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Biomedical subjects

D W Park

Publications and source records attributed to D W Park.

11 recordsLinked to original sources

Phakic patients with cystoid macular edema, retinal periphlebitis, and vitreous inflammation.

OBJECTIVE: To characterize a group of phakic patients with idiopathic intermediate uveitis as defined by vitritis, cystoid macular edema, and retinal periphlebitis. DESIGN: Cross-sectional study. PARTICIPANTS: Nineteen phakic patients (35 eyes) with vitreous inflammation, cystoid macular edema, and/or retinal periphlebitis of unknown cause. INTERVENTION: None. MAIN OUTCOME MEASURES: Best-corrected final visual acuities, standardized clinical examinations, photographic and fluorescein angiographic evaluations, and class I and II HLA analysis on all 19 patients. RESULTS: Fifteen of the 19 patients were women. The mean age was 38 years, the mean follow-up was 104 months, and the mean duration of symptoms was 154 months. All 35 affected eyes had significant vitritis; 21 eyes (60%) had cystoid macular edema, 21 eyes (60%) had retinal periphlebitis. The median initial visual acuity was 20/30. The median final visual acuity was 20/20 with 32 (91%) of 35 eyes having 20/40 or better visual acuity at the final visit. No patient developed "snow-banks" or evidence of systemic disease, including multiple sclerosis or sarcoidosis, during the follow-up period. There were no statistically significant HLA associations in these patients compared with controls from another study from Iowa, but the Iowa phakic patients with cystoid macular edema did differ from the Iowa patients with pars-planitis at loci HLA-B8, HLA-B51, and HLA-DR2. CONCLUSIONS: We describe a disease entity of idiopathic intermediate uveitis that affects primarily young to middle-aged women and usually causes bilateral vitritis, cystoid macular edema, and retinal periphlebitis. Most patients retained good vision over a prolonged follow-up period. Multiple sequential examinations and HLA associations suggest that these conditions are distinct from other syndromes of intermediate uveitis, particularly parsplanitis.

Adolescent

Acute posterior multifocal placoid pigment epitheliopathy with corneal stromal infiltrates.

PURPOSE: To report the association of perilimbal corneal stromal infiltrates with acute posterior multifocal placoid pigment epitheliopathy. METHOD: Case report. RESULTS: A 29-year-old woman with bilateral fundus lesions typical of acute posterior multifocal placoid pigment epitheliopathy presented with peripheral corneal stromal infiltrates that resolved with fundus lesions. CONCLUSION: Corneal stromal infiltrates may be associated with characteristic fundus lesions of acute posterior multifocal placoid pigment epitheliopathy.

Acute Disease

Subacute sclerosing panencephalitis manifesting as viral retinitis: clinical and histopathologic findings.

PURPOSE AND METHODS: To describe the clinical and histopathologic features of a patient with viral retinitis secondary to subacute sclerosing panencephalitis. RESULTS: The patient was a human immunodeficiency virus-negative intravenous drug abuser with an acute retinitis that later progressed to encephalitis despite aggressive treatment for possible viral, protozoal, bacterial, and rickettsial infections. The patient had many of the characteristic findings of subacute sclerosing panencephalitis, including a history of measles in early childhood, myoclonus, periodic complexes on electroencephalographic testing, persistently elevated serum and cerebrospinal fluid antimeasles immunoglobulin G (IgG) titers, and a cerebrospinal fluid oligoclonal IgG gammopathy. Ultrastructural examination demonstrated numerous filamentous microtubular intranuclear viral inclusions in the nuclear layers of the retina consistent with the measles virus. This case is unusual in that our patient developed subacute sclerosing panencephalitis later in life and because there was an 8-year period between presumed viral infections in the two eyes. CONCLUSIONS: An acute retinitis in an intravenous drug abuser is not always caused by human immunodeficiency virus-related infections; not all viral retinitis responds to therapy; and mortality as well as the usual morbidity may be associated with viral retinitis. One might consider the diagnosis of subacute sclerosing panencephalitis in a young person with an acute retinitis with little or no vitreal inflammation and lack of response to anticytomegalovirus and antitoxoplasmosis therapy.

Adult

Grid laser photocoagulation for macular edema in bilateral juxtafoveal telangiectasis.

OBJECTIVE: The purpose of the study is to report the efficacy of laser photocoagulation treatment for macular edema in bilateral juxtafoveal telangiectasis (BJT). DESIGN: The study design was a retrospective, clinical study. PARTICIPANTS: The authors observed 14 patients with BJT, studying the visual acuities and retinal changes of treated and untreated eyes. MAIN OUTCOME MEASURES: Visual acuity, presence of macular edema, and associated retinal findings were measured. RESULTS: Of 28 eyes, 10 (8 patients) received 15 laser photocoagulation treatments for macular edema. Neither treated nor untreated eyes had visual improvement of two or more lines. After treatment, five eyes (50%) had increased retinal vascular distortion develop, three (30%) had new draining retinal venules, five (50%) had intraretinal fibrovascular tissues, and four (40%) had retinal and preretinal hemorrhages develop. CONCLUSIONS: Grid laser photocoagulation therapy for macular edema in patients with BJT appears to neither improve nor stabilize long-term visual acuity. In addition, treatment is associated with retinal pigment epithelial changes, increased postoperative retinal vascular distortion, postoperative vascularized retinal scars, and postoperative retinal hemorrhages. These changes, however, do not appear to cause a further loss of vision.

Aged

Ring retinal pigment epithelial window defect of the macula in central serous chorioretinopathy.

PURPOSE: Central serous chorioretinopathy is usually a benign disorder, in which resolution of serous subretinal fluid and return to a visual acuity of 20/40 or better is the normal outcome. In unusual cases of central serous chorioretinopathy, chronic subretinal fluid can lead to permanent retinal pigment epithelial depigmentation. In this report, we describe a ring-like (bull's eye) pattern of retinal pigment epithelial atrophy associated with central serous chorioretinopathy. METHODS: We examined eight patients (nine eyes) with central serous chorioretinopathy in whom retinal pigment epithelial window defects encircling the fovea developed. RESULTS: The average duration of symptoms before recognition of a circular window defect was 6 years. Visual acuity at the time of documentation of the ring-like window defect was 20/40 or worse in seven of nine (77%) eyes. Although laser photocoagulation treatment was performed in six of the nine eyes, vision improved two or more lines in only one eye (17%). CONCLUSION: Chronic central serous chorioretinopathy can cause a ring-like (bull's eye) pattern of retinal pigment epithelial window defects encircling the fovea. This pattern of retinal pigment epithelial window defect when seen in patients with central serous chorioretinopathy may indicate that a patient has a more severe form of central serous chorioretinopathy.

Adult

Effect of diclofenac sodium (Voltaren) on hypoxia-induced corneal edema in humans.

We evaluated the effect of diclofenac sodium (Voltaren) drops on patients with hypoxia-induced corneal edema. Thirty age- and sex-matched subjects were randomly assigned to one of three groups. Members of each group received masked solutions of either Voltaren, Voltaren vehicle, or a non-preserved lubricant (Cellufresh) every 6 hours for 24 hours and then hourly for 2 hours immediately prior to inducing corneal edema in the experimental eye. Bilateral ultrasonic pachymetry was performed prior to applying a thick contact lens and light patch on the experimental eye of all subjects for 3 hours. The fellow eye served as the control. Following lens removal, bilateral corneal thickness was measured every 30 minutes. The percentage change in corneal swelling for each subject and group was calculated. The findings were also normalized to the control eye to minimize diurnal and individual variability. The results were plotted both as percentage change from hour 0 and percentage change normalized to the control eye. Corneal swelling ranged from 9-11% in all 3 groups, with recovery at 2-3 hours. No significant difference was found among the three groups (P > 0.05, ANOVA). There was a slight trend toward reduced thickness in the Cellufresh group, but this was not statistically significant. Voltaren does not appear to have an effect on the hypoxia-induced corneal edema associated with the production of arachidonic acid pathway metabolites.

Adult

Transrectal color Doppler ultrasonography for postejaculation hematuria.

A case involving an adult man with postejaculation hematuria (PEH) is described. We used transrectal color Doppler ultrasonography to evaluate periprostatic or intraprostatic vascular anomalies. We confirmed a vascular anomaly by angiography and embolized it. Periprostatic vascular anomaly may be a cause of PEH, and color Doppler ultrasonography is helpful for the initial studies of this entity.

Arteriovenous Malformations

Central serous chorioretinopathy in two families.

PURPOSE AND METHODS: The reported occurrence of central serous chorioretinopathy (CSCR) in families is rare. We report two families (five patients) who have been diagnosed with CSCR. The diagnosis of CSCR was made on clinical and fluorescein angiographic findings. RESULTS: Three members of the first family and two members of the second family had CSCR. Affected individuals were all males. CONCLUSIONS: CSCR has been associated with psychological and emotional stress and the occurrence of CSCR in families may be due to similar inherited psychological and physiological characteristics and responses that predispose these families to the development of CSCR.

Adult