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Biomedical subjects

H W Topilow

Publications and source records attributed to H W Topilow.

18 recordsLinked to original sources
PubMed1989

Cryotherapy for stage 3+ retinopathy of prematurity: visual and anatomic results.

Fifty eyes of 25 preterm infants with stage 3+ retinopathy of prematurity (ROP) and 180 degrees to 360 degrees of preretinal neovascularization were treated with cryotherapy to ablate the peripheral zone of avascular retina. All neovascularization regressed. Eleven eyes developed traction detachments, eight of which were successfully reattached with scleral buckling surgery. With follow-up of 6 to 70 months (mean, 29 months), visual acuity was 20/30 to 20/60 in 11 of 16 eyes (69%) of eight children old enough to be tested, and 20/100 to 20/200 in three of these eyes. Thus, vision was 20/200 or better in 14 of 16 eyes (87.5%). Visual behavior was normal for their age in 16 infants too young to test. One child developed bilateral inoperable detachments. We conclude that cryotherapy safely resolves stage 3+ ROP with excellent visual results.

Cryosurgery↗
PubMed1988

Successful treatment of advanced retinopathy of prematurity.

Thirty-nine eyes of 20 premature infants, mean birthweight 922 g, mean gestational age 27 weeks, with active retinopathy of prematurity (ROP), were treated. Thirty-one eyes with stage 3+ ROP and 180 degrees to 360 degrees of preretinal neovascularization received cryotherapy to ablate the zone of peripheral avascular retina. All underwent complete regression of active disease. Eight of these eyes subsequently developed retinal detachments due to ongoing vitreous traction. One detachment was inoperable. Six eyes were successfully reattached following scleral buckling surgery. One of these six redetached and became inoperable after 20 months. Pars plicata vitrectomy was not successful in reattaching the eighth case. Twenty-eight of these 31 eyes retain useful visual acuity with follow-up of 15 to 70 months (mean 41 months). There have been no complications resulting from cryotherapy. Eight other eyes with stage 4 ROP (traction retinal detachment) were treated with cryotherapy and scleral buckling surgery. All were initially reattached, but ongoing vitreoretinal traction caused redetachment in five. One was inoperable. "Open sky" vitrectomy was successful in reattaching three of the other four. Of the six cases that remained reattached with follow-up of 6 to 51 months, only two retain useful vision.

Cryosurgery↗
PubMed1985

A reduced incidence of cystoid macular edema following retinal detachment surgery using diathermy.

Cystoid macular edema (CME) is recognized as an important cause of decreased visual acuity following successful retinal detachment surgery. Postoperative fluorescein angiographic studies suggest an incidence of up to 28% in phakic patients, and 50% in aphakic cases. Cryotherapy was used with scleral buckling in all these previous studies. In the series reported here, diathermy with scleral buckling was used to reattach the retina. In 126 phakic eyes the incidence of CME was 5.6% (7 cases). This is the lowest incidence reported in any series. We attribute these results to reduced intraocular inflammation using diathermy as compared to cryotherapy.

Aged↗
PubMed1985

The treatment of advanced retinopathy of prematurity by cryotherapy and scleral buckling surgery.

Seventeen eyes of nine extremely premature infants with severe acute proliferative retinopathy of prematurity (ROP, Grades III-V) were treated. Cryotherapy alone was used in ten eyes to ablate extensive areas of avascular retina to thereby induce involution of widespread intravitreous neovascularization. No attempt was made to directly treat the arteriovenous shunt or neovascularization itself. Scleral buckling surgery was used in combination with cryotherapy in seven additional eyes to relieve diffuse vitreous traction to intravitreous neovascularization which had caused extensive traction retinal detachment. Cryotherapy was uniformly successful in causing involution of widespread intravitreous neovascularization in all patients treated. Scleral buckling surgery was initially effective in reattaching the retina in all cases but late manifestations of severe ongoing vitreoretinal traction required additional open-sky vitrectomy in two eyes and resulted in inoperable recurrent total traction retinal detachment in one eye and extensive macular scarring in another. A comparison is made between the proliferative retinopathies seen in ROP and diabetes mellitus and a rationale for effective cryotherapy in ROP is presented. In our clinical experience, the single most important prognostic factor determining the potential severity of ROP is the width and extent of the retinal avascular zone. The wider the zone, the greater the probability of rapid progression from early to advanced grades of disease.

Cryosurgery↗
PubMed1983

Massive exudative retinal and choroidal detachments following scleral buckling surgery.

Three aphakic male patients underwent successful scleral buckling surgery for unilateral rhegmatogenous retinal detachment. Within a two-week postoperative period, each developed severe ocular pain with massive exudative retinal and choroidal detachments resembling recurrent rhegmatogenous or traction retinal detachment or implant infection. Systemic prednisone therapy resulted in prompt resolution of ocular pain and reabsorption of subretinal and suprachoroidal fluid. It is important to recognize this uncommon postoperative syndrome so that proper medical therapy may be initiated and unnecessary additional retinal or vitreous surgery can be avoided.

Aged↗
PubMed1982

Prognostic value of vitreous findings in diabetic retinopathy.

We examined the vitreous in 163 eyes with diabetic retinopathy using a +58.6-diopter aspherical preset lens and a slitlamp. Sixty-eight eyes had no vitreous detachment, 76 eyes had partial vitreous detachment, and 19 eyes had complete vitreous detachment. This article studies the vitreoretinal relationship to determine its role in the progression of proliferative diabetic retinopathy. We found that partial vitreous detachment with vitreoretinal traction is a major risk factor for progression of proliferative diabetic retinopathy, whether or not photocoagulation is performed. With complete vitreous detachment or with no vitreous detachment, the absence of vitreous traction protects against the progression of proliferative diabetic retinopathy.

Adult↗
PubMed1982

Asteroid hyalosis. Biomicroscopy, ultrastructure, and composition.

The vitreous in 16 patients (average age, 65 years) with asteroid hyalosis was studied and photographed using a preset lens (El Bayadi-Kajiura) and slitlamp. Asteroid hyalosis was bilateral in one patient (6%) and unilateral in 15 patients (94%). The gel was biomicroscopically normal in 13 patients (81%) and showed moderate liquefaction in three patients (19%). In ten (63%) of the 16 patients, there was no posterior vitreous detachment, in four patients (25%), there was partial vitreous detachment, and in two patients (12%), there was complete vitreous detachment. The preponderance of complete vitreous detachment was lower than expected for patients in this age group, probably because of a reduced preponderance of vitreous liquefaction in patients with asteroid hyalosis. A vitreous aspirate from one of these patients was studied using phase-contrast microscopy and scanning and transmission electron microscopy. Asteroid bodies were enmeshed within normal vitreous collagen fibrils and some were attended by macrophages or multinucleated epithelioid cells. Transmission electron microscopy disclosed irregular calcific material and complex lipids within the asteroid bodies. X-ray spectroscopy demonstrated calcium and phosphorus.

Aged↗
PubMed1982

Bilateral acute retinal necrosis. Clinical and ultrastructural study.

In a 28-year-old man with bilateral acute retinal necrosis, a severe, bilateral panuveitis, necrotizing retinitis, and retinal vasculitis developed. Severe vitreous traction on atrophic retina resulted in bilateral giant retinal tears with an inoperable retinal detachment in the right eye. A retinal detachment developed in the left eye that was reattached after a pars plana vitrectomy and two scleral buckling procedures, but ultimately became inoperable. Large numbers of lymphocytes in the vitreous aspirate and depressed serum complement levels may indicate that an immune mechanism was involved in the necrotizing retinitis. We present the first electron microscopic evidence, to our knowledge, that preretinal membranes occurring in rhegmatogenous retinal detachment due to bilateral acute retinal necrosis arise from retinal pigment epithelium.

Acute Disease↗
PubMed1982

Bilateral peripapillary exophytic retinal hemangioblastomas.

A 14-year-old Iranian girl was referred for evaluation of bilateral elevation of the peripapillary retina. Fluorescein angiography was consistent with bilateral peripapillary exophytic retinal hemangioblastomas as seen in angiomatosis retinae (von Hippel's disease). Argon laser photocoagulation of the more severely affected left eye was performed with minimal effect upon the tumor.

Adolescent↗
PubMed1981

Bilateral corneal dermis-like choristomas; an X chromosome-linked disorder.

A male child was born with bilateral corneal opacification. His maternal uncle and a male first cousin of the patient's mother also had been born with identical bilateral corneal opacification that was pathologically proven to result from corneal dermoids. Histopathological examination of tissue removed from the present patient at the time of lamellar keratoplasty revealed thickened, keratinized epithelium, absent Bowman's membrane, and dense, irregular bands of highly vascularized collagenous connective tissue. No adnexal appendages were identified. The remainder of the ocular and general physical examination results was normal. In view of these clinical and histopathological similarities, the diagnosis of corneal dermis-like choristomas was made. To our knowledge, this report is the first to describe a family with X chromosome-linked recessive transmission of this condition.

Choristoma↗
PubMed1981

Bilateral multifocal intraocular cysticercosis.

A 47-year-old male from India was treated for the rare condition of bilateral multifocal intraocular infestation with Cysticercus cellulosae, the larval form of Taenia solium. The intravitreous parasite in the left eye was removed via pars plana vitrectomy. A subretinal cysticercus in the right eye, which caused a rhegmatogenous retinal detachment, was removed via sclerotomy during the scleral buckling procedure. An additional peripapillary subretinal cyst could not be removed. A subconjunctival cysticercus was incidentally found and removed at the time of surgery. The patient returned to India six weeks after surgery and is doing well.

Conjunctival Diseases↗
PubMed1981

Vitreous changes in retinal branch vein occlusion.

The vitreous was studied in 50 eyes with retinal branch vein occlusion (RBVO) and compared to an age-matched control group. The incidence of partial vitreous detachment was significantly higher (22%) in the RBVO group than in the control group (2.2%) (P less than 0.01). The incidence of preretinal neovascularization in the RBVO group was 22%. No new vessels formed in eyes with complete posterior vitreous detachment (P less than 0.05). The risk of vitreous hemorrhage was greatest in patients with partial vitreous detachment (64%). There was no significant correlation between the status of the vitreoretinal relationship and the development of macular edema, which occurred in 56% of the patients. In two patients, intermittent vitreous traction on the fovea may have influenced the evolution of chronic macular edema and lamellar hole formation. Vascular occlusive disease of the retina produces significant changes in the overlying vitreous. These vitreous changes in turn influence the development of complications following retinal vascular occlusions.

Adult↗
PubMed1981

Posterior internuclear ophthalmoplegia of Lutz.

Discrete lesions interrupting the fiber tracts that connect the pontine center for conjugate horizontal gaze and the ipsilateral abducens nucleus create the syndrome of Lutz's posterior internuclear ophthalmoplegia. In this syndrome the lateral rectus on the side of the lesion fails to abduct the eye normally on attempted horizontal gaze to the same side. Adduction of the contralateral eye is normal. This syndrome may be differentiated from the more common abducens nerve palsy by noting the orthotropic position of the eyes in primary position, the absence of primary and secondary deviations with alternate fixation, and the absence of diplopia. A case of this syndrome, presumably due to central nervous system vasculitis, is reported, and related human and animal studies are reviewed.

Abducens Nerve↗