Biomedical subjects
R S Riffenburgh
Publications and source records attributed to R S Riffenburgh.
Ocular findings at autopsy of child abuse victims.
The incidence of retinal hemorrhage in child abuse victims was studied in cadavers of children that underwent autopsy in the Los Angeles County Coroner's office. One hundred ninety consecutive cases of childrens' eyes received at Doheny Eye Institute from 1985 to 1989 were included in the study. Retinal hemorrhage is the most common form of eye damage due to child abuse and is more likely to occur in infants who have been shaken than after blunt trauma to the head. Accordingly, retinal involvement is seen more frequently in younger children. The mechanism of retinal hemorrhage is unknown, but the authors' evidence suggests that it is not a direct result of submeningeal hemorrhage. The retinal hemorrhages are found most frequently in the bipolar and nerve fiber layers. They may be severe and widespread or small, scattered foci; both forms are indicative of abuse type injury. Any child who is comatose or who has other unexplained neurologic symptoms should have a thorough eye examination with the pupils dilated with emphasis on studies of the retina.
The eyes of child abuse victims: autopsy findings.
The authors studied 77 pairs of eyes removed from children who had died of suspected child abuse. Forty-seven of the cases had retinal hemorrhages. Those showing retinal hemorrhages were younger children and had fewer other stigmata of child abuse. Hemorrhages are more likely to occur in cases where the child was shaken or swung than in those with severe direct head trauma. The authors recommend that examination of the eyes be included in the autopsies of all small children who died without an obvious cause of death. Experience in both processing and reading of ocular material is necessary for reliable results.
Morphological variation of Dalén-Fuchs nodules in sympathetic ophthalmia.
Fifty cases of sympathetic ophthalmia were examined histologically to determine the incidence and morphology of Dalén-Fuchs nodules. At least one well-defined Dalén-Fuchs nodule was identified in 18 (36%) of the eyes examined. Three types of lesions at the level of the retinal pigment epithelium were recognised. One type was found to consist of focal hyperplasia and aggregation of retinal pigment epithelial cells. A second type, classically referred to as Dalén-Fuchs nodules, consisted of epithelioid cells and lymphocytes covered by an intact dome of retinal pigment epithelium. The third type of lesion was characterised by degeneration of the overlying retinal pigment epithelium leading to disorganisation of the Dalén-Fuchs nodule and possible release of their contents into the subretinal space. Our study demonstrated that Dalén-Fuchs nodules in sympathetic ophthalmia vary in their morphological appearance as determined by light microscopy.
Dangers of scleral reinforcement for myopia.
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Incarceration of asteroid bodies in sclerotomy wound following pars plana vitrectomy.
A 78-year-old man had markedly decreased vision thought to be caused by severe bilateral asteroid hyalosis. Pars plana vitrectomy was performed on one eye, but the patient died shortly after surgery. At autopsy, the sclerotomy site was gaping with vitreous containing asteroid bodies in the wound and surrounding the closing suture. We speculate that wound gaping with vitreous incarceration may be more common than previously suspected.
Why patients return after refraction.
Although nonsurgical ophthalmologic practice depends on refraction, in recent years interest in this procedure has decreased. The ophthalmologist, however, must recognize that a well done refraction builds the patient's confidence and is the basis on which most surgical practices develop.
Effect of corticosteroid treatment and enucleation on the visual prognosis of sympathetic ophthalmia.
A retrospective clinicopathologic study, conducted to determine the course of disease in 30 cases of sympathetic ophthalmia with clinical follow-up of at least six months (average, 12.7 years), showed that 21 of 30 patients retained visual acuities of 20/50 or better in the sympathizing eye. The severity of inflammation graded histologically in the exciting eye did not correlate with the clinical course of final visual acuity in the sympathizing eye. Enucleation of the exciting eye within two weeks of the onset of symptoms was associated with a relatively benign clinical course (P = .008). Corticosteroid treatment in patients who underwent enucleation more than two weeks after the onset of symptoms was associated with a good visual outcome (P = .009). Early enucleation of a blind exciting eye and corticosteroid treatment appear to be important variables that influence the visual prognosis in the sympathizing eye.
Pathology associated with intraocular lens implantation.
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Pathogenesis of aphakic macular edema.
Six months after cataract extraction, a 71-year-old man had cystoid macular edema confirmed by fluorescein angiography. Microscopic examination revealed cystoid spaces in the outer plexiform and outer nuclear layer of the neurosensory retina. Chronic inflammatory cells were scattered throughout the ciliary body. Inflammatory cells were also present in a section of iris that had an adherent strand of vitreous leading to the pars plana. Comparison of these findings with other related clinical entities supported the hypothesis that ciliary body inflammation may play a significant role in postcataract extraction macular edema.
Active listening in the medical interview.
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Migraine equivalent: the scintillating scotoma.
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Lack of association between color blindness and alcoholism.
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A curriculum in sexual education for medical students.
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The psychology of blindness.
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Patientreactions to blindness.
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