Biomedical subjects
Publications and source records attributed to M Zarbin.
We report a patient with massive facial sarcoidosis. While skin involvement is a common manifestation of sarcoidosis, it is unusual to see it in the dramatic form of cutaneous tumors with mutilation of the central face. There are few reports of tumoral cutaneous sarcoidosis like that of our patient.
PURPOSE: Bartter syndrome is characterized by hyperplasia of the renal juxtaglomerular apparatus, hyperaldosteronism, and hypokalemic alkalosis. We report a case of Bartter syndrome associated with normal serum calcium levels and posterior choroidal calcification. METHODS: Case report. A 59-year-old man with bilateral cataract and Bartter syndrome underwent a complete ophthalmic examination, including standardized echography before and after cataract surgery. RESULTS: Before cataract surgery, echography identified small, hyperreflective, multifocal, bilateral choroidal lesions with posterior shadowing. After surgery, these lesions appeared as yellow-white, barely elevated plaques with smooth edges and were diagnosed as choroidal calcification. CONCLUSIONS: Choroidal calcification may occur in patients with Bartter syndrome. This condition should be added to the differential diagnosis of posterior segment calcification.
AIMS: To study the long-term results of vitrectomy and silicone oil injection in AIDS patients with retinal detachment due to viral retinitis. METHODS: A consecutive series of 83 eyes in 75 AIDS patients who were treated with vitrectomy and silicone oil for retinal detachment due to viral retinitis was studied prospectively and followed until the last patient in the series had died. RESULTS: Median postoperative survival was 6 months, but 20% of patients survived 12 months or more. Whereas best corrected visual acuity was 20/100 or better in over half the patients 1-2 months after operation, there was a distressing decrease in acuity by 6 months, owing to a variety of factors. Patients operated on before macular detachment did not have significantly better postoperative vision than those operated within a week after macular detachment. Almost all patients who had already lost vision in the fellow eye and many who had cytomegalovirus retinitis in the fellow eye with retention of good vision had their quality of life improved by the surgery in that the operated eye eventually became the better seeing eye. In no patient whose fellow eye was normal and free of retinitis, however, did the operated eye ever become the better eye. CONCLUSIONS: Although the majority of patients recovered macular vision in the first 1-2 months after operation, there was a gradual decline in acuity thereafter, sometimes without obvious cause. The results of this series suggest that it may be reasonable to postpone surgery until the macula detaches and that patients whose fellow eye is free of retinitis with normal vision are unlikely to have their quality of life improved significantly by the surgery.
PURPOSE: The purpose of this study is to delineate the natural history of indeterminate pigmented choroidal lesions and identify parameters from the initial visit that correlate with lesion enlargement. METHODS: The authors retrospectively reviewed the records of all patients with indeterminate pigmented choroidal lesions seen in consultation at the Ocular Oncology Unit at the University of California, San Francisco, after 1975. Clinical examination, fundus photography, fluorescein angiography, and ultrasound data were examined. Investigators masked to outcome coded sequential parameters of each of these modalities. Data were analyzed using both univariate and multivariate censored data techniques. RESULTS: Of 293 lesions, 98 grew. The 5-year actuarial rate of growth was 36%. Greater tumor thickness, presence of symptoms, orange pigment, internal quiet zone on B-scan, and hot spots on fluorescein angiography all were significant predictors of tumor enlargement (relative risk of detectable tumor growth, > 1.8). Risk scores were calculated, and subsets with higher probability of future growth were identified. In five of the patients with growing lesions, metastatic disease developed after a median posttreatment follow-up period of 51 months. CONCLUSION: Most small indeterminate pigmented lesions can be followed safely by serial observation and ancillary testing. The authors identified models based on data from the initial visit that can be used as an adjunct to planning tumor management.
BACKGROUND: Corneal epithelial removal finds multiple applications in ophthalmic surgery (epithelial herpes infections, recurrent epithelial erosion, corneal ulcers and plaques, and intraoperative epithelial clouding). Photorefractive keratectomy is initiated by removal of the epithelium. Current techniques for epithelial removal are suboptimal. We studied the safety and effectiveness of a new technique, hydroepithelial keratectomy, performed with the HydroBrush keratome on live rabbits. METHODS: Eighteen rabbits (18 eyes) underwent hydroepithelial keratectomy and 18 rabbits (18 eyes) underwent epithelial removal with a surgical blade (blade group). Twelve rabbits were euthanized immediately after the procedure. Twenty-four rabbits were followed for up to 120 hours after treatment. Ultrastructural analysis was performed with light and electron microscopy. RESULTS: The hydroepithelial keratectomy group healed a mean 53 hours after treatment; the blade group healed a mean 78 hours after treatment. The HydroBrush keratome exposed the basement membrane and the basal cell membrane of the epithelium. The blade exposed patches of basement membrane, as well as stroma and cell debris. CONCLUSIONS: Hydroepithelial keratectomy with the HydroBrush keratome is effective and safe. Wound healing after hydroepithelial keratectomy is faster than after blade removal. Unlike the blade, the HydroBrush keratome exposed a smooth surface, devoid of debris, with well-defined edges and round shape without hydration nor dehydration of the tissue.