Images in clinical medicine. Optic neuritis due to Bartonella henselae infection.
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Adolescent↗
Biomedical subjects
J Michael Lahey
Publications and source records attributed to J Michael Lahey.
Complications of hydrogel explants used in scleral buckling surgery.
PURPOSE: To report a group of patients with symptoms of pain, strabismus, sensation of orbital fullness, and presence of a subconjunctival mass many years after successful scleral buckling surgery using hydrogel explants. DESIGN: We present an interventional consecutive case series of patients who underwent scleral buckling surgery using hydrogel explants from 4 to 14 years before onset of clinical symptoms. SETTING: This is a retrospective, multicenter clinical study. PATIENT POPULATION: 17 eyes of 15 patients presented with this disorder. All patients were examined; Snellen acuity, ocular motility, tonometry, slit lamp, and fundus examination were recorded. Two patients underwent either computed tomography or magnetic resonance imaging. Removal of the hydrogel explant was attempted in all patients. Removal of the buckle was technically difficult; the hydrogel material was fragile and fragmented when handled. RESULTS: All patients had prompt relief of pain and discomfort. Ocular motility and diplopia were greatly improved. Extraocular muscle surgery was not required in any case. Three eyes had intraoperative eye wall perforation. One eye developed postoperative bacterial endophthalmitis. Five eyes had recurrence of retinal detachment. One eye had additional complications of corneal edema and glaucoma. CONCLUSIONS: Patients who develop this clinical condition should be considered for removal of the hydrogel scleral buckle. Early recognition of this condition may prevent serious complications associated with delayed removal.
Adolescent↗
Combining phacoemulsification and vitrectomy in patients with proliferative diabetic retinopathy.
PURPOSE OF REVIEW: Modern vitrectomy and cataract extraction techniques have reached levels not imagined 20 years ago. Combining pars plana vitrectomy with phacoemulsification and posterior capsulectomy now has the potential to condense three separate procedures: pars plana vitrectomy, phacoemulsification, and YAG capsulotomy into one procedure. Interest in combined surgery is increasing as reports in the literature documenting its safety and efficacy continue to be published. The purpose of this article is to review the recent trends in combined surgery. RECENT FINDINGS: Studies have shown that when comparing sequential surgery to combined surgery, there is no significant difference in visual outcome. Multiple reports confirm the safety of combined surgery in patients with proliferative diabetic retinopathy. SUMMARY: In select patients with diabetes, combining vitrectomy with phacoemulsification and posterior capsulectomy allows patients who often have bilateral vitreoretinal disease to come to a stable postoperative vision in the eye requiring vitreous surgery much earlier than three separate procedures spread out over months or years.
Cataract↗
Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases.
PURPOSE: To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. DESIGN: Retrospective, consecutive, noncomparative, interventional case series. PARTICIPANTS: Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. METHODS: A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. MAIN OUTCOME MEASURES: Vision, number of secondary procedures, and complications. RESULTS: Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). CONCLUSIONS: Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.
Cataract↗
Hypercoagulable states and central retinal vein occlusion.
Central retinal vein occlusion is a common cause of permanent visual loss. Work up and laboratory evaluation of patients requires the clinician to rule out hypertension, diabetes, hyperlipidemia, and glaucoma. Patients without an identifiable risk factor are often subject to extensive testing for primary and secondary thrombophilias. The purpose this paper is to review the literature to determine which of these tests is associated with central retinal vein occlusion. Antiphospholipid antibodies and elevated plasma homocysteine levels appear to be the tests associated most commonly in patients with central retinal vein occlusion in most controlled studies. Primary thrombophilias are found rarely when screening patients with central retinal vein occlusion. Extensive testing for thrombophilias is not warranted in the vast majority of patients with central retinal vein occlusion. Older patients with any of the common vascular risk factors do not require thrombophilic screening. By carefully selecting the patients who are evaluated for thrombophilias, the likelihood of finding true-positive tests is increased.
Biomarkers↗
Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less than 56 years of age.
PURPOSE: To investigate whether hypercoagulability plays a role in thrombus formation in patients with central retinal vein occlusion (CRVO) who are less than 56 years of age. DESIGN: Prospective, observational case series with retrospective comparative controls. PARTICIPANTS AND CONTROLS: Participants included 55 consecutive patients with CRVO less than 56 years of age. The laboratory's age-matched control groups were used to compare results for the same tests. METHODS: Fifty-five patients with CRVO less than 56 years old (mean age, 44 years) underwent laboratory evaluation for homocysteine, activated protein C resistance, protein C activity, protein S activity, antithrombin III activity, antiphospholipid antibodies, and anticardiolipin antibodies. The results were compared with previously drawn age-matched control groups obtained by the same laboratory for statistical significance. MAIN OUTCOME MEASURES: Patients were considered to have a positive test if their results were outside the laboratory's established range. RESULTS: Fifteen of 55 patients (27%) had one positive test result suggesting hypercoagulability. Compared with the control groups, these patients less than 56 years old with CRVO had a higher incidence of coagulation abnormalities by laboratory testing. Among the parameters tested, hyperhomocysteinemia and circulating antiphospholipid antibodies were significantly more common in the CRVO patients (P < 0.05) compared with age-matched controls. CONCLUSIONS: Hypercoagulability may play a role in the pathogenesis of CRVO in patients less than 56 years old. The cause of CRVO remains multifactorial, and laboratory tests suggesting hypercoagulable states alone cannot account for the cause in most of these patients less than 56 years of age. The authors recommend examining blood pressure, intraocular pressure, complete blood count, glucose levels, and a lipid panel on all patients with CRVO. When tests for these common risk factors for CRVO are negative, consider ordering selected tests in young patients with CRVO to rule out thrombophilias, especially in patients with bilateral CRVO, a history of previous thrombosis, or family history of thrombosis.
Activated Protein C Resistance↗
Peripheral retinoschisis and exudative retinal detachment in pars planitis.
PURPOSE: To review and describe bullous retinoschisis and exudative retinal detachment in patients with pars planitis. METHODS: Retrospective, multicenter study of patients with pars planitis who presented with retinoschisis and exudative retinal detachments. RESULTS: The authors describe 13 eyes of 9 patients with pars planitis who presented with inferior peripheral retinoschisis and/or exudative retinal detachment. Four patients were male; five were female. Patients' ages ranged from 8 years to 35 years (median, 12 years). The follow-up interval ranged from 1 month to 10 years (median, 4 years). These peripheral retinal elevations had a tendency to remain stable, although those with telangiectatic vessels or vasoproliferative tumors occasionally demonstrated an increase in accumulation of exudate. Treatment of such eyes with cryotherapy, or low-dose plaque radiotherapy, resulted in vasoproliferative tumor and telangiectatic vessel regression, absorption of the hard exudate, and resolution of the retinal elevation in four of five eyes. One patient had spontaneous regression of the retinoschisis cavity over a 4-year period. CONCLUSION: Patients with pars planitis may present with bullous retinoschisis and/or exudative retinal detachment. These findings may be related to a Coats disease-like vascular response (telangiectatic vessels and vasoproliferative tumors) secondary to chronic inflammation. Treatment of the vascular leakage tended to result in resolution of the detachment and/or schisis.
Adolescent↗