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Decision Support Systems, Management↗
Biomedical subjects
J L Combs
Publications and source records attributed to J L Combs.
Diffuse unilateral subacute neuroretinitis.
The clinical syndrome of diffuse unilateral subacute neuroretinopathy (DUSN) has been characterised in its early and late stages. Different types of migrating worms in the subretinal and intraretinal space have been described as the cause of the clinical syndrome. We observed a patient with a long history of visual loss, vitritis, and a fundus of abnormal appearance where the worm was noted to migrate to different areas over the course of hours.
Adult↗
Anterior segment ischemia: a complication of retinal detachment repair in a patient with sickle cell trait.
Anterior segment ischemia (ASI) is a dreaded complication of retinal detachment surgery particularly in patients with predisposing factors such as sickle cell disease. We report a case of ASI after scleral buckling in an otherwise healthy black patient with sickle cell trait. Conditions of relative hypoxia intraoperatively from either anesthesia or surgical manipulation may precipitate vasoocclusive phenomena in these normally asymptomatic patients. Since the incidence of sickle cell trait in the black population in the United States is 8.5%, we recommend these patients have a preoperative sickle test followed by hemoglobin electrophoresis with quantification if positive. The presence of sickle cell trait should alert the surgeon to the risk of ASI, and factors predisposing to hypoxia should be minimized when possible.
Anterior Eye Segment↗
Cryptococcal choroiditis.
Two patients with acquired immune deficiency syndrome presented with headaches and fevers. A diagnosis of cryptococcal meningitis was made by lumbar puncture and elevated cryptococcal antigens. Complaints of decreased vision in both patients led to the diagnosis of optic disc edema and cryptococcal choroiditis with yellow-white choroidal infiltrates noted in both eyes of the two patients. Systemic treatment with amphotericin B and 5' flucytosine led to resolution of the choroidal infiltrates. Late visual acuity loss was believed to be secondary to optic atrophy.
Acquired Immunodeficiency Syndrome↗
Combined hamartomas of the retinal pigment epithelium and retina.
Combined hamartomas of the retinal pigment epithelium (RPE) and retina are rare, benign lesions usually occurring in individuals with no underlying systemic abnormalities. The authors report two cases of combined hamartomas of the RPE and retina. In one case, combined macular hamartomas of the RPE and retina were present in a 5-month-old infant. This is the earliest reported case of bilateral macular involvement. In both patients, multiple cafe-au-lait spots were present, and the diagnosis of neurofibromatosis was considered. The authors suggest that combined hamartomas of the RPE and retina are congenital lesions and may be one of the ophthalmic manifestations of the phakomatoses.
Child↗
Retinal breaks without detachment: natural history, management and long term follow-up.
A group of patients with retinal breaks without detachment were analyzed. They were divided into a treatment and a nontreatment group. The treatment group consisted of cases that the authors felt to be at high risk for the development of retinal detachment. Most of these were cases of horseshoe tears following the onset of an acute posterior vitreous detachment. Although a number of modalities were used in the treatment, a transconjunctival cryotherapy approach with topical anesthetic drops is currently used and was the most frequently employed. It is of note that while no case in this series developed a detachment because of inadequate treatment of the original tear a certain number did develop new tears and detachments. This would speak for a frequent follow-up, especially within the first three months following treatment, to anticipate such an occurrence. In the untreated group there were essentially two types of patients. One was the asymptomatic patient in which a retinal tear was found on routine examination and the other was the symptomatic patient with a round hole with pulled out operculum. New tears and or detachments also occurred in the asymptomatic group (4 of 72 eyes) but none of the round holes with pulled out opercula detached. Complications of treatment were related to the anesthesia and included vasovagal reactions and retrobulbar hemorrhage. One case seen in consultation had evidence of scleral perforation from a bridle suture and illustrates the inherent danger in any ophthalmic ocular procedure. The question of macular pucker (pre-retinal fibrosis) as a high risk of treatment is not shown by this study and in fact was more common in the untreated group than the treated group; however the vision of patients with macular pucker in the treated group was generally less than that of those untreated. Recurrent vitreous hemorrhage from bridging or avulsed vessels represented a significant problem following treatment and led to the only case of total visual loss in this study. The prophylactic treatment of acute horseshoe tears with continuing vitreous traction significantly reduces the incidence of subsequent retinal detachment. Whatever method of treatment is chosen by the surgeon, he must follow the principles laid down many years ago by Jules Gonin and completely close the tear. However, it is important to recognize that a new tear or detachment may occur in some cases and seems related to the continuing evolution of the posterior vitreous detachment or residual vitreo-retinal adherence rather than a cause of the treatment itself.
Adult↗