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Biomedical subjects

L J Singerman

Publications and source records attributed to L J Singerman.

35 records · Page 2Linked to original sources
PubMed1987

Skin necrosis following fluorescein extravasation. A survey of the Macula Society.

Three patients developed cellulitis and skin necrosis following fluorescein dye extravasation. This experience prompted a survey of the Macula Society membership to determine whether this complication of fluorescein angiography is as rare as the paucity of cases in the literature suggests. In addition, the manufacturer was asked to reexamine the dye lot to determine whether an impurity had been introduced unintentionally during the manufacturing process. No impurity was found in the dye lots tested. The survey disclosed only nine additional cases of skin necrosis, leading to the conclusion that skin necrosis probably represents a rare, idiosyncratic reaction. Although fluorescein angiography remains a safe procedure, efforts should be directed toward prevention of dye extravasation. When extravasation does occur, prompt and proper medical attention with close follow-up study may minimize the likelihood of skin necrosis.

Aged↗
PubMed1986

Fluorescein angiography. Practical role in the office management of macular diseases.

Office fluorescein angiography allows optimum management of patients with macular diseases. A skilled office staff is essential. The receptionist obtains pertinent information from patients and schedules prompt appointments. Excellent angiography by photographer-technicians allows the physician to plan the best course of management. The skills of photographers can be developed through in-service training, certification programs, and participation in professional meetings. For the ophthalmologist who treats CNV but does not do fluorescein angiography, a referral service can be helpful. Ophthalmologists who do not treat CNV should refer patients with suspected CNV directly to an experienced laser surgeon for angiography and management. Future developments in office fluorescein angiography should include improved cameras and videoangiography.

Choroid↗
PubMed1985

Important points in management of patients with choroidal neovascularization.

The efficacy of argon blue-green laser treatment for extrafoveal choroidal neovascularization (CNV) in aging macular degeneration, presumed ocular histoplasmosis syndrome and idiopathic choroidal neovascularization has recently been proven by the Macular Photocoagulation Study. These results are applicable only to eyes managed according to certain principles of therapy and post-treatment follow-up. These include the use of a recent fluorescein angiogram and retrobulbar anesthetic, aiming for complete obliteration of the CNV. Meticulous post-treatment follow-up is critical. This includes daily patient monitoring of the Amsler grid, and prompt examinations if distortion is noted. Excellent quality fluorescein angiography is mandatory. This is repeated frequently and studied promptly. Residual or recurrent extrafoveal CNV requires prompt re-treatment.

Choroid↗
PubMed1982

Red krypton laser therapy of macular and retinal vascular diseases.

If the theoretical advantages of krypton laser over argon laser are proven clinically, this modality will be an important adjunct in the management of many of the leading causes of blindness. Our preliminary observations in over 400 cases treated with krypton laser correlate well with the theoretical and histopathologic observations of others. Possible advantages of krypton laser therapy for choroidal neovascularization (CNV) include its ability to penetrate foveal xanthophyll and retinal blood vessels and to minimize damage to the nerve fiber layer. Krypton also penetrates the xanthochrome in nuclear sclerotic cataract. The major disadvantage is increased choroidal hemorrhage. In proliferative retinopathies krypton penetrates moderate vitreous hemorrhage. It may minimize both epiretinal membrane changes and continuation of vitreo-retinal traction. It can be used after fluorescein injection. Disadvantages include increased choroidal hemorrhage and increased pain, often requiring retrobulbar anesthesia. Krypton laser cannot close surface neovascularization or stop bleeding by photocoagulating its source. The role of argon laser in CNV or how it benefits proliferative retinopathies is still not understood. The Macular Photocoagulation Study will help define the role of argon and krypton laser for CNV. A similar clinical trial to compare the efficacy of krypton laser to the proven efficacy of argon laser in the treatment of proliferative diabetic retinopathy is still anticipated.

Choroid↗
PubMed1981

Laser treatment of choroidal neovascular membranes in angioid streaks.

Eight patients with active extrafoveal choroidal neovascular membranes related to angioid streaks were studied. One eye of each of four patients was treated with argon laser. Two patients received bilateral treatment. Four patients received multiple treatments at different times for recurrence of neovascular membranes. Two patients were not treated. The visual acuity of the treated eyes remained the same or improved posttreatment, with one exception. The majority of untreated eyes lost vision. The vast majority of the treated eyes showed a marked improvement in central visual field posttreatment, whereas the untreated eyes remained the same or lost considerably more central visual field. In one to four years after treatment, recurrences of the neovascular membranes occurred in four of the treated eyes demonstrating that these cases must be followed indefinitely. Carefully selected cases appear to benefit from complete obliteration of choroidal neovascularization by argon laser photocoagulation.

Aged↗
PubMed1981

PDR in juvenile onset diabetics: high-risk proliferative diabetic retinopathy in juvenile onset diabetics.

We analyzed the subgroup of juvenile diabetics with proliferative diabetic retinopathy (PDR). One hundred consecutive Diabetic Retinopathy Study (DRS) defined high-risk eyes were treated with argon laser photocoagulation. Mean age of diabetes onset was 8.1 years and mean duration was 15.9 years. Average follow-up was 36 months. All treatment failures resulting in severe visual loss (less than 5/200 vision) occurred in the second eye treated, in spite of our routinely treating the worse eye first. We delayed treating fellow eyes prior to the 1976 DRS report. We now consider prompt treatment of the fellow high-risk eye mandatory. Five patients (5.6%) suffered severe visual loss in three years compared to 10.5% in two years in the DRS for high-risk treated eyes. We conclude that more extensive treatment, perhaps 2500 to over 3000 500 micron lesions, further reduces incidence of severe visual loss beyond the reduction shown by the DRS.

Adult↗
PubMed1977

Dominant slowly progressive macular dystrophy.

Twenty-three members of one white family were studied for a new form of dominant slowly progressive macular dystrophy in which visual acuity remained good until the seventh decade. Ten patients had positive signs of this entity. Eight patients had possible early forms. Five had no signs. Several patients had visual acuity fluctuations, documented by their ophthalmologists who saw associated pigment epithelial alterations in some cases. Obvious macular changes included perifoveal pigment epithelial atrophy, posterior pole flecks, and fundus lesions resembling an atrophic form of senile macular degeneration. We suggest a possible hereditary predisposition to senile macular degeneration in our patients.

Aged↗
PubMed1976

Perifoveal vascular leakage and macular oedema after intracapsular cataract extraction.

Perifoveal capillary leakage of fluorescein was demonstrated in 60 per cent of 50 eyes when angiography was performed two weeks after cataract extraction. Repeat angiography six weeks postoperatively in 17 eyes demonstrated persistence of already established leakage in 11 of 12 eyes and no new leakage in five eyes previously negative. Cystoid macular oedema with visual acuity of less than 20/40 six weeks postoperatively occurred in five eyes (10 per cent). Eyes of patients with vascular disease and those patients of 60 years or older were found to have altered vascular permeability significantly more frequently. Inflammation was no more severe or prevalent in those patients who demonstrated leakage and no inflammation was clinically apparent in 10 of 11 eyes demonstrating dye leakage six weeks postoperatively. We conclude that the constitutional factors of age and vascular disease are of prime importance in causing altered vascular permeability in the early postoperative period after cataract extraction; factors causing sustained leakage with reduction of visual acuity were not demonstrated.

Adult↗
PubMedDate not supplied

Spontaneous visual improvement in the first affected eye of patients with bilateral disciform scars.

Patients with macular disciform degeneration may undergo spontaneous improvement in visual acuity of the first affected eye when the second eye later undergoes a decrease in vision. Three hundred twenty-nine cases of age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POH) were examined. There were 20 patients who strictly met the criteria of a disciform scar causing visual acuity of 20/200 or worse in one eye, and 20/50 or better vision in the second eye, who subsequently developed involvement of the second eye with a decrease in visual acuity to 20/200 or less. Six of these 20 patients (30%), after mean follow-up of 32.8 months, achieved spontaneous visual acuity improvement, defined as at least a five-line improvement on a decimal (logarithmic) scale, with an average increase of 7.6 lines in the first affected eye. At extended mean follow-up of 50.1 months, two of the six lost vision, so that four of the 20 (20%) had five lines or more of improvement.

Adult↗
PubMedDate not supplied

Choroidal osteoma. Treatment of associated subretinal neovascular membranes.

Treatment of subretinal neovascular membranes associated with choroidal osteomas is described. Early recognition of the membranes, aided by Amsler grid self-assessment, allowed initiation of photocoagulation treatment while the lesions were still extrafoveal. In one patient, initial treatment was performed with the argon green laser and subsequent treatments were applied with the krypton red laser. In two other patients, argon-laser photocoagulation alone was used to destroy subretinal neovascular membranes. Post-treatment evaluations in one patient demonstrated persistence of recurrence of neovascular tissue and allowed for prompt retreatment. Follow-up evaluations have shown that treatment resulted in persistent destruction of the subretinal neovascular membrane in two patients, with stabilization of vision at 20/25- and 20/100, respectively. In one patient, vision has been stable at 20/50 for 6 months; however, a recurrent subretinal neovascular membrane developed, encroaching through the fovea with resultant visual loss of 20/60.

Adult↗