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Biomedical subjects

B C Polak

Publications and source records attributed to B C Polak.

At least 19 recordsLinked to original sources
PubMed2001

[Visual impairment due to optic neuropathy in 2 patients on amiodarone therapy, i.e. ethambutol and isoniazide].

Two patients, a 69-year-old man and a 49-year-old woman, developed a bilateral decrease in visual acuity, the male patient within two months of starting to use amiodarone (Cordarone) and the female patient within ten months of starting to use ethambutol (Myambutol) and isoniazid. Optic neuropathy occurred in both patients and this was probably caused by the medications. After the medication had been withdrawn, the male patient's vision remained poor (1/300); 6 months later the female patient's vision had improved to 0.8 and 1.0. Before prescribing oculotoxic medications, physicians should know about the patient's visual acuity and any ocular diseases the patient may have. The patient must also be advised to contact their doctor immediately if visual complaints occur. Before and during treatment with ethambutol, ophthalmological examinations should be carried out regularly. In the event of complaints, iatrogenic optic neuropathy must be distinguished from an ischaemic optic neuropathy. The latter is usually associated with an acute unilateral decrease in visual acuity. Withdrawal of the medication is indicated for neuropathy. However, although the vision may improve it will not be completely restored.

Aged↗
PubMed2001

[Loss of an eye due to hyper-IgE syndrome after corneal transplantation].

A 37-year-old patient with bilateral keratoconus underwent a perforating cornea transplantation after acute onset of pain and hydrops of the right cornea. One day after operation endophthalmitis developed, caused by a viridans streptococcus. Hyper-IgE syndrome was suspected because of the patient's crude facial features. His medical history brought up additional symptoms of this disease. IgE levels were extremely elevated (7320 kU/l), the eosinophil count was slightly raised (0.25 x 10(9)/l). The patient was treated with several local antibiotics but his vision was only light perception at the time of discharge from the hospital. This case illustrates how an usually successful operation may have a disastrous outcome in case of late diagnosis of the hyper-IgE syndrome. The hyper-IgE syndrome can be recognized by the characteristic facial features in combination with the often extensive (juvenile) medical history with infections, and by elevated serum IgE levels. As patients with the hyper-IgE syndrome are extremely susceptible to develop infections, prophylactic antibiotic therapy is indicated in surgical procedures.

Adult↗
PubMed2001

[Improvement of vision in nursing home patients through eyeglasses].

Adequate refraction correction may contribute to the quality of life of elderly persons who will be less dependent on care in daily life and will be less prone to fall. In nearly 20% of 102 nursing home residents binocular visual acuity improved with at least one line on the Snellen Chart by adjustment of refractive correction.

Accidental Falls↗
PubMed2000

Hyperhomocysteinemia is associated with the presence of retinopathy in type 2 diabetes mellitus: the Hoorn study.

BACKGROUND: Retinopathy is the leading cause of blindness among patients with type 2 diabetes mellitus (DM). Hyperhomocysteinemia is a recently recognized risk factor for cardiovascular disease, independent of established risk factors. OBJECTIVE: To study the association between the homocysteine level and retinopathy among subjects with and without DM. METHODS: We studied an age-, sex-, and glucose tolerance-stratified random sample of a 50- to 75-year-old general white population in the Hoorn Study (N = 625). Retinal vascular changes (retinopathy) were assessed using ophthalmoscopy and/or fundus photography. Hyperhomocysteinemia was defined as a serum total homocysteine level greater than 16 micromol/L. RESULTS: The prevalence of retinopathy was 9.8% (28/285) in subjects with normal glucose tolerance, 11.8% (20/169) in those with impaired glucose tolerance, 9.4% (10/106) in those with newly diagnosed type 2 DM, and 32.3% (21/65) in those with known type 2 DM. The prevalence of retinopathy was 10.3% (39/380) in subjects without hypertension and 16.3% (40/245) in subjects with hypertension; it was 12.0% (64/534) in subjects with a serum total homocysteine level of 16 micromol/L or less and 16.5% (15/91) in those with a serum total homocysteine level of more than 16 micromol/L. After stratification for DM and adjustment for age, sex, glycosylated hemoglobin, and hypertension, the odds ratio (95% confidence interval) for the relation between retinopathy and hyperhomocysteinemia was 0.97 (95% confidence interval, 0.42-2.82) in patients without DM and 3.44 (95% confidence interval, 1.13-10.42) in patients with DM (P =.08 for interaction). CONCLUSION: The findings suggest that hyperhomocysteinemia may be a risk factor for retinopathy in patients with type 2 DM, but probably not in patients without DM. Arch Intern Med. 2000;160:2984-2990

Aged↗
PubMed2000

Retinal blood flow changes in diabetic retinopathy measured with the Heidelberg scanning laser Doppler flowmeter.

BACKGROUND: Investigation of retinal blood flow in patients with and without diabetic retinopathy (DR). Retinal blood flow is measured with the non-invasive Heidelberg Retinal Flowmeter (HRF). The clinical suitability of the HRF in patients with diabetes mellitus is investigated, and measured blood flow is compared with blood flow in a group of non-diabetic persons. METHODS: Cross-sectional study of retinal capillary perfusion in eighty diabetic patients and forty-nine control persons, non-invasively measured with the Heidelberg scanning laser Doppler flowmeter. RESULTS: In the control group, HRF measurements could be performed in all subjects. In the diabetes group some patients had media opacities or were not able to maintain stable fixation. Therefore HRF measurement was only possible in 79%, 75% and 60% of the subjects for the nasal, papillo-macular and foveal areas respectively. Retinal blood flow as measured in the perifoveal and nasal areas was associated with the level of diabetic retinopathy. In patients with proliferative DR (levels 4 and 5) the blood flow was reduced, in comparison with that of the patients with exudative or non-proliferative DR (levels 1 and 2) and preproliferative DR (level 3). Blood flow was not correlated with age, systemic blood pressure, intra-ocular pressure and perfusion pressure in either group. A significant negative correlation with the actual blood glucose level was found in the perifoveal area (R = -0.585, P = 0.0001). CONCLUSIONS: The HRF offers an interesting non-invasive method for measurement of retinal blood flow. In this cross-sectional study variations in retinal blood flow could be detected in various stages of DR in relation to clinically visible funduscopic changes.

Adolescent↗
PubMed2000

Incidence of ocular side effects of topical beta blockers in the Netherlands.

BACKGROUND: Several ocular side effects including uveitis, have been reported following topical beta blocker treatment for glaucoma and ocular hypertension. The incidence of these side effects was investigated in the Netherlands. METHODS: A prospective observational design was used whereby monthly questionnaires were sent to all practising ophthalmologists in the Netherlands during 3 consecutive months. Questionnaires were returned at the end of each month. Any patient whose topical beta blocker therapy was altered because of an ocular reaction was noted on this questionnaire. Ophthalmologists who did not return their questionnaires were interviewed by telephone at the end of the study period. The number of patients using topical beta blockers was derived from drug sales figures. RESULTS: 70% (328/467) of the ophthalmologists in the Netherlands participated in the study. During the 3 month study period 34 cases were reported: 15 patients had periorbital dermatitis, in eight patients eyelids and conjunctiva were affected, in seven patients the conjunctiva was affected, and four patients had punctate keratitis. The calculated incidence of ocular side effects during topical beta blocker therapy was 1.51 cases/1000 patient years. CONCLUSION: Topical beta blocker therapy is associated with few clinically important ocular side effects. No cases of uveitis were reported.

Administration, Topical↗
PubMed1997

[Eye symptoms and latent diabetes].

Diabetes mellitus type II (non-insulin dependent diabetes mellitus) may run a prolonged subclinical course. In three patients, an indian man of 45, a man of 42 and a woman of 78 years old, the first symptoms were eye disorders: vision loss, burning eyes with recurring chalazion, and (neurogenic) diplopia respectively. All three had elevated blood sugar levels and were treated accordingly.

Adult↗
PubMed1996

Immunoglobulin A antibodies against Pseudomonas aeruginosa in the tear fluid of contact lens wearers.

PURPOSE: Pseudomonas aeruginosa is the most important cause of contact lens-associated ulcerative keratitis, especially for those who use extended-wear lenses. Until now, the presence of specific anti-P. aeruginosa immunoglobulin A (IgA) antibodies in the tears of contact lens wearers has not been investigated and is the purpose of the current study. METHODS: The levels of specific IgA antibodies against P. aeruginosa and total secretory IgA (s-IgA) concentrations were measured in tears of various groups of contact lens and non-contact lens wearers using enzyme-linked immunosorbent assays. Contact lens groups were divided into the following categories: daily-wear rigid gas-permeable lenses (n = 23), daily-wear soft lenses (n = 22), extended-wear soft lenses (n = 17), and non-contact lens wearers (n = 23). As a positive control group, we tested tears obtained from patients with cystic fibrosis (n = 5) because the respiratory tract of these persons often are colonized by P. aeruginosa. RESULTS: The percentage of nonresponders (< 15 U/ml) varied between 9% in daily-wear rigid gas-permeable contact lens users to 23% in daily-wear soft contact lens users. The percentage of nonresponders in controls was 13%. The frequency of nonresponders was not significantly different among the different groups tested. All patients with cystic fibrosis showed a very high anti-P. aeruginosa IgA response in their tears. When analyzing the mean anti-P. aeruginosa IgA response, a significantly lower level was found in extended-wear contact lens users (38 U/ml) compared to non-contact lens wearers (82 U/ml). Total s-IgA levels in the tears of the various groups tested were not significantly different. CONCLUSIONS: A substantial number of persons in the population of contact lens wearers tested lack detectable IgA antibodies against P. aeruginosa in their tears and may be susceptible to P. aeruginosa keratitis if the physiological condition of their cornea is compromised.

Adolescent↗
PubMed1995

Diffuse retinal pigment epitheliopathy complicating systemic corticosteroid treatment.

AIMS/BACKGROUND: This study was undertaken to confirm the association between diffuse retinal pigment epitheliopathy (DRPE) and systemic corticosteroid therapy. This finding can be of help in determining an aetiological factor in DRPE and associated diseases. Corticosteroids may contribute to the development of leakage in the presence of a retinal pigment epitheliopathy or central serous chorioretinopathy. METHODS: Cases of DRPE were collected from the files of members of the European Fluorescein Angiography Club. There were 34 who developed their ophthalmic symptoms while being treated with corticosteroids. RESULTS: DRPE developed in 34 patients from 10 European eye clinics during systemic treatment with corticosteroids. Thirteen patients were treated with corticosteroids after allotransplantation, 21 other patients developed ocular symptoms while treated with steroids for serious systemic disorders. Symptoms occurred in some patients when the daily corticosteroid dosage was elevated, and the visual complaints ameliorated or even disappeared sometimes on discontinuation of the corticosteroid therapy. CONCLUSION: Corticosteroids can damage the retinal pigment epithelial barrier and predispose a patient to serous retinal detachment, whereas psychological stress may play a role in the development of central serous chorioretinopathy. A decrease of the daily corticosteroid dosage may help to diminish the visual symptoms.

Adult↗
PubMed1995

Endothelial dysfunction precedes development of microalbuminuria in IDDM.

In patients with insulin-dependent diabetes mellitus (IDDM), microalbuminuria is a predictor of widespread severe microangiopathy and macroangiopathy. Patients with microalbuminuria show generalized dysfunction of the vascular endothelium, but it is unknown whether endothelial dysfunction precedes the development of microalbuminuria. We examined a cohort of 17 IDDM patients at baseline and on three occasions during a follow-up of (median) 64 months (range 51-89). All had normal (< 15 micrograms/min) urinary albumin excretion (UAE) at the first three examinations. At the fourth examination, 11 patients had normal UAE and 6 had microalbuminuria (median 25.7 micrograms/min [range 15.3-42.8]). Compared with patients with normal UAE, microalbuminuric patients had significantly higher plasma levels of von Willebrand factor (vWF), a marker of endothelial dysfunction, at the second (200% [168-274] vs. 131% [69-186]), third (208% [188-270] vs. 125% [82-190]), and fourth examinations (231% [202-269] vs. 132% [88-208], P < 0.0001), but not at baseline (128% [98-161] vs. 122% [87-210]). An increase in vWF preceded the occurrence of microalbuminuria by approximately 3 years. The groups did not differ with regard to age, diabetes duration, blood pressure, mean glycated hemoglobin and cholesterol, smoking habits, or extent of retinopathy. Endothelial dysfunction, as estimated by plasma vWF concentration, precedes and may predict the development of microalbuminuria in IDDM.

Adult↗