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Biomedical subjects

M J Elman

Publications and source records attributed to M J Elman.

14 recordsLinked to original sources
PubMed1992

Optic nerve decompression surgery improves visual function in patients with pseudotumor cerebri.

Papilledema from pseudotumor cerebri can cause severe loss of visual acuity and visual field. We performed optic nerve decompression surgery on 17 patients with pseudotumor cerebri who, despite maximum conventional therapy, developed progressive loss of visual acuity and/or visual field. Postoperatively, visual acuity improved or stabilized in 33 of 34 eyes (97%). Visual fields improved in 20 of 21 eyes that underwent surgery. Optic nerve decompression surgery relieves local cerebrospinal fluid pressure on the optic nerve. Progressive loss of visual function associated with pseudotumor cerebri can be reversed or stabilized with optic nerve sheath decompression surgery.

Adolescent↗
PubMed1991

Optic nerve sheath decompression for nonarteritic ischemic optic neuropathy improves multiple visual function measurements.

Optic nerve sheath decompression was performed in seven patients with nonarteritic anterior ischemic optic neuropathy. Visual function was evaluated by measurement of visual acuity with standardized Early Treatment Diabetic Retinopathy Study charts, color vision testing, quantitation of relative afferent pupillary defects with neutral-density filters, and Goldmann and Humphrey perimetry. Visual acuity improved markedly in all patients (at least doubling of the visual angle); the peripheral visual field expanded by at least 20 degrees (as measured by Goldmann perimetry) in six patients. Three patients also experienced marked improvement in color vision, relative afferent pupillary defect, and foveal sensitivity. Our experience supports the possible beneficial effect of optic nerve sheath decompression in patients with nonarteritic anterior ischemic optic neuropathy.

Aged↗
PubMed1991

Modified optic nerve decompression in patients with functioning lumboperitoneal shunts and progressive visual loss.

Chronic papilledema from pseudotumor cerebri can cause progressive visual loss despite functioning lumboperitoneal shunts. The authors performed modified optic nerve sheath decompression in 12 patients (16 operations) with functioning lumboperitoneal shunts and progressive visual loss. All of the patients demonstrated improvement in visual function. Optic nerve sheath decompression allows release of localized cerebrospinal fluid (CSF) pressure. By performing optic nerve sheath decompression, progressive visual loss secondary to chronic papilledema can be halted and reversed.

Adult↗
PubMed1991

The effect of age and initial visual acuity on the systemic and visual prognosis of central retinal vein occlusion.

Papillophlebitis is the term that is often used to describe a central retinal vein occlusion with preserved visual acuity in a young, healthy patient. Among 194 patients with a diagnosis of central retinal vein occlusion (CRVO), 19 patients were identified who were under 50 years of age and who had visual acuity of 6/12 or better in the affected eye. These patients retained good vision in the affected eye during the course of the disorder with 17 eyes returning to 6/6. All of these patients remained healthy over a mean follow-up period of about four years. This group of patients was compared to a second group of 28 patients who also were under 50 years of age, but who had initial visual acuity in the affected eye less than 6/12. These patients had a variable visual outcome. In addition, they had a higher prevalence of systemic hypertension over the follow-up period than did a group of age-matched control subjects. An additional comparison was made to a group of 26 patients with visual acuity of 6/12 or better in the affected eye but who were over 50 years of age. Forty-six per cent of these patients had final visual acuity less than 6/12, and they had a higher prevalence of systemic vascular disease than did a group of age-matched control subjects.

Adult↗
PubMed1990

The natural course of central retinal vein occlusion.

We reviewed the records of 160 patients who had central retinal vein occlusion between 1980 and 1985. Of 168 eyes, 107 (64%) were classified as nonischemic types and 61 (36%) were classified as ischemic types. Of 107 nonischemic eyes, ten (9%) converted to the ischemic variant. Of 107 nonischemic eyes, 33 (31%) lost three or more lines of visual acuity irrespective of initial visual acuity. A final visual acuity less than or equal to 20/200 was recorded in 57 of 61 (93%) of ischemic eyes and 53 of 107 (50%) of nonischemic eyes.

Adolescent↗
PubMed1990

The risk for systemic vascular diseases and mortality in patients with central retinal vein occlusion.

In this cross-sectional study, the authors evaluated 197 patients diagnosed with central retinal vein occlusion (CRVO) at the Wilmer Ophthalmological Institute between 1980 and 1985 to determine the risk of systemic disease and mortality. Complete follow-up information for mortality was obtained in 191 (97%). National Health Interview Survey (NHIS) patients and Wilmer cataract patients formed two comparison groups. The prevalence of hypertension was significantly elevated in the CRVO cases when compared with both comparison groups (P less than 0.03, 0.005). The prevalence of diabetes mellitus was increased in CRVO cases in comparison with the NHIS group (P less than 0.005). The prevalence of cerebrovascular or cardiovascular disease was the same for all three groups, as was overall mortality. Mortality was not increased in CRVO cases as compared with United States mortality rates.

Adolescent↗
PubMed1990

Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy.

Seven eyes (7 patients) developed massive suprachoroidal hemorrhage (MSCH) during pars plana vitrectomy (PPV) for complicated retinal detachments. The MSCH developed late in the procedure following PPV, air fluid exchange, endolaser, cryopexy, and scleral buckling in five of seven eyes. In two eyes, mild hemorrhagic choroidal detachments noted intraoperatively progressed to MSCH within 72 hours postoperatively. Diagnosis of MSCH was confirmed by echography and CT scan. Multiple scleral buckling surgeries, high myopia, aphakia, and intraocular inflammation were the main risk factors. Placement of a broad posterior scleral buckle with intraoperative hypotony and cryopexy were important precipitating factors. Visual results were poor, with six of seven eyes showing no light perception. The mean follow-up time was 12.8 months. Once acute MSCH is recognized intraoperatively, surgical decompression at that time should be avoided as MSCH itself may tamponade the choroidal bleed. Details of prevention and management are discussed.

Adult↗
PubMed1989

The use of fundus photographs and fluorescein angiograms in the identification and treatment of choroidal neovascularization in the Macular Photocoagulation Study. The Macular Photocoagulation Study Group.

The Macular Photocoagulation Study (MPS) Fundus Photograph Reading Center has developed a standard set of methods for assessing color photographs and fluorescein angiograms on study patients. For pretreatment angiograms, these methods are used to determine the location and extent of the choroidal neovascularization. For posttreatment color fundus photographs, these methods are used to assess the extent and intensity of treatment. Although these methods were developed to judge eligibility and treatment of patients enrolled in the MPS, they provide an excellent way for all treating ophthalmologists to evaluate their patients' angiograms and to assess immediately the intensity and extent of laser photocoagulation. The technique requires a microfilm reader or slide projection device to determine the completeness of treatment. The authors superimpose independent drawings made from pre- and posttreatment photographs. The techniques described can be applied readily in clinical practice. Since persistent neovascularization is highly correlated with incomplete and/or inadequate photocoagulation treatment, clinicians may adopt these Reading Center techniques to minimize the frequency of persistent neovascularization and, possibly, to reduce the frequency of visual loss in treated eyes.

Choroid↗
PubMed1988

Neovascularization in central retinal vein occlusion: electroretinographic findings.

Electroretinograms (ERGs) were measured in 15 patients with central retinal vein occlusion (CRVO). Seven of the patients had neovascularization of the iris (NVI) at the time of testing, and two developed NVI within one month of testing; six did not have NVI or any other form of neovascularization (NV) and were no longer considered to be at risk for NV from their present occlusion. The ERGs were recorded as a function of the stimulus intensity and to a 30-Hz flickering stimulus. A Naka-Rushton-type function was fit to b-wave amplitudes, measured as a function of stimulus intensity, to evaluate changes in ERG amplitude and sensitivity. Compared with eyes in the no-NV group, eyes developing NVI had significantly reduced ERG sensitivity and amplitudes. The distributions of sensitivity values in these two groups did not overlap. All of the eyes with NV showed large a- and b-wave and 30-Hz implicit time delays, but only one eye had a b/a-wave amplitude ratio close to or less than 1. A comparison of ERG sensitivity, amplitude data, and flicker timing data with retinal fluorescein angiography in a two-alternative forced-choice analysis showed that ERG sensitivity and amplitude loss were better than retinal fluorescein angiography at discriminating eyes with CRVO and NVI from eyes with CRVO without NVI.

Electroretinography↗
PubMed1986

Earliest symptoms caused by neovascular membranes in the macula.

One hundred three patients with neovascular maculopathy and relatively recent vision loss were surveyed to determine the most frequent symptoms and to assess the reliability of the Amsler grid in helping patients to detect early symptoms. Blurred vision and distortion, most often with near vision, were the most frequent first symptoms reported by patients. Of 49 patients who said that they were observing the Amsler grid on a regular basis, only five indicated that the Amsler grid abnormality was the first visual symptom. However, all but five of 49 patients did notice an Amsler grid abnormality during the office examination, suggesting noncompliance as the probable explanation for failure to detect an Amsler grid abnormality earlier. Patients at risk for neovascular maculopathy should be encouraged to assess a variety of visual functions--including reading vision, color saturation, and image clarity--in addition to observing the Amsler grid, in order to help them detect the earliest symptoms of submacular fluid from a potentially treatable neovascular membrane.

Choroid↗
PubMed1986

The natural history of serous retinal pigment epithelium detachment in patients with age-related macular degeneration.

One hundred ten patients with serous detachment of the retinal pigment epithelium (RPE) were reexamined to enhance our knowledge of the natural course of this condition. All patients were greater than 50 years of age, had age-related macular degeneration, and had neither blood, lipid, nor angiographic evidence of a definite choroidal neovascular membrane (NVM) at the time of the initial examination. All patients were followed up for at least six months except for two patients who had developed a choroidal NVM within the first six months of the initial exam. Forty-five of 140 eyes (32%) developed a choroidal NVM within an average of 19.6 months (median, 12 months). This was associated with a final visual acuity of 20/200 or worse (P less than 0.0001). Ophthalmoscopic and angiographic features present at the initial visit which were associated with the development of NVM and poor final visual acuity were: sensory retinal detachment; increased size of PED; hot spot; late filling; notching; and irregular filling. At the most recent examination, 39% of the eyes had a final visual acuity of 20/20 to 20/40, while 24% of the eyes had a final visual acuity of less than or equal to 20/200.

Aged↗