucker after retinal re-attachment surgery.

The ultrastructural features of the cellular components of surgically obtained preretinal membrane in twelve cases of macular pucker which followed retinal re-attachment surgery have been analysed. A mixture of different types of cells was observed. Definite (7) or probable (1) fibrous astrocytes were present in eight cases. Definite retinal pigment epithelium was the principal cell in only two cases, and four additional cases showed probable retinal pigment epithelium. Fibrocytes and macrophages were present in five cases and blood vessels in two. Nine of the twelve specimens included internal limiting membrane of the retina.

Aged↗
PubMed1979

Vitrectomy techniques in treatment of macular pucker following retinal reattachment surgery.

Vitrectomy techniques to remove epiretinal membranes causing macular pucker and reduced vision were used to treat 11 consecutive eyes with macular pucker after otherwise-successful retinal reattachment surgery. A technically successful result with visual improvement was achieved in each case. An iatrogenic retinal tear occurred in eye, and recurrent retinal detachment requiring an additional operation occurred postoperatively in 2 eyes. Despite such risks, and the fact that the best postoperative acuity achieved was 20/40, the use of vitrectomy methods in removal of epiretinal membranes in selected cases of macular pucker can provide significant improvement in vision.

Adult↗
PubMed1976

Traumatic hyphema: treatment of secondary hemorrhage with cyclodiathermy.

Four patients were treated with diathermy applications to the ciliary body for recurrent hemorrhage and elevated intraocular pressure following traumatic hyphema. In all cases, the hemorrhage and intraocular pressure were controlled without major complications. Indications for use of diathermy include a patient with recurrent secondary hemorrhage or a clotted hyphema, with elevated intraocular pressure or corneal blood-staining, in whom a site of bleeding can be identified during surgical intervention.

Adult↗