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Biomedical subjects

M G Grand

Publications and source records attributed to M G Grand.

At least 19 recordsLinked to original sources
PubMed1992

Surgical management of subfoveal choroidal neovascularization.

BACKGROUND: Subfoveal choroidal neovascularization (CNV) usually is associated with a poor visual prognosis. Laser photocoagulation of certain subfoveal membranes secondary to age-related macular degeneration (ARMD) appears preferable to observation based on recent Macular Photocoagulation Study (MPS) findings but is associated with decreased vision. The authors explored the use of vitreoretinal surgical techniques as an alternative method of eradicating subfoveal CNV. METHODS: After vitrectomy, a small retinotomy technique was used to extract or disconnect from the choroidal circulation subfoveal CNV in 58 eyes. There were 33 eyes with ARMD, 20 eyes with presumed ocular histoplasmosis, and 5 eyes with miscellaneous etiologies. Five eyes also received subfoveal RPE patches. RESULTS: With limited follow-up, significant improvement in vision (defined as 2 Snellen lines) was achieved in 7 of 22 eyes with ARMD CNV removal (1 eye 20/20), 0 of 4 eyes with ARMD CNV removal and RPE patches, and 1 of 7 eyes with ARMD CNV disconnection. Significant improvement was achieved in 6 of 16 eyes with presumed ocular histoplasmosis removal and 0 of 4 eyes with presumed ocular histoplasmosis CNV disconnection. In 5 eyes with miscellaneous CNV, 2 improved (20/20 and 20/40). CNV recurred in 29%. CONCLUSIONS: Some patients with subfoveal CNV appear to benefit from surgical removal. Only rarely do eyes with ARMD improve. Longer-term follow-up and refined case selection are required before this approach can be widely recommended.

Aged↗
PubMed1991

Endogenous Pseudallescheria boydii endophthalmitis. Clinicopathologic findings in two cases.

Two cases of endogenous Pseudallescheria boydii endophthalmitis are presented. One patient had severe pulmonary fibrosis but no history of ocular trauma and no clinical or laboratory evidence of immunocompromise. Despite therapy with repeated intravitreal miconazole nitrate injections and systemic fluconazole, enucleation of the globe was required, and the patient eventually died with disseminated pseudallescheriasis. The other patient was an immunosuppressed cardiac transplant recipient who also received systemic fluconazole therapy. The infected eye eventually required evisceration, but there was no evidence of disseminated pseudallescheriasis before his death of unrelated causes.

Antifungal Agents↗
PubMed1991

Vitrectomy for premacular fibroplasia. Prognostic factors, long-term follow-up, and time course of visual improvement.

Two hundred seventy eyes with premacular fibroplasia consecutively treated by pars plana vitrectomy and membrane peeling were reviewed. This study is among the largest series with long-term follow-up reported to date. Visual improvement of two or more lines was achieved in 43% of eyes at 6 to 12 months, in 54% at 1 to 2 years, in 60% at 2 to 3 years, and in 58% at 3 to 5 years. Overall, complications occurred in 34 eyes (13%). Cataract progression after vitrectomy was noted in 106 (57%) of phakic eyes at 3 to 5 years, and 43 of these eyes underwent subsequent cataract extraction. Mean time to best visual acuity after vitrectomy was slightly less than 1 year for all eyes unless they had cataract worsening with subsequent cataract extraction (1.9 years). Significant factors affecting visual outcome were: preoperative lens status, visual acuity before vitrectomy, duration of preoperative symptoms of distortion and/or blurred vision, and the occurrence of intraoperative complications.

Adolescent↗
PubMed1991

External argon laser drainage of subretinal fluid using the endolaser probe.

The results of 200 consecutive scleral buckling procedures in which the argon endolaser probe was used to create a choroidotomy for drainage of subretinal fluid are reported. This technique was used in any case requiring drainage and was specifically employed in cases in which needle drainage was contraindicated because the detachment was shallow. The argon laser was set at 0.2 seconds, 1.25 watts, and was used with the endolaser probe held adjacent to, but not touching, the choroid. Drainage was successfully accomplished in 98% of cases. Rates of subretinal hemorrhage, retinal incarceration, and perforation related to laser drainage were 5.5%, 2.5%, and 1%, respectively. No large or submacular subretinal hemorrhages occurred. This technique appears to be particularly promising for drainage of shallow retinal detachments.

Choroid↗
PubMed1990

Syphilitic disc edema and periphlebitis.

This photo essay shows the retinal findings in a patient with presumed syphilitic disc edema and periphlebitis. Resolution of these findings after treatment with penicillin is documented by improvement in visual acuity from 20/50 to 20/25 in the right eye and from 20/200 to 2/20 in the left eye. Photographic documentation of the resolution of retinal findings, including disc edema and periphlebitis, is presented.

Fluorescein Angiography↗
PubMed1988

Surgical management of premacular fibroplasia.

The results of pars plana vitrectomy and membrane peeling for premacular fibroplasia (PMF) were reviewed retrospectively for 88 eyes of 86 patients. Premacular fibroplasia was idiopathic in 61 eyes (69%) and postdetachment in 27 eyes (31%). All patients had a minimum follow-up of 12 months. Visual symptoms of blurring and metamorphopsia were reduced in 75 (85%) study eyes at the end of the follow-up period. Poor visual outcome was significantly related to preoperative cystoid macular edema and prolonged duration of visual blurring. Posterior retinal breaks occurred in three eyes (5%) with idiopathic PMF and five eyes (19%) with postdetachment PMF. Cataract progression was demonstrated in 35 eyes (48%) at 12 months of follow-up and 49 eyes (68%) at 24 months of follow-up, reflecting an incidence of cataract formation that has not been previously reported (to our knowledge) after limited vitrectomy and membrane peeling for PMF.

Adult↗
PubMed1988

Ocular dangers in the garden. A new menace--nylon line lawn trimmers.

Nylon line lawn trimmers represent a source of potentially devastating ocular trauma. Five cases of ocular trauma associated with the use of line trimmers are reported. These case reports document new mechanisms and circumstances of injury, including trauma from debris other than nylon line fragments and injury to bystanders. Furthermore, injuries are often serious, with two of these patients requiring an evisceration or enucleation after endophthalmitis developed. In one patient, six different organisms were cultured and another patient exhibited an Aspergillus organism and Propionibacterium acnes. As nylon trimmers gain in popularity, they will become an increasingly frequent source of ocular injury. A retrospective 40-month review of 85 cases (87 eyes) of penetrating and perforating ocular trauma shows line trimmers to be the fifth leading cause of such injury.

Accidents, Home↗
PubMed1988

Cerebroretinal vasculopathy. A new hereditary syndrome.

A new hereditary syndrome characterized by a frontoparietal lobe pseudotumor and retinal capillary abnormalities is described. A pedigree is presented in which characteristic ophthalmic findings have been found in ten family members and are suspected in eight additional family members spanning a total of four generations. Typical retinal findings include perifoveal capillary obliteration, peripheral focal capillary occlusion, and microvascular abnormalities, particularly involving the posterior pole. Eight patients spanning three generations had a central nervous system pseudotumor with identical histopathology. Histopathologic analysis of brain tissue shows a characteristic pattern of an unusual vasculopathy without vasculitis characterized by fibrinoid necrosis and resulting in necrosis of white matter with sparing of cortical brain tissue. The pedigree shows an apparent autosomal dominant pattern of inheritance with delayed expression of abnormalities. Of note, two patients unrelated to the pedigree having similar neuropathologic and retinal findings also have been seen at the authors' institution.

Adult↗
PubMed1987

Supplemental photocoagulation on the buckle for prevention of surgical revision after scleral buckling procedures.

Supplemental photocoagulation on the buckle appears to be a useful therapeutic modality in selected cases of persistent retinal detachment. In a retrospective review, 71 (63%) of 113 eyes were successfully treated with photocoagulation, thus avoiding the need for surgical revision. Median response time between treatment and postoperative subretinal fluid absorption in the successfully treated eyes was two days, with the majority responding within one day. The one favorable prognostic factor was the use of a soft silicone segmental sponge. Unfavorable prognostic factors included the following: contour of subretinal fluid (combined, ie, both anterior and posterior to the buckle); excessive amount of subretinal fluid; inadequate support of break(s); multiple drainages at first operation; rolled edge in association with a giant break; and residual vitreous traction on the break. Postoperative photocoagulation alone on the buckle did not appear to influence the rate of development of premacular fibroplasia or proliferative vitreoretinopathy.

Adolescent↗
PubMed1987

Transconjunctival anterior retinal cryotherapy for proliferative diabetic retinopathy.

Transconjunctival anterior retinal cryotherapy (ARC) for proliferative diabetic retinopathy (PDR) in 408 eyes was reviewed retrospectively. Of 266 eyes available for analysis for treatment effect on neovascularization, 138 (52%) had reduced neovascularization at 6 months. Eighty (30%) had no change in neovascularization, and 48 (18%) had increased neovascularization at 6 months. Factors having a significant effect on reduction of neovascularization were duration of diabetes and severity of retinopathy. Of 238 eyes available for analysis for treatment effect on vitreous hemorrhage at 6 months, 118 (50%) had reduced vitreous hemorrhage, 80 (33%) had no change, and 40 (17%) had increased vitreous hemorrhage. Severity of vitreous hemorrhage significantly affected the outcome in the subgroup of eyes with both neovascularization and vitreous hemorrhage. Of the total 408 eyes in this series, at 6 months, 172 (44%) had improved visual acuity, 89 (23%) had no change, and 126 (33%) had decreased visual acuity. Retinal detachments developed in 17 eyes (4%) post-treatment, 68 eyes (17%) had significant recurrent vitreous hemorrhage, and 61 eyes (15%) eventually underwent vitrectomy.

Conjunctiva↗
PubMed1987

New retinal detachment after pneumatic retinopexy.

Thirteen cases of rhegmatogenous retinal detachment repaired by pneumatic retinopexy were reviewed retrospectively. All patients were followed for a minimum of 6 months after surgery. At the end of follow-up, retinal detachment repair by pneumatic retinopexy succeeded in nine cases (70%) and failed in four (30%). Within 2 days of pneumatic retinopexy, vitreous condensation and traction with new retinal tears and associated detachments in previously uninvolved quadrants developed in two patients. The occurrence of new retinal detachments in the early postoperative period after pneumatic retinopexy has not been previously observed.

Aged↗
PubMed1987

Angioid streaks associated with pseudoxanthoma elasticum in a 13-year-old patient.

This report describes a 13-year-old girl who presented with angioid streaks associated with pseudoxanthoma elasticum (PXE). Extensive retinal pigment epithelial (RPE) mottling, known as peau d'orange, characteristic of PXE, was also noted. The potential complication of choroidal neovascularization is described. Physicians should be aware that angioid streaks and their potentially sight-threatening complications can occur in this age group.

Adolescent↗
PubMed1987

Neovascular glaucoma: a retrospective analysis of treatment with peripheral panretinal cryotherapy.

A retrospective analysis of thirty-one eyes in thirty patients with neovascular glaucoma (NVG) associated with proliferative diabetic retinopathy or venous occlusive disease was performed. Eyes treated with transconjunctival peripheral panretinal cryotherapy alone, or in combination with limited cyclocryotherapy had improvement or stabilization of visual acuity in 55%, reduction of intraocular pressure in 55%, and stabilization or regression of iris neovascularization in 70% of eyes at 12-14 months post-treatment. Transconjunctival peripheral panretinal cryotherapy alone, or in combination with limited cyclocryotherapy is recommended in the treatment of eyes with NVG and media opacities precluding photocoagulation therapy, or in eyes unresponsive to previous photocoagulation therapy.

Aged↗
PubMed1986

The Lincoff temporary balloon buckle.

The Lincoff temporary balloon buckle is an equally effective alternative to more conventional techniques in the management of selected retinal detachments. We used this technique in the management of 45 selected primary retinal detachments operated on since Nov. 22, 1980. Initial complete retinal flattening was achieved in 42 eyes (93%). Two of the three eyes that initially did not show complete flattening ultimately went on to do well without further surgery. Redetachment occurred in three of the five aphakic eyes (60%) and in four of the 36 phakic eyes (11%). None of the retinas in the four eyes with intraocular lenses redetached. Conventional scleral buckling techniques were used in the one case of initial failure and in the seven cases of redetachment for a final success rate of 98% after an average follow-up of 13 months.

Adult↗