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Biomedical subjects

J E Puklin

Publications and source records attributed to J E Puklin.

35 records · Page 2Linked to original sources
PubMed1993

Scleral flap necrosis and infectious endophthalmitis after cataract surgery with a scleral tunnel incision.

BACKGROUND: Long scleral tunnel dissection techniques have been developed for cataract surgery incisions. These incisions reduce postoperative astigmatism and keratorefractive instability. If fashioned correctly, the internal lip of the incision produces a tight seal to the anterior chamber, permissible of sutureless surgery. The behavior of such a wound during intraocular infection is unknown. METHODS: The authors describe two elderly patients in whom postoperative bacterial endophthalmitis was accompanied by infectious scleritis, infectious sclerokeratitis or keratitis, and rapid scleral flap necrosis. One of the patients had a painless disease process. RESULTS: Intraocular isolates of Staphylococcus aureus and Streptococcus equinus were recovered from the two patients, respectively. Management was complicated by loss of tectonic integrity that followed scleral flap necrosis, by impaired vitreoretinal visualization associated with rapidly progressive sclerokeratitis or keratitis, and by bacterial scleritis in the base of the scleral flap. No light perception was retained in either eye. CONCLUSION: Scleral tunnel incisions create a potential abscess cavity. Although a rare occurrence, postoperative endophthalmitis in such an eye may present major surgical and therapeutic problems intrinsic to the wound design.

Aged↗
PubMed1992

Ultrastructural immunocytochemistry of subretinal neovascular membranes in age-related macular degeneration.

BACKGROUND: The authors studied various cellular and extracellular matrix components of subretinal neovascular membranes (SRNVM) from patients with age-related macular degeneration (ARMD). METHODS: Electron microscopic immunocytochemistry was used on the subfoveal neovascular membranes surgically removed from three patients with disciform lesions due to ARMD. FINDINGS: The SRNVMs always contained large "feeder" vessels along with many new capillaries in different stages of maturation. Capillaries were sparse and embedded in an abundant stroma. The majority of the nonvascular cells were either retinal pigment epithelial (RPE) cells or fibroblast-like cells. The RPE cells formed single or multiple layers on one side of the membranes. The stroma was composed mainly of collagen types I and IV and fibronectin, with small amounts of collagen types III, V, and VI. The absence of Bruch's membrane suggests that a splitting may occur between the RPE cells and Bruch's membrane with the new vessels growing into this cleft. A thickened layer of collagen type IV was often present under the RPE cells. The basement membranes of the newly formed capillaries were morphologically ill-defined, and contained substantial amounts of collagen type IV and fibronectin, but, unlike the basement membranes of normal capillaries, they lacked laminin or heparan sulfate proteoglycan. CONCLUSION: These results on the ultrastructural components of the SRNVMs may be useful in clarifying the nature of the disciform process in ARMD.

Aged↗
PubMed1988

Optic nerve ultrastructure following amiodarone therapy.

Amiodarone has been implicated in the pathogenesis of optic neuropathy in several cases. However, that relationship is unclear, as subjects placed on amiodarone represent a high-risk group for various vasoocclusive accidents. In order to investigate the effect of amiodarone on the optic nerve, we examined histopathologically sections of the retrobulbar optic nerve obtained from an asymptomatic subject taking amiodarone. Lamellar inclusions were selectively found in the large axons. Amiodarone may have a chronic neurotoxic effect on the optic nerve via a drug-induced lipidosis. This neurotoxicity may be related to some of the acute forms of optic neuropathy described in the literature.

Amiodarone↗
PubMed1986

Pars planitis and autoimmune endotheliopathy.

A migrating endothelial rejection line is the clinical criterion of specific immune reaction in corneal allotransplantation. This line when seen in otherwise intact corneas has been presumed to be an autoimmune endotheliopathy. We have recorded corneal changes similar to autoimmune endotheliopathy in four of ten patients with the diagnosis of pars planitis. These observations suggest that pars planitis may be an autoimmune process directed against the vitreous humor.

Adult↗
PubMed1985

Clinical predictors of retinopathy and its progression in patients with type I diabetes during CSII or conventional insulin treatment.

Data from 70 type I diabetic patients with nonproliferative retinopathy participating in a multicenter clinical trial of control and complications were analyzed to test for associations of clinical variables with baseline levels and 8-mo changes in retinopathy. Predictor variables included age, duration of diabetes, systolic blood pressure, inpatient and outpatient plasma glucose levels, glycosylated hemoglobin (HbA1), M-values, serum cholesterol, serum triglycerides, and creatinine clearance. Retinopathy was assessed by fundus photography and graded at the Fundus Photograph Reading Center according to a detailed protocol. For the entire group, baseline retinopathy was positively correlated (P less than 0.05) with baseline systolic blood pressure, plasma glucose, HbA1, serum cholesterol, and duration of disease and negatively correlated with creatinine clearance. Conversely, during treatment, progression of retinopathy was negatively correlated (P less than 0.05) with mean levels during treatment of plasma glucose, HbA1, M-values, serum cholesterol, and with changes during treatment in plasma glucose and serum triglycerides. Two-group and three-group multivariate classification analysis of progression of retinopathy (improved or unchanged versus worsening--mild or moderate) indicated lower plasma glucose as the single best predictor of worsening of retinopathy (P less than 0.05), correctly classifying 71% of patients with positive progression. Decreased creatinine clearance during therapy was found to be the best discriminator between mild and moderate progression. Other multivariate models yielded specificity values of up to 71% and sensitivity values of up to 92%. We conclude that associations among clinical predictors and retinopathy during short-term glycemic control differ strikingly from those at baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1982

Serum antibody responses to bovine retinal S-antigen and rod outer segments in proliferative diabetic retinopathy before and after argon laser photocoagulation.

Using the enzyme-linked immunosorbent assay, the serum antibody titers to bovine retinal S-antigen and rod outer segments in pre- and post-argon laser treated diabetic retinopathy patients were compared to each other and to the titers of age- and sex-matched normal controls. The increase in anti-S titer following the initial laser treatment gave a P less than 0.01 using the two-tailed paired Student's t-analysis as compared to the prelaser anti-S titer. Both pre- and post-laser anti-S titers were elevated over normal controls with P values of less than 0.02 and less than 0.001, respectively. Eight weeks after the initial laser treatment, anti-S titers began to decline approaching control levels 12 weeks later. No significant change was found between pre- and post-laser titers when rod outer segments were used as antigen although the pre- and post-laser titers were increased over normal controls with P values of less than 0.05 and less than 0.001, respectively. The release and possible alteration of retinal components following photocoagulation may account for the rise in anti-S titers, while the prephotocoagulation titers may be due to retinopathy-related photoreceptor cell alteration.

Adult↗
PubMed1982

Influence of long-term insulin infusion pump treatment of type I diabetes on diabetic retinopathy.

Isolated case reports have suggested short-term beneficial effects of subcutaneous insulin infusion pump treatment on background and proliferative diabetic retinopathy. To evaluate this question further, 30 eyes of 15 Type I diabetic patients were evaluated prospectively before and after 11--23 months (mean 18.1 months) of pump treatment. In each patient plasma glucose and total glycosylated hemoglobin fell to normal or near normal levels. The ten eyes without diabetic retinopathy at entry remained without. Four of 20 eyes with diabetic retinopathy at entry advanced by modified Early Treatment Diabetic Retinopathy Study (ETDRS) classification, including one eye that progressed from background to proliferative diabetic retinopathy. No eyes with diabetic retinopathy improved their modified ETDRS classification. One eye progressed to blindness; no other eye lost vision. Six eyes had laser treatment prior to insulin pump treatment; four of these and two more required laser during pump treatment. Two eyes had vitreous hemorrhages prior to pump treatment; one of these and four others hemorrhaged during pump treatment. No eyes with diabetic retinopathy showed regression of microvascular changes. The data suggest prolonged restoration of near normal glucose metabolism with the insulin pump does not reverse established diabetic retinopathy. Whether pump treatment slows the progression, or prevents the development, of diabetic retinopathy remains to be established.

Adolescent↗
PubMed1982

Influence on retrolental fibroplasia of intramuscular vitamin E administration during respiratory distress syndrome.

The effect of vitamin E administered during the acute phase of therapy for respiratory distress syndrome (RDS) on the development of retinopathy of prematurity (ROP) was evaluated in a randomized double-masked study. One hundred neonates received either vitamin E or placebo intramuscularly within the first 24 hours of birth and at 24, 48, and 168 hours respectively. Additional doses were given twice weekly while the infant remained in an oxygen-enriched environment and could not tolerate feedings and vitamin supplements. Parenteral vitamin E-treated infants had significantly increased serum vitamin E levels compared to placebo-treated infants. Most placebo-treated patients attained normal serum vitamin E levels during the second week of life because of nutritional sources of vitamin E. Infants in both groups had RDS of similar severity. Seventy-four infants, 37 vitamin E-treated and 37 placebo-treated, survived longer than 10 days and had ophthalmologic examinations. Active changes of Stage I and Stage II ROP were noted in 17 of those patients; 9 (24.3%) vitamin E-treated and 8 (21.6%) placebo-treated patients (P = 0.572). No infants developed severe cicatricial changes, and their retinal findings regressed. The incidence of risk factors associated with ROP development occurred equally in the vitamin E-treated and placebo-treated infants that developed ROP. Thus, vitamin E-administration as described in this study did not result in any further reduction in the incidence of the active stages of ROP over that seen with standard neonatal care, which included daily oral Vitamin E supplements.

Clinical Trials as Topic↗
PubMed1981

Anterior segment and retinal pigmentary abnormalities in arteriohepatic dysplasia.

Arteriohepatic dysplasia (AHD, Alagille's syndrome) is presumed to be one of the six known familial intrahepatic cholestatic syndromes, all of which present with neonatal jaundice or failure to thrive, or both. Accurate early diagnosis of the proper syndrome is important, as arteriohepatic dysplasia has a good prognosis, whereas the other syndromes usually lead to death in infancy or early adulthood. Posterior embryotoxon was found in all five of our patients and may be one of the hallmarks of this syndrome. Axenfeld's anomaly was present in three of five patients, and retinal pigmentary abnormalities were found in four of five patients. Variable abnormalities were found in the cardiovascular system, bones, central nervous system, kidneys, endocrine system, and body habitus. Inheritance may be autosomal dominant as vertical transmission was documented in one family. Liver function improves during the first five years of life so that only the ocular and skeletal signs may be present in adults.

Abnormalities, Multiple↗
PubMed1976

Lacrimal obstruction after migration of orbital floor implant.

A 7-year-old girl developed epiphora, recurrent purulent conjunctivitis, and dacryocystitis 32 months after the repair of a traumatic orbital floor fracture. Dacryocystography and surgical exploration revealed that migration of the orbital floor implant had caused obstruction of the nasolacrimal duct at the sac. Migration of the implant was probably due to a failure to anchor the implant properly to bone.

Bone Plates↗
PubMed1976

Transient eyelid retraction in myasthenia gravis.

Three patients with myasthenia gravis had transient retraction of the upper eyelids which usually followed prolonged upgaze and which persisted for many seconds. This could result from post-tetanic facilitation, myotonia, or a transient contracture. Retraction of this type is to be distinguished from both the long-standing unilateral retraction associated with ptosis of the contralateral eyelid and the fleeting lid twitch sign.

Eyelids↗
PubMed1975

Stereoacuity development in children with normal binocular single vision.

We made 344 stereoacuity determinations (Titmus Stereotest) on 321 children, ages 1 1/2 to 13 years, who had normal binocular single vision tested by other factors. The data showed a gradual improvement in stereoacuity scores with increasing age--up to age 9--when a normal stereoacuity of 40 seconds of arc was consistently found. The lower limits of stereoacuity compatible with normal binocular single vision were 3 1/2 years, 3,000 seconds; 5 years, 140 seconds: 5 1/2 years, 100 seconds; 6 years, 80 seconds; 7 years, 60 seconds; and 9 years, 40 seconds.

Adolescent↗
PubMedDate not supplied

Long-term improvement of metabolic control with the insulin pump does not reverse diabetic microangiopathy.

Restoration of near-normal glucose metabolism with the insulin pump reduces retinal fluorescein leakage and microalbuminuria in diabetes. However, it is not known whether these functional changes reflect a true reversal of diabetic retinopathy or nephropathy. To evaluate this question, we studied the effect of 1-2 yr of insulin pump treatment on clinical endpoints in 17 type I diabetic patients. In each patient, plasma glucose and total glycosylated hemoglobin levels fell to normal or near-normal levels. The total daily dose of insulin given during the first month of pump treatment (52 +/- 5 U/day) was comparable to that given during conventional treatment (44 +/- 3 U/day) and varied little over the 1-2 yr period of observation. Ten eyes without retinopathy at the start of the study remained without retinopathy after 15-23 mo of pump treatment. One of eleven eyes with background retinopathy developed proliferative retinopathy and 3 of 13 eyes with proliferative retinopathy progressed during pump treatment. Similarly, no improvement in renal function was observed in the six patients with diabetic nephropathy on entry to the study. In the first month of pump treatment, proteinuria consistently fell to values 30% below prepump levels (P less than 0.005). However, the diminution in proteinuria was not sustained and all remain proteinuric after 13-18 mo of pump therapy. Serum creatinine rose slightly and creatinine clearance did not significantly change. These data suggest that insulin pump treatment does not reverse established diabetic microvascular complications, despite a sustained improvement in metabolic control for up to 2 yr.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗