Failure of imaging to detect optic nerve avulsion: an explanation based on histopathology.
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Adult↗
Biomedical subjects
P K Kaiser
Publications and source records attributed to P K Kaiser.
Photodynamic therapy of circumscribed choroidal haemangioma.
AIM: To evaluate efficacy of verteporfin ocular photodynamic therapy (PDT) in treatment of 10 patients with a symptomatic circumscribed choroidal haemangioma. DESIGN: Prospective non-randomised, interventional case series and critical review of previously published studies. METHODS: 10 consecutive patients (seven primary, two failed transpupillary thermotherapy (TTT), and one failed external beam radiotherapy) with symptomatic circumscribed choroidal haemangioma were treated using verteporfin 6 mg/m2 given as an intravenous infusion over 10 minutes. Diode laser (690 nm) with an intensity of 600 mW/cm2 for 83 seconds (50 J/cm2) was applied 5 minutes after completion of infusion. Single or multiple partially overlapping spots were applied based on the tumour basal dimensions. Periodic follow up with ophthalmoscopy, ultrasonography, and angiographic studies was performed. RESULTS: All 10 patients showed evidence of regression with flattening of tumour, resolution of subretinal fluid, and reduction of choroidal vasculature on angiograms. The visual acuity either improved or remained stable in eight (80%) patients. Visual loss due to delayed choroidal atrophy was seen in two patients. CONCLUSIONS: Although verteporfin PDT is an effective treatment for management of symptomatic circumscribed choroidal haemangioma, delayed treatment related effects can lead to visual loss.
Adult↗
The effect of arteriovenous sheathotomy on cystoid macular oedema secondary to branch retinal vein occlusion.
BACKGROUND: Arteriovenous (AV) sheathotomy, a potential treatment for branch retinal vein occlusion (BVO), surgically separates retinal vessels at an AV crossing. Relief of the aetiological obstruction, with resolution of cystoid macular oedema (CMO), may result in improved visual acuity. METHODS: A retrospective review of consecutive cases of AV sheathotomy for BVO was undertaken. Eyes were categorised as having resolution (group 1), reduction (group 2), or persistence (group 3) of CMO. Intergroup comparisons were made with regard to preoperative, intraoperative, and postoperative parameters. Preoperative and postoperative visual acuities were compared within each group. RESULTS: Of the 27 eyes identified, eight (29.6%) had resolution, 14 (51.8%) had reduction, and five (18.6%) had persistence of CMO. Median preoperative visual acuity was similar in all groups (1.0, 1.0, 1.3, respectively; p = 0.29). Overall median follow up was 12.0 months (Q1 = 12.0, Q2 = 22.5). Eyes in group 1 had significantly better median postoperative visual acuity than eyes in groups 2 and 3 (0.6, 1.0, 2.0 respectively; p = 0.01). A significantly higher proportion of eyes in group 1 had visual acuity improvement compared with eyes in the other groups (87.5% v 35.7% and 20.0%; p = 0.03). Median postoperative visual acuity was significantly better than median preoperative visual acuity in group 1 eyes only (p = 0.02). A higher percentage of group 1 eyes had evidence of postoperative retinal perfusion (83.0% v 21.43% and 40.0%; p = 0.16). Postoperative retinal detachment occurred in three eyes (11.1%). CONCLUSION: Complete resolution of CMO after AV sheathotomy occurred in one third of patients, and postoperative vision improved significantly in this group. However, in the majority of cases, despite an improvement in CMO, there was no improvement in vision after AV sheathotomy.
Aged↗
Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction.
PURPOSE: To review the clinical, photographic, fluorescein angiographic, and optical coherence tomographic findings in patients with the diabetic macular traction and edema (DMTE) associated with posterior hyaloidal traction (PHT). METHODS: We performed a prospective review of nine eyes of nine patients with diabetic macular edema (DME) and PHT on clinical examination. The patients had a comprehensive ophthalmic history and examination, color photographs, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: All patients had diabetic retinopathy and DME. Of the nine eyes, eight patients had previous focal or grid photocoagulation. All nine eyes had a thickened, taut, glistening posterior hyaloid on clinical biomicroscopic examination with no posterior vitreous separation. Fluorescein angiography was performed on seven eyes, and all had early hyperfluorescence with deep, diffuse, late leakage in the macular area consistent with DMTE associated with PHT. Optical coherence tomography scans of the macular region revealed retinal thickening in all eyes with a mean retinal thickness of 556.9 +/- 114.7 microns. In addition, eight of the nine eyes had a shallow macular traction detachment associated with PHT. CONCLUSION: Eyes with DME associated with PHT may have a shallow, subclinical, macular detachment. Optical coherence tomography may be useful in evaluating patients with DME to see if a macular detachment is present.
Aged↗
Retinal vasculitis and posterior pole "hypopyons" as early signs of acute bacterial endophthalmitis.
PURPOSE: To report a case of acute postoperative bacterial endophthalmitis presenting with retinal vasculitis and posterior pole "hypopyons." DESIGN: Observational case report. METHODS: Observational case report. RESULTS: In a 73-year-old woman, acute postoperative endophthalmitis presented with retinal vasculitis, diffuse retinal hemorrhages, and several posterior pole "hypopyons" that were collections of yellow-white inflammatory debris. The inflammation was located primarily in the posterior one third of the vitreous, and except for severely impaired visual acuity, the classic signs of acute postoperative endophthalmitis were not present until the next day. An immediate pars plana vitrectomy with intravitreal injection of vancomycin, amikacin, and dexamethasone was performed. Vitreous and aqueous cultures grew coagulase-negative Staphylococcus species. After intravenous and topical therapy for endophthalmitis, the inflammation subsided. Eight weeks after the initial cataract surgery, the best corrected visual acuity of the patient was 20/25. CONCLUSION: Acute postoperative bacterial endophthalmitis may present with atypical clinical signs and inflammation located primarily in the retina and posterior vitreous.
Acute Disease↗
Corticosteroid therapy for optic disc neovascularization secondary to chronic uveitis.
PURPOSE: To report successful corticosteroid treatment of optic disc neovascularization associated with uveitis. METHODS: Retrospective review of medical records. RESULTS: Nine patients were identified with chronic uveitis and optic disc neovascularization without clinical or angiographic evidence of retinal ischemia. Ages ranged from 14 to 37 years (median age, 27). All patients were treated with either oral and/or subtenon's corticosteroids. Partial regression of the neovascularization was observed in all patients within 2 to 6 weeks (median, 5 weeks) after initiating treatment. Eight of nine patients had complete resolution of disc neovascularization at a median of 3 months (range, 2 to 42 months) after initiation of treatment and a median follow-up of 24 months (range, 7 to 144 months). Recurrence of disc neovascularization occurred in two patients, but it regressed again after further corticosteroid therapy. CONCLUSIONS: Optic disc neovascularization may occur in patients with chronic uveitis in the absence of retinal ischemia. This neovascularization can be successfully treated with corticosteroids.
Administration, Oral↗
Retrobulbar chlorpromazine in blind and seeing painful eyes.
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Aged↗
Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study.
PURPOSE: To conduct a prospective study of macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: In 10 eyes of 10 patients with subfoveal choroidal neovascularization and best-corrected visual acuity ranging from 20/50 to 20/800 (median, 20/111), the fovea was relocated by means of scleral imbrication, intentional retinal detachment with small posterior retinotomies, and partial fluid-air exchange. In two eyes, the choroidal neovascular membranes were removed at the time of macular translocation; in seven eyes they were photocoagulated in the postoperative period; and in one eye the membrane was removed during reoperation to unfold a macular fold. RESULTS: All 10 eyes were followed up for 6 months. The median postoperative foveal displacement was 1286 microm (range, 114 to 1,919 microm). In three eyes (30%), a foveal fold formed postoperatively requiring reoperation, with one of these eyes requiring a second reoperation for a rhegmatogenous retinal detachment. Best-corrected visual acuity improved in four eyes (median, 10.5 letters) and decreased in six eyes (median, 14.5 letters). The median change in visual acuity was a decrease of 5 letters. The final best-corrected visual acuity was 20/80 in two eyes, 20/126 in one eye, 20/160 in four eyes, 20/200 in one eye, 20/250 in one eye, and 20/640 in one eye. CONCLUSIONS: Our initial experience with limited macular translocation suggests that this surgical technique is unpredictable. However, in patients with subfoveal choroidal neovascularization from age-related macular degeneration, it offers the potential for improving visual function and may be associated with less loss of vision than the disease itself, if allowed to progress. Further refinements in surgical indications and technique are needed to make this procedure safer, more predictable, and more beneficial.
Aged↗
Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis.
PURPOSE: To report the treatment strategies and visual acuity outcomes of chronic postoperative endophthalmitis caused by Propionibacterium acnes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: All patients presenting 8 or more weeks after cataract surgery with intraocular inflammation caused by culture-proven P. acnes infection and treated at two institutions from 1974 through 1996 were included. METHODS: Patients underwent three different initial treatment strategies. The study did not have a defined treatment protocol, but all patients received intraocular antibiotics. Patients were not randomly assigned to the various treatment strategies. MAIN OUTCOME MEASURES: Final visual acuity and effectiveness of various treatment procedures either as initial or follow-up therapy were assessed. RESULTS: Using the 3 initial strategies, 36 patients were treated: (1) intraocular antibiotic injection alone (IOAB; n = 12); (2) pars plana vitrectomy and IOAB injection (PPV; n = 10); and (3) PPV with subtotal capsulectomy and IOAB injection (PPV-PC; n = 14). The number of patients with recurrent or persistent inflammation after one of the three initial treatment strategies were as follows: (1) IOAB alone, 12 (100%); (2) PPV, 5 (50%); and (3) PPV-PC, 2 (14%). None of the patients that underwent subsequent PPV, total capsular bag removal, IOAB injection, and either intraocular lens (IOL) exchange or removal had persistent or recurrent intraocular inflammation. Overall, final visual acuity was 20/40 or better in 18 patients (50%), and a total of 28 patients (78%) retained 20/400 or better vision. The mean follow-up after the last treatment was 2.9 years. CONCLUSIONS: In this series of chronic P. acnes endophthalmitis, initial treatment with IOAB injection alone or vitrectomy without capsulectomy was associated with high rates of recurrent or persistent intraocular inflammation. Pars plana vitrectomy, partial capsulectomy, and IOAB injection without IOL exchange was usually successful on long-term follow-up. In patients with recurrent intraocular inflammation, pars plana vitrectomy, total capsular bag removal, IOAB injection, and IOL exchange or removal was a uniformly successful strategy. In contrast to other types of postoperative endophthalmitis, IOL exchange can be considered in these patients after total capsular bag removal.
Anti-Bacterial Agents↗
Neurothekeoma palpebrae: a rare nerve sheath tumor arising in the eyelid.
PURPOSE: To report a case of an eyelid neurothekeoma, a rare peripheral nerve sheath tumor. METHODS: Case report. RESULTS: An excisional biopsy, performed on a lesion removed from the upper eyelid of a 76-year-old woman, revealed the clinical and histopathologic features of a neurothekeoma, a tumor consisting of multiple collections of spindle cells in a myxomatous background. Immunohistochemical characterization showed positivity for NK1/C3, neuron-specific enolase, and alcian blue. CONCLUSION: Neurothekeoma palpebrae should be considered in the differential diagnosis of solitary nodules of the eyelids.
Aged↗
Optic nerve head neovascularization in a patient with inactive cytomegalovirus retinitis and immune recovery.
PURPOSE: To report a case of optic nerve head neovascularization in a patient with acquired immunodeficiency syndrome (AIDS) associated with inactive cytomegalovirus retinitis and immune recovery. METHOD: Case report. RESULTS: We examined a 29-year-old man with AIDS and inactive cytomegalovirus retinitis and found vitritis and prominent optic nerve head neovascularization. The patient had been treated with reverse transcriptase and protease inhibitors, resulting in a notable rise in CD4+ lymphocyte count and an undetectable human immunodeficiency virus (HIV)-RNA viral load. No cause of neovascularization other than intraocular inflammation was detected. CONCLUSION: Immune recovery in a setting of inactive cytomegalovirus retinitis can result in optic nerve head neovascularization, as seen in our patient.
AIDS-Related Opportunistic Infections↗
Bilateral choristomas in the ocular adnexa, lids, and posterior segment.
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Cartilage↗
Laser photocoagulation of choroidal and retinal tumors.
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Adult↗
Influence of luminance flicker and purity on heterochromatic brightness matching and hue discrimination: a postreceptoral opponent process.
We have studied psychophysically the characteristics of the postreceptoral stage of visual processing, using heterochromatic brightness matching (HBM) between 540 and 600 nm, and hue discrimination between 565 and 585 nm, under differing luminance flicker (0-30 Hz) and excitation purity (1.0-0.1) conditions. The HBM curves exhibit deeper minima around 575 nm with decreasing purity. The minimum is generally most pronounced with a 3 Hz flicker and least pronounced with a 30 Hz flicker. Hue discrimination ability is relatively insensitive to flicker and deteriorates at the lower purities. The HBM results for low purities can be explained by the upper envelope of activities in PC- and MC-pathways.
Adult↗
A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Corneal Abrasion Patching Study Group.
OBJECTIVE: To evaluate the effectiveness of an ophthalmic nonsteroidal anti-inflammatory drug (NSAID) in the treatment of noninfected, non-contact lens-related, traumatic corneal abrasions and no pressure patch. DESIGN: A single-center, randomized, double-masked, placebo-controlled study. PARTICIPANTS: One hundred patients with noninfected, non-contact lens-related, traumatic or foreign body removal-related corneal abrasions less than 36 hours in duration. INTERVENTION: All patients received a cycloplegic drop and erythromycin or polymyxin B (Polysporin Ophthalmic Ointment, Burroughs Wellcome, Research Triangle Park, NC). Patients were then randomized to receive either ketorolac tromethamine 0.5% ophthalmic solution or control vehicle drops. MAIN OUTCOME MEASURES: The main outcome measures were six subjective symptoms monitored daily, evaluation of corneal abrasion, and determination of adverse events. Long-term complications were determined 3 to 8 months after randomization. RESULTS: Twelve patients were excluded from the study. One day after randomization, patients receiving ketorolac tromethamine 0.5% ophthalmic solution noted significantly decreased levels of pain (P < 0.002), photophobia (P < 0.009), and foreign body sensation (P < 0.003) as compared with the control vehicle group. In addition, the time to resumption of normal activities was shorter in the group who received ketorolac tromethamine 0.5% ophthalmic solution (P < 0.001). There was no statistical difference in the amount of tearing, healing time, acuity changes, or complication rates between the two groups. CONCLUSIONS: Ketorolac tromethamine 0.5% ophthalmic solution provides increased patient comfort without clinical adverse effects when used as adjunctive therapy in the treatment of noninfected, non-contact lens-related, traumatic corneal abrasions.
Adult↗
The subretinal fibrosis and uveitis syndrome.
The subretinal fibrosis and uveitis syndrome is a rare posterior uveitis characterized in the early stages by a multifocal choroiditis, followed by progressive subretinal fibrosis. It usually is seen in otherwise healthy, young myopic women with no systemic disease. Symptoms include acute, unilateral visual loss, scotomas, metamorphopsia, and photopsias. Ophthalmic examination reveals a mild anterior or posterior uveitis, and transient, multiple, small, whitish-yellow RPE or choroidal lesions in the posterior pole and midperiphery. These lesions fade or enlarge and coalesce to create areas of white subretinal fibrosis, a progression that occurs over weeks to months. The visual prognosis generally is poor, and recurrences are common. Treatment is controversial, with some authors finding an early beneficial effect of steroids and chemotheraphy in severe cases. The etiology is not known, but is believed to be a localized autoimmune reaction to the RPE.
Blindness↗
A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group.
PURPOSE: To evaluate the effectiveness of pressure patching in the treatment of noninfected, noncontact lens-related traumatic corneal abrasions and abrasions secondary to removal of corneal foreign bodies. METHODS: Two hundred twenty-three patients with noninfected, noncontact lens-related traumatic or foreign body removal-related corneal abrasions were followed daily after receiving topical antibiotics and mydriatics and after being randomized to receive either a pressure patch or no patch. RESULTS: Twenty-two patients were excluded from the study. For data analysis, the remaining patients were split into two sections: those with traumatic corneal abrasions (120 patients) and those with corneal abrasions secondary to removal of corneal foreign bodies (81 patients). Patients with traumatic corneal abrasions healed significantly faster, had less pain, and had fewer reports of blurred vision" when they were not wearing a patch. The amount of photophobia, tearing, and foreign body sensation were similar between the patch and no-patch groups. Similarly, for corneal abrasions due to removal of foreign bodies, patients healed significantly faster and had less pain when they were not wearing a patch. There was no difference in the amount of photophobia, tearing, foreign body sensation, or blurred vision. Finally, there was better compliance in the no-patch group. CONCLUSIONS: Noninfected, noncontact lens-related traumatic corneal abrasions as well as abrasions secondary to foreign body removal can be treated with antibiotic ointment and mydriatics alone without the need for a pressure patch.
Adult↗
Dissociation of achromatic and chromatic processing of spatial form and temporal modulation by the titration method.
Using a titration method to attempt to silence the achromatic contrast subsystem, we tested the assumption that an equiluminant chromatic pattern does not stimulate the physiological achromatic contrast subsystem. We also examined the question whether contrast threshold is entirely or even partially determined by the chromatic contrast subsystem at equiluminance. We report a method for demonstrating when contrast threshold is entirely determined by the chromatic contrast subsystem.
Adult↗