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Ingrid U Scott

Publications and source records attributed to Ingrid U Scott.

At least 55 records · Page 3Linked to original sources
PubMed2004

The impact of echography on evaluation and management of posterior segment disorders.

PURPOSE: To investigate the impact on patient management of posterior segment echographic evaluation at an academic institution. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Records were reviewed of all patients evaluated for the first time with ocular echography for posterior segment evaluation at Bascom Palmer Eye Institute between September 2000 and August 2001. Patients with prior posterior segment echography, intraocular tumors, or suspected optic nerve or orbital disease were excluded. An "impactful" echographic evaluation was defined as an evaluation that confirmed the diagnosis and management plan. A "pivotal" evaluation was defined as an evaluation that either (1) made or subclassified the diagnosis or (2) established or changed the management plan or both. Main outcome measures include proportions of impactful and pivotal echographic evaluations and factors associated with pivotal evaluations. RESULTS: The study included 154 eyes of 143 patients. The requesting physician was a retina fellowship-trained faculty member in 55 cases (36%), a nonretina faculty member in 22 (14%), a fellow in 9 (6%), and a resident in 68 (44%). Reasons for obtaining echography included evaluation for retinal tear or detachment in 83 eyes (54%), evaluation for posterior segment disease (for example, before cataract extraction) in 40 (26%), evaluation for endophthalmitis in 10 (7%), evaluation for intraocular foreign body in 8 (5%), characterization of choroidal detachment in 4 (2%), and other in 9 (6%). Echography confirmed the suspected diagnosis and pre-echography management plan in 128 eyes (83%). Echography made or subclassified the diagnosis in 20 eyes (13%) and established or changed the management plan in 12 eyes (8%). Accounting for definitional overlaps, echography was pivotal in 22 eyes (14%). Significant predictors of a pivotal evaluation or an evaluation that affected the management plan include a retina faculty member as the requesting physician (P =.003), lack of a management plan before echography (P <.001), and certain reasons for obtaining echography (for example, to rule out retinal tear or detachment and to rule out intraocular foreign body; P =.032). The final clinical or pathologic diagnosis confirmed the echographic diagnosis in 148 eyes (96%). CONCLUSIONS: Posterior segment echography may be a very useful diagnostic tool. Its value may be optimized in certain subsets of patients. Considerations such as these may contribute to more cost-effective allocation of resources.

Adolescent↗
PubMed2004

Evolving guidelines for intravitreous injections.

Intravitreous (i.v.t.) injection is increasingly being incorporated into the management of ocular diseases. While only fomivirsen sodium (Vitravene) is currently approved by the Food and Drug Administration as an i.v.t. injection, the number of approved i.v.t. injections indications is anticipated to grow on the basis of promising results from ongoing clinical studies. Despite the potential benefits that may be derived from intraocular injections of different agents, no guidelines have been published previously for i.v.t. injection. The purpose of this document is to identify specific strategies for the delivery of i.v.t. injection that may reduce risks and improve outcomes. Consensus was sought among a panel of investigators, surgeons experienced with this technique, and industry representatives. Objective evidence was sought for all guidelines, but consensus was accepted where evidence remains incomplete. In the absence of either evidence or consensus, the current manuscript identifies outstanding issues in need of further investigation. It is anticipated that more complete guidelines will evolve over time, potentially altering some of the guidelines included here, based on new applications of i.v.t. injection, additional clinical experience, and results of clinical trials.

Humans↗
PubMed2003

Use of glaucoma drainage devices in the management of glaucoma associated with aniridia.

PURPOSE: To describe intraocular pressure (IOP) and visual acuity outcomes after glaucoma drainage device placement in eyes with glaucoma associated with aniridia. DESIGN: Retrospective, noncomparative, consecutive, interventional case series. METHODS: The medical records of all patients who underwent glaucoma drainage device placement for the management of glaucoma associated with aniridia at the Bascom Palmer Eye Institute between January 1, 1989, and December 31, 1999, were reviewed. RESULTS: The study included eight eyes of five patients with a median age at the time of glaucoma drainage device placement of 92 months (range, 10- 495 months) and a median follow-up of 19 months (range, 11- 33 months). Preoperatively, the mean IOP was 35 mm Hg using a mean of one antiglaucoma medication. Postoperatively, the mean IOP was reduced to 14.9 mm Hg and no patient was using antiglaucoma medication. Final visual acuity was improved compared with preoperatively in five of eight eyes (63%) and remained unchanged in two eyes (25%). Loss of light perception occurred in one eye owing to retinal detachment. Success rates using Kaplan-Meier survival analysis were 100% at 6 months and 88% at 1 year. CONCLUSIONS: Glaucoma drainage device placement for glaucoma associated with aniridia achieves IOP control and vision preservation in most patients.

Adolescent↗
PubMed2003

Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery.

PURPOSE: To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. RESULTS: Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. CONCLUSIONS: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.

Aged↗
PubMed2003

Outcomes of surgery for retinal detachment associated with proliferative vitreoretinopathy using perfluoro-n-octane: a multicenter study.

PURPOSE: To report visual acuity and anatomical outcomes, as well as complications, of management of complex retinal detachment with proliferative vitreoretinopathy using pars plana vitrectomy and intraoperative perfluoro-n-octane (PFO), and to investigate clinical features associated with anatomical and visual acuity outcomes. DESIGN: Prospective, noncomparative, interventional multicenter study. METHODS: The study included 555 patients (555 eyes) 15 months of age or older who underwent pars plana vitrectomy for complex retinal detachment associated with proliferative vitreoretinopathy with intraoperative PFO at 24 study sites between April 1994 and February 1996. Main outcome measures included visual acuity and rates of retinal reattachment, reoperation, retained PFO, corneal edema, elevated intraocular pressure ([IOP] > 25 mm Hg), hypotony (IOP < 5 mm Hg), and cataract. All outcome measures were assessed at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively and at the last examination. RESULTS: The study included 555 eyes of 555 patients followed up at a median of 5.6 months. Visual acuity of 20/200 or better was recorded in 51 (10%) patients preoperatively and 85 (24%) at 6 months postoperatively. Among the 465 eyes with both preoperative and final visual acuities available, postoperative visual acuity improved in 274 (60%) eyes, remained stable in 106 (23%), and worsened in 85 (18%) eyes. Six-month follow-up data were obtained for 356 (65%) eyes; the retina was attached in 279 (78%) eyes and retained PFO was noted in 20 (6%). Throughout follow-up, 238 of 555 (43%) eyes underwent reoperation for recurrent retinal detachment. At 6 months, corneal edema, elevated IOP, and hypotony were noted in 26 of 356 (7%), 6 of 356 (2%), and 48 of 356 (15%) eyes, respectively. Of the 114 phakic eyes without significant cataract preoperatively, 105 (92%) developed a significant cataract or underwent cataract surgery during study follow-up. Operative factors significantly (P <.05) associated with recurrent retinal detachment include female gender, creation of a relaxing retinotomy, and the use of sulfur hexafluoride (SF(6)) gas tamponade, air tamponade, or no tamponade (compared with perfluoropropane [C(3)F(8)] or silicone oil tamponade). Factors significantly associated with final vision of 20/200 or better include first operation anatomic success, prior scleral buckling procedure, no diabetes mellitus, no prior vitrectomy, no silicone oil retinal tamponade, and no relaxing retinotomy. Cases that require relaxing retinotomy generally represent more severe cases of complex retinal detachment and, therefore, relaxing retinotomy is likely associated with a poorer visual outcome owing to the nature of the cases selected for this procedure. CONCLUSIONS: In the management of complex retinal detachment associated with proliferative vitreoretinopathy, pars plana vitrectomy and use of intraoperative PFO was associated with retinal reattachment and preserved visual acuity in most eyes.

Adolescent↗
PubMed2003

Intravitreal triamcinolone acetonide for idiopathic cystoid macular edema.

PURPOSE: To report intravitreal triamcinolone acetonide for idiopathic cystoid macular edema (ICME). DESIGN: Interventional case series. METHODS: Two patients with ICME were treated with intravitreal triamcinolone. RESULTS: In one patient, best-corrected acuity was 20/70 before treatment and 20/30 6 months posttreatment in both eyes. Foveal thickness was 606 microm before and 197 microm posttreatment in the right eye and 542 microm before and 190 microm posttreatment in the left eye. In another patient, best-corrected acuity was 20/200 before treatment and 20/50 5 months posttreatment; foveal thickness was 580 microm before and 208 microm posttreatment. Recurrence of macular edema responded to repeat intravitreal triamcinolone acetonide in both patients. CONCLUSIONS: Intravitreal triamcinolone may be associated with reduced edema and improved vision in patients with ICME; however, these changes may be transient.

Female↗
PubMed2003

Acute endophthalmitis following intravitreal triamcinolone acetonide injection.

PURPOSE: To report the clinical features, causative organisms, management, and visual acuity outcomes of eight eyes of eight patients who developed acute postoperative endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA). DESIGN: Retrospective, multicenter, interventional, case series. METHODS: A retrospective, interventional, case series of all patients with acute postoperative endophthalmitis following IVTA at seven academic clinical centers between March 2001 and July 2002. RESULTS: A total of 922 IVTAs were performed. Eight eyes of eight patients with acute postoperative endophthalmitis were identified in the 6 weeks following IVTA for an incidence of 0.87% (95% confidence interval of 0.38% to 1.70%). The median time to presentation was 7.5 days (range, 1-15 days) after IVTA. The most common clinical findings were iritis (n = 8), vitritis (n = 8), hypopyon (n = 8), pain (n = 7), red eye (n = 6), and decreased vision (n = 5). The median presenting visual acuity was 20/1127 (range, 20/60 to light perception). Initial treatment consisted of vitreous tap and injection of antibiotics (n = 6) or pars plana vitrectomy and injection of intravitreal antibiotics (n = 2). Intraocular cultures yielded identification in seven patients. One demonstrated intracellular gram-positive cocci in chains with numerous polymorphonuclear cells on gram stain. The median postinfection vision was 20/400 (range, 20/40 to no light perception). Three patients ended up with no light perception visual acuity, including enucleation (n = 1) and phthisis (n = 1). CONCLUSIONS: Acute postoperative endophthalmitis following IVTA occurs rapidly and can result in severe loss of vision.

Acute Disease↗
PubMed2003

Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments.

PURPOSE: To investigate the incidence and outcomes of retinal detachment (RD) associated with retained lens fragments removed by pars plana vitrectomy (PPV). DESIGN: Retrospective, noncomparative, interventional consecutive case series. PARTICIPANTS: All patients who underwent PPV for retained lens material after cataract surgery at Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001. METHODS: Demographic and clinical data were extracted from patients' medical records. MAIN OUTCOME MEASURES: Incidence of retinal detachment, reattachment rate, and visual acuity outcome. RESULTS: RD occurred in 44 of 343 (12.8%) patients, including 25 (7.3%) before or during PPV and 19 (5.5%) after PPV. The RD was macula-on in 22 of 44 (50%) patients and macula-off in 22 of 44 (50%) patients. The RD was associated with a giant retinal tear in 7 of 44 (15.9%) patients, limited suprachoroidal hemorrhage in 3 of 44 (6.8%) patients, and endophthalmitis in 4 of 44 (9.1%) patients. Retinal reattachment was achieved in 40 of 44 (90.9%) patients; 14 of 44 (31.8%) patients underwent one or more additional procedures for recurrent detachment. Final visual acuity in the patients in this series was >/=20/40 in 8 of 44 (18%), 20/50 to 20/100 in 13 of 44 (30%), 20/200 to 5/200 in 13 of 44 (30%), and <5/200 in 10 of 44 (23%). In the 36 patients with vision less than 20/40, the primary causes of decreased vision were attributed to prior history of RD in 8 of 36 (22.2%), corneal edema in 7 of 36 (19.4%), cystoid macular edema in 5 of 36 (13.9%), persistent retinal detachment in 4/36 (11.1%), preexisting primary open-angle glaucoma in 4 of 36 (11.1%), age-related macular degeneration in 3 of 36 (8.3%), epiretinal membrane in 2 of 36 (5.5%), macular hole in 1 of 36 (2.7%), optic atrophy in 1 of 36 (2.7%), and irregular astigmatism in 1 of 36 (2.7%) patients. CONCLUSIONS: RD is a frequent complication in eyes undergoing PPV for removal of retained lens fragments. Despite favorable retinal reattachment rates, visual acuity outcomes are often poor in these eyes and are associated with other comorbidities such as corneal edema and cystoid macular edema. Poor initial visual acuity and the presence of a retinal tear at the time of PPV were associated with a higher rate of RD after PPV.

Adult↗
PubMed2003

Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments.

PURPOSE: To investigate the clinical features, visual acuity outcomes, and adverse events in patients with retained lens fragments managed by pars plana vitrectomy (PPV). DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent PPV for retained lens fragments at Bascom Palmer Eye Institute during the 12-year interval between January 1, 1990, and December 31, 2001, were reviewed. RESULTS: The study included 343 eyes of 343 patients, with a median age of 76 years and a median follow-up after PPV of 8 months. The median interval between cataract surgery and PPV was 12 days. Visual acuity was >or=20/40 in 29 (9%) patients preoperatively and 190 (56%) at last follow-up (P < 0.001). Visual acuity was or=30 mmHg was present in 87 (25%) eyes preoperatively and 7 (2%) at last follow-up (P < 0.001); the number of patients on antiglaucoma medications at these two time points was 135 (40%) and 96 (29%), respectively (P = 0.001). Among the 148 (44%) patients with final vision <20/40, the primary cause of visual impairment was cystoid macular edema (CME) in 41 (29%), preexisting ocular disease in 34 (24%), corneal edema in 22 (15%), history of retinal detachment (RD) in 19 (13%), epiretinal membrane in 6 (4%), and other causes in 21 (15%). Significant predictors of better final visual acuity include better presenting visual acuity (P < 0.001), presence of an intraocular lens (i.e., no aphakia) before PPV (P = 0.026), no suprachoroidal hemorrhage (P = 0.010), no serous choroidal detachment (P = 0.037), no RD (P = 0.005), no CME (P = 0.038), and no additional surgery after the PPV (P < 0.001). Timing of PPV (i.e., 1 to 4 to 12 weeks between cataract surgery and PPV) was not significantly associated with final visual acuity or IOP outcome; there was also no significant difference in acuity or IOP outcome between patients who underwent PPV on the same day as cataract surgery compared with all other patients. CONCLUSIONS: The most important predictor of final visual acuity after PPV for retained lens fragments is a less complicated clinical course (e.g., no suprachoroidal hemorrhage, no RD, no CME, and no additional surgery after PPV). The most common cause of decreased final vision was CME.

Adult↗
PubMed2003

Open globe injuries with positive intraocular cultures: factors influencing final visual acuity outcomes.

PURPOSE: To investigate the clinical features influencing final visual acuity outcomes of eyes with positive intraocular cultures after open globe injuries. DESIGN: Retrospective, consecutive, interventional case series. PARTICIPANTS: Thirty-seven patients. METHODS: The medical records were reviewed of all patients with positive intraocular cultures after open globe injuries treated at Bascom Palmer Eye Institute between January 1, 1995, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity. Clinical features investigated included the following: (1). presence or absence of clinical endophthalmitis; (2). virulence of the cultured organism (coagulase-negative Staphylococci, Corynebacterium, and Propionibacterium acnes were classified as nonvirulent organisms, whereas all other organisms were classified as virulent organisms); (3). presence of intraocular foreign body (IOFB); (4). presence of retinal detachment; (5). interval between ocular injury and surgical repair; (6). severity of vision loss at presentation; (7). zone of injury; (8). wound length; and (9). presence of vitreous hemorrhage. RESULTS: The study included 37 eyes of 37 patients with a mean age of 30 years (range, 18 months-85 years) and a median follow-up of 13 months (range, 1-71 months). Study eyes were stratified into two groups: group 1 eyes (n = 16) were those in which clinical endophthalmitis did not develop, whereas group 2 eyes (n = 21) were those in which clinically diagnosed endophthalmitis developed at some point during their clinical course. Presenting visual acuity was similar in the two groups (mean logarithm of the minimum angle of resolution [logMAR] acuity, 1.91 and 2.22 [Snellen equivalents, 2/162 and 2/331] respectively; P = 0.33). Final acuities in the two groups were different, but not to a statistically significant level (mean logMAR acuity, 1.14 and 2.05 [Snellen equivalents, 20/276 and 2/224], respectively; P = 0.069). In group 1, final visual acuity ranged from 20/20 to no light perception (median acuity, 20/186); 12 eyes (75.0%) achieved a final visual acuity of 20/400 or better. In group 2, final visual acuity ranged from 20/25 to no light perception (median acuity, 7/200); of 20 eyes with known final visual acuity, 10 (50.0%) retained 20/400 or better vision. In group 1, three eyes (19%) eyes had virulent organisms, and 13 eyes (81%) had nonvirulent organisms. In group 2, 12 eyes (57%) had virulent organisms, and nine eyes (43%) had nonvirulent organisms. A final acuity of 20/60 or better was achieved in 14 eyes (41%), and a final acuity of 20/400 or better was achieved in 22 eyes (59%). Better presenting visual acuity (P = 0.038), culture of a nonvirulent organism (P = 0.011), lack of a retinal detachment (P = 0.002), absence of clinical endophthalmitis (P = 0.069), and shorter wound length (P = 0.024) were associated with better visual acuity outcome. In four of six eyes (67%) with both an IOFB and clinical endophthalmitis (group 2), the final visual acuity was no light perception (IOFB was not itself significantly associated with final visual acuity; P = 0.11). CONCLUSIONS: Among eyes with positive intraocular cultures after open globe injury, the visual prognosis is guarded. Clinical features associated with better visual acuity outcomes include better presenting visual acuity, culture of a nonvirulent organism, lack of a retinal detachment, absence of clinical endophthalmitis, and shorter wound length.

Adolescent↗
PubMed2003

Endophthalmitis caused by enterococcus faecalis: antibiotic selection and treatment outcomes.

PURPOSE: To investigate clinical settings, treatment strategies, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis and to determine antibiotic sensitivity and resistance patterns. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS AND METHODS: Records were reviewed of all patients with culture-positive endophthalmitis caused by E. faecalis evaluated at the Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001. MAIN OUTCOME MEASURES: Associated prior surgical procedures, clinical features, treatments administered, antibiotic sensitivity and resistance patterns, and final visual outcomes. RESULTS: Endophthalmitis caused by E. faecalis was identified in 29 eyes of 29 patients. The mean follow-up was 17.8 months (range, 0.1-86.7 months). Endophthalmitis caused by E. faecalis was associated with, in order of decreasing frequency, cataract surgery in 12 of 29 eyes (41.4%), trabeculectomy in 8 of 29 eyes (27.6%), penetrating keratoplasty in 4 of 29 eyes (13.8%), combined cataract and trabeculectomy in 3 of 29 eyes (10.3%), seton implantation in 1 of 29 eyes (3.5%), and pupilloplasty in 1 of 29 eyes (3.5%). Resistance patterns among the isolates were the following: vancomycin in 0 of 23 eyes (0.0%), linezolid in 0 of 29 eyes (0.0%), ciprofloxacin in 1 of 14 eyes (7.1%), gentamicin (minimum inhibitory concentration >8 mg/l) in 8 of 16 eyes (50.0%), high-level gentamicin (minimum inhibitory concentration >500 mg/l) in 5 of 29 eyes (17.2%), cefazolin in 7 of 8 eyes (87.5%), and quinupristin and dalfopristin in 29 of 29 eyes (100.0%). Preinfection baseline visual acuities ranged from 20/30 to hand motions. Visual acuities on presentation with endophthalmitis ranged from 2/200 to no light perception. Final visual acuity was better than or equal to 20/50 in two cases (6.9%), 20/60 to 20/400 in three cases (10.3%), 5/200 to hand motions in 10 cases (34.5%), and light perception to no light perception in 14 cases (48.3%). CONCLUSIONS: E. faecalis often is resistant to gentamicin and cephalosporins but was sensitive to vancomycin in all isolates tested. Endophthalmitis caused by E. faecalis usually is associated with poor visual outcomes.

Aged↗
PubMed2003

Endophthalmitis caused by Pseudomonas aeruginosa.

OBJECTIVE: To investigate the clinical settings and treatment outcomes for endophthalmitis caused by Pseudomonas aeruginosa. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for P. aeruginosa endophthalmitis at a single institution between January 1, 1987, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity and rate of enucleation or evisceration. RESULTS: The study included 28 eyes of 28 patients with a median age of 75 years (range, 5-93 years). The clinical setting of endophthalmitis included: cataract surgery (n = 9), corneal ulcer (n = 7), penetrating keratoplasty (n = 5), bleb associated (n = 2), glaucoma drainage implant (n = 2), pars plana vitrectomy (n = 1), iris cyst removal (n = 1), and trauma (n = 1). In acute-onset postoperative cases (n = 10), the median interval between surgery and presentation with endophthalmitis was 4 days (range, 1-26 days). The median duration of symptoms was 1 day, and all patients were treated on the day of diagnosis. Eleven patients (39%) had hand motions or better vision in the infected eye at the time of initial diagnosis. Because of no light perception visual acuity, necrosis of cornea and sclera, and intractable pain, 7 eyes (25%) underwent evisceration or enucleation as initial treatment; of the remaining 21 eyes, intravitreal antibiotics were administered in all cases and intravitreal dexamethasone was administered in 15 cases (71%). Pars plana vitrectomy was performed in 12 patients (43%). The organism was sensitive to the initial antibiotics administered in all but 2 cases. Final visual acuity was 5/200 or better in 2 of 28 eyes (7%). Nineteen patients (68%) had a final visual acuity outcome of no light perception, and no patient achieved a final visual acuity of better than 20/400. Overall, 18 of the 28 eyes (64%) were either eviscerated or enucleated. CONCLUSIONS: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.

Aged↗
PubMed2002

Endophthalmitis caused by Moraxella osloensis.

PURPOSE: To report the clinical presentation, antibiotic sensitivities, and treatment outcomes of endophthalmitis caused by Moraxella osloensis. METHODS CASE SERIES: retrospective review of the medical records of all patients treated for endophthalmitis at Bascom Palmer Eye Institute between 1 January 1991 and 31 December 2000. RESULTS: During the study interval, 757 eyes were treated for endophthalmitis. Moraxella osloensis was isolated from three eyes of two patients (3/757, or 0.39%). In all three eyes, the endophthalmitis was delayed-onset and bleb-associated; Moraxella osloensis was isolated on chocolate agar and 5% sheep's blood agar using a RapNH commercial Kit (by Remel) through an automated system (Vitek). Like most gram-negative organisms, Moraxella was sensitive to ceftazidime, ciprofloxacin, and the aminoglycosides. Although vision at presentation was poor, both patients regained baseline vision after treatment with pars plana vitrectomy and injection of intravitreal antibiotics. CONCLUSIONS: To our knowledge, this is the first report of endophthalmitis caused by Moraxella osloensis. Unlike most series of delayed-onset, bleb-associated endophthalmitis the visual prognosis following treatment for endophthalmitis caused by Moraxella osloensis appears to be generally favorable.

Aged↗
PubMed2002

Hyperfractionated external beam radiation therapy in the treatment of murine transgenic retinoblastoma.

OBJECTIVE: To determine the in vivo efficacy of hyperfractionated external beam radiation therapy (EBRT) in comparison with standard daily EBRT in a murine model of heritable retinoblastoma. METHODS: Two hundred twenty eyes from 6-week-old simian virus-40 large T-antigen--positive mice were treated with a total dose of EBRT ranging from 10-76 Gy (1000 to 7600 rad). One hundred ten eyes underwent EBRT administered in 2.0-Gy (200-rad) fractions once per day. Forty-two eyes received hyperfractionated EBRT administered in 1.2-Gy (120-rad) fractions twice per day, while 48 eyes received EBRT twice daily in fractions of 5.0 Gy (500 rad). Twenty eyes served as untreated controls. All eyes were obtained for histopathologic examination and graded positive if any tumor was present. RESULTS: A dose-dependent inhibition of ocular tumor was observed for EBRT in these transgenic retinoblastoma mice. The tumor control dose for 50% of eyes (TCD(50)) treated with 2.0 Gy fractions of EBRT was 45 Gy (4500 rad) when treatments were administered once daily. A significant increase in tumor control was observed when treatments were administered twice per day at fractions of 1.2 Gy, resulting in a TCD(50) of 33 Gy (3300 rad) (P =.003). A further increase in tumor control was observed when twice-daily EBRT was administered in 5.0 Gy fractions resulting in a TCD(50) of 28 Gy (2800 rad). CONCLUSIONS: Hyperfractionated EBRT safely and effectively controls intraocular retinoblastoma in this transgenic animal model. Use of hyperfractionation allows for a reduction in total radiation delivered dose, while shortening the total treatment time. CLINICAL RELEVANCE: This treatment approach may be applicable in the management of pediatric retinoblastoma by maintaining excellent tumor control, while reducing treatment-associated complications.

Animals↗
PubMed2002

Atypical anterior optic neuropathy caused by toxoplasmosis.

PURPOSE: To report atypical anterior optic neuropathy due to toxoplasmosis. METHODS: Interventional case report. A 33-year-old male presented with sudden painless loss of vision and floaters in the right eye. Examination demonstrated a best-corrected visual acuity of 20/200, optic nerve head edema, retinal hemorrhages, and vitreous opacities. RESULTS: Nine days later, a granuloma at the optic nerve head was apparent, and the patient was treated with pyrimethamine, sulfadiazine, folinic acid, and prednisone. Six weeks after initiating therapy, best-corrected visual acuity had improved to 20/25. CONCLUSION: Optic nerve involvement in toxoplasmosis is uncommon and, when it occurs, usually presents with a white inflammatory mass on the optic disk. The current case demonstrates the importance of including toxoplasmosis in the differential diagnosis of unilateral anterior optic neuropathy, even if a focal inflammatory mass is not apparent.

Adult↗