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Biomedical subjects

S Krupsky

Publications and source records attributed to S Krupsky.

7 recordsLinked to original sources
PubMed2000

ICGA-guided laser photocoagulation of feeder vessels of choroidal neovascular membranes in age-related macular degeneration. Indocyanine green angiography.

PURPOSE: To report the ability of indocyanine green angiography (ICGA) with a confocal scanning laser ophthalmoscope (SLO) to identify feeder vessels of choroidal neovascular membranes (CNVM) secondary to age-related macular degeneration (ARMD) and to show the feasibility of inducing complete closure of the CNVM by photocoagulation targeted exclusively to the feeder vessels. METHODS: Five consecutive patients with exudative ARMD in whom ICGA with the confocal SLO showed extrafoveal feeder vessels supplying choroidal neovascular nets had laser photocoagulation done only to the feeder vessels. In two patients, two separate membranes were seen. RESULTS: Laser photocoagulation resulted in closure of the feeder vessels and the CNVM in four patients. Complete closure was achieved with one treatment in one patient and with two treatments in three patients. In one patient, two treatments failed to close the feeder vessel and the CNVM, but a third, more intense laser treatment resulted in temporary closure of the feeder vessel and CNVM, which recanalized 2 to 4 weeks later with development of a large rip in the retinal pigment epithelium. In one patient, two separate CNVMs grew from the edge of the laser scars, but they were not directly related to the original CNVM and its feeder vessel, and were treated successfully. The same eye later developed subfoveal occult CNVM with gradual deterioration of visual acuity. In the other four patients, visual acuity improved in two and was unchanged in two. CONCLUSIONS: Indocyanine green angiography with the confocal SLO can identify choroidal feeder vessels supplying CNVM secondary to ARMD. Laser treatment to such extrafoveal feeder vessels, particularly in membranes that are large or subfoveal, may be effective in closing the feeder vessel and CNVM with preservation of the fovea and central vision. More than one treatment may be required, however, and failures and complications may be expected with this treatment modality.

Aged↗
PubMed1998

Confocal tomographic angiography of the optic nerve head in patients with glaucoma.

PURPOSE: To demonstrate the superficial and deep blood supply of the optic nerve using a new method, confocal tomographic angiography, which combines two new techniques, confocal laser scanning ophthalmoscopy and indocyanine green angiography, into one system. METHODS: In a prospective study using confocal tomographic angiography, we evaluated the correlation between the vascular supply of the optic nerve and that of the visual field in 90 eyes of 49 subjects (25 eyes of 20 subjects with normal visual field and 65 glaucomatous eyes of 39 subjects with visual field defects; 10 subjects each had one eye with normal visual field and one with visual field defects). RESULTS: In 22 of 25 eyes with a normal visual field, a diffuse microvascular filling pattern of the optic disk area was apparent with no filling defects. The confocal tomographic angiography of 49 of 65 glaucomatous eyes had good correlation with their visual field defect location. In 20 of 27 eyes with superior visual field loss, an inferior vascular filling defect was detected. In 10 of 13 eyes with inferior visual field loss, a superior vascular filling defect was detected. In 10 of 15 eyes with superior and inferior visual field loss, inferior and superior vascular filling defects were detected. Finally, in nine of 10 eyes with total visual field loss, no vascularity of the optic disk could be detected. CONCLUSION: Confocal tomographic angiography is a new imaging technology that may be applied for the evaluation of the vascular supply of the optic nerve head.

Blood Flow Velocity↗
PubMed1995

Ocular blood flow velocity in age-related macular degeneration.

BACKGROUND: Changes in the structure of the ocular blood vessels associated with age-related macular degeneration (AMD) have been described in some detail, but comparatively little is known of the concomitant circulatory changes. The goal of this study is to evaluate changes in the ocular circulation that may be associated with AMD. METHODS: Ocular blood flow velocities and vessel pulsatilities were measured in volunteers with and without AMD using a color Doppler imaging unit. Spectral analyses were recorded from the ophthalmic artery, central retinal artery and vein, the temporal and nasal short posterior ciliary arteries, and the four vortex veins. RESULTS: Adjusting for age, pulsatility indices of all arteries were higher in subjects with AMD (central retinal artery [P = 0.02]; temporal and nasal short posterior ciliary arteries [P = 0.06 and 0.002, respectively]; and ophthalmic artery [P = 0.24]). End-diastolic blood flow velocity of the short posterior ciliary arteries tended to decrease in the presence of AMD. CONCLUSIONS: The combination of increased pulsatility and decreased velocity of the short posterior ciliary arteries, observed in the presence of AMD, are interpreted as evidence of increased vascular resistance. The clinical signs of AMD may be related to degradation of the metabolic transport function of the retinal pigment epithelium, resulting from impaired choroidal perfusion.

Aged↗
PubMed1994

Adverse reactions due to indocyanine green.

BACKGROUND: Although adverse reactions to indocyanine green (ICG) are known to occur, the dye has been used for more than 30 years in tests of cardiac and hepatic function, with a high level of safety. Improved digital video technology has renewed interest in the use of intravenous ICG in ophthalmic imaging. This report describes the authors' experience regarding the safety of ICG for digital angiography and their recommendations for its use in the ophthalmic setting. METHODS: Digital ICG videoangiography was performed in 1226 consecutive patients, and 1923 ICG videoangiography tests were performed. A registry of adverse reactions to ICG was established. Criteria were used to define mild, moderate, and severe adverse reactions, and these data were recorded for every ICG study performed. RESULTS: There were three (0.15%) mild adverse reactions, four (0.2%) moderate reactions, and one (0.05%) severe adverse reaction. There were no deaths. CONCLUSIONS: This study documents the safety of intravenous ICG for use in ophthalmic videoangiography.

Adult↗
PubMed1991

Anterior segment complications in diabetic patients following extracapsular cataract extraction and posterior chamber intraocular lens implantation.

Recovery of the anterior segment following extracapsular cataract extraction and posterior chamber intraocular lens implantation in 112 diabetic eyes was compared to that in 108 eyes of nondiabetic patients who underwent a similar procedure. The incidence of postoperative anterior segment complications was significantly higher in the diabetic than in the nondiabetic patients. The main complications were pigment dispersion, appearance of fibrin, development of posterior synechiae, and--rarely, and only in diabetic patients--pupillary block and transient iridal vascular congestion. The fibrin resolved following increased administration of steroids by means of eye drops and subconjunctival injections, with or without the addition of systemic steroids. Women were found to be at greater risk for development of posterior synechiae (P less than .025). Accumulation of fibrin was seen more often in women and in patients with preexisting diabetic retinopathy than in other patients, although the difference was not significant.

Adult↗
PubMed1987

Sigmoid volvulus in adolescence.

Sigmoid volvulus in young adults is rare. It usually presents as chronic recurrent attacks of abdominal pain. The diagnosis is usually delayed because of a low level of suspicion. We present the case of a 17-year-old girl with recurrent episodes of sigmoid volvulus, to illustrate the problem.

Adolescent↗