Biomedical subjects

R J Madonna

Publications and source records attributed to R J Madonna.

4 recordsLinked to original sources

PubMed2000

Intravitreal injection of tissue plasminogen activator and gas bubble for treatment of subretinal hemorrhage in ARMD.

BACKGROUND: Subretinal hemorrhage (SRH) can arise from any number of underlying etiologies and can stem from either the choroidal and/or retinal circulation. It is most commonly associated with age-related macular degeneration (ARMD), in which a choroidal neovascular membrane is the usual source of bleeding. Vision loss resulting from SRH can be secondary to toxic, tractional, and barrier effects from persistent blood. To minimize long-term visual loss from SRH, several treatment modalities have evolved over the past few years. The most-recent therapeutic techniques involve treatment with the thrombolytic agent tissue plasminogen activator The value of surgical removal of subretinal hemorrhage to improve visual outcome remains unsubstantiated, as definitive studies have not been completed. CASE REPORT: A 73-year-old man manifested a 1-day history of decreased vision in his right eye. A large submacular hemorrhage had developed as a result of exudative age-related macular degeneration. Treatment included intravitreal injection of tissue plasminogen activator, followed by intravitreal injection of SF6 gas, which displaced the subretinal hemorrhage away from the fovea and resulted in clearance of the submacular blood. This case describes a new treatment for submacular hemorrhage secondary to ARMD. CONCLUSIONS: Subretinal hemorrhage secondary to ARMD can cause significant permanent visual loss. A thorough understanding of the pathogenesis of vision loss and the treatment options available are essential in successful management of these patients. Intravitreal injection of tissue plasminogen activator and gas bubble may provide an effective treatment for subretinal hemorrhage in age-related macular degeneration.

Aged↗

PubMed1999

Postprandial transient visual loss.

BACKGROUND: Temporary loss of vision after ingestion of a large meal is a phenomenon that has been reported in only a small number of cases in the ophthalmic literature. CASE REPORT: A 60-year-old man reported episodes of blurred vision associated with visual aberrations in his left eye for 5 minutes after eating large meals. His medical history was significant for carotid artery disease, hypertension, "diet-controlled" diabetes, and hypercholesterolemia. The patient's symptoms abated when he ate in smaller quantities and was placed on a regimen of IOP-lowering eye drops. CONCLUSIONS: Postprandial transient visual loss can occur when blood gets shunted to the mesenteric system after eating, leaving the eye hypoperfused. It most commonly takes place in individuals whose ocular perfusion is already compromised by carotid disease, in combination with other vascular conditions that result in the inability to compensate for decreased perfusion to the eye. The signs and symptoms of postprandial visual loss--as well as the mechanisms thought to contribute to it--are discussed.

Blindness↗

PubMed1997

Current perspectives on nonarteritic anterior ischemic optic neuropathy.

BACKGROUND: The traditional view of nonarteritic anterior ischemic optic neuropathy (NAION) has been challenged. Progressive forms of the disease and spontaneous improvements in vision have been reported with increasing frequency. The pathogenesis of the disease has been refined. Treatment in the form of optic nerve sheath decompression has been advocated and dismissed by a major study. METHODS: The pathogenesis, presentation, risk factors, and associated conditions, differential diagnosis, and management of NAION are reviewed. RESULTS: NAION is currently considered an untreatable, ischemic disorder of the optic nerve head. In most cases, it results from a drop in optic nerve head perfusion pressure, below a critical level. No treatment is available to restore perfusion before loss of vision and visual field takes place. CONCLUSIONS: Despite changes in the reported natural history and pathogenesis of NAION, there is still no available treatment. Management involves reduction of risk factors to prevent development of the disease and differentiating it from the arteritic type.

Aged↗

PubMed1993

Optometry and the carotid artery.

BACKGROUND: Carotid artery disease may directly cause stroke and is an important indicator of other forms of cardiovascular disease. Patients with carotid artery disease often have visual symptoms as the first sign of their illness and therefore may present to the optometrist as they enter the health care system. METHODS: The previous ophthalmic and medical literature was evaluated and organized into a cohesive review of the literature and recommendations for treatment and management of patients with carotid artery disease. RESULTS: Ocular findings include retinal emboli, retinal artery occlusion, amaurosis fugax, hypoperfusion retinopathy, and the ocular ischemia syndrome. Each of these has a different relative risk for stroke and vision loss and must be managed accordingly. CONCLUSIONS: The optometrist as a primary provider of eye and health care may well be the first health practitioner to evaluate a patient with carotid artery disease. The ability to recognize, differentiate, and manage the variety of presentations of this disease can preserve sight, quality of life, and even life itself.

Carotid Artery Diseases↗