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Biomedical subjects

I U Scott

Publications and source records attributed to I U Scott.

At least 19 recordsLinked to original sources
PubMed2001

Echographic evaluation of a patient with diabetes and dense vitreous hemorrhage: an avulsed retinal vessel may mimic a tractional retinal detachment.

PURPOSE: To report that an avulsed retinal vessel may appear as a tractional retinal detachment on echographic evaluation. METHODS: Case report. RESULTS: A 57-year-old diabetic woman presented with a nonclearing vitreous hemorrhage of 2 months duration in the left eye. Echography was consistent with a localized tractional retinal detachment on longitudinal sections; transverse sections demonstrated a pinpoint opacity in the vitreous cavity. Intraoperatively, an avulsed retinal vessel was noted in the area of echographic abnormality. CONCLUSION: An avulsed retinal vessel may mimic tractional retinal detachment on echography. Although trained ophthalmic echographers routinely perform both longitudinal and transverse sections during an echographic evaluation, less skilled observers must be aware of the importance of performing both longitudinal and transverse sections for accurate echographic diagnosis.

Diabetes Mellitus, Type 1↗
PubMed2001

Emotional distress in patients with retinal disease.

PURPOSE: To investigate the prevalence of, and potential risk factors for, emotional distress among patients with retinal disease. DESIGN: Cross-sectional study. METHODS: Cases consisted of 86 consecutive patients at Wilmer Eye Institute Retinal Vascular Center. Fifty-one controls with normal visual acuity and no known ocular disease were frequency-matched to the cases by age, sex, and race. Subjects were interviewed using the Community Disability Scale, a functional status questionnaire, and the General Health Questionnaire, a questionnaire assessing emotional distress. RESULTS: The prevalence of probable (General Health Questionnaire score 4 or greater and less than 10) or definite (General Health Questionnaire score 10 or greater) emotional distress was 59.3% among ophthalmic patients and 2.0% among controls. There were significant relationships between emotional distress, as assessed by General Health Questionnaire score, and degree of 1) visual impairment, as assessed by weighted bilateral average logarithm of minimal angle of resolution (logMAR), and 2) functional impairment, as assessed by Community Disability Scale score (P =.001). Univariate analyses identified significant predictors of emotional distress: shorter duration of ocular disease (P =.019), worse visual acuity (P =.001), increased systemic comorbidities (P =.001), and increased functional impairment (P <.001). Multiple regression analysis demonstrates that worse visual acuity, increased systemic comorbidities, and shorter duration of ocular disease each explain over 10% of the variability in General Health Questionnaire score (r(2) = 0.15, 0.12, and 0.11, respectively). Addition of Community Disability Scale score to the regression model eliminates the significance of visual acuity and systemic comorbidities; Community Disability Scale score explains nearly 30% of the variability in emotional distress, as assessed by General Health Questionnaire score (r(2) = 0.29). CONCLUSIONS: Emotional distress is prevalent among patients with retinal disease; potential risk factors for emotional distress among such patients include shorter duration of ocular disease, worse visual acuity, increased systemic comorbidities, and increased functional impairment.

Aged↗
PubMed2001

Visual hallucinations in patients with retinal disease.

PURPOSE: To investigate the prevalence and phenomenologic nature of visual hallucinations among patients with retinal disease and to investigate whether presence of hallucinations is a significant predictor of functional status, quality of life, and/or emotional distress after adjusting for visual acuity. DESIGN: Cross-sectional study. METHODS: Eighty-six consecutive patients at the Wilmer Ophthalmologic Institute Retinal Vascular Center were interviewed using the Sickness Impact Profile, Community Disability Scale, General Health Questionnaire, Visual Phenomena Interview, Eysenck Personality Questionnaire, and Telephone Interview for Cognitive Status. RESULTS: The prevalence of visual hallucinations was 15.1%. Most were formed hallucinations in clear consciousness that lasted for seconds to minutes. The majority of patients had been experiencing visual hallucinations for less than 1 year (61.5%) or for 1 to 2 years (23.1%). Only two of the 13 patients with hallucinations had informed a physician of their hallucinations. Univariate analyses revealed that variables significantly associated with experiencing hallucinations were female sex, worse visual acuity, bilateral visual impairment, emotional distress, decreased functional status, and decreased quality of life. Regression analysis demonstrated that among patients with relatively good vision, those who experienced hallucinations were more emotionally distressed and had a lower quality of life than patients without hallucinations. CONCLUSIONS: Visual hallucinations among patients with retinal disease are common, underdiagnosed, and not associated with cognitive deficits, abnormal personality traits, or a family or personal history of psychiatric morbidity. Among patients with relatively good vision, hallucinations are associated with increased emotional distress and decreased quality of life.

Cross-Sectional Studies↗
PubMed2001

Endophthalmitis caused by Moraxella species.

PURPOSE: To report the incidence, clinical presentation, antibiotic sensitivities, and treatment outcomes for endophthalmitis caused by Moraxella species. METHODS: Consecutive interventional case series. Medical records were reviewed of all patients treated at Bascom Palmer Eye Institute between 1991 and 2000 for endophthalmitis caused by Moraxella species. RESULTS: Moraxella species were recovered from 9 patients (10 eyes), or 1.3% (10 of 757) of all culture-proven bacterial endophthalmitis cases; Moraxella catarrhalis was recovered from 7 eyes and Moraxella osloensis from 3. Endophthalmitis was delayed-onset (5 months to 10 years postoperatively) and bleb-associated in 9 eyes and trauma-related in 1. All isolates were sensitive to ceftazidime, ciprofloxacin, and the aminoglycosides, and they were resistant to vancomycin; resistance to ampicillin and trimethoprim/sulfa was 11%. Although presenting vision was hand motion or worse in 7 of 10 eyes, all but 3 regained baseline visual acuity (including two eyes in which the post-treatment course was complicated by retinal detachment and one eye with coexistent traumatic injuries). CONCLUSION: Endophthalmitis caused by Moraxella species is usually delayed-onset and bleb-associated. Although patients usually present with a profound decrease in vision, the organisms are sensitive to most antibiotics and, unlike most series of delayed-onset bleb-associated endophthalmitis, visual outcomes are generally good unless coexistent ocular morbidities exist.

Adult↗
PubMed2001

Outcomes of vitreoretinal surgery for complications of branch retinal vein occlusion.

OBJECTIVE: To investigate outcomes of vitreoretinal surgery for complications of branch retinal vein occlusion (BRVO). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The medical records of all patients who underwent vitreoretinal surgery for complications of BRVO at Bascom Palmer Eye Institute between January 1, 1991 and December 31, 1998 were reviewed. Thirty-six eyes from 36 consecutive patients were identified. MAIN OUTCOME MEASURES: Visual acuity outcomes include preservation of preoperative visual acuity and visual acuity greater than or equal to 20/40, 20/200 and 5/200. When preoperative retinal detachment was present, the anatomic outcome assessed was complete retinal attachment. Postoperative event rates of retinal detachment, vitreous hemorrhage, epiretinal membrane (ERM), and cataract were tabulated. All outcomes were assessed at 6 months. RESULTS: Surgical indications included nonclearing vitreous hemorrhage (17 patients), traction retinal detachment involving the macula (15), and ERM (4). Mean follow-up was 19 months. Preoperatively, best-corrected vision was greater than or equal to 20/200 in 19/36 (53%) eyes. Six months postoperatively, best-corrected vision was greater than or equal to 20/40 in 12/36 (33%) eyes, greater than or equal to 20/200 in 27/36 (75%) eyes, and greater than or equal to 5/200 in 31/36 (86%) eyes. Postoperative complications included retinal detachment (2/36; 6% eyes), ERM (3; 8%), vitreous hemorrhage (2; 6%), suprachoroidal hemorrhage (1; 3%), central retinal vein occlusion (1; 3%), and central retinal artery occlusion (1; 3%). Clinical features associated with better visual outcome include better preoperative visual acuity (P: = 0.05), absence of preoperative afferent pupillary defect (P: = 0.01), and absence of preoperative macular edema (P: = 0.08). CONCLUSIONS: Following surgery, retinal attachment and improved visual acuity were achieved in the majority of patients. Pre-existing pathology and postoperative complications may limit final vision in eyes with BRVO.

Adult↗
PubMed2001

Intermediate-term outcomes of 350-mm(2) Baerveldt glaucoma implants.

OBJECTIVE: To determine the intermediate-term outcome of 350-mm(2) Baerveldt glaucoma implants. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Sixty-five patients (65 eyes). INTERVENTION: Implantation of 350-mm(2) Baerveldt glaucoma drainage device. MAIN OUTCOME MEASURES: Intraocular pressure, number of glaucoma medications, best-corrected Snellen visual acuity, length of follow-up, risk factors for failure, and complications. RESULTS: Mean intraocular pressure was reduced from a preoperative value of 32 mmHg to a 2-year postoperative value of 14 mmHg (56% reduction, P < 0.001). Success rates at 2-year follow-up were 71%, 81%, 78%, 60%, and 47% for the overall group, primary open-angle glaucoma group, neovascular group, uveitic group, and other group, respectively. After accounting for the effect of diagnosis group, significant risk factors in the overall group for failure at 2 years included younger age, high preoperative intraocular pressure, and more prior incisional surgeries. Glaucoma medication use in our overall study population was reduced from 2.5 mean preoperative medications to 0.8 postoperative medications (68%). Median change in Snellen visual acuity between preoperative and 2-year postoperative visits was not significant in the overall group. Postoperative complications included choroidal effusion in 15 patients (23%), tube obstruction by blood or vitreous in five patients (8%), phthisis in four patients (6%), aqueous misdirection in two patients (3%), strabismus in two patients (3%), tube-cornea touch in two patients (3%), endophthalmitis in two patients (3%), and retinal detachment in two patients (3%). No patients had suprachoroidal hemorrhage. CONCLUSIONS: The 350-mm(2) Baerveldt glaucoma implants are a safe and effective treatment for intermediate-term intraocular pressure control in patients with refractory glaucoma.

Adult↗
PubMed2001

Long-term follow-up of unoperated macular holes.

OBJECTIVE: To investigate the anatomic and visual acuity outcomes among patients with unoperated macular holes and at least 5 years of follow-up. DESIGN: Retrospective, noncomparative case series from an institutional practice setting. PARTICIPANTS: All patients with unoperated full-thickness macular holes evaluated at Bascom Palmer Eye Institute between January 1, 1968 and December 31, 1993 and observed for at least 5 years. METHODS: Demographic and clinical data were abstracted from patients' medical records and ophthalmologic photography records. For patients with bilateral macular holes, only one eye was included. MAIN OUTCOME MEASURES: Visual acuity and clinical features on initial examination, at 5 years, and at final follow-up. RESULTS: The study included 65 eyes of 65 patients with a median age of 65 years (range, 52-85 years) and a median follow-up of 9.3 years (range, 5-29 years). On initial examination at Bascom Palmer Eye Institute, the macular hole was stage 2 in 15 eyes (24%), stage 3 in 23 eyes (37%), and stage 4 in 25 eyes (40%). At final follow-up, the macular hole was stage 3 in 10 eyes (16%) and stage 4 in 53 eyes (84%). Visual acuity was 20/200 or worse in 35 eyes (54%) on initial examination, in 43 eyes (74%) at 5 years, and in 53 eyes (82%) at final follow-up. Poorer visual acuity on initial examination was a significant predictor of poorer final vision (P < 0.01). Other accompanying clinical features such as the presence of operculum, posterior vitreous detachment, and epiretinal membrane were not significantly associated with final vision. Throughout follow-up, there was a redistribution and reduced number of yellow nodular opacities at the level of the retinal pigment epithelium at the base of the macular holes and the development of retinal pigment epithelial atrophy around the macular holes. CONCLUSIONS: Long-term follow-up of unoperated macular holes demonstrates progression in hole size and stage, vision loss which generally stabilizes at the 20/200 to 20/400 level, a redistribution and reduced number of yellow nodular opacities at the level of the retinal pigment epithelium, and the development of retinal pigment epithelial atrophy surrounding the macular hole, resulting in a "bull's-eye" macular appearance.

Aged↗
PubMed2001

Late endophthalmitis associated with glaucoma drainage implants.

OBJECTIVE: To report the clinical course of a series of patients who had late endophthalmitis develop after glaucoma drainage implant (GDI) surgery. DESIGN: Noncomparative, interventional, consecutive case series. PARTICIPANTS: Four patients were identified with late endophthalmitis associated with Baerveldt glaucoma implants. METHODS: The medical records of all patients with endophthalmitis associated with a GDI treated at the Bascom Palmer Eye Institute or University of Florida between January 1, 1987 and December 31, 1999 were retrospectively reviewed. Patients with culture-positive endophthalmitis diagnosed more than 1 month after GDI surgery were included in this series. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure (IOP). RESULTS: Late endophthalmitis associated with Baerveldt glaucoma implants developed 7 weeks to 2 years postoperatively. Exposure of the GDI tube was present in all cases. The implant was removed in three of four patients. Visual acuity worsened from preinfection level in two of four cases. IOP was controlled at last follow-up in all patients, although replacement of the explanted GDI was required in one patient. CONCLUSIONS: Late endophthalmitis may occur after GDI surgery. Exposure of the GDI tube seems to represent a major risk factor for these infections. To prevent this potentially devastating complication, we recommend prophylactic surgical revision with a patch graft in all cases in which there is an exposed GDI tube.

Aged↗
PubMed2001

Corneal graft survival and intraocular pressure control after penetrating keratoplasty and glaucoma drainage device implantation.

OBJECTIVE: To investigate corneal graft survival rates and intraocular pressure (IOP) control in eyes after penetrating keratoplasty (PK) and glaucoma drainage device (GDD) implantation. DESIGN: Retrospective, comparative, consecutive case series. PARTICIPANTS: All patients who underwent PK and GDD implantation at the Bascom Palmer Eye Institute between January 1, 1993 and October 31, 1998. MAIN OUTCOME MEASURES: Graft clarity and IOP control. RESULTS: Of the 72 eyes in 72 patients identified, 47 (65%) underwent combined PK and GDD implantation, and 25 (35%) underwent GDD placement after PK (2-30 months after PK; median, 13 months). The GDD type was Baerveldt 350 mm(2) in 57 eyes, Ahmed in 9, Krupin in 2, and other in 4 eyes. The GDD was placed in the anterior chamber in 54 eyes (75%) and in the vitreous cavity in 18 eyes (25%). Preoperative IOP was 11 to 53 mmHg with or without antiglaucoma medications in 16 eyes (30%) with the GDD implanted in the anterior chamber and in 4 eyes (22%) with the GDD placed in the vitreous cavity (P = 0.76). At 1 year after GDD implantation, the graft was clear in 26 eyes (48%) with the GDD in the anterior chamber compared with 15 eyes (83%) with the GDD in the vitreous cavity (P = 0.013). Forty-eight eyes (89%) with the GDD in the anterior chamber and 18 eyes (100%) with the GDD in the vitreous cavity had IOP between 5 and 21 mmHg with or without antiglaucoma medications (P = 0.33). The mean reduction in IOP, 1 year after surgery, was 12 mmHg among eyes with the GDD in the anterior chamber, compared with 17 mmHg among eyes with the GDD in the vitreous cavity (P = 0.13) CONCLUSIONS: Corneal graft survival at 1 year is significantly higher among eyes with the GDD implanted in the vitreous cavity compared with those in which the GDD is implanted in the anterior chamber. The IOP was significantly lower at 1 year after surgery compared with before surgery in both groups, and there was no significant difference between the groups in IOP control and amount of IOP reduction. There was no significant difference in corneal graft survival or IOP control between eyes with the GDD implanted concurrently with the PK versus after the PK.

Adolescent↗
PubMed2001

Cataract surgery in previously vitrectomized eyes.

Because of the application of vitreoretinal surgical techniques to a broader range of posterior segment diseases and because cataract develops frequently in postvitrectomy eyes, cataract surgeons should be familiar with the challenges of cataract extraction in vitrectomized eyes. The cataract surgeon can prepare for these challenges with awareness of such potential factors as an excessively mobile posterior capsule, possible need for vitrectomy equipment, and special considerations concerning intraocular lens selection and power calculation. Knowledge of ocular comorbidities will help the cataract surgeon to counsel the patient appropriately and will help the patient to form realistic expectations. Despite the challenges it presents, cataract extraction in postvitrectomy eyes is usually associated with favorable visual outcomes.

Cataract↗
PubMed2001

Retained lens fragments after cataract surgery.

In conclusion, the incidence of retained lens fragments appears to have increased in recent years. The timing of vitrectomy can be delayed to permit improvement of corneal edema, ocular congestion, and acute postoperative inflammation. Placement of a posterior chamber intraocular lens at the time of the initial cataract surgery does not adversely affect final visual results. Retinal detachment is a frequent adverse event in these eyes. Vitrectomy and removal of retained lens fragments restores good visual acuity and reduces secondary glaucoma in the majority of patients.

Cataract Extraction↗
PubMed2001

Lacrimal gland ductal cyst abscess.

PURPOSE: To describe a case of lacrimal gland ductal cyst complicated by secondary infection. METHODS: Case report. RESULTS: A 51-year-old woman presented acutely with an enlarging, painful mass in the superotemporal fornix. Clinical examination, echography, and surgical evaluation revealed a lacrimal gland ductal cyst with abscess formation. The lacrimal gland cyst was treated with oral antibiotics in combination with incision, drainage, and marsupialization. CONCLUSIONS: Lacrimal gland ductal cysts are rare but must be considered in the differential diagnosis of lacrimal gland and upper eyelid mass lesions. Typically, lacrimal gland ductal cysts develop after chronic inflammation, infection, or trauma. We describe a patient who presented acutely with a lacrimal gland ductal cyst associated with a rare complication of abscess formation.

Abscess↗
PubMed2001

Long-term visual outcome in patients with anterior visual pathway gliomas.

OBJECTIVES: To investigate the visual outcomes of patients with gliomas of the anterior visual pathway and the clinical features associated with prognosis. MATERIALS AND METHODS: During retrospective review, demographic and clinical data were abstracted from medical records of patients seen at the Bascom Palmer Eye Institute between January 1, 1970 and December 31, 1998. RESULTS: Of the 42 patients identified, 68% were female, and 55% had neurofibromatosis (NF) type I. There was no substantial difference in presenting signs, symptoms, and visual acuity between the NF(+) and NF(-) groups except for nystagmus, which was more common in the NF(-) group (p = 0.014). Throughout follow-up evaluation, vision in the better eye remained stable in both groups, independent of treatment or NF status. Vision in the worse eye often declined, despite treatment. However, binocular visual status, measured as average weighted logMAR (MAR, minimum angle of resolution) vision, did not change significantly over time, regardless of treatment or NF status. CONCLUSIONS: In the NF(+) and NF(-) groups, vision in the better eye remained stable, regardless of treatment, and vision in the worse eye often declined, despite treatment. Binocular visual acuity (measured as weighted logMAR) did not change significantly over time, regardless of NF status or treatment modality.

Adolescent↗
PubMed2001

Optic neuropathy and chiasmopathy in the diagnosis of systemic lupus erythematosus.

PURPOSE: To report the clinical presentation of acute visual loss in six patients who were ultimately diagnosed with systemic lupus erythematosus (SLE). METHODS: Retrospective case series. RESULTS: All patients had a positive antinuclear antibody and elevated anti-double stranded DNA titers. Five of six patients demonstrated gadolinium enhancement of the optic nerve and/or chiasm on magnetic resonance imaging (MRI). Most patients showed initial improvement after treatment with high-dose systemic corticosteroids, but five experienced recrudescences during steroid taper, requiring further treatment with immunosuppressive or cytotoxic medications. CONCLUSIONS: Visual loss owing to optic neuropathy or chiasmopathy may be the presenting sign of SLE or the event that leads to this diagnosis. Gadolinium-enhanced MRI is useful for identifying anterior visual pathway lesions in these patients. Corticosteroids are effective in the treatment of this condition; however, relapses requiring further treatment are common.

Adult↗
PubMed2001

Evaluation of chemoprophylaxis in patients with unilateral retinoblastoma with high-risk features on histopathologic examination.

OBJECTIVES: To identify risk factors for metastatic disease on histopathologic specimens of enucleated eyes from patients with unilateral retinoblastoma, and to evaluate the value of chemoprophylaxis in preventing disease dissemination. METHODS: Medical records from patients with unilateral retinoblastoma who underwent primary enucleation were reviewed at the University of California, San Francisco (1977-1998) and Bascom Palmer Eye Institute, University of Miami, Miami, Fla (1991-1998). All routine histopathologic specimens were reexamined. The extent of tumor invasion into the optic nerve or ocular coats and the prescribed chemoprophylactic regimen were recorded. RESULTS: This retrospective study included 129 patients followed for a median of 54 months. Three patients had tumor invading the sclera. The optic nerve was involved to some extent in 82 patients, 11 of whom had tumor extension beyond the lamina cribrosa. The surgical margin of the optic nerve was involved in an additional 4 patients. The choroid was involved in 43 patients, and was considered massively affected in 12 patients. Anterior segment involvement was observed in 10 patients. Postenucleation chemoprophylaxis was administered to 4 of 4 patients who had tumor cells at the surgical margin of the optic nerve and to 7 of 11 patients with postlaminar disease, all of whom had at least 1 mm of postlaminar tumor extension. External beam radiotherapy was administered to 3/4 and 1/11 of these patients, respectively. Chemoprophylaxis was not administered to patients with choroidal or anterior chamber involvement unless the optic nerve was also involved beyond the lamina cribrosa. One patient with tumor extending to the surgical margin of the optic nerve died of metastatic disease. CONCLUSIONS: Chemoprophylaxis is necessary for patients with tumor extending to the surgical margin of the optic nerve and is likely to be beneficial in preventing metastases in patients with tumor extending beyond the lamina cribrosa. We did not offer chemoprophylaxis to patients with prelaminar optic nerve disease or isolated choroidal involvement, and these patients remained free of disseminated disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Baerveldt drainage implants in eyes with a preexisting scleral buckle.

OBJECTIVE: To describe the surgical insertion of a Baerveldt drainage implant and postoperative visual acuity and intraocular pressure (IOP) outcomes in patients with a preexisting scleral buckle. METHODS: Medical records of all patients with a preexisting scleral buckle who underwent insertion of a Baerveldt drainage implant at Bascom Palmer Eye Institute, Miami, Fla, from January 1, 1994, through December 31, 1998, were reviewed. Outcome measures included visual acuity and IOP at 1 year. RESULTS: At 1 year postoperatively, 14 (88%) of 16 patients had stable or improved visual acuity. Preoperatively, mean IOP was 30.9 mm Hg and the mean number of antiglaucoma medications was 3.4; at 1 year postoperatively, mean IOP was 12.0 mm Hg and the mean number of antiglaucoma medications was 0.8 (P<.001). Nine patients (56%) achieved an IOP of greater than 5 and no greater than 21 mm Hg without medication, and an additional 7 (44%) achieved this level of IOP control with medication. No patient required further surgery for uncontrolled IOP during the follow-up interval, which ranged from 19. 1 to 45.5 months. CONCLUSION: Baerveldt drainage device insertion behind or over a preexisting encircling band is often successful in managing refractory glaucoma in patients who have undergone previous scleral buckling procedures. Arch Ophthalmol. 2000;118:1509-1513

Adolescent↗