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Biomedical subjects

L M Jampol

Publications and source records attributed to L M Jampol.

At least 91 records · Page 5Linked to original sources
PubMed1987

Epiretinal membranes in sickle cell retinopathy.

We examined the hospital records (including fundus photographs) of 769 patients (1486 eyes) with sickle cell disease from June 1978 to July 1985 for evidence of epiretinal membranes in the macula (51 eyes) or extramacular region (four eyes) of the posterior pole. The incidence of epiretinal membranes, seen in the eyes of patients with hemoglobin SC, SS, and SB+ thalassemia, was 3.7%. Most epiretinal membranes were mild, and visual acuity was 20/40 or better in 78.2% of these eyes. Severe macular pucker was occasionally noted following retinal detachment surgery. One patient with SC disease developed a macular epiretinal membrane that led to a macular hole and eventually to macular and extra-macular retinal detachment. Epiretinal membranes are a relatively common cause of maculopathy in patients with sickle cell disease.

Adult↗
PubMed1987

Neodymium-YAG laser vitreolysis in sickle cell retinopathy.

Six patients with proliferative sickle cell retinopathy and vitreous bands were treated with the neodymium-YAG (Nd-YAG) laser to accomplish lysis of avascular traction bands or to clear the media in front of the macula. Transection of bands was possible in five of the six cases but in two of these the effect was only partial. Three cases were satisfactorily treated with the Nd-YAG laser application alone, two eventually required conventional vitreoretinal surgery, and one patient's condition stabilized despite failure of the treatment. Complications from the treatment occurred in three cases and included subretinal (choroidal) hemorrhage, preretinal hemorrhage, microperforation of a retinal vein, and focal areas of damage to the retinal pigment epithelium. Neodymium-YAG vitreolysis may be a useful modality in carefully selected patients with proliferative sickle cell retinopathy, but potentially sight-threatening complications may occur.

Adult↗
PubMed1987

Knowledge of diabetic retinopathy before and 18 years after the Airlie House Symposium on Treatment of Diabetic Retinopathy.

In 1968, The Airlie House Symposium evaluated the current knowledge of the natural history of diabetic retinopathy. The effects of tight metabolic control, pituitary ablation, and photocoagulation were discussed at length. Xenon arc photocoagulation was the mainstay of therapy and was usually applied focally to individual patches of new vessels. Photocoagulation of background retinopathy was rarely done. Panretinal photocoagulation was in its infancy, the ruby laser was newly introduced, there were no data on the use of the argon laser, and automated vitrectomy had not been introduced. Participants in the symposium set the stage for the acquisition of valid clinical data from which important therapeutic conclusions have subsequently been drawn by (1) summarizing the areas of consensus and disagreement, (2) devising a standard classification of diabetic retinopathy, and (3) proposing controlled clinical trials for unanswered questions.

Blindness↗
PubMed1987

Oxygen therapy and intraocular oxygenation.

When delivered to the corneal surface of rabbits or monkeys, 100% oxygen can significantly increase the pO2 in the aqueous humor. Under hyperbaric conditions (two atmospheres), an observed rise in the aqueous pO2 in rabbits breathing room air can be increased further by exposing the rabbit cornea to 100% oxygen. The high oxygen levels under hyperbaric conditions are mediated by intravascular and transcorneal delivery of oxygen. The increase in the pO2 levels in the aqueous can prevent sickling of intracameral human erythrocytes containing sickle hemoglobin. Thus, oxygen therapy transcorneally or systemically could potentially be used to treat a sickle cell hyphema. The exposure of rabbit eyes to 100% oxygen at the corneal surface is followed by autoregulation (constriction) of the iris vasculature. We could demonstrate no constriction in the eyes of two normal human volunteers or of four patients with chronic stable rubeosis iridis. Preretinal vitreous pO2 levels can be significantly raised by exposing monkeys to hyperbaric 100% oxygen. This procedure may be of value in treating acute, reversible ischemic inner retinal diseases. Transcorneal or vascular delivery of oxygen to the eye under normobaric or hyperbaric conditions may be effective in treating ischemic diseases of the anterior segment, such as anterior segment necrosis or rubeosis iridis, or ischemic inner retinal diseases.

Animals↗
PubMed1987

Computed tomography of optic nerve colobomas, morning glory anomaly, and colobomatous cyst.

CT scanning can be of great value in evaluating optic nerve colobomas, particularly in clinical situations in which corneal, lenticular, vitreal, or other opacities hinder visualization of the optic disc. Experience with the patients presented here demonstrates that CT scanning is useful in the assessment of the presence and size of classic colobomas, morning glory anomaly, and microphthalmos with cyst. It is also of value in assessing associated ocular defects such as microphthalmos, shallow anterior chamber, and atrophic ciliary body.

Child↗
PubMed1986

Changes in diabetic retinopathy during pregnancy. Correlations with regulation of hyperglycemia.

Thirty-eight pregnancies in 35 women with insulin-dependent diabetes mellitus were monitored for changes in diabetic retinopathy during the institution of "tight" metabolic control by intensive medical management. Eye findings were scored on paired sets of retinal photographs obtained when enrolled in this study and shortly after delivery. These findings were then correlated with measurements of diabetic regulation. Intensive therapy for the diabetes mellitus resulted in improved glucose control by the time of delivery. However, retinal abnormalities worsened as gestation proceeded in 55% of the pregnancies. Deterioration of background retinopathy correlated significantly with the levels of plasma glucose at entry and with the magnitude of improvement in glycemia achieved during the first six to 14 weeks after entry (ie, "early changes") and by the final week before delivery (ie, "overall changes"). Our findings indicate that the changing retinopathy during pregnancy cannot be interpreted without assessment of concurrent changes in the regulation of maternal diabetes and that the abrupt institution of improved diabetic control during pregnancy may be one factor in the deterioration of background retinopathy sometimes seen during pregnancy.

Adult↗
PubMed1986

Alteration of the blood-retinal barrier and vitreous in sickle cell retinopathy.

Nineteen eyes with background sickle cell retinopathy, eleven from patients with SC disease, eight from patients with SS disease, and twelve eyes with proliferative sickle cell retinopathy were examined by direct and indirect ophthalmoscopy, slit-lamp, fluorescein angiography and vitreous fluorophotometry. Calculation of the alteration of the blood-retinal barrier (BRB) and estimation of the diffusion coefficients of fluorescein in the vitreous were performed by fluorophotometry. In background sickle cell retinopathy, the results show a normally functioning BRB in the posterior pole. Abnormally increased fluorescence values to the mid-vitreous (peripheral leakage) were found only in 3 of these 19 eyes, at the two-hour examination (all SC patients). Similarly, mid-vitreous fluorescence values at the two-hour examination were 4.19 +/- 1.52 ng/ml in eyes of patients with SC disease, compared with 2.65 +/- 0.56 ng/ml in eyes of patients with SS disease. All eyes with background sickle cell retinopathy, except one, showed values for the coefficient of diffusion of fluorescein within normal limits, indicating normal vitreous gel structure. In proliferative retinopathy, the mid-vitreous fluorophotometry readings were abnormally increased, correlating well with the extent of the peripheral angiographic changes (neovascularization). The coefficient of diffusion of fluorescein in the vitreous was generally increased in the eyes with proliferative retinopathy (15.0 +/- 8.4 X 10(-4) cm2/min) in comparison with a mean value of 5.4 +/- 1.4 X 10(-4) cm2/min in the eyes with background sickle cell retinopathy, suggesting an alteration of the vitreous structure eyes with proliferative retinopathy. Fluorophotometry is considered a useful tool to follow patients with sickle cell retinopathy by quantitating peripheral retinal vascular leakage.

Adult↗
PubMed1986

Iatrogenic choroidal neovascularization in sickle cell retinopathy.

Fifteen patients (16 eyes) with proliferative sickle retinopathy treated with argon or xenon arc feeder vessel photocoagulation had chorioretinal (CRN) or choriovitreal (CVN) neovascularization develop. These patients were followed from 2 1/2 to 11 1/2 years with a mean follow-up of 6 years and 8 months. Clinically important late complications of the choroidal neovascularization included vitreous hemorrhage (in three of eight patients with CVN). However, in only two of these three eyes was there any drop in vision related to residual vitreous hemorrhage, and this was limited to loss of only one line of Snellen visual acuity. Therefore, treatment is not usually recommended if CRN or CVN develops after intense photocoagulation. Vitreous fluorophotometry was performed on these patients to examine the breakdown of the blood-retinal barrier. This gave a quantitative measure of fluorescein leakage not obtained with fluorescein angiography. Midvitreous measurements, which are more representative of these peripherally located proliferative lesions than are pre-retinal measurements, suggest that vitreous fluorophotometry may be helpful in differentiating the higher leakage of CVN from the CRN.

Anemia, Sickle Cell↗
PubMed1986

Hyperviscosity retinopathy secondary to polyclonal gammopathy in a patient with rheumatoid arthritis.

A patient with rheumatoid arthritis developed retinal venous stasis as part of a hyperviscosity syndrome secondary to a polyclonal gammopathy. Ocular findings included bilateral retinal venous dilation, disc hyperemia, optociliary venous collaterals, and left macular edema. This clinical picture improved following systemic corticosteroid therapy. Although occasional cases of rheumatoid polyclonal gammopathy causing hyperviscosity have been described in the rheumatology literature, this case represents the first detailed ophthalmological documentation of this occurrence.

Arthritis, Rheumatoid↗
PubMed1986

Drug-induced acute transient myopia with retinal folds.

A patient was seen with acute bilateral transient myopia, shallowing of the anterior chamber, and radiating perimacular folds. This was believed to be a drug reaction. A fluorescein angiogram was performed which showed no retinal edema. A number of pathophysiologic mechanisms have been proposed for acute transient myopia, but the findings in this patient support ciliary body swelling as the cause of the changes in the eye. This swelling of the ciliary body results in a forward rotation of the lens-iris diaphragm and the vitreous, which causes both the myopia and the retinal folds.

Acetaminophen↗
PubMed1985

Secondary angle-closure glaucoma after central retinal vein occlusion.

A 65-year-old man developed unilateral nonrubeotic secondary angle-closure glaucoma after central retinal vein occlusion. Therapy was nonsurgical and included medical control of the intraocular pressure. The anterior chamber eventually deepened and panretinal photocoagulation was later necessary because of developing rubeosis iridis and neovascularization of the optic disk. Secondary nonrubeotic angle-closure glaucoma from central retinal vein occlusion must be distinguished from rubeotic glaucoma or pupillary-block glaucoma so that inappropriate medical or surgical treatment can be avoided.

Aged↗
PubMed1985

Near-UV radiation from the operating microscope and pseudophakic cystoid macular edema.

We performed a prospective randomized study of 297 patients to determine the effect of a UV-blocking filter on the operating microscope on the angiographic incidence of cystoid macular edema in patients undergoing extracapsular surgery with implantation of a posterior chamber lens. Patients were randomly allocated preoperatively to two groups undergoing surgery with or without a UV filter in place. Of the 297 patients, 205 had angiograms readable for the presence or absence of cystoid macular edema. The incidence of aphakic cystoid macular edema in patients without the filter was 21% v 17.3% in the group with a filter. This difference was not significant. The presence of a UV-blocking filter on the operating microscope makes no difference in the angiographic incidence of cystoid macular edema or the visual outcome in these cases.

Cataract Extraction↗
PubMed1985

Factors affecting pseudophakic cystoid mascular edema: five randomized trials.

We summarize the findings of five randomized prospective, controlled studies that evaluated the following factors associated with the development of cystoid macular edema (CME) following cataract surgery: ultraviolet (UV) light from the operating microscope; postoperative UV light exposure; primary capsulotomy; retrobulbar hyaluronidase; and prostaglandin synthesis in the eye. The following were the major findings: (1) The presence of a UV-light filter on the operating microscope during cataract surgery made no statistically significant difference in the early postoperative (two to six months) angiographic incidence of CME or the visual outcome. (2) A UV-filtering posterior chamber intraocular lens (IOL) resulted in a statistically significant decrease in the early postoperative incidence of angiographic CME in postcataract-surgery patients but did not affect visual acuity. (3) Patients receiving primary capsulotomy during extracapsular cataract surgery showed a statistically significant higher incidence of early postoperative angiographic CME than did patients with an intact posterior capsule. Again there was no difference in visual acuity. (4) The addition of hyaluronidase to the retrobulbar anesthetic injection made no significant difference in the CME rate or postoperative visual results of patients undergoing extracapsular cataract surgery. (5) Patients undergoing IOL implant surgery who received topical indomethacin before surgery and for nine months postoperatively to inhibit prostaglandin synthesis in the eye showed a statistically significant lower incidence of early postoperative angiographic CME than did placebo-treated patients, but there was no significant difference between the two groups in postoperative visual acuity.

Cataract Extraction↗
PubMed1985

Pharmacologic therapy of aphakic and pseudophakic cystoid macular edema. 1985 update.

Major advances in the pharmacologic therapy of aphakic cystoid macular edema (ACME) have not occurred since 1982. Topical nonsteroidal anti-inflammatory agents are still not commercially available for ocular therapy. Topical indomethacin remains the one agent which has been proven to be of prophylactic value for angiographic aphakic cystoid macular edema although other non-steroidal agents may also work. The therapeutic value of these compounds for established ACME remains uncertain. No prospective randomized prophylactic or therapeutic trials of either topical or systemic corticosteroids have been performed.

Administration, Topical↗