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Biomedical subjects

R S Rubinfeld

Publications and source records attributed to R S Rubinfeld.

11 recordsLinked to original sources
PubMed1992

Ocular hydrofluoric acid burns.

A 30-year-old man sustained exposure of his eyes, face, and neck involving 4% of body surface area to hydrofluoric acid. He was treated with immediate lavage and topical calcium gluconate. Because free fluoride ions from ocular and facial exposures can form complexes with body stores of calcium and magnesium, the patient was transferred to a burn unit for cardiac and electrolyte monitoring. He was also treated with calcium gluconate skin injections, pulmonary nebulizer therapy, and topical antibiotics and corticosteroids. In another case, a 25-year-old man with less severe exposure to hydrofluoric acid was treated as an outpatient with topical antibiotics, corticosteroids, and cycloplegia. If an ophthalmologist is the first to treat a patient with chemical exposure, the history of hydrofluoric acid exposure must be obtained, and the burn team and other medical specialists must be quickly consulted to avoid potentially fatal complications.

Adult↗
PubMed1992

Serious complications of topical mitomycin-C after pterygium surgery.

BACKGROUND: The use of topical mitomycin (mitomycin-C) as a medical adjunct to pterygium and glaucoma surgery is increasing. METHODS: The authors report on a series of 10 patients who experienced serious, vision-threatening complications associated with the use of this drug after pterygium surgery. RESULTS: Complications included severe secondary glaucoma (4 patients), corneal edema (3 patients), corneal perforation (1 patient), corectopia (2 patients), iritis (8 patients), sudden onset mature cataract (2 patients), scleral calcification (1 patient) and incapacitating photophobia and pain (8 patients). Two patients required penetrating keratoplasties and a third required three lamellar keratoplasties. Another patient underwent four additional surgeries including a conjunctival Z-plasty, scleral patch grafting, and conjunctival autografting before his intractable pain and photophobia resolved 15 months after the original surgery. Because of these complications, 6 patients required a total of 20 return visits to the operating room after their original pterygium surgery. In 5 eyes, visual acuity remained at 20/200 or less. Three of the six patients with the most severe complications had concomitant chronic external diseases (rosacea [3 patients], ichthyosis [1 patient], keratitis sicca [1 patient]). CONCLUSION: The authors urge extreme caution in the use of mitomycin. If mitomycin is used, the lowest possible concentration should be applied for the shortest time period in an effort to avoid these complications. A prospective multicenter study of the ophthalmic use of this medication is needed.

Adult↗
PubMed1992

Giant papillary conjunctivitis and meibomian gland dysfunction blepharitis.

In this prospective pilot study we saw 42 consecutive giant papillary conjunctivitis (GPC) patients (80 eyes), all of whom were found to have some meibomian gland dysfunction blepharitis. Severity of GPC at presentation correlated with severity of meibomian gland dysfunction blepharitis (Kendall's tau b averaged 0.246 across the adjusted statistical analyses). Thirty-two patients (63 eyes) were refit after treating meibomian gland dysfunction blepharitis. Twenty-eight of these patients (55 eyes; 87%) continue to wear contact lenses, maintaining an improvement in GPC (mean follow-up 21 months; range 11-36 months). We hypothesize that meibomian gland dysfunction blepharitis may play a role in the pathogenesis of GPC and suggest that a large, controlled, multi-observer study be performed to further investigate this possible association.

Adolescent↗
PubMed1990

Anterior stromal puncture for recurrent erosion: further experience and new instrumentation.

Anterior stromal puncture has recently been proposed as a new treatment for recalcitrant cases of recurrent corneal erosion. Concerns about the risks of corneal perforation and scarring, as well as doubts regarding its efficacy have prevented many patients from benefiting from this procedure. We introduce a new, inexpensive, commercially available instrument designed to standardize this technique, minimize scarring, and prevent corneal perforation. In a clinical trial involving 25 consecutive patients with recurrent erosions resistant to vigorous conservative treatment, the first 11 patients underwent stromal puncture in which a straight tuberculin needle was used; the following 14 were treated with a newly designed prototype needle. All patients in this series remained free of erosions after completion of stromal puncture, except for one woman with marked diffuse anterior basement membrane dystrophy, who went on to develop spontaneous bilateral erosions. Follow-up ranged from 2 months to 30 months (mean, 13 months). There were no complications of stromal puncture, and subjective and objective evaluations revealed no significant postoperative glare. Microscopic analysis of eye bank eyes subjected to anterior stromal puncture procedures demonstrated that the new prototype needle provided shallower penetration and thus less likelihood of perforation or excessive scarring than the straight needle. Also, postoperative discomfort and scarring appeared to be significantly less in patients treated with the prototype needle.

Adult↗
PubMed1990

Keratoconus after penetrating keratoplasty.

Signs of keratoconus, including Munson's sign, apical thinning, and Vogt's striae, developed in a 41-year-old woman 6 years after successful penetrating keratoplasty. Screening donor corneas for ectatic diseases may prevent such occurrences.

Adult↗
PubMed1989

Diphtheroids as ocular pathogens.

Unlike Corynebacterium diphtheriae and Propionibacterium acnes, the pleomorphic gram-positive rods known as diphtheroids are generally regarded as nonpathogenic contaminants of the human external eye. We reviewed five years of microbiology records at Wills Eye Hospital and studied a series of eight cases of apparently infectious keratitis associated with heavy growth of diphtheroids on cultures of ulcer scrapings. All of these cases included indolent ulcers that occurred almost exclusively in elderly patients (mean age, 72 years; range, 11 to 92 years). All patients had preexisting ocular conditions that compromised the corneal surface such as exposed corneal sutures, eyelid surgery, aphakic extended wear contact lenses, viral keratitis, and diabetes mellitus. No other pathogens were isolated. All infections responded well to antibiotic therapy with all organisms sensitive to cefazolin and all but one sensitive to gentamicin.

Aged↗
PubMed1988

Penetrating keratoplasty for pseudophakic bullous keratopathy. Management of the intraocular lens.

Management of the intraocular lens (IOL) at the time of penetrating keratoplasty (PK) for pseudophakic bullous keratopathy has been based on lens-related factors and coexisting anterior segment abnormalities. The authors reviewed the results of PK for 102 cases of pseudophakic bullous keratopathy (43 anterior chamber, 50 iris-supported, and 9 posterior chamber) with respect to: (1) the type of IOL, (2) coexisting abnormalities, and (3) management of the IOL at surgery. Graft failure after 2 years of follow-up was: (1) retained iris-supported IOLs, 9%; (2) retained anterior chamber IOLs, 60%; (3) retained posterior chamber intraocular lenses (PC IOL), 0%; (4) removed IOLs, 9%; and (5) exchanged IOLs, 20%. After 5 years of follow-up, 13 of 13 PKs with retained closed-loop anterior chamber IOLs had failed. Visual results were best in eyes with retained iris-supported, rigid anterior chamber or PC IOLs and when the IOL was removed without replacement. The authors recommend that closed-loop anterior chamber lenses and unstable lenses of any type be removed or exchanged and that well-fixated PC IOLs and iris-clip IOLs be retained at the time of PK for pseudophakic bullous keratopathy.

Aged↗
PubMed1988

Early onset acute orbital involvement in childhood acute lymphoblastic leukemia.

A 5-year-old girl with acute lymphoblastic leukemia undergoing induction chemotherapy experienced acute proptosis while agranulocytotic and febrile. Orbital biopsy showed leukemic infiltration, and complete resolution was achieved with local irradiation and chemotherapy. Early onset orbital involvement is highly unusual in acute lymphoblastic leukemia. In the setting of agranulocytosis and fever, rapidly enlarging intraorbital masses require urgent ophthalmologic attention. Immediate biopsy is indicated to distinguish between several treatable conditions including opportunistic infection, hemorrhage, and neoplastic infiltration.

Acute Disease↗
PubMed1987

Accidental mydriasis from blue nightshade "lipstick".

A 7-year-old girl presented with bilaterally dilated pupils, nausea, and vomiting 2 days after head trauma. Pilocarpine pupil testing led to the correct diagnosis of pharmacologic pupillary dilation from an unexpected and unusual source of plant poisoning, Solanum dulcamara (blue nightshade). In patients with internal ophthalmoplegia, awareness of the possibility of pharmacologic mydriasis and correct use of topical pilocarpine testing can preclude the necessity for neuroradiologic and invasive diagnostic studies, even in cases with atypical or complex presentations.

Child, Preschool↗