PubMed Health⌕ Search

Biomedical subjects

J L Keltner

Publications and source records attributed to J L Keltner.

At least 19 recordsLinked to original sources
PubMed1992

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.

BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

Acute Disease↗
PubMed1992

Management and monitoring of cancer-associated retinopathy.

Cancer-associated retinopathy is a rare paraneoplastic event that can involve allergic reactions and result in retinal degradation. A patient, who had a 35-year smoking history, complained of visual loss and was found to have serum antibodies that reacted with an extract of retina, including the previously described retinal cancer-associated retinopathy antigen. Prednisone treatment appeared to reduce the patient's antibody titers to normal levels. Visual fields stabilized, and the patient was able to maintain useful vision throughout the course of treatment until his death 1 year following initial diagnosis. To our knowledge, this is the first reported case in which monitoring of antibody responses to retinal antigens appeared to be useful in the decision whether to initiate prednisone therapy. Rising antibody titers to the cancer-associated retinopathy antigen probably occurs before progressive visual field loss and may be considered an indication for prompt steroid therapy.

Aged↗
PubMed1992

The cancer-associated retinopathy antigen is a recoverin-like protein.

Cancer-associated retinopathy (CAR) is a rare form of retinal degeneration that occurs in association with certain forms of cancer. CAR patients typically possess high titers of autoantibodies against a specific photoreceptor protein--the 23 kD retinal CAR antigen. The mechanisms involved in the vision loss experienced by CAR patients are not understood, but serologic studies indicate the process could include a series of autoimmune reactions directed at specific components of the retina. Because the retinal CAR antigen is the principal ocular autoantigen involved in the antibody response of CAR patients, characterizing it would contribute to the understanding of putative autoimmune involvement. Serum antibodies from CAR patients have been used to isolate the gene encoding the CAR antigen from a cDNA library of human retina. Nucleotide sequence analysis suggests that the CAR antigen shows approximately 90% homology to the published amino acid sequence of bovine recoverin.

Amino Acid Sequence↗
PubMed1991

Antibody indications of secondary and superimposed retinal hypersensitivity in retinitis pigmentosa.

Antibody reactions with recognized retinopathy-inducing retinal antigens may be interpreted to reflect ongoing autoimmune events responsible for some forms of vision loss. We sought evidence of secondary and superimposed retinal hypersensitivity indicated by such antibody reactivity in a random group of patients with retinitis pigmentosa. We identified patterns of immunologic reactivity within members of a group of 52 patients with retinitis pigmentosa, which suggests some patients with retinitis pigmentosa may experience consequential superimposed retinal hypersensitivity. Identifying subgroups of patients with retinitis pigmentosa who exhibit indications of retinal hypersensitivity to known uveitopathogenic retinal proteins may permit the reduction of their rate of retinal degradation by immunomodulation.

Adult↗
PubMed1979

Acuity profile perimetry: description of technique and preliminary clinical trials.

Acuity profile perimetry is a technique that allows visual acuity properties to be rapidly measured at any location in the visual field. This report describes our initial clinical trials with acuity profile perimetry, as performed in combination with standard static perimetry. Preliminary results from patients with cataracts, amblyopia, and central serous retinopathy show, in general, a much greater deficit for acuity profiles than for static sensitivity profiles. In contrast, patients with optic neuritis or other optic neuropathies display approximately equivalent losses for static and acuity profiles. The recovery process in optic neuritis is also about equal for the two functions. Our initial findings suggest that acuity profile perimetry may be a valuable differential diagnostic test, particularly for cases in which optic nerve disease is suspected.

Adult↗
PubMed1979

Virus-simulating structures in the optic nerve head in Creutzfeldt-Jakob disease.

A 68-year-old man was treated for and died of Creutzfeldt-Jakob disease. At autopsy we found multiple virus-like particles in the optic nerve head, but saw no similar structures in the cornea. Although these particles were morphologically similar to those previously reported in brain, we believe that they are not virions but unrelated cellular structures. We speculate that the causative agents may be naked membrane bound nucleic acids rather than true viruses. We found no optic atrophy or other specific pathologic changes in the eyes; severe occipital cortical degeneration was responsible for the patient's visual loss.

Aged↗
PubMed1979

Comparison of photographic techniques and films used in stereophotogrammetry of the optic disk.

We compared photogrammetric measurements of optic cup volume, area, and depth made from two types of stereophotography and two types of film to determine their effect on the precision of the measurements. We found that measurements from simultaneous stereophotography (Donaldson stereoscopic fundus camera) had a smaller range of values and a smaller mean percent error than measurements from consecutive stereophotography (Zeiss Fundus Flash II camera). However, a Student's t-test for related measures showed no significant difference. The measurements from Kodachrome 25 film and Kodak Photomicrography film varied in range and mean percent error without a pattern. The Student's t-test for related measures showed no significant difference.

Evaluation Studies as Topic↗
PubMed1979

Suprathreshold static perimetry in glaucoma and other optic nerve disease.

Comparisons between automated suprathreshold static perimetry and manual kinetic perimetry were performed for 226 eyes with glaucoma or ocular hypertension, and 147 eyes with other optic nerve disease. Both techniques produced similar high detection rates for glaucomatous visual field defects, whereas suprathreshold static perimetry performed significantly better than kinetic testing in optic nerve disease other than glaucoma. It is concluded that automated suprathreshold static perimetry is an excellent quantitative screening technique for detecting visual field defects.

Glaucoma↗
PubMed1979

A regional course to update the practicing specialist.

Four medical centers collaborated in the development of a course in ophthalmology to present new information and skills to the practicing specialist who is not associated with a medical center. The course is presented in 8 two-day sessions, scheduled Friday and Saturday, four times a year, on a two-year cycle. Thus, the participant loses only four days a year from his practice. This course differs from most of the postgraduate courses currently being offered in that it is designed to update basic specialty knowledge and skills systematically to improve health care delivery.

Education, Medical, Continuing↗
PubMed1979

Photogrammetry of the optic disc in glaucoma and ocular hypertension with simultaneous stereo photography.

Stereophotogrammetric evaluations of the optic cup were performed for normal, ocular hypertensive, and glaucomatous eyes. Average volume, area, and depth measurements were progressively larger from normal to ocular hypertensive to glaucomatous eyes, although the distributions of individual values exhibited considerable overlap among the three groups. Similar results were obtained for volume, area, and depth asymmetry between each pair of eyes. None of these measurements was able to distinguish accurately between normal and glaucomatous optic cups. However, normal eyes showed a high correlation (r = +0.85) between area and depth of the optic cup, whereas this area/depth relationship was reduced in ocular hypertensives (r = +0.63) and completely broke down for glaucomatous eyes (r = +0.04). Approximately 89% of the glaucomatous eyes and 47% of the ocular hypertensive eyes were beyond the range of normal area/depth correlation values. These findings represent an improvement over most previous attempts to quantitatively differentiate between normal and glaucomatous eyes on the basis of optic disc measurements alone, and support the hypothesis that optic disc damage usually precedes visual field loss in glaucoma. With further technical refinements such as computer image processing, stereophotogrammetry of the optic cup may become a valuable differential diagnostic technique for glaucoma.

Glaucoma↗
PubMed1977

Optic nerve decompression. A clinical pathologic study.

Decompression of the perioptic meninges for intractable chronic papilledema was done in a patient with a right parietal temporal glioblastoma multiforme. The patient died 39 days postoperatively. Histologic study of the optic nerves indicated fistulas in the dura compatible with cerebrospinal fluid (CSF) egress and maintenance of a normal subarachnoid space around the nerve. Two additional patients with unilateral optic nerve decompression producing bilateral resolution of papilledema were studied. We contend that egress of CSF was the principle mode of action in these three cases. How long the dural fistula remains patent is unknown. Reports in the literature show considerable variation in the effects of optic nerve decompression. Anatomic variation of the intracanalicular subarachnoid space together with differences in underlying pathologic condition, surgical technique, and patient response may explain discrepancies among the results reported.

Adolescent↗
PubMed1977

Mycosis fungoides. Intraocular and central nervous system involvement.

A 58-year-old man with mycosis fungoides was treated with chemotherapeutic agents and radiation for the recurrent cutaneous form of this disease. Five years after the onset, he developed blurring of vision, neurologic signs, and then lapsed into coma. Chemotherapy and radiation treatment resulted in improvement of the ocular and systemic picture. Within three months, however, the patient's vision deteriorated and swelling of both optic discs, along with retinal and vitreous infiltrates, was noted. Local radiation of the eyes was followed by improvement of the ocular changes. Five months later the patient died. Results of a histologic examination of the eyes showed extensive involvement of the retina and vitreous by tumor cells. The CNS was remarkably free of tumor cells and it was assumed that the radiation and chemotherapy were responsible for this.

Central Nervous System Diseases↗