Biomedical subjects

M S Cox

Publications and source records attributed to M S Cox.

At least 19 recordsLinked to original sources

PubMed2001

Clinical course and surgical treatment of macular epiretinal membranes in young subjects.

OBJECTIVE: To examine the surgical and nonsurgical visual outcomes of young subjects with idiopathic macular epiretinal membranes (ERMs). DESIGN: Retrospective observational and noncomparative interventional case series. PARTICIPANTS: Nineteen consecutive subjects (20 eyes) aged 40 years or less with an idiopathic macular ERM. METHODS: Group 1: 10 consecutive eyes were initially seen with visual acuity of 20/50 or better; 7 eyes were observed, and 3 eyes with progressive visual loss to <20/50 underwent vitrectomy and membrane peeling. Group 2: 10 consecutive eyes with presenting visual acuity of 20/60 or worse underwent vitrectomy and membrane peeling. MAIN OUTCOME MEASURES: Visual acuity, cataract formation, ERM recurrence, operative complications. RESULTS: Group 1: With no surgery, visual acuity remained stable or improved in 5 of 10 eyes (50%), with a mean follow-up of 3.7 years. Three of 10 eyes (30%) had visual loss < or =20/60 develop and underwent vitrectomy. Postoperative visual acuity improved an average of 6 lines with a mean follow-up of 17.6 months. Group 2: After vitrectomy, visual acuity improved 2 or more lines in 7 of 10 eyes (70%), with a mean improvement of 4.4 lines and mean follow-up of 29.2 months. Groups 1 and 2: Three of 13 eyes (23%) that underwent vitrectomy had recurrent ERM formation. CONCLUSIONS: Young subjects with idiopathic macular ERMs and a presenting visual acuity of 20/50 or better had a favorable visual outcome with observation. Subjects with an initial vision of 20/60 or worse, or those who had a visual decrease to < or =20/60 had significantly improved visual acuity after vitrectomy. ERM recurrence is relatively high after surgery.

Adolescent↗

PubMed2001

Adult retinopathy of prematurity: outcomes of rhegmatogenous retinal detachments and retinal tears.

PURPOSE: To describe the results of retinal tears and rhegmatogenous retinal detachments (RD) in adults with retinopathy of prematurity (ROP). DESIGN: Noncomparitive interventional case series. METHODS: Retrospective cohort of 216 eyes of 108 patients, 15 years or older, followed for up to 23 years (median, 6.2 years). RESULTS: One eye was initially seen with an RD, and during follow-up 30 eyes had an RD develop. An additional surgical procedure was required in 7 of the 31 eyes (23%) with an RD. Four eyes were initially seen with retinal tears, and during follow-up 19 eyes had a retinal tear develop. Seven of the 23 eyes (30%) with a retinal tear had initial repair fail. Eyes with minimal cicatricial changes from ROP were still at high risk for tears and detachments developing. Eighty percent of eyes with retinal tears and 60% of eyes with an RD that started with vision >20/60 maintained that level of vision at the final examination. CONCLUSION: In patients with a history of premature birth, features of fundus examinations do not correlate with the occurrence of a retinal tear or RD. Repair of a tear or detachment in such a patient is more likely to require multiple procedures but can still be associated with good visual results. Physicians should consider widespread relief of vitreoretinal traction for a tear or detachment in any patient with a history of premature birth.

Adolescent↗

PubMed2000

Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid.

PURPOSE: To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid. METHODS: Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on contact lens examination and confirmed with fluorescein angiography. On fundus examination, the premacular posterior hyaloid was attached and appeared taut. RESULTS: The mean preoperative best-corrected visual acuity was 20/160, and the mean final best-corrected visual acuity was 20/80 (P <.0001, Wilcoxon signed rank test), with 27 (49.1%) of the 55 eyes demonstrating improvement in best-corrected visual acuity of 2 or more lines. Fifty-two (94.5%) of the 55 vitrectomized eyes showed improvement in clinically significant macular edema and in 45 eyes (81.8%) the macular edema resolved completely during a mean period of 4.5 months (range, 1 to 13 months). Eyes with macular ischemia and preoperative best-corrected visual acuity of 20/200 or less tended to respond less favorably to vitrectomy than eyes lacking these characteristics. All eyes had at least 6 months of follow-up after surgery, with a mean follow-up of 23.2 months. CONCLUSION: In eyes with persistent diffuse diabetic macular edema with a taut premacular posterior hyaloid face unresponsive to laser therapy, vitrectomy with removal of the posterior hyaloid appears to be beneficial in some cases. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.

Adult↗

PubMed2000

External versus internal approach to the removal of metallic intraocular foreign bodies.

OBJECTIVE: To review the management of metallic intraocular foreign bodies (IOFB) at a single institution and to compare the use of internal and external approaches for their removal. SUBJECTS AND METHODS: A retrospective review was conducted on 70 eyes from 70 patients who underwent surgical removal of a metallic IOFB with either an internal (vitrectomy followed by forceps or internal magnet use) or external approach (large electromagnet) by seven vitreoretinal surgeons at a single institution between 1973 and 1996. Visual acuity and complications occurring with the two approaches were the main outcome measures studied. RESULTS: Overall, patients showed significant improvement in visual acuity following surgical intervention (P < 0.001) despite widely varying surgical techniques. When the authors compared patients treated with an external versus an internal approach they found no statistically significant difference with regard to visual outcome and a trend toward a higher rate of postoperative endophthalmitis in the external approach group. CONCLUSION: Surgical removal of metallic IOFB results in significant visual improvement. The external approach to the removal of magnetic metallic IOFB remains a viable treatment option in select cases.

Adolescent↗

PubMed1999

Vitrectomy for chronic pseudophakic cystoid macular edema.

PURPOSE: We report the results of pars plana vitrectomy for chronic pseudophakic cystoid macular edema unresponsive to medical treatment. METHODS: Retrospective analysis of 23 consecutive eyes of 23 patients with chronic pseudophakic cystoid macular edema was performed. Eyes with vitreous incarceration into the cataract wound or vitreous-cornea contact were excluded from the study. Preoperatively, all eyes had cystoid macular edema confirmed on fluorescein angiography and were unresponsive to medical treatment. Pars plana vitrectomy was performed using standard techniques and vitreous adhesions to the iris, intraocular lens, or both were lysed if present. RESULTS: The mean interval between cataract surgery and vitrectomy was 32.3+/-30.9 months (median, 20 months; range, 3 to 110 months). The vitreous was adherent to the iris or intraocular lens in 12 eyes (52.2%) and was present in the anterior chamber with no evidence of adhesions in seven eyes (30.4%). In four eyes (17.4%) the vitreous was posterior to the iris plane with no adhesions to anterior segment structures. The median preoperative best-corrected visual acuity was 20/200, and the median final postoperative best-corrected visual acuity was 20/60 (P<.0001) after a mean follow-up of 30.2+/-31.2 months (median, 14 months; range, 2 to 109 months). Final best-corrected visual acuity improved by a mean of 3.3+/-2.6 Snellen lines, with a median percent change of 70% (mean, 57.3%; range, 0% to 99%). In all 23 eyes the cystoid macular edema resolved postoperatively by biomicroscopic examination in a mean period of 3.3 months (median, 2 months; range, 1 to 12 months). CONCLUSIONS: In pseudophakic eyes with chronic cystoid macular edema unresponsive to medical treatment, vitrectomy resulted in resolution of the cystoid macular edema with improved visual acuity in some cases. Clinical improvement may occur in eyes with no apparent vitreous disturbance.

Aged↗

PubMed1998

Good visual acuity in an adult population with marked posterior segment changes secondary to retinopathy of prematurity.

PURPOSE: To show that good visual acuity can be compatible with marked posterior segment changes secondary to retinopathy of prematurity (ROP) in the adult population. METHODS: A retrospective chart review of adult patients with regressed ROP. We found 14 eyes in 12 patients who were older than 21 years with a visual acuity of 20/60 or better associated with marked posterior segment changes secondary to ROP. RESULTS: Of the 14 eyes, 11 were myopic, with six eyes having the spherical equivalent of > or = -6.00. Best-corrected visual acuities ranged from 20/15-20/60. One eye had a macular fold. Thirteen eyes had macular ectopia. CONCLUSIONS: Good vision can be compatible with marked posterior segment changes secondary to ROP in an adult population. This emphasizes the need to follow these patients closely during childhood and treat them promptly for any amblyogenic condition that could prevent them from reaching their full visual potential.

Adult↗

PubMed1997

Vitrectomy for retained lens fragments after phacoemulsification.

PURPOSE: Posterior lens fragments after phacoemulsification can be a serious complication of cataract surgery. This study is designed to evaluate the clinical features of eyes after pars plana vitrectomy has been performed to remove posteriorly dislocated lens fragments after phacoemulsification. METHODS: The authors performed a retrospective chart review of 126 consecutive eyes of 126 patients with dislocated lens fragments after phacoemulsification, managed with pars plana vitrectomy at Associated Retinal Consultants of Michigan. These eyes were operated on from January 1986 through January 1996. RESULTS: The relation of the intervals between cataract surgery and vitrectomy to various postoperative clinical parameters was studied. Clinical features at presentation included elevated intraocular pressure (IOP over 25 mmHg) in 52.4% of the eyes, uveitis in 69.6%, and corneal edema in 50.8%. Initial visual acuity was 20/400 or worse in 73.8% of the eyes. The mean preoperative visual acuity was 20/278 (median, 20/400), whereas the mean final visual acuity was 20/40 (median, 20/50) after a mean follow-up of 18.9 months. Retinal detachments were found in 20 eyes: 7 before vitrectomy and 13 during or after it. After surgery, 44% of eyes achieved a final visual acuity of 20/40 or better and 90% were 20/400 or better. The distribution of best-corrected final visual acuities among the eyes showed statistically significant differences based on the type of intraocular lens (IOL) used, with posterior chamber IOL greater than anterior chamber IOL, and anterior chamber IOL greater than aphakia. Reasons for a poor visual outcome included persistent corneal edema (four eyes), retinal detachment (two eyes), central retinal vein occlusion (two eyes), age-related macular degeneration (two eyes) glaucoma (one year), and endophthalmitis (one eye). CONCLUSIONS: There were no statistically significant differences between early (< 7 days) and delayed (8 days or more) vitrectomy when increased IOP, corneal edema, choroidal effusions, cystoid macular edema, and visual acuity were analyzed. The use of vitrectomy to remove posteriorly dislocated lens fragments has been shown to be an effective treatment method that significantly reduces the inflammatory response and hastens visual recovery.

Adult↗

PubMed1996

Irreversible silicone oil adhesion to silicone intraocular lenses. A clinicopathologic analysis.

PURPOSE: To report a newly defined complication of foldable intraocular lenses (IOLs), namely silicone oil-silicone IOL interaction. This is a complication not generally seen by the implanting cataract surgeon but, rather, at a later stage in a patient's postoperative course, by a vitreoretinal surgeon. METHODS: Three clinical case histories, including two explanted silicone IOLs, were submitted for analysis. The submitted silicone lenses were photographed under water, and the nature of the silicone oil coating was documented. RESULTS: In each instance, the silicone coating was manifest as a thick coating with droplet formation on the lens surface that was tenaciously adherent and could not be dislodged by instruments or injection of viscoelastics. CONCLUSION: The use of silicone IOLs in patients with current vitreoretinal disease or those who are at high risk for future vitreoretinal disease that may require silicone oil as part of the therapy should be reconsidered. The authors recommend that information regarding the existence and significance of this complication be printed on all silicone oil and silicone IOL packages and inserts (if not as a warning, at least as an informative comment regarding the existence of this condition). This is a rare but clinically significant complication that will affect the occasional patient treated with both of these modalities.

Adult↗

PubMed1996

Optical coherence tomography of macular lesions associated with optic nerve head pits.

PURPOSE: Although optic pits were described more than a century ago, the pathogenesis and pathologic nature of the associated macular lesions remain controversial. The authors used the technique of optical coherence tomography (OCT) to further define the anatomic relation that exists between optic pits, macular schisis-like spaces, and macular detachments. METHODS: Four eyes of three consecutive patients with optic pit-related macular pathology were evaluated. Cross-sectional OCT images were correlated with findings from slit-lamp biomicroscopy and stereo fundus photography. All eyes previously had undergone unsuccessful photocoagulation to the temporal juxtapapillary retina. One eye had undergone vitrectomy and intraocular gas tamponade, resulting in partial resorption and displacement of the submacular fluid. RESULTS: Retinal edema and cystic degeneration were present, overlying macular neurosensory detachments in all four eyes. The most prominent edema was present in the outer retina at the level of the outer plexiform layer. This mimicked a true retinoschisis cavity, although bridging retinal elements were identifiable. A lesser degree of edema was present in the inner retina, predominantly located between the disc and fovea. In one eye, a lamellar hole was shown to be a defect in the outer neurosensory retina. In another eye, a macular detachment developed under a pre-existing schisis-like cavity. The schisis-like cavity or edematous retina communicated with the optic disc in all eyes, whereas none of the eyes demonstrated a direct connection between the macular detachment and optic pit. CONCLUSION: These findings support the concept of a bilaminar structure in which a macular detachment develops secondarily to a pre-existing schisis-like lesion consisting of severe outer retinal edema. Fluid may enter from the optic pit into the retinal stroma and not directly into the subretinal space, explaining the prolonged recovery and frequency of treatment failure after photocoagulation to the juxtapapillary retina.

Adult↗

PubMed1995

Macular pucker after successful surgery for proliferative vitreoretinopathy. Silicone Study Report 8.

BACKGROUND: The prevalence of postoperative macular pucker and the factors associated with its development after successful surgery for proliferative vitreoretinopathy (PVR) using silicone oil or gas tamponade are unknown. METHODS: The postoperative status of the macula was determined by reviewing the photographs of 336 eyes taken 6 months after randomization. Two hundred eleven eyes with attached maculas were identified and analyzed to determine the prevalence of macular pucker after silicone oil and gas tamponades in eyes without (group 1) and with (group 2) previous vitrectomy surgery. Data obtained at baseline, from the primary study surgery, and from subsequent examinations and repeat surgeries during a follow-up period of 6 months were analyzed for factors associated with postoperative macular pucker. RESULTS: The 6-month-point prevalence rate of postoperative macular pucker was 15% (32 of 211 eyes). Ten of the 32 eyes were new cases of macular pucker. The authors were unable to document a difference in the 6-month-point prevalence of postoperative macular pucker between group 1 and group 2 eyes (13% versus 18%) or between eyes randomized to gas versus silicone oil (19% versus 12%). Postoperative pucker was three times as likely to develop in aphakic/pseudophakic eyes compared with phakic eyes (P = 0.02). Focal contraction posteriorly causing starfolds, and intravitreal contraction involving the vitreous base or vitreous cavity, were significantly less prevalent in eyes with postoperative macular pucker (P < 0.05). Large (> or = 2 disc diameters) retinal breaks (P = 0.04) were associated significantly with postoperative macular pucker (P = 0.04). The authors were unable to document an association between postoperative macular pucker and the type of adhesive modality used or the extent of its application. Postoperative visual acuity was significantly better if the macula was not puckered (P < 0.01). CONCLUSIONS: The occurrence of macular pucker after successful surgery for retinal detachments complicated by severe PVR is not influenced by the choice of intraocular tamponade. Certain preoperative factors may be associated with postoperative macular pucker.

Cohort Studies↗

PubMed1995

Lens-sparing vitrectomy with perfluorocarbon liquid for the primary treatment of giant retinal tears.

PURPOSE: To evaluate the surgical success of vitrectomy without initial lensectomy in the primary treatment of retinal detachment associated with giant tears without proliferative vitreoretinopathy. METHODS: Thirty-four consecutive phakic eyes with idiopathic giant retinal tears underwent vitrectomy, injection of perfluorocarbon liquid, endolaser, and gas tamponade. Encircling scleral buckling was performed in 14 of 34 patients. Preoperative visual acuity ranged from 20/25 to hand motions. Giant tear size ranged from 90 degrees to 330 degrees. Follow-up ranged from 10 to 64 months. RESULTS: Anatomic retinal re-attachment was achieved intraoperatively in all eyes. The re-operation rate was 14% for eyes that underwent scleral buckling with the initial vitrectomy and 45% in eyes without primary scleral buckling. In 59% of eyes with cataract formation, 32% underwent cataract surgery with or without intraocular lens implantation. Best-corrected final visual acuity ranged from 20/15 to 20/400. CONCLUSION: Most phakic eyes with giant retinal tear not associated with proliferative vitreoretinopathy can be re-attached successfully with initial preservation of the lens.

Adolescent↗

PubMed1994

Reproducibility of a comprehensive diet history in the Diabetes Control and Complications Trial. The DCCT Research Group.

OBJECTIVE: To evaluate the reproducibility of a modified Burke-type diet history within the context of a long-term, randomized, 29-center clinical diabetes study. DESIGN: Diet histories were collected by trained interviewers at the end of years 1 and 2 after subjects were randomly assigned to the intensive treatment group or the conventional treatment group. Mean daily intakes of energy, protein, carbohydrate, total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, and dietary fiber were calculated for each treatment group at each time period. SUBJECTS: The study population consisted of 139 subjects in the intensive treatment group and 128 subjects in the conventional treatment group. Ages ranged from 13 to 39 years; groups included men and women. Distribution by age, sex, race, proportion of smokers, weight reported as percent ideal body weight, and duration of IDDM were similar in both groups. STATISTICAL METHODS: Differences in nutrient intake between the conventional and intensive treatment groups at each time period were tested for significance using the Wilcoxon rank-sum test. The Wilcoxon paired differences test was used to assess changes between time periods within treatment groups. Linear agreement between repeated administrations of the diet history was evaluated using Pearson's correlation coefficient, and the extent of within-subject reproducibility was assessed by intraclass correlation. RESULTS: No statistically significant differences in energy and nutrient intakes were observed between the two groups at either year 1 or year 2. Within each treatment group, energy and nutrient intake differences between times were not statistically significant. Correlation coefficients between years 1 and 2 ranged from .51 for dietary fiber to .72 for dietary cholesterol; within-subject reproducibility was slightly higher. APPLICATIONS: These results demonstrate long-term reproducibility for the meal-based diet history in the DCCT population.

Adolescent↗

PubMed1991

Enlargement of circumscribed choroidal hemangiomas.

The authors describe five patients with circumscribed choroidal hemangiomas. Fundus photography, fluorescein angiography, and ultrasound examinations showed progressive enlargement of these hemangiomas. In all cases, the extent of lesion enlargement was slight: the mean change in tumor size was 1.6 mm x 1.5 mm in basal diameters by 0.9 mm in thickness during a median interval of 52 months (range 33 to 100 months) between initial tumor diagnosis and detection of lesion enlargement. This series of cases demonstrates that circumscribed choroidal hemangiomas can enlarge slightly during long intervals between observations.

Adolescent↗

PubMed1991

An ambulatory approach to self-care of diabetes.

Managing the insulin-requiring diabetic patient in an ambulatory setting includes metabolic regulation of the diabetes and education in its self-care. Means of achieving these goals include structured group or one-on-one individualized sessions. Third party policies relating to ambulatory care are challenged and their need for fiscal support emphasized. During the coming decade, diabetic patients should 1) have access to ambulatory care programs for metabolic regulation and education in self-care, 2) expect third party support of these programs, and 3) heighten their own priorities on diabetes care to ensure quality management of their diabetes.

Ambulatory Care↗

PubMed1991

A videofluoroscopy chair for the evaluation of dysphagia in patients with severe neuromotor disease.

Due to the difficulties encountered in positioning severely neurologically impaired individuals for videofluoroscopic studies, the Rehab Tech Video FluoroChair was developed. The purpose of the chair is to provide the severely disabled patient with safe, stable postural support in an upright position for videofluoroscopic studies, with anterior-posterior, lateral, and rotational views easily performed. The chair features a removable headrest, a full back support, armrests, lateral truncal supports, and a patented base which is clamped to the footboard of the radiology table and allows for 200 degrees rotation of the patient. Two case studies illustrate the practical use and versatility of the Rehab Tech Video FluoroChair.

Adult↗

PubMed1989

Silicone oil for the treatment of severe proliferative diabetic retinopathy.

Although silicone oil is being used with increasing frequency for proliferative vitreoretinopathy (PVR), few studies have reported on its use for severe forms of proliferative diabetic retinopathy (PDR). Vitreous microsurgery with silicone oil tamponade was performed on 34 patients (37 eyes) with refractory severe neovascular glaucoma and/or recurrent retinal detachment (RD) from PDR that failed to respond to conventional techniques including vitrectomy, membrane peeling, gas tamponade and photocoagulation. With all patients followed a minimum of 6 months (mean, 13 months), anatomic attachment was maintained in 26 (70%) of the eyes. At the last follow-up examination, a final visual acuity of at least 5/200 was found in 9 (24%) of 37 eyes and 9 (35%) of 26 anatomically successful cases. Regression of iris neovascularization occurred in 8 (36%) of 22 eyes with rubeosis and the silicone oil was removed in 3 (8%) eyes. Significant complications included band keratopathy in nine (24%) eyes, corneal decompensation in three (8%) eyes, and recurrent retinal detachment in seven (19%) eyes.

Adolescent↗

PubMed1988

Evolving techniques in the treatment of macular detachment caused by optic nerve pits.

Fourteen patients with macular detachments caused by optic nerve pits were treated for progressive visual loss, cystoid macular changes, or atrophy of the macular retinal pigment epithelium. Photocoagulation of the temporal disc border alone was unsuccessful in two cases but promptly reattached the macula of two patients immobilized after laser surgery. Vitrectomy and gas tamponade improved vision and flattened the macula of three patients over various periods. The detachment recurred in one patient. Prompt and sustained macular reattachment with improved vision was noted after photocoagulation, vitrectomy, and gas tamponade in eight patients, although four required second operations. The prompt reattachment and visual recovery noted in these eight patients surpasses the reported 25% rate of spontaneous resolution.

Bed Rest↗

PubMed1986

Silicone oil for advanced proliferative vitreoretinopathy.

Repeated vitreous microsurgery followed by silicone oil injection was performed on a consecutive series of 51 patients with retinal detachment and advanced proliferative vitreoretinopathy who were not cured by previous conventional management, including vitrectomy, membrane peeling, gas tamponade, and scleral buckling. Anatomic reattachment was achieved in 65% of these cases. Ambulatory or better vision was restored in 74% of the anatomically successful cases. The silicone oil was removed from 30% of the eyes with complete attachment of the retina posterior to the buckle.

Adolescent↗