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Biomedical subjects

M H Goldbaum

Publications and source records attributed to M H Goldbaum.

At least 19 recordsLinked to original sources
PubMed1998

Imaging the microvasculature of choroidal melanomas with confocal indocyanine green scanning laser ophthalmoscopy.

OBJECTIVE: To image the microvasculature of choroidal melanoma with a new confocal scanning laser ophthalmoscope. METHODS: Eighteen consecutive patients, each with a unilateral choroidal melanoma, were examined prospectively. Indocyanine green angiography was performed with a new confocal scanning laser ophthalmoscope that enabled serial optical sectioning through the tumor. Two additional patients were studied with indocyanine green angiography and confocal scanning laser ophthalmoscopy just before enucleation for posterior choroidal melanomas. The histologic identification of microvasculature patterns was compared with the angiograms for these patients. RESULTS: In the series of 18 patients, 16 (89%) indocyanine green angiograms with optical sectioning revealed tubular structures within the melanoma that were identified as tumor vessels based on their angiographic appearance. The microvasculature patterns identified by indocyanine green angiography correlated well with the histologic appearance of these microvasculature patterns in both patients for whom histologic verification was available. CONCLUSIONS: This preliminary study suggests that indocyanine green angiography with confocal scanning laser ophthalmoscopy images the microvasculature of choroidal melanomas and may be capable of detecting microvasculature patterns that have been shown to be prognostically significant from histopathological studies.

Adult↗
PubMed1998

Silicone oil tamponade to seal macular holes without position restrictions.

OBJECTIVE: The authors performed a study to determine the effectiveness and safety of silicone oil as a substitute for gas to fill the vitreous cavity to treat macular holes. DESIGN: Multicenter, nonrandomized, interventional trial. PARTICIPANTS: Thirty-seven consecutive patients chose vitrectomy with silicone tamponade instead of gas to treat 40 eyes with stage-2 to stage-4 idiopathic age-related macular holes. Stage-2 holes constituted 40% of the holes, and stage-3 and stage-4 holes made up 60%. INTERVENTION: All eyes were treated with vitrectomy, manual detachment of the posterior vitreous face (not done for stage-4 holes), autologous serum instillation, and silicone fill of the vitreous cavity. After insertion of the oil, the patients resumed normal activity with no restriction of head or eye position except to avoid faceup position. The oil was removed after approximately 6 weeks. MAIN OUTCOME MEASURES: The authors considered the seal of the macular hole and the preoperative and postoperative logarithm of the minimum angle of resolution (logMAR) visions the most significant measures for comparison to other studies. RESULTS: Eighty percent of all holes and 86% of holes not treated previously were sealed with a single silicone tamponade of the vitreous cavity. The logMAR value of visual acuity improved an average of 0.26 (2.6 lines) to 0.61 (20/81) for all eyes and 0.34 (3.4 lines) to 0.52 (20/66) when the macular hole sealed. Completeness of fill of the vitreous cavity with silicone affected seal of the macular hole. Three of eight eyes in which open holes developed after oil removal had less than 90% fill of the vitreous cavity by silicone. Sixty-nine percent of lenses increased opacity one grade or were removed after silicone tamponade. There were no significant adverse effects arising from silicone tamponade. CONCLUSIONS: Silicone oil tamponade of macular holes is effective and safe. Silicone may be optimal for the treatment of macular holes in persons who must travel, who cannot maintain facedown positioning, or who have monocular vision. The most important factor in the successful closure of the macular hole was the completeness of fill of the vitreous cavity with silicone oil.

Adult↗
PubMed1994

Interpretation of automated perimetry for glaucoma by neural network.

PURPOSE: Neural networks were trained to interpret the visual fields from an automated perimeter. The authors evaluated the reliability of the trained neural networks to discriminate between normal eyes and eyes with glaucoma. METHODS: Inclusion criteria for glaucomatous and normal eyes were the intraocular pressure and the appearance of the optic nerve; previous visual fields were not used. The authors compared the backpropagation learning method used by automated neural networks to those used by two specialists in glaucoma to classify the central 24 degrees automated perimetric visual fields from 60 normal and 60 glaucomatous eyes. RESULTS: The glaucoma experts and a trained two-layered network were each correct at approximately 67%. The average sensitivity of this test was 59% for the two glaucoma specialists and 65% for the two-layered network. The corresponding specificities were 74% and 71% for the specialists and the two-layered network, respectively. The experts and the network were in agreement about 74% of the time, which indicated no significant disagreement between the methods of testing. Feature analysis with a one-layered network determined the most important visual field positions. CONCLUSIONS: The authors conclude that a neural network can be taught to be as proficient as a trained reader in interpreting visual fields for glaucoma.

Adult↗
PubMed1992

Digital overlay of fluorescein angiograms and fundus images for treatment of subretinal neovascularization.

A system for comparing sequential fundus photographs and angiograms has been developed using a personal computer and commercially available image processing software. This process provides rapid results and a high degree of accuracy in image correlation, even when images come from different cameras with different magnifications. Though no concentrated effort was made to compare the superiority of this method to the manual technique, the value of the manual results is fully acknowledged, and this technique is offered as another method of achieving the same end. This technique can be used to determine the adequacy of treatment of subretinal neovascularization, recurrence of subretinal neovascularization in subsequent angiograms, pigment epithelial creep, and changes in fundus lesions.

Adult↗
PubMed1990

Magnetic resonance imaging in the evaluation of vitreoretinal disease in eyes with intraocular silicone oil.

Media opacification in eyes filled with silicone oil makes the evaluation of recurrent retinal detachment difficult. Ultrasonography through silicone oil is subject to significant imaging artifacts. We performed magnetic resonance imaging on six patients with unilateral intravitreal silicone oil to determine if the technique would detect detached retina and subretinal oil. All patients had undergone pars plana vitrectomy with silicone oil injection for proliferative vitreoretinopathy; five patients had encircling solid silicone scleral buckles. In five patients the media were clear, and ophthalmoscopic findings were correlated with magnetic resonance findings. Four patients had recurrence of inferior retinal detachment; magnetic resonance imaging demonstrated subretinal oil in three of these patients. One patient had a concentric, shallow, anterior retinal detachment; magnetic resonance scanning demonstrated a globular hyperintensity suggestive of subretinal oil. In the sixth patient, who had an opaque cornea, magnetic resonance imaging suggested that the retina was attached preoperatively; this was confirmed at subsequent surgery. A chemical shift artifact was helpful in defining the contour of retinal detachments and the presence of subretinal oil by outlining the silicone oil within the eye.

Eye↗
PubMed1990

The discrimination of similarly colored objects in computer images of the ocular fundus.

The STARE (STructured Analysis of the REtina) project uses object-identification and artificial intelligence techniques to provide automated diagnoses from color pictures and fluorescein angiograms of the ocular fundus, or automated change detection from sequential images. As part of the object-identification process, we apply expert judgment and experimentation to define features--such as size, shape, color, and texture--of objects (disk, blood vessels, lesions) in digitized images. In our initial investigations, we explored color alone, because it yields a great deal of information in the classification process. We verified that even similarly colored lesions (exudates, cotton-wool spots, and drusen) could be classified by color with moderate success by a quadratic discriminant function. When color alone is not sufficient, refinement in the classification of objects may be achieved by using more features in statistical pattern recognition. Ultimately, we build a description of the fundus image which can be used either to identify one or more diagnoses that can cause the pattern of lesions in the ocular fundus or to recognize change in sequential images.

Color↗
PubMed1989

Optic neuropathy associated with cryptococcal arachnoiditis in AIDS patients.

We studied two cases of bilateral visual loss secondary to an optic neuropathy in patients with cryptococcal meningitis. In both cases a history of visual loss after the onset of an episode of cryptococcal meningitis was elicited. Visual fields were consistent with optic nerve disease. The patients' visual loss appeared to be the result of perineuritic adhesive arachnoiditis. Although no surgical interventions were carried out in our patients, medical or surgical intervention may be useful to prevent or relieve constrictive arachnoiditis and preserve vision in selected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The extracellular matrix of the human optic nerve.

The nerve fibers of the optic nerve are enclosed and segmented by extracellular matrix. With immunostains, we localized collagen types I through VI, laminin, and fibronectin in frozen sections of the extracellular matrix of the prelaminar, laminar, and retrolaminar human optic nerve. The internal limiting lamina of the optic nerve has an extracellular composition similar to the thicker adjacent retinal internal limiting lamina. We confirmed that the lamina cribrosa contains type IV collagen and laminin, whereas the sclera does not. The septa of the retrolaminar optic nerve appear as vascular inward extensions of the pia mater. The glial tube that lines the optic nerve extends forward from the retrolaminar optic nerve through the lamina cribrosa to end anteriorly at the retinal pigment epithelium. It does not separate the optic nerve from the adjacent sensory retina.

Aged↗
PubMed1989

Useful adjuncts for vitreoretinal surgery.

Many vitreoretinal procedures are performed in offices and hospitals where cost control is important. We describe three useful devices and techniques that facilitate these procedures at minimal expense and often greater convenience. These include an accurate method for localising the pars plana without the use of callipers, an inexpensive, reliable, pressure regulated air pump for fluid-air exchange, and an easy method for intraocular injection of silicone oil through 20 gauge instrumentation without the need for expensive pumps. These procedures and techniques should prove to be useful in the treatment of vitreoretinal disease.

Air Pressure↗
PubMed1983

Subretinal neovascularization as a complication of drainage of subretinal fluid.

Four cases of subretinal choroidal neovascularization that developed at the sight of breaks in Bruch's membrane were made for the drainage of subretinal fluid during retinal reattachment surgery. This neovascularization can occur in both young and older patients. All drainage sights were posterior to the equator, which may indicate a higher risk of the development of this complication from posterior drainage sights. Unless the fovea is threatened, there is no urgency to treat this choroidal neovascularization. It is unclear why this complication is so rare, considering the frequency of surgical perforation of the choroid and Bruch's membrane during drainage of subretinal fluid in retinal reattachment surgery.

Adolescent↗
PubMed1982

A new perspective on Bruch's membrane and the retinal pigment epithelium.

Trypsin digestion of retinal pigment epithelium is a technique that bares Bruch's membrane, to allow topographical examination by scanning electron microscopy. Twenty-five human eyes were examined. The zonula occludens of the pigment epithelium was clearly seen as a surface feature, but attachment plaques at the sides and base were not visible. The adhesion between the pigment epithelium and the basal lamina was stronger than between the basal lamina and the rest of Bruch's membrane. Surface features of the basal lamina, inner collagenous zone, elastic layer, and outer collagenous zone were seen in a way that previously required an artist's representation constructed from microscopic sections.

Basement Membrane↗
PubMed1981

Rapid and efficient immobilization of soluble and small particulate antigens for solid phase radioimmunoassays.

A rapid method of antigen immobilization (10 min.) was developed using soluble antigens (bovine serum albumin, epidermal growth factor, and goat IgG) and small particulate antigens (Keyhole limpet hemocynanine and E. coli) by drying them on filter paper discs. This technique results in a high % of the soluble antigen remaining firmly bound, goat IgG (89%), bovine serum albumin (73%). All the antigens we tested retained their antigenicity after drying as detected by [125I] labeled staphylococcal protein A radioimmunoassay. This method of antigen immobilization was compared to adsorption to plastic wells and was found to be much faster (10 min vs 18 hrs) and was 5 times more efficient than adsorption to plastic wells. Using this technique, we were able to detect as little as 40 ng of bovine serum albumin. These characteristics suggest that this technique of soluble antigen immobilization may be useful in rapid detection of antibodies to many different antigens, as well as detecting ng amounts of the antigens directly.

Animals↗
PubMed1979

Cryotherapy of proliferative sickle retinopathy, II: triple freeze-thaw cycle.

Complete closure of retinal neovascularisation due to proliferative sickle cell retinopathy was achieved in 28 'sea fans' (areas of neovascularisation) in 9 eyes of 9 patients by means of a triple freeze-thaw technique. However, 2 eyes developed subsequent rhegmatogenous retinal detachments, presumably related to vitreous traction on necrotic retina. We therefore recommend photocoagulation as the best treatment of proliferative sickle cell retinopathy. If opacities in the media prevent photocoagulation, a single freeze-thaw cycle is preferable.

Adolescent↗