Contributions of A. Edward Maumenee in the field of retinal and choroidal diseases.
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Involvement of the choroid plexus by lymphoma (Hodgkin) is a hitherto undescribed complication. We report herein the case of a 49-year-old man who developed, shortly before death, neurologic symptoms seemingly related to extensive involvement of choroid plexus and surrounding ventricular structures by lymphoma (Hodgkin's). There was also multifocal involvement of cranial nerves and spinal canal contents.
Two distinct episodes of posterior ciliary artery occlusion were studied in a 32-year-old man with hemoglobin SS disease and multiple episodes of amaurosis fugax. Although posterior ciliary artery occlusions have been observed following photocoagulation of sickle cell retinopathy, their spontaneous evolution in patients with sickling hemoglobinopathies has received little attention. The manifestations of posterior ciliar artery occlusion seen in this case and in other clinical and experimental situations are reviewed. Histopathologic examination of three additional eyes of patients with sickle hemoglobinopathies revealed changes which may have been the result of previous small posterior ciliary artery occlusions or small vessel occlusive disease related to the sickling hemoglobinopathies; these cases are also reported.
The "Visual Retinal Profile" can be obtained in the complete office evaluation of patients with night vision disorders, unexplained poor visual acuity, or undiagnosed retinal and/or choroidal diseases. This profile allows later follow-up evaluations and comparisons of previous tests to document improvement or progression of disease. The profile consists of the usual ophthalmologic evaluation plus color vision testing Amsler grid, stereoacuity, visual fields, electroretinogram (ERG), and electrooculogram (EOG). This entire set of tests, though time consuming, can be performed in the office by an ophthalmic assistant and greatly add to the ophthalmologists ability to evaluate and diagnose subtle retinal and/or choroidal diseases. A portable ERG/EOG and light source will be described that can be used in the office, clinic, nursing home, or operating room by trained office personnel.
A 71-year-old woman had a history of recent weight loss and bilateral decreased visual acuity, bilateral serous detachment, and mental depression. Fluorescein angiograms showed a myriad of retinal pigment epithelial leakage points. Despite extensive evaluation, the cause of her weight loss and ocular process remained uncertain until her death, when postmortem examination revealed leukemia infiltrates of many organs, including the choroid. After death, we correlated the clinical signs and fluorescein angiograms with the histopathologic findings. This case shows that choroidal disease may be a symptom of undetected leukemia.
Twenty-one patients under age 55 had idiopathic serous detachments of the retinal pigment epithelium (rpe) one-fifth disc diameter or larger in size. In the absence of other choroidal diseases, such as senile mascular degeneration, presumed ocular histoplasmosis syndrome, or anglioid streaks, serous RPE detachments have a good prognosis and probably are a variant of idiopathic central serous choroidopathy. The presence of associated subretinal fluid involving the macula was the factor that had the most effect on visual acuity. Serous detachments of the RPE should be distinguished from multiple vitelliform lesions (a variant of vitelliform dystrophy).
An ultrasound diagnostic coding system was developed that permitted entry of diagnoses into a programmable calculator, thus permitting rapid information retrieval of patients with a specific diagnosis or diagnoses as well as the number of patients with a specific diagnosis. Cataract, vitreous opacity, trauma, choroidal disease, and retinal detachment were the most common diagnoses made. Only 7.2% of the patients had a normal ultrasound, indicating that ultrasound examination is a test probably underutilized by ophthalmologists.
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Patients with Eales' disease, chorioretinitis, central serous retinopathy, or malignant choroidal melanoma were tested for HLA antigen deviation. When corrected p values (pc) are used, the first three disorders did not show any significant deviation, whereas a significant increase of HLA-Aw32 (pc = 0.026) was found in the malignant melanoma group. For conclusive evidence the latter finding needs confirmation by analysis of a greater number of patients with this disorder.
PURPOSE: To assess anterior scleral thickness and the presence of ciliochoroidal effusion (CE) in eyes with peripapillary pachychoroid syndrome (PPS), and to compare the results with a cohort of healthy age-matched controls. DESIGN: Retrospective cross-sectional study METHODS: A total of 20 eyes from 12 patients diagnosed with PPS and 30 eyes from 15 healthy control subjects. All participants underwent a comprehensive ophthalmic examination, including spectral-domain optical coherence tomography with enhanced depth imaging (EDI-OCT) and anterior segment OCT (AS-OCT). Choroidal thickness was measured at predefined macular and peripapillary locations, while anterior scleral thickness was assessed 6 mm posterior to the scleral spur in 4 quadrants. Ciliochoroidal effusion was evaluated qualitatively using AS-OCT. Comparisons between groups were performed using linear mixed models with Bonferroni correction (scleral thickness corrected P < .010) RESULTS: The mean age of PPS patients was 75.6 ± 9.8 years, and 16% were females. Anterior scleral thickness was significantly greater in the temporal quadrant in PPS eyes compared to controls (396.85 ± 74.97 µm vs 331.13 ± 62.65 µm: P = .007). Ciliochoroidal effusion was detected in 60% of PPS eyes, predominantly in the superior and temporal sectors, whereas no effusion was observed in healthy controls (P < .001). Eyes with CE exhibited a thicker mean scleral thickness and a thicker subfoveal choroidal thickness compared to eyes without effusion (P < .05). CONCLUSION: Eyes with PPS demonstrated increased temporal scleral thickness and a high prevalence of CE. These findings suggest that scleral characteristics may represent a predisposing anatomical factor in PPS, although the precise pathophysiological mechanisms remain to be elucidated.
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