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Biomedical subjects

Igor Kaiserman

Publications and source records attributed to Igor Kaiserman.

At least 19 recordsLinked to original sources
PubMed2006

Risk factors for photodynamic therapy of predominantly classic choroidal neovascularization in age-related macular degeneration.

PURPOSE: To investigate the influence of various risk factors for age-related macular degeneration (AMD) on the rate of undergoing photodynamic therapy (PDT). DESIGN: An observational population based cohort study. METHODS SETTINGS: A district of the largest health maintenance organization (HMO) in Israel. STUDY POPULATION: All HMO members in the district, older than 50 years on January 1, 2001, who did not terminate their membership until May 31, 2005 (139,894 members); of those, 283 underwent PDT for AMD during the study period (775 procedures). OBSERVATION PROCEDURES: We extracted information from the chronic disease registry of the HMO as well as demographic information including age, gender, country of birth, place of residency, and social security economic status. MAIN OUTCOME MEASURES: Effect of various risk factors for AMD on the rate of PDT. RESULTS: The age-adjusted proportion of patients requiring PDT was significantly higher in hypertensives (P = .03, chi2 test), in hyperlipidemics (P = .002), in ischemic heart disease patients (P = .002) and among males (P = .03) and Ashkenazi Jews (P = .02). No significant difference in PDT rates was noted in diabetics, congestive heart failure (CHF), and chronic renal failure (CRF) patients. PDT rates were lower in the lower socioeconomic class (P = .002). Logistic regression found a significant effect of age, hyperlipidemia, hypertension, socioeconomic status, and gender on the rate of PDT, while ischemic heart disease (IHD), diabetes, CHF, CRF, place of birth, and place of residence did not contribute significantly to the model. CONCLUSIONS: Advanced age, hypertension, hyperlipidemia, male gender, and socioeconomic status are risk factors for undergoing PDT for predominantly classic neovascular AMD.

Age Factors↗
PubMed2006

Topical beta-blockers are not associated with an increased risk of treatment for depression.

PURPOSE: To investigate the effect of topical beta-blockers on the prevalence of depression among glaucoma patients. DESIGN: Retrospective observational population-based cohort study. PARTICIPANTS: We reviewed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (Central District of Clalit Health Services) who were older than 20 years (317,469 members). METHODS: We documented all antiglaucoma prescriptions (n = 274,023) and all antidepressant prescriptions (n = 16,948) filled by glaucoma patients in the district between January 1, 2001 and December 31, 2003. We included only those patients who filled at least 6 consecutive antiglaucoma prescriptions at least once every 2 months (n = 6597; 5846 [88.6%] were treated with topical beta-blockers). Depressed patients were defined as patients that filled at least four prescriptions for antidepressants during the study period (n= 810, 12.3% of all glaucoma patients). MAIN OUTCOME MEASURE: Relationship of topical beta-blocker use and prevalence of depression among glaucoma patients. RESULTS: No significant demographic differences were noted between glaucoma patients treated and not treated with topical beta-blockers. Of those treated and not treated with beta-blockers, 12.2% (12.7% after age-adjustment) and 12.7%, respectively, were also receiving drug therapy for depression (P = 0.7, chi-square test). With stratification by age, treatment with topical beta-blockers did not influence the prevalence of depression in any age group. Logistic regression analysis revealed a significant effect of age, place of birth, and gender on the prevalence of depression, but the prevalence of use of topical beta-blockers had no significant effect. CONCLUSIONS: Use of topical beta-blockers by glaucoma patients does not appear to increase the risk of depression in this population.

Administration, Topical↗
PubMed2006

Increased risk for herpetic eye disease in patients with allergic conjunctivitis.

PURPOSE: To evaluate the risk of ocular surface herpetic eye disease (osHED) in allergic eye disease. METHODS: We calculated the risk for osHED in 11,205 patients on antiallergic ocular topical agents compared with 453,069 controls based on filled prescriptions for topical acyclovir between 2001 and 2003. RESULTS: Significantly more allergic patients, of all age groups, received treatment for osHED (p < 0.01). The age and gender adjusted relative risk for allergic patients to suffer an osHED event was 2.31 (95% CI: 1.84-2.90), raising to 3.55 (95% CI: 2.0-6.4) in patients that filled > or = 4 antiallergic prescriptions. CONCLUSIONS: Patients treated for allergic eye disease have an increased risk of osHED.

Acyclovir↗
PubMed2006

Prescription of ocular beta-blockers in patients with obstructive pulmonary disease: Does a central electronic medical record make a difference?

OBJECTIVES: Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists. METHODS: The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel. The physicians at the HMO all work with an EMR, either a central EMR incorporating data from primary-care physicians and consultants, or a local one. The study population included all HMO members who filled at least one prescription for antiglaucoma medications in 2004. The patients were divided into two groups: those with a previous diagnosis of OPD (ICD-9 codes 493) and those with no known diagnosis of OPD. RESULTS: 7481 patients consumed topical antiglaucoma medications during the study period, and 14.5% had a diagnosis of OPD. 798 OPD patients were treated by ophthalmologists, and of the 61.8% who were treated with topical beta-blockers, only 38 received betaxolol. In comparison with glaucoma patients without OPD, OPD patients received fewer beta-blockers (p < 0.001), more selective beta-blockers (p < 0.0001) and less timolol (p < 0.001). Of the OPD patients treated by ophthalmologists with a central EMR, 59.5% received beta-blockers in comparison with 66.4% treated by ophthalmologists with a local EMR (p = 0.06). OPD patients treated by ophthalmologists with a central EMR received more non-beta-blockers in comparison with patients treated by ophthalmologists with a local EMR (p = 0.02). CONCLUSION: Most patients with OPD and glaucoma continued to receive topical beta-blockers, mostly noncardioselective beta-blockers. A central EMR with a comprehensive and highly available medical history reduced the prescription of beta-blockers to OPD patients, but rates remained unacceptably high.

Adrenergic beta-Antagonists↗
PubMed2005

Herpetic eye disease in diabetic patients.

PURPOSE: To study the incidence of herpetic eye disease (HED) of the ocular surface in diabetics. DESIGN: Observational historical cohort study. SETTING: A district of the largest health maintenance organization in Israel (the Central District of Clalit Health Services). PARTICIPANTS: We reviewed the electronic medical records of all patients older than 50 years (159634 patients) in the district, and of these, 22382 (14.0%) patients had diabetes mellitus. METHODS: All filled prescriptions for acyclovir eye ointment between January 1, 2001 and December 31, 2003 (1483 tubes) and all hemoglobin A1c laboratory tests during 2003 (41910 tests) were documented. An ocular surface HED event was defined when a patient consumed at least 1 tube of topical acyclovir per month, whereas no acyclovir use was documented 3 months before and 3 months after that event. MAIN OUTCOME MEASURES: Incidence of ocular surface HED events in diabetics compared with nondiabetics adjusted for age and gender. RESULTS: After age and gender adjustment, significantly more diabetics had ocular surface HED (5.21 per thousand) compared with nondiabetics (4.27 per thousand; P<0.0001). Stratification by age revealed a significantly higher prevalence of HED in diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual hemoglobin A1c > 9%) consumed significantly more ocular acyclovir (P = 0.01). Multivariate analysis revealed this effect to be independent of age, gender, place of birth, or place of residency. CONCLUSIONS: Ocular surface HED is significantly more common among patients with diabetes mellitus. Poor glycemic control correlates with increased consumption of ocular acyclovir in diabetic patients.

Acyclovir↗
PubMed2005

Alcohol- vs hypertonic saline-assisted laser-assisted subepithelial keratectomy.

OBJECTIVE: To evaluate the predictability and safety of hypertonic saline (5% sodium chloride) [correction]-assisted laser-assisted subepithelial keratectomy (HS-LASEK) vs 20% alcohol-assisted LASEK (A-LASEK). SETTING: American Laser Medical Center, Rishon Le-Zion, Israel. METHODS: Fifty-two consecutive eyes (26 patients) were randomized to HS-LASEK (30 eyes) and A-LASEK (22 eyes) groups. The patients' eyes were examined, refracted, and photographed at 1 day, 5 days, 2 weeks, and 1 month postoperatively by a masked physician. Corneal topography and confocal examination were performed before and 1 month after surgery. MAIN OUTCOME MEASURES: The predictability, accuracy, and visual recovery of HS-LASEK vs A-LASEK in the first postoperative month. RESULTS: The accuracy of HS-LASEK was similar and sometimes better than A-LASEK. Two weeks after surgery, 17 eyes (57%) in the HS-LASEK group and 10 eyes (46%) in the A-LASEK group were within +/- 0.5 diopter of the intended refractive correction (P<.05). At all time points eyes in the HS-LASEK group had better best-corrected visual acuity than eyes in the A-LASEK group, although the uncorrected visual acuity was similar. Eighteen (61%) of the HS-LASEK-treated eyes and 12 (55%) of the A-LASEK-treated eyes had an epithelial defect after surgery. The HS-LASEK-treated eyes had significantly larger epithelial defects. The resolution of the defects was faster in the HS-LASEK-treated eyes (mean +/- SD, 4.5 +/- 0.4 days vs 5.8 +/- 0.2 days, P = .002). The subepithelial scar was thicker in A-LASEK-treated eyes. CONCLUSIONS: Hypertonic saline-assisted LASEK provides good postoperative accuracy, safety, and a similar rate of complications. In view of recent evidence regarding the epithelial toxic effects of alcohol, HS-LASEK might be a better treatment alternative.

Adult↗
PubMed2005

Dry eye in diabetic patients.

PURPOSE: To compare the prevalence of keratoconjunctivitis sicca (KCS) in a prospective cohort of 22,382 diabetic patients with that in the general population. DESIGN: Prospective, observational, cohort study. METHODS SETTING: A district of israel's largest health maintenance organization. STUDY POPULATION: We followed the electronic medical records of all patients in the district older than 50 years (159,634 patients) between January 1 and December 31, 2003. Of those, 22,382 (14.0%) had diabetes. OBSERVATION PROCEDURE: The proportion of ocular lubrication consumers was compared among diabetic and nondiabetic patients. All HbA1c laboratory tests performed by the diabetic patients were documented (41,910 tests), and glycemic control was correlated with the consumption of ocular lubrication. MAIN OUTCOME MEASURES: Ocular lubrication use by diabetic patients compared with the general population and the relationship between glycemic control and ocular lubrication use. RESULTS: After age and gender adjustment, a significantly higher percentage of diabetic patients (20.6%) received ocular lubrication, compared with nondiabetic patients (13.8%, P < .001). The difference was significant for all age groups and for both sexes (P < .001). A similar significant difference was prominent between diabetic and nondiabetic patients aged 60 to 89 years who were frequent users of ocular lubrication. Ocular lubrication consumption increased with poorer glycemic control (mean annual HbA1c levels). Multivariate analysis revealed this effect to be independent of age, sex, place of birth, or place of residence. CONCLUSIONS: KCS is significantly more common among diabetic patients. Poor glycemic control correlates with increased artificial tear use in diabetic patients.

Aged↗
PubMed2005

Forecasting the prognosis of choroidal melanoma with an artificial neural network.

PURPOSE: To develop an artificial neural network (ANN) that will forecast the 5-year mortality from choroidal melanoma. DESIGN: Retrospective, comparative, observational cohort study. PARTICIPANTS: One hundred fifty-three eyes of 153 consecutive patients with choroidal melanoma (age, 58.4+/-14.6 years) who were treated with ruthenium 106 brachytherapy between 1988 and 1998 at the Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. METHODS: Patients were observed clinically and ultrasonographically (A- and B-mode standardized ultrasonography). Metastatic screening included liver function tests and liver imaging. Backpropagation ANNs composed of 3 or 4 layers of neurons with various types of transfer functions and training protocols were assessed for their ability to predict the 5-year mortality. The ANNs were trained on 77 randomly selected patients and tested on a different set of 76 patients. Artificial neural networks were compared based on their sensitivity, specificity, forecasting accuracy, area under the receiver operating curves, and likelihood ratios (LRs). The best ANN was compared with the results of logistic regression and the performance of an ocular oncologist. MAIN OUTCOME: The ability of the ANNs to forecast the 5-year mortality from choroidal melanoma. RESULTS: Thirty-one patients died during the follow-up period of metastatic choroidal melanoma. The best ANN (one hidden layer of 16 neurons) had 84% forecasting accuracy and an LR of 31.5. The number of hidden neurons significantly influenced the ANNs' performance (P<0.001). The performance of the ANNs was not significantly influenced by the training protocol, the number of hidden layers, or the type of transfer function. In comparison, logistic regression reached 86% forecasting accuracy, with a very low LR (0.8), whereas the human expert forecasting ability was <70% (LR, 1.85). CONCLUSIONS: Artificial neural networks can be used for forecasting the prognosis of choroidal melanoma and may support decision-making in treating this malignancy.

Brachytherapy↗
PubMed2005

Ultrasonographic tissue characteristics of mushroom-shaped uveal melanoma.

PURPOSE: To evaluate the ultrasonographic tissue characteristics of mushroom-shaped versus dome-shaped uveal melanoma and to compare them with the tumor vasculature. METHODS: We examined clinically and ultrasonically 18 dome-shaped and 11 mushroom-shaped uveal melanomas (29 consecutive patients; mean age 57 years) and compared their normalized A-scan patterns. Using histological sections from a different set of patients (12 dome- and 17 mushroom-shaped tumors), we calculated the percentage of area covered by blood vessels. RESULTS: A-scans of dome-shaped tumors presented low homogeneous reflectivity, whereas the heads of mushroom-shaped tumors had high and irregular reflectivity (p < 0.001). The reflectivity of their bases was low and similar to dome-shaped tumors. The blood vessel area in the histological sections was significantly larger in the heads of mushroom-shaped tumors (0.88 +/- 0.14%), compared both to their bases (0.29 i 0.06%) (p < 0.001) and to dome-shaped tumors (0.07 i 0.03%) (p < 0.0001). CONCLUSIONS: The ultrasonographic pattern suggests vascular congestion in the heads of mushroom-shaped tumors,probably due to strangulated blood vessels in the tumor neck.

Adult↗
PubMed2005

The effect of combination pharmacotherapy on the prescription trends of glaucoma medications.

PURPOSE: To describe prescription trends within a managed care setting for glaucoma medications and to examine the effect of introduction of Cosopt--a fixed combination of dorzolamide and timolol. PATIENTS AND METHODS: All prescriptions dispensed to any of the 470,350 members of an Israeli health maintenance organization were monthly scanned for patients treated for glaucoma, between January 2000 and May 2003. The monthly mean number of glaucoma patients was 3899 +/- 104 (mean +/- SD). All topical glaucoma prescriptions were documented, and the monthly prescription rate of each medication was calculated and plotted. The monitored glaucoma medications were: beta-adrenergic antagonists, dorzolamide, latanoprost, pilocarpine, brimonidine, Cosopt, and others. RESULTS: beta-adrenergic antagonists were the top prescribing drug (>35% of all glaucoma prescriptions). The prescription rates of pilocarpine and beta-adrenergic antagonists were in constant decline, while latanoprost and brimonidine increased steadily. The introduction of Cosopt changed the prescription trends of dorzolamide from increasing to rapidly decreasing, and accelerated the long-term decline of beta-adrenergic antagonists. Concomitant with the introduction of Cosopt the prescription rate of beta-adrenergic antagonists temporarily increased. This was due to a total increase in glaucoma prescriptions. When Cosopt was introduced, 37.5% of patients were prescribed Cosopt together with beta-adrenergic antagonists, and 16.5% also received dorzolamide. Thereafter the co-prescription decreased steadily. CONCLUSIONS: Introduction of a combination drug should be accompanied by physicians', pharmacists', and patients' education to prevent its inappropriate usage together with its components.

Antihypertensive Agents↗
PubMed2004

Liver function tests in metastatic uveal melanoma.

PURPOSE: To evaluate trends in liver function tests before detection of liver metastases from uveal melanoma. DESIGN: Retrospective, comparative, observational case control study. METHODS SETTING: The Israel uveal melanoma center at the Hadassah University Hospital. PATIENT POPULATION: A total of 307 uveal melanoma patients who were diagnosed with uveal melanoma and followed between the years 1988 and 1998. Of them, 30 metastatic patients who had regular follow-up by liver function tests (LFTs) and liver imaging were included in this study. Eighty nonmetastatic patients were randomly chosen as controls. OBSERVATION PROCEDURE: The medical records of the metastatic and control groups were reviewed documenting LFTs and liver imaging results. MAIN OUTCOME MEASURES: The mean level of each LFT, its sensitivity, specificity, and likelihood ratio at various time periods before the detection of metastases by liver imaging. RESULTS: At the time of diagnosis of liver metastases by imaging, 50% of patients had at least one abnormal LFT (compared with only 5% of the control group). While no change was noted in the mean serum levels of bilirubin, mean lactate dehydrogenase (LDH), alkaline-phosphatase, gamma glutamyl transpeptidase (gamma GTP) aspartate-aminotrasferase, and alanine-aminotrasferase levels seem to rise, even within normal limits, during the 6 months before the detection of metastases. Based on likelihood ratios, alkaline-phosphatase and lactate dehydrogenase were the most predictive tests. Lactate dehydrogenase and aspartate-aminotransferase were already predictive at 80% of the upper normal limit, whereas alkaline-phosphatase and gamma-glutamyltransferase were most predictive at the upper normal limit. CONCLUSIONS: Monitoring the changes in selected LFTs, even within normal limits, can help predict metastatic uveal melanoma.

Adult↗
PubMed2004

Contrast sensitivity after wave front-guided LASIK.

PURPOSE: To compare the effects on contrast sensitivity of wave front-guided (WFG) versus standard LASIK. DESIGN: Prospective, nonrandomized, comparative clinical study. PARTICIPANTS: Twenty-four eyes of 13 consecutive patients (mean age, 25.2+/-8.4 years; spherical equivalent, -0.5 to -4.25 diopters [D]) treated with WFG LASIK (WaveLight-Allegretto scanning-spot laser and wave front analyzer) and 22 eyes of 12 consecutive patients (mean age, 28.4+/-9.1 years; spherical equivalent, -0.75 to -4.5 D) treated with standard LASIK (WaveLight-Allegretto scanning-spot laser). METHODS: Best-corrected contrast sensitivity was measured before and 1 month after surgery in both the WFG LASIK group and the standard LASIK group. A sine-wave contrast sensitivity test (functional acuity contrast test) was used to measure contrast sensitivity at 5 spatial frequencies (1.5, 3, 6, 12, and 18 cycles/degree). We compared the LASIK-induced changes in contrast sensitivity in each groups at each spatial frequency. MAIN OUTCOME MEASURE: The effect on contrast sensitivity of WFG LASIK versus standard LASIK. RESULTS: Uncorrected visual acuity of 20/20 or better was achieved by 72% of eyes treated with WFG LASIK and by 70% of the eyes treated with standard LASIK. One month after LASIK, 88% of the contrast sensitivity measurements improved in the WFG LASIK group, whereas in the standard LASIK group, only 40% of the contrast sensitivity measurements improved. The contrast sensitivity improvement was significantly larger in the WFG LASIK group at all spatial frequencies (P<0.05). The WFG LASIK patients had a negative correlation between the changes in contrast sensitivity and the preoperative refractive error. CONCLUSIONS: The ability of WFG LASIK to correct optical aberrations results in significantly improved contrast sensitivity compared with standard LASIK 1 month after surgery.

Adult↗
PubMed2004

Long-term effects of mitomycin C in pterygium surgery on scleral thickness and the conjunctival epithelium.

PURPOSE: To evaluate the long-term effects of intraoperative application of mitomycin C on the scleral thickness and the conjunctival epithelium at the surgical site of pterygium excision. DESIGN: Prospective observational case series. PARTICIPANTS: Twenty-four patients who underwent excision of primary pterygium with intraoperative mitomycin C in our department during the year 1996. METHODS: Patients were evaluated by slit-lamp biomicroscopy, impression cytology, and high-frequency ultrasonography. Impression cytology was performed by applying a small nitrocellulose filter paper for a few seconds at the excision area and for a few seconds at the opposite perilimbal area, and subjecting the specimens to the periodic acid-Schiff-Gill modified Papanicolaou staining protocol. The morphology of the conjunctival epithelium and goblet cell density (GCD) were recorded. High-frequency ultrasound was performed at the same sites, and the scleral thickness was measured at a distance of 1 mm from the limbus. MAIN OUTCOME MEASURES: Goblet cell density, conjunctival epithelial morphology, and the scleral thickness at the operated and nonoperated sites. RESULTS: All patients had successful pterygium removal with no corneal recurrence after a mean follow-up of 77.2+/-3.9 months (range, 72-84). Impression cytology revealed normal nongoblet conjunctival epithelial cells at the excision area, with a 4-fold decrease in the GCD at the excision area when compared with the contralateral nonoperated site (296+/-120 cells/mm(2) and 1183+/-310 cells/mm(2), respectively; P = 0.0036). No differences were noted between the scleral thicknesses at the operated site (750+/-70 microm) and the opposite site (740+/-80 microm) (P = 0.84). CONCLUSIONS: A single application of mitomycin C after pterygium excision is not associated with reduction in scleral thickness more than 6 years postoperatively. The conjunctival epithelium retains its normal phenotype, with a marked reduction of the GCD.

Adult↗
PubMed2004

Topographic patterns in refractive surgery candidates.

PURPOSE: To evaluate the prevalence of different topographic patterns in refractive surgery candidates and to estimate the extent of candidate rejection based on topography alone. METHODS: We performed a retrospective evaluation of videokeratographies of previously unoperated refractive surgery candidates. The defined topographic patterns of their corneas and the indices computed by the videokeratographer software were registered. The data were evaluated by SPSS/PC statistical software. RESULTS: One hundred candidate electronic topography records were evaluated. The candidates included 41 women and 59 men whose average age was 32 years (range 17.5-63.5). Their topographic patterns were: spherical (36/200 evaluated eyes), spherocylindrical (60), upper steep (32), lower steep (43), irregular astigmatism (9), decentered (3), suspected keratoconus (11), and probable keratoconus (6 eyes). Rejection from undergoing the procedure was based on topography alone in 27 of the 200 eyes. It was difficult to decide what to do with the 43 eyes with a lower steep pattern, and they were eventually rejected. Of the nine software-calculated indices, only one, "keratoconus index," could distinguish between the spherocylindrical and the lower steep patterns. CONCLUSIONS: More than one-half of corneal topographies of refractive surgery candidates did not comply with the assumed "normal" spherical or spherocylindrical patterns. The possible continuum of keratoconus-suspected keratoconus-lower steep pattern raises the question of where to draw the line between reasonable and risky when considering corneal refractive surgery.

Adolescent↗
PubMed2003

Severe allergic blepharoconjunctivitis induced by a dye for eyelashes and eyebrows.

PURPOSE: To report a case of severe allergic blepharoconjunctivitis induced by a dye for eyebrows and eyelashes. METHODS: A 38-year-old healthy female was examined one day after dyeing her eyebrows and eyelashes with a black cream dye intended for this purpose (FDA-approved). The patient complained of severe eye itching, redness, and epiphora. RESULTS: Vision was 20/40 in both eyes; a moderate edema of the eyebrows and eyelid margins was noted. The conjunctiva was severely hyperemic with papillary reaction and chemosis. The corneas, anterior chambers, irides, lenses, and posterior segments were normal. The patient was treated with Dexamethasone 0.1% and ocular lubrication. After five days of treatment, the ocular symptoms improved, her vision returned to 20/20 in both eyes, and the ocular examination was within normal limits. CONCLUSION: FDA-approved dyes for eyebrows and eyelashes can sometimes irritate the ocular surface.

Adult↗
PubMed2002

Anterior ischemic optic neuropathy after a trans-Atlantic airplane journey.

PURPOSE: To report a case of anterior ischemic optic neuropathy after a trans-Atlantic airplane journey. DESIGN: An observational case report. METHODS: A 48-year-old healthy man presented with severe visual loss in his left eye within 12 hours after a 15-hour-long trans-Atlantic airplane flight. The patient underwent slit-lamp examination, funduscopy, fluorescein angiography, automated perimetry, and various blood examinations. RESULTS: Visual acuity was LE: 20/30, and a mild left eye relative afferent pupillary defect was noted. Funduscopic evaluation revealed an edematous optic disk in the left eye with a para-diskal retinal hemorrhage. Fluorescein angiography revealed a leaking optic disk, and perimetry showed an inferior hemi-field scotoma. Anterior ischemic optic neuropathy was diagnosed. CONCLUSION: Prolonged airplane travel may compromise vision either by a thromboembolic mechanism caused by prolonged immobilization or by a vasospasm mechanism induced by the low oxygen pressure during the flight.

Aerospace Medicine↗
PubMed2002

Detachment of subfoveal choroidal neovascularization in age-related macular degeneration.

PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.

Aged↗