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Biomedical subjects

W F Mieler

Publications and source records attributed to W F Mieler.

At least 73 records · Page 4Linked to original sources
PubMed1994

Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection.

We evaluated intravitreal perfluoro-n-octane injection for the positioning of large retinal flaps after relaxing retinotomies. Nineteen eyes underwent vitrectomy for advanced retinal detachments from proliferative vitreoretinopathy (11 eyes), trauma (five eyes), and proliferative diabetic retinopathy (three eyes). After retinotomy and complete relief of traction, injection of perfluoro-n-octane to a level anterior to the retinotomy edge was used to remove subretinal fluid thoroughly from beneath the retinal flap. All irrigation fluid anterior to the perfluoro-n-octane meniscus was aspirated before perfluoro-n-octane removal. Final tamponade was obtained with gas (four eyes) or silicone oil (15 eyes). After six to 17 eyes) or silicone oil (15 eyes). After six to 17 months of follow-up, the retinas were attached in 13 eyes (68%), and visual acuity of 5/200 or better was obtained in eight eyes (42%). Subretinal migration of perfluoro-n-octane and posterior slippage of the retinal flap occurred during perfluoro-n-octane/silicone oil exchange in one eye. No other complications were detected. Perfluoro-n-octane injection is an effective technique for positioning large retinal flaps after relaxing retinotomy.

Adolescent↗
PubMed1994

A modified en bloc excision technique during vitrectomy for diabetic traction retinal detachment. Results and complications.

PURPOSE: The visual results and complications were determined for a modified en bloc excision technique for management of diabetic traction macular detachment. PATIENTS AND METHODS: A consecutive series of 30 eyes with this condition underwent pars plana vitrectomy, during which all posterior hyaloid except for portions essential for membrane dissection were excised. Bimanual dissection techniques then allowed excision of fibrovascular membranes "en bloc" with the retained hyaloid. RESULTS: After 6 to 44 months of follow-up, visual acuity of 5/200 or better was obtained in 23 (77%) of 30 eyes, with complete reattachment in 29 (97%) of 30 eyes. Iatrogenic retinal breaks occurred in 6 (20%) of 30 eyes. Two eyes required repeat vitrectomy. CONCLUSIONS: The modified en bloc excision technique allowed similar visual outcome, a higher reattachment rate, and less postoperative morbidity than previously reported surgical approaches to diabetic traction macular detachment.

Adult↗
PubMed1994

Surgical removal of an extrafoveal fibrotic choroidal neovascular membrane with foveal serous detachment in age-related macular degeneration.

BACKGROUND: Visual recovery after submacular surgery for age-related macular degeneration (AMD) has been very limited. METHODS: A patient with an extrafoveal fibrotic choroidal neovascular membrane from AMD had an overlying serous foveal detachment with the fibrotic tissue elevating the foveal retina. Photocoagulation of the neovascular membrane was not recommended because of its nonpigmented, fibrotic nature. The membrane was surgically excised. RESULTS: Preoperative and postoperative visual acuity and central 30 degrees visual fields were followed. Visual acuity improved from 20/200 to 20/25, and a preoperative central scotoma resolved completely 18 months after surgical excision of the extrafoveal fibrotic neovascular membrane. There were no intraoperative or postoperative complications. CONCLUSION: This type of patient may represent a distinct subset of patients with AMD amenable to subretinal surgery who could potentially have good recovery of vision.

Aged↗
PubMed1994

Postoperative fibrin formation and visual outcome after pars plana vitrectomy.

PURPOSE: To determine whether postvitrectomy fibrin formation was associated with visual outcome, a prospective study of patients undergoing pars plana vitrectomy was performed. METHODS: In 121 patients undergoing vitrectomy at the Medical College of Wisconsin between July 1986 and April 1989, the association of fibrin formation and other perioperative factors with visual outcome was evaluated by univariate and multivariate regression analysis. Poor visual outcome was defined as visual acuity worse than 5/200. RESULTS: After a median follow-up period of 23 months (range 6 to 51 months), patients with severe fibrin formation experienced a higher rate of poor visual outcome (19 of 26 patients, 73%) than patients with little or no fibrin formation (23 of 95 patients, 24%; P < 0.0001, univariate analysis). After adjusting for a variety of factors with multivariate regression analysis, fibrin formation was not significantly predictive of final visual outcome. CONCLUSIONS: Factors associated with postvitrectomy fibrin formation may affect visual outcome more than fibrin formation itself.

Adolescent↗
PubMed1993

Assault-related penetrating ocular injury.

We performed a retrospective study of 42 patients with penetrating ocular injury resulting from assault over a five-year period (1986 through 1991). Thirty-six patients were male (86%) and six were female, with a mean age of 29 years. Twenty-nine of 42 patients (70%) had consumed alcohol or used illegal drugs before their injury. Fists were the leading cause of injury (ten patients), followed by broken glass (nine patients). At least six months of follow-up was obtained on 40 patients (95%), with a mean follow-up of ten months. Ten (25%) patients had good visual outcome with final visual acuity of 20/40 or better. Twenty-five patients (63%) had final visual acuity of less than 5/200 at final follow-up. In this group with poor visual outcome, 12 patients (48%) underwent enucleation or evisceration (five primarily) because of extensive ocular damage. Five of 42 patients (12%) had visual acuity of no light perception, and eight (20%) had visual acuity ranging from light perception to counting fingers. The remaining five patients (12%) had final visual acuities between 20/100 and 5/200. Factors predictive of poor visual outcome were as follows: (1) initial visual acuity of light perception or worse; (2) injury by a blunt object; (3) posterior scleral lacerations (> 15 mm in length); and (4) presence of vitreous hemorrhage, retinal detachment, and prolapsed uvea. Penetrating ocular injury with posterior segment involvement caused by assaultive injury results in guarded visual outcome in most patients. Prevention of such injuries remains difficult.

Adolescent↗
PubMed1993

Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System.

PURPOSE: To determine the risk factors and prognostic indicators of infectious endophthalmitis in eyes with penetrating injury and retained intraocular foreign body. METHODS: From the National Eye Trauma System (NETS) Registry, 492 eyes with intraocular foreign bodies were reviewed for signs of infectious endophthalmitis. RESULTS: Thirty-four eyes (6.9%) with intraocular foreign bodies had evidence of infectious endophthalmitis, and 31 (91.2%) of those eyes had signs of infection at the time of removal of the intraocular foreign body. The majority of eyes with an intraocular foreign body with or without endophthalmitis were in patients between 10 and 39 years of age, but the risk of endophthalmitis developing increased with age, especially in patients 50 years of age or older with delayed primary repair (P = 0.005). Endophthalmitis was more likely to develop in eyes with home or occupational injuries (33/358, 9.2%) than in those with injuries from other settings (1/128, 0.8%; P = 0.001). Infectious endophthalmitis was much less likely to develop in eyes with primary repair within 24 hours of the injury (10/287 = 3.5%) than in eyes with primary repair more than 24 hours after the injury (22/164, 13.4%; P < 0.0001). Bacilli or staphylococci were isolated in 21 (95%) of 22 eyes with positive cultures. Visual prognosis was reasonably good with 15 (58%) of 26 eyes attaining a visual acuity of 20/200 or better. CONCLUSIONS: Removal of a retained intraocular foreign body within 24 hours of injury markedly reduces the risk of infectious endophthalmitis developing. Older persons are at high risk for endophthalmitis developing after retaining an intraocular foreign body when there is delayed surgical repair.

Adolescent↗
PubMed1993

Retinal folds in Terson syndrome.

BACKGROUND: Perimacular retinal folds have been reported in the shaken baby syndrome, but have not been described in adults with Terson syndrome. METHODS: The authors present two patients with perimacular retinal folds in adults with Terson syndrome. In one patient, electron microscopy was used to examine the membrane spanning the fold. RESULTS: The membrane spanning the perimacular fold was found to be internal limiting membrane. The pathogenesis of these perimacular folds found in adults sustaining direct head trauma is probably different from that previously described for folds seen in infant eyes with shaken baby syndrome. CONCLUSION: Retinal folds occurring in Terson syndrome are clinically similar to those seen in the shaken baby syndrome.

Adult↗
PubMed1993

Perioperative choroidal hemorrhage at pars plana vitrectomy. A case-control study.

PURPOSE: Risk factors for choroidal hemorrhage during pars plana vitrectomy surgery are currently not well defined. The authors analyzed potential risk factors for perioperative choroidal hemorrhage at pars plana vitrectomy in a case-control study. METHODS: Of 683 consecutive vitrectomy procedures, 13 cases of choroidal hemorrhage were identified in the operative or immediate postoperative period. Fifty vitrectomy controls from the same period were randomly selected and were compared with the hemorrhage cases by univariate analysis with respect to various potential risk factors. RESULTS: The incidence of choroidal hemorrhage associated with vitrectomy was 1.9%. Statistically significant risks (P < or = 0.05) included: greater age (mean, 70.9 versus 52.1 years); elevated preoperative pressure (19.9 versus 13.0 mmHg); preoperative diagnosis of rhegmatogenous retinal detachment (relative risk, 8.1); aphakic or pseudophakic status (relative risk, 5.2); and scleral buckle procedure at vitrectomy (relative risk, 12.0). Eyes with previous ocular trauma and previous vitrectomy had a reduced risk of choroidal hemorrhage. The incidence of severe visual loss (final visual acuity < 5/200) did not differ significantly from controls. CONCLUSIONS: Significant risk factors for choroidal hemorrhage are identified in this study which may help to identify patients at increased risk for this complication. Good visual outcome is possible after choroidal hemorrhage at vitrectomy (69% with visual acuity > 5/200).

Aged↗
PubMed1993

Penetrating ocular injuries secondary to motor vehicle accidents.

BACKGROUND: Penetrating ocular trauma is second only to cataracts as the most common cause of visual impairment in the United States; motor vehicle accidents are an important cause of injuries (ocular and non-ocular). METHODS: The files of 293 consecutive patients treated for a penetrating ocular injury over a 5-year period (1986 to 1991) were reviewed, and 10 (3.4%) were associated with a motor vehicle accident. RESULTS: Median age was 27.5 years and median initial visual acuity was 20/200 (range, 20/30 to light perception). A sharp glass fragment penetrating the eye was the mechanism of injury in seven cases. A seatbelt was worn by only one patient. Six patients had a corneoscleral laceration, and two patients each had corneal and scleral lacerations. Primary repair of the laceration was solely performed in eight patients. Vitreous surgery was required in two cases, one with retained intraocular foreign bodies and one with a retinal detachment. The median follow-up period was 5 months, and 8 of 9 retinas remained attached at final follow-up. One patient died of unrelated causes. Final median visual acuity was 20/25 (range, 20/20 to hand motions). CONCLUSION: Among patients in a large series of penetrating ocular injuries, the percentage of injuries due to motor vehicle accidents is low. The anterior segment is predominantly involved, and the final visual prognosis is favorable. Compulsory seatbelt legislation may reduce the frequency and morbidity of these accidents in the United States.

Accidents, Traffic↗
PubMed1992

Posterior segment changes in membranoproliferative glomerulonephritis.

Membranoproliferative glomerulonephritis is a renal disorder characterized by proliferation of cells and changes in the basement membrane of the glomerulus. The disease is divided into three subtypes: type I, characterized by the presence of subendothelial electrondense deposits; type II, characterized by deposition of electrondense material of unknown origin in the lamina densa of the glomerular basement membrane; and type III, characterized by lesions having both type I and type II qualities. Specific posterior segment changes have been reported with membranoproliferative glomerulonephritis type II. We examined three patients with membranoproliferative glomerulonephritis type II and two patients with type III disease. All three patients with type II disease had Bruch's membrane and retinal pigment epithelial changes, whereas both patients with type III disease had normal posterior segments.

Adult↗
PubMed1992

Macular phototoxicity caused by fiberoptic endoillumination during pars plana vitrectomy.

Three cases of retinal phototoxicity were caused by light from the endoilluminator used in vitrectomy. Preoperative clinical examination, color photography, and fluorescein angiography in all three cases failed to disclose retinal pigment epithelial changes. Postoperative clinical findings, photographs, and fluorescein angiograms are highly suggestive of the presence of retinal phototoxicity. The characteristics of these lesions and surgical conditions implicate the endoilluminator as the source of photic injury. The macular lesions were noted within one week of the surgical procedure, measured between 2 and 5 disk diameters in size, involved the fovea in two eyes, and resulted in marked decrease in visual acuity in two of three eyes, with persistence in one eye. Initially, whitening of the outer retina was present, but was replaced by pigmentary mottling at the level of the retinal pigment epithelium within a few weeks. Preventive measures to avoid macular phototoxicity associated with vitrectomy are discussed.

Adult↗
PubMed1992

Submacular fibrosis after photocoagulation for diabetic macular edema.

Ten eyes of nine patients developed submacular fibrotic scars without fluorescein angiographic evidence of choroidal neovascularization between two and 11 months (mean, 6.1 months) after argon laser treatment for diabetic macular edema. In four eyes, development of the subretinal scar was associated with visual acuity loss of two, two, four, and eight lines of Snellen visual acuity, respectively, within five to 11 months of laser treatment. At the final follow-up visit, the visual acuity of the eyes with two lines of visual acuity loss had returned to within one line of the initial value, but the visual acuity of the eyes with more severe initial visual acuity loss did not recover notably. In four eyes, fibrous submacular strands extended from macular laser scars, suggesting an iatrogenic role of the laser in inducing this complication.

Aged↗
PubMed1992

Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion.

Eighteen eyes with coexisting cataract and vitreoretinal disease underwent combined phacoemulsification, pars plana vitrectomy, and posterior chamber lens implantation. Preoperative vitreoretinal disease included nonclearing vitreous hemorrhage (eight eyes), vitreous hemorrhage and tractional retinal detachment (three eyes), tractional retinal detachment (one eye), epiretinal membranes (three eyes), peripheral uveitis (two eyes), and a retained intraocular metallic foreign body (one eye). Postoperative visual acuity improved in each case; 14 eyes achieved visual acuity between 20/20 and 20/80 during an average postoperative period of 11 months (range, 3 to 39 months). Perioperative complications included an iatrogenic retinal break (one eye) and pupillary block glaucoma (one eye). Four eyes required YAG laser capsulotomy postoperatively. Phacoemulsification did not interfere with corneal clarity, allowed water-tight wound closure during vitrectomy, and preserved the capsular bag, allowing endocapsular fixation of the posterior chamber lens. Combining phacoemulsification, posterior chamber lens implantation, and pars plana vitrectomy allows rapid visual rehabilitation and functional unaided vision in these eyes.

Adult↗
PubMed1992

The lowest effective dose of tissue plasminogen activator for fibrinolysis of postvitrectomy fibrin.

Tissue plasminogen activator (tPA) has been shown to be effective at a dose of 25 micrograms in the treatment of severe postvitrectomy fibrin. However, a recent report based on an animal model indicates that retinal toxicity may occur at doses as low as 25 micrograms. This study uses a low dose (1.5 micrograms to 3 micrograms) of tPA for 34 injections in 26 eyes, and determines the lowest effective dose to be between 1.5 and 3 micrograms. Complete fibrinolysis was achieved in all 28 eyes in which 3 micrograms of tPA was administered within 10 days of vitrectomy, whereas partial fibrinolysis was achieved in eyes treated with 3 micrograms of tPA 27 days and 82 days after vitrectomy. Complete fibrinolysis occurred in only 1 of 4 eyes that receive 1.5 micrograms of tPA. A dose of 3 micrograms of tPA is recommended for treatment of severe fibrin after vitrectomy, as it has a wider margin of safety than do higher doses.

Adolescent↗
PubMed1992

Favourable outcome of traumatic endophthalmitis with associated retinal breaks or detachment.

Traumatic endophthalmitis in association with retinal breaks or detachments is reported to have uniformly poor visual and anatomic outcomes. We describe two cases of culture-positive traumatic endophthalmitis with retinal breaks or detachment in which the final visual result was 20/70 in one case and 20/40 in the other. Factors that may improve the prognosis in such cases include attention to the possibility of infection, selective use of broad-spectrum antibiotics, prompt surgical intervention and improvement in vitreous surgical techniques. Modification of intravitreal antibiotic regimens may be indicated in eyes in which the vitreous cavity is partially filled with air or gas.

Adolescent↗
PubMed1992

Hemorrhage associated with localization of melanoma margins during radioactive plaque placement.

Accurate placement of a radioactive plaque is essential in brachytherapy of choroidal melanoma. Various localization techniques, including transillumination of anteriorly located tumours and scleral indentation to mark the anterior margin of posteriorly located tumours, have been used in initially placing a plaque over the base of the tumour. Of 40 consecutive patients treated for choroidal melanoma between 1986 and 1990, 8 had posteriorly located tumours, all localized by means of scleral indentation; subretinal hemorrhage occurred in 3 of the 8 during marking of the tumour margins. No hemorrhages occurred in the 32 patients with tumours localized by means of transillumination (p less than 0.01). It is not clear whether the method of marking or the location of the tumour itself contributed to the development of the hemorrhage. Hemorrhage around the base of a tumour may mask the tumour margins, making assessment of the response to therapy difficult. Caution should be used when marking posteriorly located tumours.

Aged↗