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Stanley Chang

Publications and source records attributed to Stanley Chang.

32 records · Page 2Linked to original sources
PubMed2003

Treatment of choroidal melanoma using photodynamic therapy.

PURPOSE: To InternetAdvance publication at ajo.com Feb 26, 2002. investigate the effect of photodynamic therapy using verteporfin on choroidal melanoma. DESIGN: Interventional case series. METHOD: Four patients with choroidal melanoma who showed recurrence or no response after previous brachytherapy and transpupillary thermotherapy were treated with photodynamic therapy. RESULTS: One tumor decreased in size and remained stable for 18 months. One tumor had no growth for 11 months. Two melanomas continued to grow, necessitating enucleation. CONCLUSIONS: Of the four eyes that had failed conventional therapies, two would have been salvaged (to date) with photodynamic therapy. However, additional studies are needed to determine if photodynamic therapy can play a role in the management of choroidal melanoma.

Aged↗
PubMed2003

Ruptured retinal arterial macroaneurysm associated with a stage IV macular hole.

PURPOSE: To report a case of stage IV macular hole associated with ruptured retinal arterial macroaneurysm. DESIGN: Observational case report. METHOD: The patient's clinical, angiographic, and ophthalmic coherent tomography data were reviewed. RESULTS: A stage IV macular hole was observed in association with a ruptured retinal arterial macroaneurysm in a 79-year-old patient. After vitrectomy surgery, the macular hole closed and vision improved from counting fingers to 20/100. CONCLUSIONS: Macular hole associated with ruptured retinal macroaneurysm can be closed successfully to result in improved vision.

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PubMed2003

Persistent indocyanine green fluorescence after vitrectomy for macular hole.

PURPOSE: To evaluate the persistence of indocyanine green (ICG) autofluorescence after ICG-assisted internal limiting membrane peeling for macular hole surgery. DESIGN: Interventional case series. METHODS: Retrospective institutional study. Four eyes of four patients who underwent pars plana vitrectomy with ICG-assisted internal limiting membrane peeling for macular hole repair were imaged for ICG autofluorescence at 795 nm with a scanning laser ophthalmoscope. The main outcome measure was persistence of ICG autofluorescence. RESULTS: All four patients demonstrated persistent ICG fluorescence in the central macula up to 8 months postsurgery. CONCLUSIONS: Persistent ICG signal was noted in the macula months after vitrectomy for macular hole surgery. The persistence of ICG autofluorescence could be responsible for delayed photochemical damage to the retinal pigment epithelium. Further studies must quantify the risk of retinal pigment epithelium injury when ICG-assisted internal limiting membrane peeling is used in macular hole surgery.

Aged↗
PubMed2003

Intraocular dispersion of perfluorocarbon liquids in silicone oil.

PURPOSE: To report one case of intraocular emulsification of perfluorocarbon liquids (PFCLs) and silicone oil after vitrectomy surgery. DESIGN: Interventional case report. METHODS: Retrospective review of the clinic, and surgical record of a 39-year old female referred for persistent retinal detachment after vitrectomy surgery; PFCLs and silicone oil were left in the eye at the end of the surgery. RESULTS: There was intraocular emulsification of PFCLs into silicone oil. Electron microscope examination of the silicone oil surgically extracted from the eye demonstrated emulsification of small PFCL bubbles into the silicone oil. CONCLUSION: Perfluorocarbon liquids are surgical tools. They should be completely removed from the eye at the end of the surgery; PFCLs and silicone oil tend to emulsify together, originating an opaque fluid, which contains both silicone oil and dispersed PFCL bubbles.

Adult↗
PubMed2003

Cytomegalovirus retinitis and FK 506.

PURPOSE: To report a case of cytomegalovirus (CMV) retinitis in a patient immunosuppressed with FK 506. DESIGN: Interventional case report. METHODS: Retrospective institutional study. One patient, diagnosed with bilateral CMV retinitis while on immunosuppressive treatment with FK 506, received systemic ganciclovir and intravitreal, slow-release ganciclovir implant in one eye, combined with reduction in FK 506 dose. Main outcome measures were visual acuity and regression of CMV retinitis. RESULTS: Visual acuity at presentation was 20/20 in the right eye and 20/50 in the left eye. During the 6 months of follow-up, there was no change in visual acuity in either eye. The areas of CMV retinitis demonstrated progressive regression, leaving diffuse retinal atrophy. CONCLUSIONS: Cytomegalovirus retinitis can be a sight-threatening complication of immunosuppressive treatment with FK 506. Ganciclovir treatment together with a reduction in FK 506 dose was effective in preserving vision.

Adult↗
PubMed2003

Epithelial ingrowth under a laser in situ keratomileusis flap after phacoemulsification.

A 47-year-old man was referred to us for management of a cataract in the left eye. The patient had an ocular history of high myopia with anisometropia, amblyopia in the left eye, and stable myopic lattice degeneration in both eyes. The patient had successful bilateral laser in situ keratomileusis 3 years before and multiple retinal surgeries for treatment of a rhegmatogenous retinal detachment associated with a giant retinal tear in the temporal region of the retina with subsequent proliferative vitreoretinopathy. Phacoemulsification was performed uneventfully. A single interrupted 10-0 nylon suture was placed in the temporal clear corneal wound and removed 7 weeks postoperatively. One month later, slitlamp examination revealed a 1.5 mm tongue-like area of epithelial ingrowth under the corneal flap. The epithelial cells seemed to enter the flap-stroma interface through the previously placed suture tract and advanced centrally.

Corneal Diseases↗
PubMed2002

Macular pigment and visual acuity in Stargardt macular dystrophy.

PURPOSE: To test the hypothesis that macular pigment reflects foveal cone function and possibly the presence of foveal cones in recessive Stargardt macular dystrophy. METHODS: Sixteen patients (32 eyes) diagnosed to have Stargardt macular dystrophy by clinical criteria were studied with a scanning laser ophthalmoscope (SLO) comparing argon laser blue (488 nm), green (514), helium-neon laser red (633 nm) and infrared diode laser (780 nm) images for the presence or absence of macular pigment in the fovea. Fifteen of the patients were screened for mutations in the ABCR gene. Eyes were graded into three categories: those without foveal macular pigment, those with partial pigment and those with normal amounts of macular pigment. These categories were compared with visual acuity determined by the Snellen chart. RESULTS: All patients with a visual acuity of 20/200 or worse had no macular pigment in the fovea. All patients with visual acuity of 20/40 or better had a normal amount of macular pigment in the fovea. Patients with partial macular pigment had intermediary acuity values except for two eyes, one with 20/20 and another with 20/200 acuity. Infrared light revealed more retinal abnormalities than blue light at early stages of the disease. CONCLUSION: Foveal macular pigment is related to foveal cone acuity in Stargardt macular dystrophy and may be a marker for the presence of foveal cones. Infrared light is a sensitive monitor of early Stargardt macular dystrophy.

Adolescent↗
PubMed2002

Spontaneous resolution of bilateral stage 1 macular holes documented by optical coherence tomography.

PURPOSE: To describe a case of spontaneous resolution of bilateral stage 1 macular holes documented using optical coherence tomography. DESIGN: Observational case report. METHODS: A patient presented with blurring and distortion in the right eye. Optical coherence tomography showed a stage 1 macular hole manifested as a foveal pseudocyst. The left eye appeared normal. RESULTS: On 6-month follow-up, symptoms had resolved in the right eye but had developed in the left eye. Optical coherence tomography revealed normal anatomy in the right eye with a foveal pseudocyst in the left eye. At 10 months, the patient was asymptomatic and had normal foveal anatomy in both eyes on optical coherence tomography. CONCLUSION: Stage 1 macular holes may appear as foveal pseudocysts on optical coherence tomography. In such cases, optical coherence tomography can provide definitive diagnostic information when clinical examination is equivocal. The observation and spontaneous resolution of bilateral stage 1 holes documented by optical coherence tomography are unique and interesting events of which a MEDLINE search found no previous reports.

Diagnostic Techniques, Ophthalmological↗
PubMed2002

Variability of three-dimensional ultrasonography for assessment of intraocular tumours.

BACKGROUND: Variability is introduced in three-dimensional (3-D) ultrasound assessments of intraocular tumours when multiple observers examine the same tumour or when multiple scans and measurements of the same tumour are carried out. We evaluated the magnitude and sources of variation associated with 3-D ultrasound measurements of choroidal tumour volume. METHODS: Three examiners performed 3-D ultrasonography of five choroidal tumours. Each examiner performed three scans of each tumour and then measured each scan three times to determine the volume. We determined the variation attributable to differences between examiners, scans and measurements by evaluating the contribution of each to the overall variation in tumour volume. A similar process was performed for tumour height for comparison purposes. RESULTS: The reliability of tumour volume measurements was found to be very high. The amount of overall variation, as defined by the coefficient of variation, was similar for tumour volume and tumour height and ranged from 4% to 17%. A total of 97% of the variation in tumour volume measurements and 84% of the variation in tumour height measurements was due to differences between tumours. Differences between examiners accounted for the most of the remaining variation (2% for volume and 7% for height). INTERPRETATION: Three-dimensional ultrasonography of intraocular tumours was highly reliable. Differences between examiners were the main source of variation.

Choroid Neoplasms↗
PubMed2002

Outcome of phacoemulsification after pars plana vitrectomy.

PURPOSE: To compare the outcome of phacoemulsification surgery in patients with and without prior vitrectomy, adjusted for confounding factors. DESIGN: Retrospective cohort study. PARTICIPANTS AND CONTROLS: Thirty-one consecutive eyes undergoing phacoemulsification after pars plana vitrectomy (PPV) and 116 consecutive eyes undergoing phacoemulsification without previous PPV. METHODS: Office records of the operating surgeons were reviewed for age, gender, type of cataract, vitrectomy status, best-corrected visual acuity (BCVA) before and after phacoemulsification, intraoperative difficulties, and postoperative complications. Bivariate analyses between these predictors and the main outcome, BCVA of 20/40 or better after phacoemulsification, were performed using Pearson's chi-square tests. An adjusted analysis of the relationship between outcome and vitrectomy status was performed with logistic regression. Pearson's chi-square tests were used to compare type of cataract, intraoperative difficulties, and postoperative complications in study and control eyes. MAIN OUTCOME MEASURES: BCVA of 20/40 or better after phacoemulsification, rates of intraoperative difficulties, and postoperative complications. RESULTS: The most common indication for PPV was macular hole. The average interval from PPV to phacoemulsification was 15.4 months. Study eyes were followed for an average of 10 months compared with 6.6 months for controls. Study eyes were more likely than controls to have predominantly nuclear sclerotic cataracts (P = 0.002). After cataract extraction, 24 of 31 study eyes (77.4%) and 110 of 116 control eyes (94.8%), had BCVAs of 20/40 or better. After adjusting for confounders, eyes without previous vitrectomy were 3.44 times more likely to obtain a BCVA of 20/40 or better than eyes with prior PPV, but this difference was not statistically significant (95% CI, 0.72-16.67). Only 3 of 31 (9.7%) study and 11 of 116 (9.4%) control eyes had intraoperative difficulties (P = 0.47). Posterior capsule plaque was the most common intraoperative difficulty in study eyes; small pupil requiring stretching or iris hooks was most common in controls. Only 1 of 31 (3.2%) study eyes had a postoperative complication other than posterior capsule opacification compared with 18 of 116 (15.5%) controls (P = 0.07). CONCLUSIONS: A large proportion of patients with prior PPV obtain good visual acuity after phacoemulsification. We did not find significantly higher rates of intraoperative difficulties or postoperative complications compared with controls. The benefits of phacoemulsification seem to be limited only by retinal comorbidity.

Adolescent↗
PubMedDate not supplied

Intravitreal triamcinolone treatment for macular edema associated with central retinal vein occlusion and hemiretinal vein occlusion.

PURPOSE: To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). METHODS: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n = 21) and HRVO (n = 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre- and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. RESULTS: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n = 23] 635 vs. 352 mum, respectively; P < 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, -3-7) over the course of the study period. Ten eyes gained > or =2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P = 0.24). None of the eyes of diabetic patients (n = 6) or patients with ischemic CRVO (n = 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P = 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P = 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n = 16] 20/133 vs. 20/67, respectively; P < 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P = 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. CONCLUSIONS: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.

Adult↗
PubMedDate not supplied

Intravitreal triamcinolone injection for treatment of macular edema secondary to branch retinal vein occlusion.

PURPOSE: To evaluate the efficacy of intravitreal triamcinolone injection in eyes with macular edema due to branch retinal vein occlusion (BRVO) over a 2-year period. METHODS: The authors performed a retrospective chart review of 13 eyes of 13 patients (mean age 68 years) who underwent intravitreal injections with 4 mg triamcinolone acetonide for macular edema due to BRVO. Six eyes received a single injection. Repeated injections were performed in one eye twice, four eyes three times, and two eyes four times. Mean follow-up was 13 months (range, 4 to 24). The time between the onset of symptoms and the injection averaged 7.4 months (range, 2 to 24). RESULTS: Mean postinjection central foveal thickness decreased to 56% of preinjection values (529 mum versus 295 mum, P < 0 .001). Final visual acuity improved in seven eyes (range 2 to 6 Snellen lines), remained the same in four eyes (range 0 to 1 Snellen lines), and worsened in two eyes (range -1 to -4 Snellen lines) compared to baseline. The retinal thickness decreased in all cases; vision improved in most cases. As the number of injections increased cataractous changes increased. Visual acuity improvement was significantly correlated with patient age (P = 0.026). Eight patients developed steroid induced ocular hypertension controlled by topical medication. Cataract extraction was judged to aggravate macular edema in three of the five eyes undergoing surgery, based upon optical coherence tomography or fluorescein angiography. Median best postinjection visual acuity (20/50) was significantly better than that of baseline (20/100) (P = 0.028) as well as last follow-up (20/70) (P = 0.003). CONCLUSIONS: Intravitreal triamcinolone should be further evaluated as a treatment option for macular edema associated with BRVO.

Aged↗
PubMedDate not supplied

Optical coherence tomography in asteroid hyalosis.

PURPOSE: To demonstrate the clinical utility of optical coherence tomography (OCT) in diagnosing macular structural abnormalities in patients with asteroid hyalosis. METHODS: Case series. RESULTS: Seven eyes of seven patients underwent OCT due to inadequate funduscopic visualization secondary to asteroid hyalosis. Fluorescein angiography and B-scan ultrasonography were conducted for two patients but failed to provide diagnostic clarity. OCT provided definitive anatomical diagnoses that included macular epiretinal membrane, macular hole, traction retinal detachment, cystoid macular edema, and drusen. On the basis of OCT-assisted diagnoses, three patients elected to undergo surgical intervention. CONCLUSION: OCT can be critical to diagnose macular conditions when retinal visualization is limited by asteroid hyalosis.

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