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Biomedical subjects

Ingrid U Scott

Publications and source records attributed to Ingrid U Scott.

84 records · Page 5Linked to original sources
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Hypopyon and pseudoendophthalmitis associated with chronic vitreous hemorrhage.

Infectious endophthalmitis is an uncommon but potentially devastating eye disease. Although the presence of a hypopyon is considered one of the hallmark clinical signs of infectious endophthalmitis, hypopyon associated with non-infectious causes may occur. Two patients with hypopyon and pseudoendophthalmitis secondary to chronic vitreous hemorrhage are described. In both cases, the hypopyon improved without the use of intravitreal antibiotics.

Adult↗
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Implantation of second glaucoma drainage devices after failure of primary devices.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of implantation of a second glaucoma drainage device for eyes that have failed a primary device. PATIENTS AND METHODS: Medical records of patients receiving a primary glaucoma drainage device at Bascom Palmer Eye Institute from January 1987 to October 1998 were reviewed, of which 18 eyes of 18 patients were studied. Patients failing a primary glaucoma drainage procedure and receiving a second glaucoma drainage device were included in this study. The second eye in the same patient was excluded if a second drainage implant was required. All patients received a second device in a standardized fashion with the drainage tube inserted in the anterior chamber. Main outcome measures included: visual acuity, intraocular pressure (IOP), antiglaucomatous medication, length of follow up, and surface area of glaucoma drainage device. Success was defined as an IOP less than or equal to 21 mm Hg with or without medications, and at least a 20% reduction in IOP, without the need for additional glaucoma procedures. RESULTS: The mean postoperative IOP (19.6 +/- 9.4 mm Hg; range, 8-50 mm Hg) was significantly (P = 0.006) lower than the mean preoperative IOP (29.5 +/- 8.1 mm Hg; range, 20-52 mm Hg) at last follow up (mean 19.6 +/- 13.6 months; range, 6-47 months). The mean number of postoperative antiglaucomatous medications (2.2 +/- 1.2; range 0-4) was statistically similar (P = 0.2) to mean preoperative number of antiglaucomatous medications (2.6 +/- 1.2, range 1-4). Using Kaplan-Meier estimates, successful IOP reduction was observed in 89%, 83%, 63%, and 37% of eyes at 6 months, 1, 2, and 3 years, respectively. Four patients (21%) had a decline in visual acuity. CONCLUSIONS: Implantation of secondary glaucoma drainage devices may be useful in eyes that have failed primary devices.

Adult↗
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Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes (1995-2001).

BACKGROUND AND OBJECTIVE: To determine the incidence rate of acute-onset postoperative endophthalmitis and to assess visual acuity outcomes after treatment from the most recent 7 years (1995-2001) compared with the previous 11 years (1984-1994) among patients undergoing intraocular surgery at the same institution. PATIENTS AND METHODS: The medical records were reviewed of all patients undergoing intraocular surgery at the Bascom Palmer Eye Institute between January 1, 1995 and December 31, 2001. RESULTS: The 7-year incidence rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916 intraocular surgeries). The number of patients with endophthalmitis (incidence) and their median final visual acuity for each surgical category are as follows: cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%) - 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after cataract surgery, 6 cases occurred after phacoemulsification and 2 of these cases had a dear corneal sutureless incision. CONCLUSION: The most recent 7-year incidence rate of acute-onset postoperative endophthalmitis is significantly lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the same institution. Visual acuity outcomes after treatment were generally better in cataract surgery, glaucoma surgery, and secondary intraocular lens categories compared to pars plana vitrectomy and penetrating keratoplasty categories.

Acute Disease↗
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Pars plana lensectomy, pars plana vitrectomy, and silicone oil tamponade as initial management of cataract and combined traction/rhegmatogenous retinal detachment involving the macula associated with severe proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVES: To evaluate visual acuity and anatomic outcomes, and complications, following pars plana lensectomy, pars plana vitrectomy, and silicone oil tamponade (PPL/PPV/SO) in the initial management of cataract and combined traction/rhegmatogenous retinal detachment involving the macula associated with severe proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Retrospective, noncomparative, consecutive case series including all patients who underwent PPL/PPV/SO for the initial management of cataract and traction/rhegmatogenous retinal detachment involving the macula associated with severe PDR at Bascom Palmer Eye Institute between 1989 and 2000. Main outcome measures included visual acuity and rates of retinal reattachment and reoperation. RESULTS: The study included 22 eyes of 22 patients. The mean follow-up was 15.2 months. Preoperatively, 13 of 22 (59%) fellow (non-study) eyes had vision of light perception or worse, and 7 (32%) had vision of no light perception. The number of study eyes with a best-corrected vision of 20/400 or better increased from 5 (23%) preoperatively to 12 (55%) at 6 months (P < .05) and 15 (68%) at final follow-up (P < .05). The macula was attached at final follow-up in 20 (91%) eyes. In 14 (64%) eyes, silicone oil was removed at a mean of 8.4 months following retinal detachment repair; postoperative vision was 20/400 or better in 11 (79%) of these eyes at 6 months and 13 (93%) at final follow-up. In contrast, only 1 of 8 (13%) eyes with retained silicone oil achieved a postoperative vision of 20/400 or better (P < .05). CONCLUSIONS: Initial management with PPL/PPV/SO can achieve favorable anatomic and visual outcomes in selected patients with cataract and traction/rhegmatogenous retinal detachment involving the macula associated with severe PDR. This surgical approach should be especially considered in patients with traction/rhegmatogenous retinal detachment involving the macula in one eye and poor vision in the fellow eye.

Adult↗
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Eyelid and scleral necrosis following bare iridium-192 seed for retinoblastoma.

A 2 1/2-year-old girl with a history of bilateral retinoblastoma underwent primary enucleation of the right eye and was referred for further management of persistent tumor in the fellow eye. Previous treatment of the left eye included external beam radiotherapy, systemic chemotherapy, laser photocoagulation, cryotherapy, and direct scleral application of a bare iridium-192 radioactive seed. Examination revealed focal full-thickness necrosis of the left upper and lower eyelid and a large inferonasal viable retinoblastoma tumor with overlying retinal detachment. Systemic chemotherapy and direct laser photocoagulation were administered. Four months after presentation, the patient developed focal scleral necrosis with 360 degrees hemorrhagic choroidal detachment. Enucleation was performed and histopathologic examination demonstrated full-thickness scleral necrosis with adjacent viable retinoblastoma tumor cells. Follow-up examinations showed no evidence of recurrent or metastatic tumor. This case is the first report of scleral necrosis following combined modality treatment of retinoblastoma.

Child, Preschool↗
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Walker-Warburg syndrome: congenital neurodysplasia and bilateral retinal folds.

A 2-month-old girl with a history of congenital hydrocephalus presented due to "wandering eyes." Initial eye examination at age 2 months showed response to light and a prominent retinal fold that extended through the macula and made contact with the posterior and inferior temporal lens capsule in each eye. Combined with the patient's neurologic findings, the results of the ocular examination led to the diagnosis of Walker-Warburg syndrome. During 5 years of follow-up, the patient developed progressive cataracts in both eyes but maintained ambulatory vision in the left eye. Walker-Warburg syndrome should be included in the differential diagnosis for pediatric patients with a history of prominent retinal folds.

Abnormalities, Multiple↗
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Anatomic and visual acuity outcomes following thermal laser photocoagulation or photodynamic therapy for symptomatic circumscribed choroidal hemangioma with associated serous retinal detachment.

BACKGROUND AND OBJECTIVE: This study reports and compares the anatomic and visual acuity outcomes of patients treated with either thermal laser photocoagulation or photodynamic therapy for circumscribed choroidal hemangioma with associated serous retinal detachment. PATIENTS AND METHODS: Retrospective, consecutive, interventional case series of patients treated for symptomatic circumscribed choroidal hemangioma. RESULTS: Thirteen of 23 patients (57%) treated with thermal laser photocoagulation exhibited complete resolution of subretinal fluid, 6 (26%) had partial resolution of subretinal fluid, and 4 (17%) had persistent subretinal fluid despite therapy. At 3 months posttreatment, visual acuity was improved in 6 (26%), stable in 13 (57%), and worsened in 4 (17%) of 23 patients. All 5 patients who underwent photodynamic therapy had complete resolution of subretinal fluid. At 3 months posttreatment, visual acuity improved in 4 (80%), remained stable in 1 (20%), and worsened in 0 (0%) patients. CONCLUSIONS: Photodynamic therapy shows similar if not better anatomic and visual acuity results than thermal laser photocoagulation when treating symptomatic circumscribed choroidal hemangioma.

Adolescent↗
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Presumed sterile endophthalmitis following intravitreal triamcinolone acetonide injection.

BACKGROUND AND OBJECTIVE: To report acute postoperative, presumed sterile endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA). PATIENTS AND METHODS: Retrospective, interventional, multicenter study of patients with acute sterile endophthalmitis following IVTA injection. RESULTS: A total of 922 IVTA injections were performed. Eight eyes of 8 patients with presumed sterile endophthalmitis were identified. The incidence of endophthalmitis was 0.87% (95% confidence interval, 0.38% to 1.70%). Median time to presentation was 1.5 days (range, 1 to 7 days). Median presenting visual acuity was 20/563 (range, 20/80 to light perception). Initial treatment included vitreous tap and injection of antibiotics (n = 4), pars plana vitrectomy and injection of intravitreal antibiotics (n = 2), or systemic treatment alone with oral levofloxacin (n = 2). Six of 6 intraocular cultures were sterile. Median follow-up was 5.9 months (range, 4 to 9 months) with a median visual acuity at last follow-up of 20/75 (range, 20/40 to counting fingers). CONCLUSIONS: Acute presumed sterile endophthalmitis following IVTA injection presents early in the postoperative period. Visual outcomes are generally good.

Adult↗
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Regional anesthesia with monitored anesthesia care for surgical repair of selected open globe injuries.

BACKGROUND AND OBJECTIVE: To investigate clinical features and visual acuity outcomes associated with the use of regional anesthesia with monitored anesthesia care (RA/MAC) versus general anesthesia for open globe injuries in adult reparable eyes. PATIENTS AND METHODS: Retrospective, consecutive case series including all adults with open globe injuries repaired at Bascom Palmer Eye Institute between 2000 and 2003. RESULTS: The study included 238 eyes of 238 patients with a median age of 41 years. RA/MAC was employed in 141 (59%) eyes and general anesthesia in 97 (41%) eyes. Patients who had RA/MAC were significantly (P< .001) more likely to have anterior wound location (64% corneal/limbal vs 50%), shorter wound length (6.5 vs 12 mm), and formed anterior chamber (82% vs 56%), and were significantly less likely to have an afferent pupillary defect (12% vs 43%). The improvement from presenting visual acuity to each postoperative follow-up interval was similar for the two groups. CONCLUSIONS: RA/MAC is a reasonable alternative to general anesthesia for selected patients with open globe injuries.

Adolescent↗
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A cluster of patients with acute-onset endophthalmitis following cataract surgery.

BACKGROUND AND OBJECTIVE: To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. PATIENTS AND METHODS: Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. RESULTS: Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). CONCLUSIONS: Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.

Acute Disease↗
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Bilateral optic disc edema in patients with severe systemic arterial hypertension: clinical features and visual acuity outcomes.

BACKGROUND AND OBJECTIVE: To report clinical features and visual outcomes in patients with bilateral optic disc edema and severe systemic arterial hypertension. PATIENTS AND METHODS: Records were reviewed of patients with bilateral optic disc edema, severe arterial hypertension, and 3 or more months of follow-up evaluated at Bascom Palmer Eye Institute between 1982 and 2003. RESULTS: Sixteen patients (median age = 41 years; median follow-up = 31 months) were identified. Median blood pressure on initial eye examination was 220 mm Hg systolic and 126 mm Hg diastolic. Among all study eyes, median visual acuity was 20/55 on presentation. At the last follow-up examination, an acuity of 20/50 or better was achieved in 20 (63%) eyes; 12 (75%) patients achieved a final acuity of 20/50 or better in at least one eye. Posterior segment abnormalities at last follow-up included disc pallor (n = 16), macular star (n = 7), retinal pigment epithelial atrophy (n = 7), epiretinal membrane (n = 5), branch retinal vein occlusion (n = 4), and persistent disc edema (n = 2). Causes of final acuity of less than 20/50 included optic atrophy, epiretinal membrane, serous retinal detachment, macular hole, and branch retinal vein occlusion. CONCLUSION: Most patients with bilateral optic disc edema and severe arterial hypertension maintained visual acuity of 20/50 or better in at least one eye.

Adolescent↗