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Biomedical subjects

C L Schepens

Publications and source records attributed to C L Schepens.

At least 73 records · Page 4Linked to original sources
PubMed1985

Biomicroscopic study of the vitreous in eyes with macular pucker after retinal detachment surgery.

The posterior vitreous condition of 43 eyes with macular pucker following retinal detachment surgery was studied using the El Bayadi-Kajiura preset lens mounted on a slit lamp. The posterior vitreous was found to be attached in one eye (2%), completely detached in 29 eyes (68%), and partially detached with residual vitreoretinal adhesion to the macular area in 13 eyes (30%). Macular pucker with partial posterior vitreous detachment was significantly more frequent (P less than .05) in eyes with refractive errors of -4 diopters or less. That condition was also accompanied by a higher incidence of dye leakage in the macular area by fluorescein angiography, a shorter time lapse between retinal detachment surgery and development of macular pucker, and a worse visual outcome than was found in eyes with complete posterior vitreous detachment.

Adult↗
PubMed1984

Manifestations of Whipple's disease in the posterior segment of the eye.

Ocular manifestations of Whipple's disease result from CNS involvement, direct intraocular involvement, or both. Ocular signs caused by CNS involvement occurred in 30 of the 34 patients with ocular manifestations described in the literature. In only four of the 34 cases were ocular manifestations due solely to intraocular involvement. Two cases reported herein had unique intraocular involvement, manifested as diffuse chorioretinal inflammation. Fluorescein angiography showed diffuse vasculitis, with hemorrhages, exudates, retinal capillary occlusion in the perifoveal and midperipheral areas, capillary dilation at the optic disc, and choroidal folds. Proper antibiotic treatment resulted in ocular and systemic recovery. Follow-up is mandatory because of possible recurrences, which may start with intraocular signs, followed by systemic manifestations. Some cases progress to fetal CNS involvement. Therefore, when intraocular signs recur in treated patients, antibiotic therapy should be restarted or dose should be increased.

Adult↗
PubMed1984

Immersion A- and B-scan ultrasonography. Its use in preoperative evaluation of diabetic vitreous hemorrhage.

Immersion A- and B-scan ultrasonography was performed before vitreous surgery in 256 eyes with diabetic vitreous hemorrhage. Of 32 eyes with vitreous hemorrhage without vitreous traction (group 1), 28 (88%) showed useful postoperative vision. Of 87 eyes with vitreous traction without tractional retinal detachment (group 2), 69 (79%) had useful postoperative vision. Eyes with tractional retinal detachments were classified as follows: X-shaped detachment with narrow vitreoretinal adhesions (group 3, 75 eyes), and H-shaped detachment with broad vitreoretinal adhesions (group 4, 62 eyes). Useful postoperative vision returned in 43 eyes in group 3 (57%) and in only 14 eyes in group 4 (23%), a statistically significant difference. Visual improvement was greater in groups 1 and 2 than in groups 3 and 4. Postoperative functional results were worse when the macular area was the site of vitreoretinal adhesion and traction.

Adolescent↗
PubMed1984

Surgical treatments of proliferative vitreoretinopathy.

Four hundred ten eyes with retinal detachment and proliferative vitreoretinopathy underwent closed vitrectomy with membrane peeling, scleral buckling, and intraocular air injection. The retina was reattached in 243 eyes (59.3%). Useful vision was attained in 223 eyes. The preoperative proliferative vitreoretinopathy was clinically graded in six groups of increasing severity (C-1, C-2, C-3, D-1, D-2, D-3). From grades C-2 to D-3, a significant trend related a decreased rate of retinal reattachment with increased severity. However, grade C-1 showed a significantly lower success rate than did grade C-2. Scleral buckling alone may be the treatment of choice in grade C-1 eyes. Grade D-3 eyes had the worst anatomic and functional results. Preoperatively, there was a significant relationship between increasing severity of proliferative vitreoretinopathy and frequency of aphakia, and aphakic eyes showed a significantly lower rate of retinal reattachment than did phakic eyes.

Adult↗
PubMed1984

Role of the vitreous in cystoid macular edema.

Eyes suffering from various conditions, such as aphakia, diabetic retinopathy, peripheral uveitis, branch vein occlusion, or retinitis pigmentosa, are predisposed to vitreous detachment. When vitreous detachment occurs, the vitreous can remain attached to the macula due to a firm vitreomacular adhesion. This partial posterior vitreous detachment associated with continuous vitreous traction to the macular area can lead to the development of cystoid macular edema. Two types of vitreous traction have been observed: traction with narrow vitreous strand and traction with broad vitreoretinal adhesion. It has been postulated that the posterior vitreous can cause cystoid macular edema by vitreous contraction without vitreous detachment, producing tractional forces at sites of firm vitreoretinal adhesions that are located at the optic disc and macula. Cystoid macular edema is often accompanied by leakage from dilated retinal capillaries at the optic disc.

Adult↗
PubMed1984

Retinal pigment epithelium decompensation. I. Clinical features and natural course.

We studied 97 eyes (73 patients) that showed a sharp contrast between the grossly normal appearance of the posterior pole by funduscopy and the fluorescein angiography findings of multiple patches of retinal pigment epithelium (RPE) transmission defect in the early transit, associated with focal areas of RPE staining in the late transit. The staining was located primarily at the superior edge of the RPE defect (63 eyes). The average age of the patients was 52.2 years at the time of diagnosis, and the ratio of men to women was 3.5 to 1. Ocular histories were unremarkable, except for 27 eyes with documented central serous retinopathy. Thirty-two consecutive eyes have been followed for an average of 3.9 years, and 30 of those eyes have shown visual deterioration.

Adult↗
PubMed1984

Severe proliferative vitreoretinopathy and retinal detachment. II. Surgical results with scleral buckling.

Prior to the era of vitrectomy, scleral buckling was used to treat 521 eyes with total retinal detachment and proliferative vitreoretinopathy (PVR) of various degrees of severity. The retina was reattached for at least six months in 46.9% of eyes; the anatomic success rate decreased with increasing severity of PVR. Within each grade of PVR, the reattachment rate was higher for eyes with smaller breaks than for eyes with larger breaks, and the prognosis was not worse when smaller breaks were found than when no breaks were found. The cumulative success rate rose with increasing number of reoperations. None of the anatomically successful cases had a final visual acuity of no light perception; 82.9% of them achieved a visual acuity of counting fingers or better. The prognosis for visual improvement after successful scleral buckling was unrelated to the preoperative severity of PVR. Severe intraoperative complications occurred in 5.0% of the eyes, all of which resulted in failure.

Eye Diseases↗
PubMed1984

Severe proliferative vitreoretinopathy and retinal detachment. I. Initial clinical findings.

We studied 716 eyes of 697 patients with retinal detachment associated with the more advanced stages of proliferative vitreoretinopathy (PVR). The factors that influenced the severity of PVR and our criteria for surgical treatment were analyzed using statistical methods. The more severe cases of PVR showed a higher prevalence of cases with (1) retinal detachment exceeding 12 months' duration, (2) no retinal breaks observed, (3) the largest retinal break of a size equal to or exceeding one clock hour, and (4) poor initial visual acuity. Compared with the unoperated group, the eyes on which we subsequently operated were characterized by a greater prevalence of (1) patients with bilateral retinal detachment complicated by PVR, (2) cases with relatively recent onset of retinal detachment, (3) phakic eyes, (4) eyes without vitreous hemorrhage, (5) eyes with one or more visible retinal breaks and with smaller breaks, (6) relatively better initial visual acuity, and (7) less severe degrees of PVR.

Eye Diseases↗
PubMed1984

Natural history of choroidal neovascularization in degenerative myopia.

We studied 354 eyes with myopic chorioretinal degeneration by means of standard clinical evaluation and fluorescein angiography. The eyes were classified on the basis of the degree of chorioretinal degeneration found in the posterior pole. Lacquer cracks (breaks in Bruch's membrane) were noted in 82% of the 149 eyes with choroidal neovascular membranes (CNM) and in 96% of the 58 eyes with isolated subretinal hemorrhages. These hemorrhages were reabsorbed without adverse visual sequelae in 32 eyes that were followed; in 14 of these eyes that were followed closely, the average time of reabsorption was 6.4 weeks. Seventy eyes with CNM were followed for an average of 40.9 months. In 96% of these eyes the CNM remained stable or regressed, leaving an atrophic, nonexudative scar. This study indicates that CNM in degenerative myopia is usually self-limited.

Adolescent↗
PubMed1984

Retinal pigment epithelium decompensation. II. Laser treatment.

Forty-one of 97 eyes with retinal pigment epithelium decompensation (RPED) were treated with monochromatic green argon laser photocoagulation to the focal area of RPE staining detected in the late fluorescein transit. Nineteen eyes were treated because of progressive visual deterioration. The other 22 eyes already had visual acuities of 20/50 or worse. Vision stabilized or improved in 34 eyes (82.9%) after an average of 1.6 years following treatment, compared with improvement in only 5 of 56 untreated eyes after an average follow-up period of 2.1 years. After an average follow-up of 7.1 years, 12 of 97 eyes with RPED developed choroidal neovascularization (9 spontaneously and 3 after photocoagulation) in the area where late RPE staining had been observed.

Adult↗
PubMed1984

An optimized zoom ophthalmoscope.

An indirect ophthalmoscope that could provide higher magnification (up to 15X) would offer definite advantages in fundus diagnosis. If it could also supply an erect fundus image, it could advantageously replace the surgical microscope in vitrectomy operations. The surgical microscope requires the use of a contact lens, which restricts the surgical techniques and may damage the corneal epithelium, and it reduces image brightness when the magnification is increased. In contrast, an indirect ophthalmoscope does not require a contact lens and keeps the image brightness constant regardless of magnification. Increased magnification can be obtained in an indirect ophthalmoscope by incorporating telescopes in the ophthalmoscope oculars. The possible use of two telescopic systems, Keplerian and Galilean, and the problems of stereopsis and image inversion are discussed. A new, optimized ophthalmoscope is described, with Keplerian telescopes, that provides a range of magnifications from 2X to 15X as well as options for an erect or inverted fundus image.

Humans↗
PubMed1984

Chronic macular edema in retinal branch vein occlusion: role of laser photocoagulation.

We used the monochromatic green argon laser to treat 41 eyes with retinal branch vein occlusion (RBVO) and decreased vision because of chronic macular edema of at least six months duration after the onset of RBVO. The average follow-up period after treatment was 19 months. Cystoid macular edema (CME) occurred in 34 eyes and noncystoid macular edema in seven eyes. In eyes with chronic CME we decreased intracapillary pressure in the portion of the macula drained by the occluded vein by segmental retinal arteriolar narrowing using photocoagulation to the retinal arterioles that perfused the involved portion of the macula. Partial or complete resolution of macular edema occurred in 27 eyes. Vision improved in 19 eyes and was stabilized in seven eyes. In eyes with chronic noncystoid macular edema treatment consisted of focal closure of leaking microaneurysms and retinal telangiectasias with photocoagulation. Closure of these leaking vessels associated with partial or complete resorption of hard exudates that had accumulated in the macula secondary to the leakage occurred in six of the seven photocoagulated eyes. Vision improved in four eyes and was stabilized in two eyes.

Aged↗
PubMed1984

Choroidal melanoma associated with rhegmatogenous retinal detachment.

A case of pigmented choroidal lesion coincident with rhegmatogenous retinal detachment was observed. The patient refused enucleation, and the retinal detachment was successfully treated by diathermy without drainage of subretinal fluid. Clinically the lesion was observed to enlarge, and upon enucleation five years after diathermy the tumor was seen to be a spindle-cell choroidal melanoma. The patient died from metastases of melanoma six years after the enucleation.

Choroid Neoplasms↗
PubMed1983

Choroidal neovascularization in fellow eyes of patients with advanced senile macular degeneration. Role of laser photocoagulation.

Choroidal neovascularization in fellow eyes of patients with advanced disciform macular scars usually has an unfavorable prognosis. Fifty-two such fellow eyes were treated, using the monochromatic green argon laser. The neovascular membranes were foveal in 24 eyes, juxtafoveal in ten eyes, and perifoveal in 18 eyes. Complete closure of the choroidal new vessels after treatment was seen in 46 eyes. Only one eye in the foveal group and five eyes in the juxtafoveal group had residual new vessels. After an average follow-up period of 16 months, improvement or stabilization of vision was seen in 36 eyes--18 eyes in the foveal group, four in the juxtafoveal group, and 14 in the perifoveal group. In view of the rewarding anatomical and functional results, photocoagulation, using the monochromatic green argon laser, should be considered in these high-risk eyes. Treatment of foveal neovascular membranes seems to be indicated if the visual acuity is 20/70 or worse.

Aged↗
PubMed1983

Intravitreous silicone injection. Histopathologic findings in a human eye after 12 years.

Histopathologic changes occurred in a human eyeball enucleated 12 years after intravitreous silicone injection for the treatment of complicated retinal detachment with massive preretinal membrane. Silicone "bubbles" (droplets) were found in the chamber angle, iris, ciliary body, retina, and preretinal and subretinal membrane, as well as in the optic nerve. Clinically, glaucoma developed in the eye. A review of the literature indicates that the common late complications of intravitreous silicone injection are cataract, glaucoma, and retinal changes.

Adult↗
PubMed1983

Management of choroidal neovascularization within the foveal avascular zone in senile macular degeneration.

After fluorescein angiography, central visual field testing, and photofield mapping, 94 eyes with senile macular degeneration and foveal choroidal new vessels (distance of 200 micron or less from the center of the foveal avascular zone) were treated with the monochromatic green argon laser. By the end of the follow-up period (average follow-up, 15 months), the new vessels were closed in 88 eyes and visual acuity was stabilized or improved in 70 eyes. These 70 eyes included 68 of 80 eyes with preoperative visual acuities of 20/70 or worse and only two of 14 eyes with preoperative visual acuities of 20/60 or better. Visual acuity was stabilized or improved in 55 of 62 eyes in which the foveal edge of the choroidal new vessels was within the margins of the pretreatment scotoma and in only 15 of 32 eyes with foveal edges extending beyond the scotoma margins.

Choroid↗
PubMed1983

Biomicroscopic study of the vitreous in macular breaks.

The vitreous in 74 eyes with macular breaks was studied using the El Bayadi-Kajiura preset lens mounted on a slit lamp. Fifteen of the eyes had macular breaks secondary to various causes, and 59 eyes had idiopathic senile macular breaks. Vitreous traction, indicated by the presence of opercula or visible vitreous strands, was present in 29 (49%) of the idiopathic cases. In 17 of 31 eyes without posterior vitreous detachment (PVD), an operculum was seen. In these eyes, intravitreous traction was suspected to be the cause of macular breaks. Opercula were seen attached to the posterior hyaloid membrane in six of the nine eyes with partial PVD. An operculum corresponding to the macular break was observed on the posterior hyaloid membrane in only five of 19 eyes with complete PVD. Of the 15 eyes with macular breaks secondary to various causes, complete PVD was seen in 10 eyes, one of which had an operculum. One eye had no PVD, and four eyes had partial PVD. Opercula were detected in two of the latter eyes. In one eye of the senile group and one eye of the secondary group, partial PVD caused traction at the edges of the macular break, resulting in retinal detachment.

Adult↗