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Biomedical subjects

C E Margo

Publications and source records attributed to C E Margo.

At least 55 records · Page 3Linked to original sources
PubMed1996

Progressive subretinal fibrosis and blindness in patients with multifocal granulomatous chorioretinitis.

PURPOSE: To describe the clinical and histopathologic findings in four eyes of three patients who became blind because of multifocal choroiditis and massive subretinal fibrosis. METHODS: Clinicopathologic correlative study. RESULTS: During a period of several years, three healthy elderly patients developed severe visual loss only partly explained by multifocal chorioretinitis and massive subretinal fibrosis. Histopathologic examination of four eyes from these patients disclosed widespread destruction of the outer retina and retinal pigment epithelium, massive areas of subretinal fibrous tissue proliferation, granulomatous inflammation centered around degenerated and fragmented Bruch's membrane, and chronic uveitis. No infectious organisms were identified by special stains or electron microscopy in one eye. CONCLUSIONS: Clinical and histopathologic findings in these three patients were consistent with an autoimmune disease process directed at the retina, retinal pigment epithelium, inner choroid, or all three. Cellular injury in this location can result in massive subretinal fibrosis. Subretinal fibroplasia, however, is probably a nonspecific reparative response to injury. The pathogenesis of this blinding disorder in elderly patients may be similar to the less severe disease usually occurring in younger patients with multifocal choroiditis, panuveitis, and punctate inner choroiditis.

Aged↗
PubMed1996

Therapeutic decisions involving disparate clinical outcomes: patient preference survey for treatment of central retinal artery occlusion.

BACKGROUND: Major therapeutic decisions are made by patients with information and guidance provided by their physicians. The values patients place on different outcomes and the risks they are willing to accept are important factors in making these decisions. New beneficial therapies associated with potentially serious complications are now available for some blinding diseases. The authors aim to determine the maximum amount of risk of stroke and death persons would accept to recover vision. METHODS: Standardized survey of adults with normal vision. RESULTS: Thirty-nine percent and 37% of surveyed adults would accept some risk of stroke and death, respectively, to triple the chances of recovering 20/100 visual acuity in one eye when binocular. More than 80% of persons would accept these risks if they were monocular. Maximum risk scores were significantly higher in the monocular case scenarios than in binocular case scenarios. Medical students and eye physicians were more likely to accept risk than persons with high school or university educational backgrounds. CONCLUSIONS: The value persons place on vision when weighed against the risk of stroke or death varies considerably. More persons are willing to accept life-threatening risks if they are monocular. The reasons physicians and medical students are more likely to accept serious risks to improve vision than nonphysicians is unclear. Further studies are needed to determine how physicians' values effect the patient decision-making processes.

Adult↗
PubMed1996

Submacular neovascular membrane and focal granulomatous inflammation.

BACKGROUND: Subretinal choroidal neovascular membranes in persons younger than 55 years old are commonly idiopathic or associated with the ocular histoplasmosis syndrome. There have been a few reports describing the histopathologic features of these membranes. Studies have shown that idiopathic membranes have the same morphologic features as membranes in age-related macular degeneration except for the absence of basal laminar deposits. METHOD: The authors studied a clinicopathologic case of a macular lesion associated with two peripheral hypopigmented spots in a healthy 30-year-old woman. RESULTS: The clinical and fluorescein angiographic findings in this patient were characteristic of submacular neovascular membranes, except that the edge of the lesion remained distinct in the late phase of the fluorescein angiogram. Results of histopathologic examination of the surgically excised membrane showed a well-circumscribed granuloma containing some eosinophils. Attenuated vascular spaces were present within the hard tubercle. Special stains for micro-organisms were negative. The patient had no evidence of a systemic inflammatory disease. CONCLUSIONS: A visible edge despite intense staining in the late phases of a fluorescein angiogram may suggest the possibility of subretinal granulomatous inflammation in a lesion that otherwise appears like a neovascular membrane. The clinical distinction between this pattern of subretinal neovascularization and a typical idiopathic membrane may be important because subretinal granulomatous inflammation could respond to treatment with systemic corticosteroids.

Adult↗
PubMed1995

Bilateral central retinal vein occlusions in a patient with acquired immunodeficiency syndrome. Clinicopathologic correlation.

Four patients with human immunodeficiency virus (HIV) infection and central retinal vein occlusion have been previously described in the literature. The pathologic findings in a fifth patient with this association are reported. The histopathologic findings were similar to ischemic central retinal vein occlusion in persons without HIV infections. There was no evidence of HIV in vascular endothelial cells using electron microscopy and in situ hybridization techniques. The failure to identify any structural or direct infectious cause for central retina vein occlusion in this setting suggests that other hemorheologic factors related to HIV infection are probably responsible for the predisposition to vascular thrombosis.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Fixation of whole eyes: the role of fixative osmolarity in the production of tissue artifact.

BACKGROUND: Whole eyes fixed in 4% buffered formaldehyde (10% neutral buffered formalin) demonstrate a variety of artifacts, including separation of the neurosensory retina from the retinal pigment epithelium. We postulate that the osmolarity of 4% buffered formaldehyde causes contraction of the internal compartments of the eye leading to several artifactual changes commonly observed in routine histologic sections. METHODS: In part I of the study, enucleated animal eyes were examined histologically after immersion in different concentrations of formaldehyde. The variables of fixation and processing were kept constant except for the concentration and osmolarity of formaldehyde. In part II, enucleated animal eyes were used to empirically determine the optimal mixture of formaldehyde and glutaraldehyde for fixation based on subjective assessment of histologic sections. RESULTS: In the first part of the study, the post-fixed volume of the anterior chamber and vitreous increased as the concentration (and osmolarity) of formaldehyde decreased. In part II of the study, fixation of whole eyes was optimal with a mixture of 1% buffered formaldehyde and 1.25% glutaraldehyde. The neurosensory retina was less likely to detach from the retinal pigment epithelium, and the anterior chamber retained a more normal shape with this fixative. CONCLUSIONS: Volume contraction of whole eyes fixed in 4% buffered formaldehyde is caused by the relatively high osmolarity of the fixative. Immersion fixation of whole eyes for 36 h (or longer) in 1% buffered formaldehyde/1.25% glutaraldehyde reduces tissue distortion without compromising cellular preservation.

Animals↗
PubMed1995

Hemorrhagic retinopathy as the presenting manifestation of sarcoidosis.

BACKGROUND: The diagnosis of ocular sarcoidosis is particularly challenging in patients who present with atypical clinical findings and no evidence of systemic disease. We describe a patient whose initial clinical manifestation of sarcoidosis was a unilateral hemorrhagic retinopathy. METHOD: Clinicopathologic case study. RESULTS: The diagnosis of sarcoidosis in this patient was delayed for over a year principally because of the atypical retinal findings and because repeated chest X-rays and serum angiotensin covering enzyme (ACE) levels were normal. Surgical enucleation of the eye once it was blind revealed a large noncaseating granuloma of the ciliary body. Inflammation and thrombosis of several large caliber retinal veins and a single branch of the retrolaminar hemicentral retinal vein were found. CONCLUSIONS: Major retinal branch vein occlusion and hemi-central retinal branch occlusion are rare complications of ocular sarcoidosis. Normal serum ACE levels do not exclude the diagnosis of ocular sarcoidosis even in patients with considerable amounts of intraocular granulomatous inflammation.

Adult↗
PubMed1994

Experimental vitreous replacement with perfluorotri-n-propylamine.

OBJECTIVE: To evaluate perfluorotri-n-propylamine, a perfluorocarbon oil, as a temporary vitreous replacement in rabbits. METHODS: After undergoing gas compression vitrectomy, rabbits were injected with perfluorotri-n-propylamine for 24 hours or 2 weeks. The rabbits were evaluated clinically and with electroretinography. The globes were then enucleated and processed for histological evaluation. RESULTS: Clinical results showed droplet dispersion in the 2-week but not in the 24-hour group. Histological evaluation showed no changes in the retinal pigment epithelium or photoreceptor outer segments. Foam cells were seen in the 2-week but not in the 24-hour group. There was a marked dampening of the electroretinographic response that normalized after the removal of the oil. CONCLUSIONS: Perfluorotri-n-propylamine demonstrated no retinal toxic side effects in rabbits and is a promising liquid perfluorocarbon oil.

Animals↗
PubMed1994

Endogenous Klebsiella endophthalmitis. Report of two cases and review of the literature.

BACKGROUND: Endogenous endophthalmitis is a rare complication of gram-negative sepsis. The diagnosis often is delayed unless a high index of suspicion exists. Familiarity with the clinical setting in which endogenous Klebsiella endophthalmitis occurs will hasten diagnosis and may improve outcome. METHODS: The authors reviewed the medical literature and describe two patients with diabetes who lost vision from endogenous Klebsiella endophthalmitis. FINDINGS: One patient lost all vision in both eyes before the diagnosis of sepsis was clinically suspected. In the other, endophthalmitis was the only clinical sign of septicemia 8 days after hospital discharge for treatment of a Klebsiella urinary tract infection. Survey of the literature showed an increase in the number of cases of endogenous Klebsiella endophthalmitis reported over the last 12 years. Sixty-one percent of the 44 patients reported in the literature since 1981 had diabetes, 68% had suppurative liver disease, and 16% had urinary tract infection. CONCLUSION: An important implication of these associations is that metastatic Klebsiella endophthalmitis must be considered when vitritis occurs in patients with diabetes, particularly in those with acute liver disease or a urinary tract infection, or in any patient with vitritis and suppurative liver disease.

Adult↗