Biomedical subjects
Publications and source records attributed to Jay C Bradley.
We report an observational case of Bartonella quintana-associated neuroretinitis. The patient had a positive IgM IFA titer for Bartonella quintana early in the disease. After treatment, the neuroretinitis and IgM resolved. Given the patient's history, symptoms, response to treatment, and IgM course, we believe his neuroretinitis was secondary to Bartonella quintana.
A case of Pseudallescheria boydii keratitis is presented. The patient was successfully treated with topical natamycin and systemic itraconazole in conjunction with penetrating keratoplasty, leading to visual acuity of 20/40.
BACKGROUND: The purpose of this study was to determine age-dependent values for mean sensitivity, mean deviation, and loss variance for normal children age 6 through 13 years, using the Octopus 301 perimeter and the Tendency Oriented Perimetry 32 (TOP-32) program. METHODS: Healthy children from 6 through 13 years of age with a visual acuity of 20/20 OU and at least 60 arc seconds of stereopsis were recruited. They were tested on the Octopus 301 perimeter using the TOP-32 program, and each eye was tested twice during one session. Results for all four tests were averaged for each subject, and the average was used for statistical analysis. The main outcome measures were mean sensitivity, mean deviation, and loss variance by age. The test duration, learning and fatigue effects, and the influence of false positive responses on the average mean sensitivity were also analyzed. RESULTS: There were 142 subjects tested. Six-year-old children showed high intersubject variability and were excluded (N=23). The average age of the remaining 7- to 13-year-old cohort (N=119) was 9.8 +/- 1.7 years. The average test duration was 2.9 +/- 0.3 min. The average mean sensitivity was 28.7 +/- 1.9 dB. The mean sensitivities for tests 1 through 4 were 28.14, 28.63, 28.96, and 28.92 dB, respectively. The average mean deviation was 0.4 +/- 1.9 dB. The slope of the regression line for mean sensitivity vs age was -0.018 +/- 0.165 dB/year, which was not significantly different from zero (two-tailed t test, p=0.83). The false positive catch trial rate was high (mean 26%) and was independent of age. When the data from subjects who had more than two false positive catch trial responses on any one test were eliminated, the mean sensitivity decreased to 28.3 +/- 1.9 dB. CONCLUSIONS: When testing patients age 7 through 13 years on the Octopus 301 perimeter using the TOP-32 program, comparison against the programmed normal mean sensitivity value for 20-year-old subjects (29.0 dB) is appropriate. During a sequence of four tests, both learning and fatigue effects are evident. The false positive response rate is naturally high regardless of age, and children should not be overencouraged to respond during testing.
A 39-year-old man with Candida glabrata endophthalmitis was successfully treated with a 28-day course of intravenous caspofungin. Presence of underlying renal insufficiency and infection with a drug-resistant strain precluded use of amphotericin B or fluconazole. Intravitreal administration of antifungals and vitrectomy were not required. The role of caspofungin in Candida endophthalmitis is discussed.
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PURPOSE: To determine whether laser in situ keratomileusis (LASIK) affects the central 30-degree visual field. SETTING: University-based ophthalmology practice. METHODS: This nonrandomized clinical trial comprised 14 normal patients (27 eyes) scheduled to have LASIK for myopia or myopic astigmatism. Automated static perimetry was performed before and 6 months after surgery using the Octopus 1-2-3 perimeter and the Dynamic-32 test strategy. Patient data included sex, age, preoperative and postoperative refractive errors, preoperative and postoperative best corrected visual acuity, preoperative corneal thickness, programmed optical zone, programmed total ablation diameter, and duration of microkeratome suction. All surgery was performed using the same Alcon LADARVision 4000 excimer laser. The main outcome measures were the mean sensitivity (MS) change in the central 15-degree visual field and the MS change in the 15- to 30-degree visual field. A multivariate analysis of the MS change as a function of preoperative clinical parameters was performed. RESULTS: There was no significant change in the MS in the central 15-degree visual field; between 15 and 30 degrees, there was a statistically significant decrease of -0.82 dB +/- 1.40 (SD) (P=.01, 2-tailed t test). The decline in MS was positively correlated with refractive error and corneal thickness; it was negatively correlated with the programmed optical zone diameter. CONCLUSIONS: Automatic static perimetry can detect decreased sensitivity in the midperipheral visual field after myopic LASIK. It may be a useful quantitative subjective test for measuring the effects of future improvements in surgical technique on vision quality.
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PURPOSE: To investigate the accuracy of pupil diameter measurement using the Colvard pupillometer and to determine the learning curve for inexperienced examiners. SETTING: Texas Tech University Health Sciences Center, Lubbock, Texas, USA. METHODS: In this population study, subjects with normal pupillary behavior were tested by 1 of 2 investigators (examiner A, examiner B). After 5 minutes of dark adaptation at 1 lux, digital infrared pupil photography of the right eye was performed, followed by measurement of the horizontal pupil diameter and vertical pupil diameter with the Colvard pupillometer. The photographs were digitally analyzed to determine the horizontal and vertical pupil diameters. During phase I of the study, examiners were masked to the results of infrared pupil photography; during phase II, they reviewed the infrared pupil photography results after each testing session. Bland-Altman plots were created to detect measurement bias; results were graphed by subject test sequence to assess learning. A test difference of less than +/-0.5 mm was considered clinically acceptable. RESULTS: Fifty-nine subjects were tested in phase I, of whom 39 had adequate infrared pupil photography for analysis; 40 were tested in phase II, of whom 34 were included. The mean age of the analyzed subjects was 27 years (range 18 to 44 years). For all subjects, the infrared pupil photography median horizontal pupil diameter was 7.09 mm +/- 0.75 (SD) (range 5.44 to 8.79 mm); the median vertical pupil diameter was 7.22 +/- 0.79 mm (range 5.45 to 9.10 mm). Examiner A initially had a negative bias (Colvard pupillometer value less than infrared pupil photography value) for both horizontal and vertical pupil diameter measurements, which resolved during phase I after 23 subjects were tested; 18 of the final 19 subjects tested (11 phase I, 8 phase II) showed a test difference of less than 0.5 mm for all readings. The pupil diameter did not affect the bias. Examiner B had a strong positive bias that persisted throughout the study. Testing 26 subjects in 5 sessions during phase II did not improve the accuracy. During the final testing session, 3 of 8 subjects had a test difference of 0.5 mm or more in at least 1 dimension. The pupil diameter did not affect the bias. CONCLUSION: The Colvard pupillometer is susceptible to user errors causing unidirectional bias and seems to have a steep and variable learning curve.
We report a case of Aspergillus terreus endophthalmitis and review the 4 previously reported cases. Immunosuppression, intravenous drug use, intraocular surgery or trauma, and a compatible clinical picture should raise suspicion of the diagnosis. This species often exhibits resistance to amphotericin B and outcomes are poor despite current therapies.
The role of other non-perfringens Clostridium species in endophthalmitis infections has not been analyzed. We describe a case of non-perfringens Clostridium endophthalmitis and review prior cases in the literature. Fulminant clinical presentations and poor visual outcomes are the rule, but a combined aggressive medical and surgical approach may conserve vision.
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