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Biomedical subjects

James M Klancnik

Publications and source records attributed to James M Klancnik.

14 recordsLinked to original sources
PubMed2006

Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To describe the short-term anatomical and visual acuity responses after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: We conducted a retrospective study of patients with CNV secondary to AMD who were treated with intravitreal injection of bevacizumab (1.25 mg) during a 3-month period. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: There were 266 consecutive eyes of 266 patients who received injections, and follow-up information was available for 251 (94.4%). The mean age of the patients was 80.3 years, the mean baseline visual acuity was 20/184, and 175 (69.7%) had inadequate response to alternate methods of treatment. At the 1-month follow-up (data available for 244 patients), the mean visual acuity was 20/137 (P < 0.001 as compared with baseline), and 74 (30.3%) of patients had improvement in visual acuity as defined by a halving of the visual angle. At the 2-month follow-up (data available for 222 patients), the mean visual acuity was 20/122 (P < 0.001), and 78 (31.1%) of patients had visual improvement. At the 3-month follow-up (data available for 141 patients), the mean visual acuity was 20/109 (P < 0.001), and 54 (38.3%) of patients had visual acuity improvement. The mean central macular thickness at baseline was 340 mum and decreased to a mean of 247 microm at month 1 (P < 0.001) and 213 microm at month 3 (P < 0.001). At 1 month, two patients had mild vitritis, as did one patient at 2 months, who had a history of recurrent uveitis. No endophthalmitis, increased intraocular pressure, retinal tear, or retinal detachment occurred. The risk for thromboembolic disorders did not seem to be different than reported previously in studies concerning macular degeneration. CONCLUSION: There were no apparent short-term safety concerns for intravitreal bevacizumab injection for CNV. Treated eyes had a significant decrease in macular thickness and improvement in visual acuity. The follow-up was too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed.

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PubMed2005

Fundus autofluorescence and central serous chorioretinopathy.

PURPOSE: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. DESIGN: Observational case series. PARTICIPANTS: Thirty consecutive patients examined in a private referral practice. METHODS: Patients were imaged with autofluorescence photography, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). The mean and standard deviation (SD) of the grayscale values from a 100-pixel-diameter circle centered on the fovea were obtained and normalized with the level of autofluorescence of the posterior pole. RESULTS: There were 30 patients, 23 male (76.7%) and 7 female (23.3%), with a median visual acuity (VA) of 20/25 and a range of 20/15 to 20/400. Stepwise linear regression that included individual fixed effects found that normalized central macular autofluorescence (P < 0.001), pigment mottling in the fovea (P = 0.045), subfoveal fluid detected by OCT (P = 0.033), and the SD of the central macular autofluorescence (P = 0.025) produced a highly significant model (R2 = 0.92, P < < 0.001) predicting VA. Increasing levels of autofluorescence were correlated with accumulation of material on the outer surface of the retina as seen by OCT. Decreased central macular autofluorescence, particularly in those eyes with central geographic retinal pigment epithelial atrophy, was associated with poor VA. CONCLUSIONS: This study established that autofluorescence changes occurring in central serous chorioretinopathy with explicit patterns can be measured in a noninvasive manner, and this information can be used to estimate the damage induced by central serous chorioretinopathy with a high degree of statistical significance. We hypothesize that the material on the outer surface of the elevated retina may represent accumulation of photoreceptor outer segments secondary to the lack of direct apposition and phagocytosis by the retinal pigment epithelium.

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PubMed2005

Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation.

PURPOSE: To determine the nature and risk of neovascularization in the fellow eyes of patients with unilateral retinal angiomatous proliferation (RAP), a neovascular form of age-related macular degeneration (AMD). METHODS: A consecutive series of 52 patients diagnosed with unilateral RAP were studied retrospectively. Clinical biomicroscopic examination, fluorescein angiography, and indocyanine green angiography were used to evaluate all patients for the development of neovascular manifestations in the fellow eye. RESULTS: Neovascularization developed in the fellow eye in 52 patients over the follow-up period (range, 2-36 months). All patients developed neovascular manifestations of RAP in the fellow eye. Twenty-one patients (40%) developed a RAP lesion within 1 year; 29 (56%), within 2 years; and 52 (100%), within 3 years. At the time of diagnosis of neovascularization in the fellow eye, 8 patients (15%) had a stage I RAP lesion, 36 (70%) had a stage II RAP lesion, and 8 (15%) had a stage III RAP lesion. Other characteristic findings in these patients included the presence of preretinal, intraretinal, and subretinal hemorrhages in 49 patients (94%) and pigment epithelial detachments in 41 patients (79%). CONCLUSIONS: In patients diagnosed with unilateral RAP lesions, the form of neovascularization that develops in the fellow eye is virtually always RAP. The annual and accumulative risk of neovascularization in the fellow eye is higher in patients with RAP than in those with other forms of neovascular AMD. These new findings enhance our understanding of the clinical spectrum of RAP in terms of its natural course and visual prognosis and may possibly offer useful information to establish future treatment options.

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PubMed2004

Voluntary suppression of the multifocal electroretinogram.

OBJECTIVE: To describe multifocal electroretinogram (mfERG) responses in 2 patients with nonorganic visual loss and in 11 eyes of 6 healthy persons who suppressed their mfERG responses. DESIGN: Observational case series. METHODS: The mfERG results were recorded in all individuals using the Veris Science 4.2 instrument. All subjects were instructed to adjust the hexagonal test pattern so that it was in best focus. A second mfERG was recorded subsequently in volunteers who attempted suppression with inattention and poor fixation and by adjusting the focus to greatest blur. MAIN OUTCOME MEASURES: Amplitude and latency of mfERG responses. RESULTS: Suppressed mfERGs in patients with nonorganic visual loss and healthy volunteers demonstrated reduced amplitude, especially centrally. Amplitude reduction was statistically significant in the postsuppression as compared with the presuppression recordings in wave forms N1 and N2. Statistically significant shortening of postsuppression implicit times of P1 and N2 waveforms also was demonstrated. CONCLUSIONS: The mfERG responses may be suppressed voluntarily. Amplitude may be reduced. In contrast to most reported pathologic conditions, the implicit time is shortened.

Adult↗
PubMed2004

Retinal choroidal collateral circulation after radial optic neurotomy correlated with the lessening of macular edema.

PURPOSE: To evaluate patients who had undergone radial optic neurotomy for central retinal vein occlusion for the presence of retinal choroidal collateral circulation and to correlate these collaterals with changes in macular thickness during follow-up. Radial optic neurotomy is designed to release proposed pressure within the scleral canal. METHODS: Retrospective review of patients undergoing radial optic neurotomy. The patients had a baseline examination including ophthalmoscopy, fluorescein angiography, and optical coherence tomography. At an interval follow-up at approximately 3 months the patients were reevaluated with ophthalmoscopy, optical coherence tomography, and indocyanine green angiography. RESULTS: There were 6 patients, and the mean age was 68.3 years. The mean time from onset of the central retinal vein occlusion to the radial optic neurotomy was 2.3 months. One patient had no collateral vessels, three patients had significant collaterals, and two patients had moderate-caliber collaterals. The mean central macular thickness preoperatively was 1,021 microm and the mean central macular thickness postoperatively was 733 microm. The change in macular thickness was highly correlated with the degree of development of collaterals from the retinal to the choroidal circulation (P = 0.008, Spearman's rho = 0.93). CONCLUSION: Although all patients had a radial optic neurotomy a significant determinant in reduction of macular edema was the presence of retinal-choroidal collateral circulation. This suggests that there may be additional mechanisms, other than simple release of alleged pressure in the scleral canal, for any observed effects from radial optic neurotomy.

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PubMed2003

Optical coherence tomography findings in nicotinic acid maculopathy.

PURPOSE: To report optical coherence tomography findings in nicotinic acid maculopathy. DESIGN: Observational case report. METHOD: The patient was examined with ophthalmoscopy, fluorescein angiography, and optical coherence tomography. RESULTS: A 71-year-old man presented with bilateral decreased visual acuity with metamorphopsia. Optical coherence tomography demonstrated cystoid spaces in the outer plexiform layer and inner nuclear layer. Fluorescein angiography did not show leakage. Two weeks after stopping the nicotinic acid, the cystoid spaces resolved. CONCLUSIONS: Niacin maculopathy causes cystoid spaces in the inner nuclear and outer plexiform layers that resolve with discontinuation of the drug.

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PubMed2003

Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study.

BACKGROUND: Most patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green (ICG) angiography. A small percentage of patients develop chronic or progressive disease with widespread decompensation of the retinal pigment epithelium and severe vision loss. There is no known treatment for this variant of the disorder. PURPOSE: To study ICG-guided photodynamic therapy (PDT) with verteporfin as a potential treatment for patients with chronic CSC. METHODS: Twenty eyes of 15 patients were studied with fluorescein angiography, optical coherence tomography, and ICG angiography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. PDT with ICG guidance was applied to areas of choroidal hyperpermeability, and the patients were observed to determine the anatomic and functional outcomes. RESULTS: Photodynamic therapy guided by ICG was associated with complete resolution of exudative macular detachments in 12 patients and incomplete resolution in the remaining eight eyes. The vision improved in six eyes and remained unchanged in 14 eyes during a mean follow-up of 6.8 months. Six weeks after treatment, the mean visual acuity improved by 0.55 lines, an amount that was marginally significant. There was a significant inverse correlation between the baseline visual acuity and the amount of improvement in acuity at 6 weeks. No patient had any treatment-related side effects. CONCLUSIONS: Indocyanine green angiography-guided PDT with verteporfin seems to aid in the resolution of exudative detachments in patients with chronic CSC. This treatment was associated with a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.

Adult↗
PubMedDate not supplied

Intravitreal triamcinolone treatment for macular edema associated with central retinal vein occlusion and hemiretinal vein occlusion.

PURPOSE: To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). METHODS: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n = 21) and HRVO (n = 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre- and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. RESULTS: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n = 23] 635 vs. 352 mum, respectively; P < 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, -3-7) over the course of the study period. Ten eyes gained > or =2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P = 0.24). None of the eyes of diabetic patients (n = 6) or patients with ischemic CRVO (n = 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P = 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P = 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n = 16] 20/133 vs. 20/67, respectively; P < 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P = 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. CONCLUSIONS: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.

Adult↗
PubMedDate not supplied

An "exploding cataract" following Nd:YAG laser iridectomy.

A case of an "exploding" cataract (an iatrogenic posterior capsular rupture) following Nd:YAG laser iridectomy is described. Rapid cataract development was observed in the right eye of a 76-year-old woman following an iridectomy. B-scan ultrasonography documented cortical debris in the vitreous cavity. The patient underwent an extracapsular cataract extraction and intraocular lens implantation. During the cataract extraction, a posterior capsular tear extending from the 10-o'clock to the 4-o'clock position was noted, through which fluffy cortical material was floating in the vitreous.

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