Biomedical subjects
Publications and source records attributed to R R Ober.
We used new applications for a pars plana infusion cannula in three patients with retinal and choroidal detachments. Because the cannula maintained intraocular volume and form, it was helpful in treatment bullous retinal detachment and choroidal detachment.
Twenty-three patients had bilateral intraretinal talc microemboli, which were seen on ophthalmoscopic examination. Twelve of these patients had additional retinal vascular or choroidal abnormalities in the posterior pole that were confirmed by fluorescein angiography. Six patients had peripheral retinal neovascularization associated with peripheral retinal vascular nonperfusion. Of these six patients, three had associated vitreous hemorrhage, and two had optic disk neovascularization and traction retinal detachment. The progressive fundus changes seen in talc retinopathy were documented by fluorescein angiography and compared to those seen in sickle-cell retinopathy. One eye in one patient was treated by argon laser photocoagulation for proliferative retinopathy, and three eyes in two patients with vitreous hemorrhage were treated by pars plana vitrectomy.
Twelve affected members from 3 families with autosomal dominant exudative vitreouretinopathy were examined, and the following conclusions were drawn: (1) There is great variability in the phenotypic expression of the abnormal gene, such that many patients have very mild disease which can be detected with certainty only by fluorescein angiography. (2) Gene penetrance is close to 100%. (3) Progress of fundus changes and visual threat is rare after 20 years of age.
The clinical and fluorescein angiographic findings in 2 cases of retinal detachment occurring in toxaemia of pregnancy are presented. Both cases showed angiographic evidence of abnormal choroidal leakage of dye unassociated with signs of retinal angiospasm. Both cases also showed angiographic evidence of delayed filling of the choriocapillaris. We believe this finding has not previously been reported. These observations provide further clinical evidence that retinal detachment in toxaemia of pregnancy is secondary to choroidal damage.
We developed and evaluated clinically a series of three vitreoretinal dissection instruments with a constant-diameter shaft and various tip designs including a 90-degree hooked tip, a 130-degree hooked tip, and a blunt-tip right-angle spatula. The instruments, manufactured from a titanium alloy, are lightweight and glare resistant. We have used these instruments interchangeably with other vitreous surgery instruments introduced through a 20-gauge sclerotomy. They facilitate delicate manipulations associated with separation of epiretinal membranes from the inner retinal surface.
A 37-year-old black man had a clinically documented case of optic disk neovascularization associated with hemoglobin SC disease. Through medical evaluation, we ruled out other disorders associated with proliferative retinopathy. Extensive areas of retinal nonperfusion were associated with vasoproliferative retinopathy at the junction of the perfused and nonperfused retina; and a delicate network of neovascularization extended from the optic disk into the vitreous gel in one eye.
A 59-year-old Oriental male with chronic uveitis associated with vitiligo, poliosis, tinnitus and sunset glow fundus was diagnosed as having chronic Vogt-Koyanagi-Harada syndrome. He was treated successfully with steroids (systemic and sub-Tenon's) for two years, but then developed intractable vitritis and visual loss that worsened with the addition of azathioprine. A vitreous biopsy showed large B-cell lymphoma; a mass was also apparent in the subretinal space in the operated eye. Evaluation of the central nervous system was negative for lymphoma. Combined radiation treatment and chemotherapy resulted in dramatic resolution of the intraocular tumor. The possible role of immunosuppression in the development and progression of this tumor is discussed.
The clinical and pathological findings of an infant with severe, bilateral hemorrhagic retinopathy and unilateral retinal detachment are presented. Acceleration-deceleration forces may have caused the ocular damage in the absence of significant direct trauma to the head or eyes. This mechanism may account for injuries inflicted by physical child abuse, but without the usual associated findings of this syndrome.