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Biomedical subjects

T M Aaberg

Publications and source records attributed to T M Aaberg.

At least 37 records · Page 2Linked to original sources
PubMed1996

Cataract extraction after silicone oil repair of retinal detachments due to necrotizing retinitis.

Cataract is common after silicone oil repair of retinal detachment due to necrotizing retinitis in acquired immunodeficiency syndrome. Surgical management has not been reported. Twenty-two eyes of 19 patients were reviewed. The majority underwent phacoemulsification with a posterior chamber convexoplano implant without iridotomy Complications included capsular fibrosis and hyphema. Unpredictable refractions in the first 16 eyes prompted refinement of lens calculations and resulted in a reduction in refractive errors. A 3-step modification of intraocular lens calculations is recommended: (1) use of specific sound velocities to calculate axial length; (2) use of convexoplano lenses; and (3) addition of a constant to the lens power to compensate for the refractive index of silicone oil. Good surgical technique and accurate lens calculations should improve management of cataracts that arise after retinal detachment repair with silicone oil in patients with acquired immunodeficiency syndrome.

AIDS-Related Opportunistic Infections↗
PubMed1996

Postoperative hypopyon after intravitreal bovine thrombin for macular hole surgery.

PURPOSE: We used intravitreal autologous fibrinogen with bovine thrombin for the surgical closure of macular holes in 60 cases. METHODS: Pars plana vitrectomy with separation of the posterior cortical vitreous was performed after air/fluid exchange. One to two drops each of autologous fibrinogen and bovine thrombin (20 to 80 U) were instilled in each patient. RESULTS: Five (8%) of 60 patients developed a hypopyon without unusual pain on the first postoperative day. Inflammation responded to frequent topical corticosteroids within 48 to 72 hours. CONCLUSION: Postvitrectomy hypopyon after the use of bovine thrombin may represent an immune reaction that must be differentiated from endophthalmitis. We recommend careful observation and frequent topical corticosteroids.

Adult↗
PubMed1996

Subfoveal choroidal neovascularization in punctate inner choroidopathy. Surgical management and pathologic findings.

PURPOSES: To evaluate submacular surgery for the management of subfoveal choroidal neovascularization in punctate inner choroidopathy, to describe the histopathology and ultrastructure of the excised subretinal tissue, and to propose a staging system that characterizes the development of choroidal neovascularization with associated subretinal fibrosis. METHODS: The authors reviewed the records of five patients (6 eyes) with punctate inner choroidopathy who underwent submacular surgery for subfoveal choroidal neovascularization. Surgical specimens were examined using light and transmission electron microscopy. RESULTS: Visual improvement was noted postoperatively in all six eyes, with follow-up ranging from 8 to 36 months (median, 14 months). Recurrences (6 in 4 eyes) were common. Five of the six recurrences required additional procedures: three were managed surgically, two with laser photocoagulation, and one with observation. "Bridging" of separate foci of choroidal neovascularization resulted in stellate or "dumbbell-shaped" areas of subretinal fibrosis in four of six eyes. Histopathologic evaluation of the excised tissue showed endothelial-lined vascular channels, retinal pigment epithelium, lymphocytes, plasma cells, fibrocytes, collagen fragments, and rarely, outer retinal elements. CONCLUSIONS: Subfoveal choroidal neovascularization in punctate inner choroidopathy may be managed with submacular surgery. Recurrences are common and may result in substantial loss of vision. Choroidal neovascular membranes with an accompanying fibrotic reaction are responsible for the stellate or dumbbell-shaped areas of subretinal fibrosis. No beneficial effect was demonstrated using corticosteroid treatment of the choroidal neovascularization.

Adult↗
PubMed1996

Anterior proliferative vitreoretinopathy in the silicone study. Silicone Study Report Number 10.

BACKGROUND: As part of the design of the Silicone Study, a new classification of proliferative vitreoretinopathy (PVR) was developed that distinguishes the different types of contraction found in PVR. In contrast to the original Retina Society system that emphasized the post-equatorial retinal pathology (posterior PVR), the Silicone Study classification system included the characteristic types of contraction found in both the equatorial region and the pre-equatorial retina and vitreous base (anterior PVR). METHODS: The authors contrast (1) preoperative and intraoperative findings and (2) vision and anatomic outcomes in the cohort of anterior PVR eyes with the cohort of posterior-only PVR eyes. For the cohort of eyes randomized to perfluoropropane gas (C3F8) or silicone oil, the authors carry out univariate and multivariate analyses to assess the predictive value of baseline and intraoperative parameters on vision and anatomic outcome. RESULTS: Anterior PVR was present in 321 eyes (79%) and was more prevalent in eyes that had undergone an unsuccessful vitrectomy before study entry than in eyes that underwent a primary vitrectomy for PVR (88% versus 73%; P < 0.001). Compared with eyes that had posterior PVR at the preoperative examination, eyes that had anterior PVR tended to (1) be graded (Retina Society classification system) as D-1 or worse (86% versus 49%; P < 0.0001), (2) have worse (< 2/200) visual acuity (93% versus 86%; P = 0.003), (3) have more hypotony (24% versus 11%; P = 0.03), more edema (8% versus 2%; P = 0.04), more aqueous flare (P = 0.02), more macular pucker (69% versus 52%; P = 0.005), and more intravitreal contraction (21% versus 6%; P = 0.002). When compared with eyes that had anterior PVR, eyes with posterior PVR had a better outcome at the 6-month postoperative examination: complete attachment of the retina (76% versus 62%; P = 0.04), visual acuity of 5/200 or better (64% versus 45%; P = 0.006), and normal intraocular pressure (86% versus 71%; P = 0.04). For eyes with anterior PVR, significant predictors of poor (< 5/200) visual acuity were a preoperative PVR grade D-1 or worse and the use of C3F8 gas as the intraocular tamponade. CONCLUSION: The Silicone Study classification of anterior PVR permits greater specificity in characterizing PVR and is prognostic of anatomic and vision outcome. Eyes with anterior PVR and clinically significant posterior PVR changes had a better visual prognosis if silicone oil was used. With the current understanding of the pathoanatomy of anterior PVR and the recent development of new surgical techniques, the incidence of anterior PVR in eyes that previously underwent vitrectomy may decline, and the prognosis in eyes with anterior PVR may improve.

Adult↗
PubMed1996

Ciliary body endophotocoagulation during pars plana vitrectomy in eyes with vitreoretinal disorders and concomitant uncontrolled glaucoma.

PURPOSE: To investigate the efficacy of ciliary body endophotocoagulation during pars plana vitrectomy in eyes with medically uncontrolled glaucoma and concomitant vitreoretinal disorders. METHODS: The authors compared preoperative and postoperative intraocular pressure (IOP) and visual acuity in 21 eyes of 21 patients undergoing ciliary body endophotocoagulation with pars plana vitrectomy. RESULTS: Preoperative IOPs ranged from 22 to 59 mmHg (median, 46 mmHg). Visual acuity ranged from 20/200 to light perception (median, hand motions). Follow-up ranged from 3 to 18 months (median, 10 months). Postoperative IOPs ranged from 11 to 19 mmHg (median, 16 mmHg) at 6 weeks, 4 to 20 mmHg (median, 14 mmHg) at 3 months, 1 to 26 mmHg (median, 12 mmHg) at 6 months, and 0 to 48 mmHg (median, 12 mmHg) at 12 months. Postoperative visual acuity was statistically improved from preoperative visual acuity by 6 weeks. CONCLUSION: Ciliary body endophotocoagulation combined with pars plana vitrectomy can effectively treat concomitant glaucoma and vitreoretinal disorders.

Adult↗
PubMed1995

Metastatic tumors to the pituitary.

PURPOSE: To illustrate how the ophthalmologist can distinguish a metastatic tumor to the pituitary from a pituitary adenoma through clinical, particularly ophthalmic, findings. METHODS: We studied three patients with metastatic disease to the pituitary. One patient had a history of breast cancer without known metastatic disease, and two patients had no previous diagnosis of malignancy. We reviewed the literature with respect to signs and symptoms that may differentiate such lesions from histologically benign pituitary adenomas. RESULTS: Including our patients and the recent cases in the literature, 42% of patients with metastatic tumors had oculomotor palsies, compared with less than 5% of patients with pituitary adenomas. Of patients with metastatic tumors, 33% had diabetes insipidus, compared with 1% who had pituitary adenomas. Furthermore, with respect to differentiating a pituitary adenoma from a metastatic process, radiographic examinations were not helpful, and histopathologic examination was occasionally incorrect. CONCLUSION: The ophthalmologist can potentially differentiate a metastatic tumor to the pituitary from a pituitary adenoma, thereby assisting in the proper treatment of patients.

Adenocarcinoma↗
PubMed1995

Selective use of indocyanine green angiography for occult choroidal neovascularization.

PURPOSE: Indocyanine green angiography is useful in situations where fluorescein angiography shows occult choroidal neovascularization or pigment epithelial detachment. We sought to determine how often the selective application of indocyanine green angiography results in useful information for eyes with occult choroidal neovascularization. METHODS: We reviewed 153 consecutive indocyanine green angiograms and identified 77 in which corresponding fluorescein angiograms showed occult choroidal neovascularization or pigment epithelial detachment. We examined the indocyanine green angiograms to detect areas of hyperfluorescence and to classify the margins of hyperfluorescence as well demarcated or poorly demarcated. RESULTS: Of 77 eyes, 42 (55%) eyes had occult choroidal neovascularization by fluorescein angiography, seven (9%) eyes had both classic and occult choroidal neovascularization by fluorescein angiography, and 28 (36%) eyes had pigment epithelial detachments. Of 42 eyes with occult choroidal neovascularization by fluorescein angiography, 21 (50%) had well-demarcated margins, 13 (31%) had poorly demarcated margins, and eight (19%) had no detectable hyperfluorescence by indocyanine green angiography. Of seven eyes with both classic and occult choroidal neovascularization by fluorescein angiography, two had both poorly demarcated and well-demarcated borders, two had only poorly demarcated borders, and three had well-demarcated borders by indocyanine green. The indocyanine green angiogram showed 23 (82%) of 28 pigment epithelial detachments to have well-demarcated borders of hyperfluorescence; 13 (57%) of 23 were treated. CONCLUSION: Indocyanine green angiography adds clinically useful information to fluorescein angiography by demonstrating well-demarcated areas of hyperfluorescence in 50% of eyes selected because of diagnosis of occult choroidal neovascularization and in 82% of eyes selected because of pigment epithelial detachment.

Choroid↗
PubMed1995

Submacular hemorrhage removal.

PURPOSE: To determine whether pars plana vitrectomy combined with tissue plasminogen activator for evacuation of submacular hemorrhage results in improved visual acuity. METHODS: Retrospective review of 18 patients who received a subretinal injection of tissue plasminogen activator during a pars plana vitrectomy to evacuate dense submacular hemorrhages. RESULTS: Diagnoses included age-related macular degeneration (16 patients), ruptured macroaneurysm (1 patient), and penetrating ocular trauma (1 patient). Preoperative visual acuity ranged from 20/200 to counting fingers (median visual acuity, counting fingers). Follow-up ranged from 10 to 104 weeks (median, 33 weeks). Best postoperative visual acuity ranged from 20/30 to counting fingers (median, 20/300). Best postoperative visual acuity improved two or more lines in 11 (61%) of 18 eyes, remained unchanged in 4 (22%) of 18 eyes, and decreased two or more lines in 3 (17%) of 18 eyes (P = 0.10, Wilcoxon sign-rank test). Final visual acuity ranged from 20/40 to light perception (median, counting fingers). Final visual acuity improved two or more lines in 5 (28%) of 18 eyes, remained unchanged in 6 (33%) of 18 eyes, and decreased two or more lines in 7 (39%) of 18 eyes (P = 0.53, Wilcoxon sign-rank test). CONCLUSIONS: Pars plana vitrectomy to evacuate massive subretinal hemorrhage can improve visual acuity, but final visual acuity is limited by the underlying disease.

Adult↗
PubMed1995

Silicone oil in vitreoretinal surgery.

Silicone oil has been in use as a vitreoretinal surgical adjunct for more than 30 years. The literature from late 1993 through 1994 is dominated by reports from the Silicone Study, which addresses outcome differences after primary versus repeat vitrectomy, combined retinotomy and retinectomy, and silicone oil removal, as well as the problem of postoperative intraocular pressure abnormalities. Contemporary retrospective series reporting on the use of silicone oil for pediatric, cytomegalovirus retinitis-related, and diabetic retinal detachments are also reviewed.

Eye Diseases↗
PubMed1994

Retinal necrosis in X-linked lymphoproliferative disease.

BACKGROUND: X-linked lymphoproliferative disease is a hereditary disease that renders the males susceptible to fatal infectious mononucleosis, aplastic anemia, malignant lymphoma, and hypogammaglobulinemia after infection by the Epstein-Barr virus. METHODS: The authors examined the clinical and pathologic findings in an 8-year-old boy with bilateral retinal necrosis who died with aplastic anemia as a complication of X-linked lymphoproliferative disease. RESULTS: Results of histopathologic examination of the eyes disclosed retinal necrosis, and examination using the polymerase chain reaction technique showed Epstein-Barr virus genomic DNA in the left eye. CONCLUSION: Retinal necrosis may be part of the expanding spectrum of X-linked lymphoproliferative disease. It is unknown if the retinal necrosis is due directly to Epstein-Barr virus infection or a host inflammatory response.

Child↗
PubMed1993

Pneumococcal endophthalmitis associated with nasolacrimal obstruction.

Pneumococcal endophthalmitis can be a devastating postoperative infection after cataract extraction or penetrating keratoplasty. Streptococcus pneumoniae was isolated as the causative agent in three of the 124 patients (2%) who were treated for endophthalmitis at our institution between 1984 and 1990. Two of the three patients lost light perception in the affected eye. All three patients had previously unrecognized or untreated chronic nasolacrimal obstruction of varying causes. We studied the role of pneumococcal lacrimal conjunctivitis in the pathogenesis of the postoperative pneumococcal endophthalmitis in these patients.

Aged↗
PubMed1993

Ultrastructural features of surgically excised idiopathic subfoveal neovascular membranes.

The ultrastructural features of three surgically excised idiopathic subfoveal neovascular membranes were examined. Ultrastructural features of the cellular components in the membranes included retinal pigment epithelium, endothelial-lined vascular channels, photoreceptor cells, macrophages, myofibroblasts, glial cells, erythrocytes, and ghost erythrocytes. Extracellular constituents included 200-nm to 250-nm collagen fibrils, 100-nm collagen fibrils and fibrin. The findings in this study are consistent with previously reported findings of subfoveal neovascular membranes in age-related macular degeneration and the ocular histoplasmosis syndrome, with the exception of the presence of basal laminar deposit in membranes from age-related macular degeneration.

Adult↗
PubMed1992

Vogt-Koyanagi-Harada syndrome in patients with Cherokee Indian ancestry.

Eight patients with Vogt-Koyanagi-Harada syndrome who have Cherokee Indian ancestry ranged from 17 to 49 years of age. Five of the patients were black, three were white. Visual acuity at the time of initial examination ranged from 20/20 to counting fingers. Clinical findings included granulomatous iridocyclitis in six patients, vitreitis in seven patients, disk edema in five patients, exudative retinal detachment in six patients, and multifocal choroidal lesions in all eight patients. All of the patients were treated with systemic corticosteroids, and they recovered visual acuity of 20/40 or better. The seven patients assayed had the HLA-DRw52 haplotype, including five who were homozygous for this allele. This finding may add to the increasing evidence that a class II HLA antigen at a D-related locus may predispose carriers to the development of Vogt-Koyanagi-Harada syndrome.

Adolescent↗
PubMed1992

Immunohistochemical and histochemical properties of surgically excised subretinal neovascular membranes in age-related macular degeneration.

The immunohistochemical and histochemical properties of 16 surgically excised subretinal neovascular membranes from 16 patients with age-related macular degeneration were studied. Primary antisera to c-retinaldehyde-binding protein; leukocyte common antigen; factor VIII-related antigen; S-100 protein; glial fibrillary acid protein; muscle-specific actin; neuron-specific enolase; collagen types I, II, III, IV, and V; laminin; and fibronectin were used for immunohistochemical characterization of the membranes. Histochemical staining for lipid and mucopolysaccharide was performed. The results of the staining in conjunction with histologic examination showed the cellular components of the membranes to be composed of retinal pigment epithelium, inflammatory cells, vascular endothelium, glial cells, myofibroblasts, photoreceptor cells, and fibrocytes. The extracellular matrix of the membranes contained collagen types I, III, IV, and V; fibronectin; laminin; mucopolysaccharide; and lipid. These findings are consistent with the concept that subretinal neovascular membranes in age-related macular degeneration are composed of localized intra-Bruch's membrane granulation tissue proliferation associated with diffuse drusen.

Aged↗
PubMed1992

Pathogenetic mechanisms in anterior proliferative vitreoretinopathy.

A clinicopathologic study of ten consecutive patients (ten eyes) undergoing surgery for rhegmatogenous retinal detachment with anterior proliferative vitreoretinopathy and a subsequent histopathologic, immunohistochemical, and ultrastructural study of ten enucleated eyes with anterior proliferative vitreoretinopathy were performed in order to elucidate relevant pathogenetic mechanisms. Our findings suggest that the pathogenetic evolution of anterior proliferative vitreoretinopathy occurs in three consecutive stages: (1) traction on the ciliary body and peripheral retina induced by fibrocellular contraction of the vitreous base; (2) incorporation of tractionally denuded components of the ciliary body and peripheral retina into the fibrocellular membranes overlying the vitreous base; and (3) proliferation of the incorporated components and fibrovascular ingrowth from the uvea, the retina, or both, into the fibrocellular membranes. Tractional disruption of the epithelium of the ciliary body pars plicata and breakdown of the ciliary blood-aqueous barrier are the principal pathogenetic mechanisms of chronic intractable hypotony and the post-vitrectomy fibrin syndrome in anterior proliferative vitreoretinopathy.

Adult↗
PubMed1992

Examination of macular vitreoretinal interface disorders with monochromatic photography.

Monochromatic light accentuates details of different retinal layers because of its variable absorption and reflectance by structures both within and above these layers. Monochromatic photography was used to examine macular vitreoretinal interface abnormalities in 19 patients. Short wavelength photographs (490 nm) provided the best detail of inner retinal abnormalities, including epiretinal membranes, vitreoretinal traction, and the internal surface of confluent macular edema (pseudocyst). Although 540-nm red-free photography provided acceptable photographs, it did not provide optimal detail of inner or deep retinal abnormalities. Longer wavelengths, 585 and 610 nm, best disclosed the extent of deep retinal abnormalities, including the extent of confluent macular edema (pseudocysts) and retinal detachment that surrounded macular holes. The addition of short- and long-wave-length photography to traditional red-free photography may provide better localization, understanding, and documentation of the three-dimensional relationships in macular vitreoretinal interface disorders.

Eye Diseases↗