Computed tomography: not an ophthalmic polygraph.
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Blast Injuries↗
Biomedical subjects
Joseph Pikkel
Publications and source records attributed to Joseph Pikkel.
Optic disc traction syndrome associated with central retinal vein occlusion.
OBJECTIVE: To describe the association between ischemic central retinal vein occlusion (CRVO) and the development of optic disc (vitreopapillary) traction, as verified by optical coherence tomography (OCT). METHODS: In a prospective, noncomparative, observational patient series, 3 women aged 51 to 64 years developed an ischemic type of CRVO. One patient underwent cannulation of the central retinal vein with injection of a tissue plasminogen activator. In each eye, the contour of the optic nerve head could not be accurately detected because of overlying fibrous tissue. Each patient underwent OCT examination 6 to 10 months (average, 8.3 months) after the occlusive event. RESULTS: Optic disc traction was found by OCT in the 3 patients. In each, the disc was elevated, associated with either incomplete posterior vitreous detachment (2 eyes) or vitreopapillary fibrous membrane (1 eye). Secondary peripapillary retinal traction and macular or retinal detachment developed ("optic disc traction syndrome"). These findings were less marked, or not evident, on both clinical examination and ocular ultrasonography. CONCLUSIONS: Optic disc traction and secondary localized retinal detachment can develop after ischemic CRVO and may contribute to the poor visual acuity. This syndrome should merit special attention before surgery for CRVO is planned. The use of OCT was helpful to diagnose this syndrome.
Diagnostic Imaging↗
Detachment of subfoveal choroidal neovascularization in age-related macular degeneration.
PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.
Aged↗
Acetazolamide for central serous retinopathy.
OBJECTIVE: To find out whether acetazolamide has a beneficial effect in the treatment of central serous retinopathy (CSR). DESIGN: Prospective, nonrandomized, comparative trial. PARTICIPANTS: Fifteen acetazolamide-treated and 7 untreated (control) CSR patients who completed at least 24 months of follow-up. METHODS: Patients in the treatment group were given systemic acetazolamide according to a standard protocol. Main outcome measures were compared between treatment and control groups using Student's t test and the Mann-Whitney U test for statistical analysis. MAIN OUTCOME MEASURES: Time until subjective visual improvement, time until full clinical resolution, and rate of recurrences. RESULTS: Mean times to both subjective visual improvement and clinical resolution of the attack were shorter in the study group than in the control group. Recurrence rate did not differ between the study and control groups. CONCLUSIONS: Acetazolamide treatment for CSR shortens the time for subjective and objective clinical resolution, but has no effect on either final visual acuity or recurrence rate of the disease.
Acetazolamide↗