Ophthalmology.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
M F Goldberg
Publications and source records attributed to M F Goldberg.
Choroidal neovascularization associated with choroidal hemangiomas.
Two patients with choroidal hemangiomas developed choroidal neovascularization. One patient with Sturge-Weber syndrome, a unilateral diffuse choroidal hemangioma, and a serous detachment of the macula was treated with yellow dye laser photocoagulation in a grid pattern to the tumor before glaucoma filtration surgery. Four years after successful laser treatment, the patient developed subfoveal choroidal neovascularization in an area of treatment. A second patient with a circumscribed choroidal hemangioma developed spontaneous subfoveal choroidal neovascularization 12 years after initial diagnosis of the hemangioma. The development of choroidal neovascularization associated with choroidal hemangiomas represents a potential cause of poor visual outcome in these patients.
Adolescent↗
Intraocular tissue plasminogen activator in a rabbit model of traumatic hyphema.
Tissue plasminogen activator was used to evaluate the clearance of traumatic hyphema in a rabbit model. A neodymium-YAG laser was used to disrupt iris vessels, creating a traumatic hyphema. Tissue plasminogen activator (1800 IU/0.1 mL) was injected into the anterior chamber 24 hours after creation of the hyphema. Two control groups (one receiving balanced salt solution and one receiving no treatment) were used for comparison. A multivariate analysis of covariance indicated that the greatest difference in hyphema clearance between the groups occurred at days 3, 4, and 5. Five days after tissue plasminogen activator treatment, the mean size of the clot remaining in the anterior chamber was 27% of that of the original hyphema. In control eyes, almost 60% of the original clot remained at day 5. Treatment of animals with tissue plasminogen activator doses of 5000 IU and 10,000 IU produced a substantial increase in repeated bleeding episodes in our rabbit model. We concluded that although the use of tissue plasminogen activator in our rabbit model of traumatic hyphema significantly improved clearance of blood from the anterior chamber, the remaining clot was of such size that the clinical benefit was questionable.
Animals↗
A randomized clinical trial of feeder vessel photocoagulation of sickle cell retinopathy. A long-term follow-up.
Long-term follow-up of patients enrolled in a randomized prospective trial of feeder vessel photocoagulation for proliferative sickle retinopathy has been completed. Of the 44 patients enrolled in Chicago, nearly a decade follow-up has been achieved on 29 patients (45 eyes). There were 20 control untreated eyes and 25 argon laser-treated eyes. Prolonged loss of visual acuity was rare in both groups. Argon laser photocoagulation has had a sustained effect on reducing the incidence of vitreous hemorrhage and visual loss from vitreous hemorrhage. Nine (45%) of 20 control eyes had vitreous hemorrhage, and it was recurrent in six (66%) of these nine eyes. A single episode was the only hemorrhagic event in the treated eyes. The laser-induced complications of choroidal neovascularization or retinal detachment were not associated with long-term visual sequelae. New sea fan evolution in 47% of study eyes suggests that these patients require long-term surveillance.
Adolescent↗
Aminocaproic acid versus prednisone for the treatment of traumatic hyphema. A randomized clinical trial.
One hundred twelve patients who sustained hyphema after blunt trauma were enrolled in a double-blind randomized clinical trial to determine the relative efficacies of aminocaproic acid (Amicar) and systemic prednisone for reducing the rate of secondary hemorrhage. Fifty-six patients received an oral dosage of 50 mg/kg of aminocaproic acid every 4 hours for 5 days, up to a maximum of 30 g daily, and 56 patients received an oral dosage of 40 mg of prednisone daily (adjusted for weight) in two divided doses. Placebo pills and liquids were given to each patient to mask the treatment schedules. There were no statistically significant differences between the patient populations for any demographic or clinical characteristic (e.g., visual acuity, intraocular pressure [IOP], initial hyphema size) measured in the study. Blacks comprised 53% of the study population, and the mean age of the patients was 23.5 years. Four patients in each of the treatment groups experienced a secondary hemorrhage; the rebleed rate was 7.1% in each group.
Administration, Oral↗
Improved method of fluorescein angioscopy.
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Fluorescein Angiography↗
Retinal arterial macroaneurysms: risk factors and natural history.
A case control study was conducted to identify the systemic and ocular risk factors for retinal arterial macroaneurysms. Forty-three patients with 52 photographically confirmed macroaneurysms were located. Forty-three age-matched, race-matched concurrent control patients were also identified. The patients with macroaneurysms had decreased visual acuity (p less than 0.0001) and a higher prevalence of hypertension (p = 0.037), female sex (p = 0.099), and retinal vein occlusions (p = 0.055) than controls. In patients with both a macroaneurysm and venous occlusion there was a 12.0 times higher prevalence of macroaneurysms in the area of retina drained by the occluded vein (p less than 0.05). Common findings associated with macroaneurysms included retinal haemorrhage (81% of patients), retinal exudate (70%), vitreous haemorrhage (30%), macular involvement (30%), and distal arteriolar narrowing (26%). Arteriolar occlusion occurred spontaneously (8%) or after laser photocoagulation (16%).
Adult↗
Sympathetic ophthalmia and subretinal neovascularization.
We report a case of sympathetic ophthalmia with subretinal neovascularization of the macula. The subretinal neovascularization developed after penetrating trauma to the fellow eye. The occurrence of subretinal neovascularization in sympathetic ophthalmia is not surprising since disintegrative changes and breaks in Bruch's membrane have been reported in sympathetic ophthalmia. Subretinal neovascularization has also been reported in Vogt-Koyanagi-Harada syndrome, which is histopathologically similar to sympathetic ophthalmia.
Adolescent↗
Nodular adenomatosis of iris pigment epithelium.
A 62-year-old man manifested multiple nodular growths in his left iris and unilateral glaucoma. Detailed clinical and pathologic studies showed that these lesions were adenomas derived from the spurs of Fuchs, Michel, and Grunert in the iris pigment epithelium. We suggest terming this newly described entity nodular adenomatosis of the iris pigment epithelium and propose a classification of primary neoplastic lesions of the iris.
Adenoma↗
Reducing birth defect risk in advanced maternal age.
The incidence of birth defects increases with maternal age. Recent advances in fetal diagnosis, coupled with elective abortion, offer the older pregnant woman an opportunity to reduce this risk. To determine the magnitude of potential risk reduction, we reviewed the maternal age-specific incidence of infants born with one or more severe birth defects in metropolitan Atlanta from 1968 to 1975, removing from analysis certain anomalies that were preventable by currently available methods. For women aged 35 to 44 years, the risk of bearing an infant with a severe birth defect was reduced to a level comparable with that for younger women. Despite prenatal diagnosis and elective abortion, the risk for women aged 45 years or older, although reduced considerably, was two times greater than that for women aged 34 years or younger.
Adult↗
Rh hemolytic disease. Epidemiologic surveillance in the United States, 1968 to 1975.
Nationwide surveillance of Rh hemolytic disease of the newborn showed that associated infant mortality decreased from 941 deaths in 1968 to 269 deaths in 1975, or from 2.7 to 0.9 per 10,000 live births. The incidence of Rh hemolytic disease declined from 45 per 10,000 total births in 1970 to 21 per 10,000 in 1975. In 1970, an estimated 16,000 infants were affected, whereas in 1975, the number was 6,000. Several state-based Rh disease surveillance programs reported declining mortality and incidence and increasing use of Rh immune globulin. Rh immune globulin was administered to an estimated 80% of eligible Rh-negative women in 1974, eighty-one percent in 1975, and 82% in 1976. More concerted efforts are needed to determine the frequency of maternal sensitization and to identify and correct gaps in postpartum and postabortion use of Rh immune globulin.
Erythroblastosis, Fetal↗
Interpreting elevated amniotic fluid alpha-fetoprotein levels in clinical practice: use of the predictive value positive concept.
The amniotic fluid alpha-fetoprotein assay (AF-AFP) is the single most valuable method of detecting anencephaly--spina bifida (ASB) in utero. A raised AF-AFP, however, is a more reliable indicator of a fetus with ASB in the pregnancy at high risk for ASB. Most women undergoing fetal chromosomal analysis are at low risk for ASB. Consequently, gravid patients who have an AF-AFP incidental to chromosomal studies, and elect abortion because of a raised AF-AFP, will more frequently abort a normal fetus than the gravida who has previously had an infant with ASB. For the obstetrician utilizing this assay, the predictive value positive (PVP) concept, a guide for the interpretation of a positive result, is introduced and then applied to examples of patients at varying risk for ASB in their offspring.
Amniocentesis↗
The angiographic pattern of the peripheral retinal vasculature.
Various diseases of the peripheral retinal vasculature, such as sickle cell retinopathy and Eales' disease, demonstrate vascular abnormalities. For comparative purposes, we documented angiographically the peripheral retinal vasculature in young, healthy subjects. Our findings showed the density of the capillary bed to be highest in the posterior pole and least concentrated toward the periphery. Peripheral capillaries are considerably larger than those found posteriorly and have fewer bifurcations. Our technique also detected the periarterial capillary-free zone and the zone without capillaries adjacent to the ora serrata. These aspects were consistent with findings of other investigators using in vitro techniques. By creating a standard of normalcy in vivo, the angiographic technique allows vascular abnormalities evident in diseases of the peripheral retinal vasculature to be more precisely defined and compared.
Adolescent↗
Talc emboli and retinal neovascularization in a drug abuser.
A 38-year-old male drug abuser had multiple emboli in the retinal circulation of the posterior pole of both eyes. He showed widespread peripheral retinal capillary nonperfusion and neovascular proliferation at the junction of perfused and nonperfused retina. The emboli were considered to be talc particles from the intravenous administration of suspensions of oral medications. The presumed mechanism of development of neovascularization in this case was the filtering out of the particles by the retinal vasculature with vaso-occlusion, ischemia and subsequent retinal neovascularization.
Adult↗
The diagnosis and treatment of secondary glaucoma after hyphema in sickle cell patients.
Four patients with sickle cell hemoglobinopathies (one sickle cell hemoglobin C disease (SC); three sickle cell trait (AS)) and hyphemas had a higher percentage of erythrocytes sickled in their anterior chambers than in their circulating venous blood. Intraocular pressure (IOP) was severely increased, despite relatively small amounts of intracameral blood. Systemic hypotensive agents were not always successful in reducing IOP, and in patients with sickle cell hemoglobinopathy, are probably contraindicated in high or repeated dose regimens. Moderate increase of IOP in sickle cell hemoglobinopathy patients may produced rapid deterioration of visual function, because of a greater than usual effect on vascular perfusion in the central retinal artery and optic nerve. Early anterior chamber paracentesis may be the best treatment for this type of hyphema-induced secondary glaucoma.
Acetazolamide↗
Vascular anastomoses between the iris and persistent hyperplastic primary vitreous.
Prominent radial iris blood vessels created small but definite pupillary notches in five children with persistent hyperplastic primary vitreous and persistence of the tunica vasculosa lentis. Detection of these abnormal iris vessels suggested the presence of persistent hyperplastic primary vitreous and related syndromes even when the diagnosis was obscured by the presence of an opaque lens. These vessels represented early developmental arrest and may have been associated with abnormal development of the macula and optic nerve. Surgical and amblyopia therapy, therefore, may not provide useful vision, and should be undertaken with caution.
Abnormalities, Multiple↗
Prospective observation of vascular anastomoses between the retina and choroid in recurrent toxoplasmosis.
Prospective angiographic observations demonstrated the formation of both choroidoretinal arteriolar anastomoses as well as retinochoroidal venular anastomoses in the ocular fundus of a young man with recurrent ocular toxoplasmosis.
Adult↗
Failed intrauterine device contraception and limb reduction deformities: a case-control study.
Three recent case reports have suggested an association between failed intrauterine device (IUD) contraception and limb reduction deformities in the resulting offspring. To clarify further the purported teratogenic role of the IUD in the etiology of these defects, we conducted a case-control study of 96 mothers who had given birth to infants with limb defects. Interview data about IUD exposure at conception among these mothers were compared with interview data from 2 sets of controls: (1) 915 mothers of infants with other major defects and (2) a subset of the first group consisting of 169 mothers with chromosomally defective infants. No significant increase in the incidence of IUD use was found for cases when compared with either control group. Estimates of the relative risk were 1.28 (95% confidence limits [CL]of 0.29 to 5.67) and 1.78 (95% CL of 0.25 to 12.82) when the first and second groups of controls were used, respectively. These risk figures were not significantly different from 1.0. The evidence accumulated thus far militates against a teratogenic role for the IUD.
Clinical Trials as Topic↗