Branch retinal vein occlusion in sarcoidosis.
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Adult↗
Biomedical subjects
J C Folk
Publications and source records attributed to J C Folk.
The multiple evanescent white-dot syndrome with acute blind spot enlargement.
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Adult↗
Rural endophthalmitis.
The antibiotic regimens recommended for empiric use in posttraumatic endophthalmitis are based on data collected from medical centers in large metropolitan areas. In rural areas, trauma resulting in endophthalmitis frequently involves injuries with perforating objects that are contaminated with organic matter. These rural cases therefore may not be comparable with endophthalmitis occurring after nonrural injuries. A 10-year retrospective analysis was performed to investigate the incidence of rural endophthalmitis as well as determine the type of causative organisms. Endophthalmitis developed in 24 (30%) of 80 patients with rural penetrating trauma, compared with 23 (11%) of 204 patients with nonrural penetrating trauma. Of 24 patients, Bacillus spp were isolated in 11 (46%), followed by gram-negative rods in 7, Staphylococcus epidermidis in 6, and streptococcal species in 5. In 10 (42%) of these 24 patients with rural trauma, more than one organism was isolated. Bacillus spp were involved in six (60%) of ten of these mixed infections. Based on these findings, the authors suggest an intravitreal regimen of gentamicin along with either vancomycin or clindamycin for the empiric therapy of rural endophthalmitis.
Adolescent↗
Early retinal adhesion from laser photocoagulation.
Histopathologic examination of eight cynomolgus monkey eyes and one human eye revealed that both argon and krypton laser photocoagulation cause adhesion between the neurosensory retina and the retinal pigment epithelium (RPE) within 24 hours of treatment. The neurosensory retina remained attached at the sites of laser burns despite surrounding retinal detachment in untreated areas. This early adhesion with the laser is useful for the treatment of eyes in which the retina has been recently reattached such as at the end of a vitrectomy for a retinal detachment with proliferative vitreoretinopathy (PVR) or after a pneumatic retinopexy. It is also useful for the treatment of retinal breaks without detachment.
Adhesiveness↗
The treatment of serous macular detachment secondary to choroidal melanomas and nevi.
The authors successfully treated with laser photocoagulation five patients who had a serous macular detachment secondary to leakage from a pigmented choroidal tumor. Three patients had dye leakage on fluorescein angiography from a choroidal neovascular membrane. The subretinal fluid resolved in all three patients after the neovascular membrane was obliterated by either krypton red (2 patients) or argon green (1 patient) laser photocoagulation. The other two patients had prominent leakage from a localized choroidal neovascular membrane as well as mild diffuse leakage over the entire tumor. Focal argon laser treatment to the neovascular membrane alone did not cause permanent resolution of the subretinal fluid. The fluid did resolve, however, after the entire area of diffuse leakage was retreated with photocoagulation. In one of the patients who received both focal and confluent laser treatment, the choroidal tumor grew in a collar-button fashion through Bruch's membrane at the original site of focal treatment. This eye was enucleated, and results of histopathologic examination showed a choroidal melanoma.
Aged↗
The fellow eye of patients with phakic lattice retinal detachment.
A retrospective study was performed to determine whether the prophylactic treatment of areas of lattice degeneration, holes, or breaks reduced the risk of subsequent new breaks or detachment in the fellow undetached phakic eyes of patients with a phakic lattice retinal detachment (RD). Three hundred eighty-eight consecutive patients who presented to the University of Iowa between 1959 and 1984 were followed for a mean of 7.9 +/- 5.8 years after the detachment in the first eye. Fellow eyes which received no prophylactic treatment had a 2.5 times greater risk of a new break or RD over 7 years than eyes receiving full prophylactic treatment (19.4 versus 7.5%; P = 0.0002). Fellow eyes receiving no treatment also had a greater risk of a new RD over 7 years than eyes receiving full treatment (5.1 versus 1.8%; P = 0.0125). These results do not allow us to make recommendations concerning which fellow eyes, if any, should be prophylactically treated. On the one hand, prophylactic treatment did significantly reduce the risk of new breaks and detachments. On the other hand, however, prophylactic treatment reduced the risk of new RD alone in the fellow eye only from 5.1 to 1.8% over 7 years. In addition, prophylactic treatment did not reduce the risk of detachment in the higher risk eyes with high myopia or extensive lattice.
Follow-Up Studies↗
Predictors of scleral rupture and the role of vitrectomy in severe blunt ocular trauma.
We reviewed retrospectively 40 eyes that had received blunt trauma and had been explored for scleral rupture. Twenty-nine eyes had scleral rupture. Of these 29, ten had ruptures seen preoperatively. Nineteen had occult ruptures. The preoperative findings predictive of scleral rupture were a visual acuity of light perception or no light perception, an intraocular pressure of less than 10 mm Hg, hyphema, and chemosis. Of the 29 ruptures, 27 involved the superior hemisphere and 25 involved the anterior hemisphere of the globe. Ten of 29 eyes (34%) with scleral rupture and eight of 11 eyes (73%) without rupture achieved a final visual acuity of 5/200 or better over an average follow-up period of 6.7 months. Factors prognostic of ambulatory vision for eyes with ruptured and intact globes included an initial visual acuity of 5/200 or better, absence of scleral rupture, and a rupture length of less than 11 mm in eyes with ruptures. The vitrectomized eyes also had a better result, suggesting that early pars plana vitrectomy is of benefit in selected rupture cases.
Eye Injuries↗
Retinal revascularization following laser photocoagulation treatment for choroidal neovascular membranes.
Retinal revascularization developed within the treatment scar in 7% of patients who had laser photocoagulation treatment for a choroidal neovascular membrane. This revascularization could be mistaken for recurrent choroidal neovascularization because it initially proliferated into a glomerularlike structure and showed dye leakage on angiography. Unlike choroidal neovascularization, these vessels, however, filled entirely from the retinal circulation and stereoscopic angiograms showed them to be located in the inner retina. In the 20 patients who were followed up, the retinal revascularization first appeared approximately four weeks after treatment and persisted for an average of ten weeks. It was associated with dense laser scarring, retinal capillary obliteration, and internal limiting membrane wrinkling, suggesting that heavy initial laser treatment was a predisposing factor for its development. It is important to differentiate retinal revascularization, which has an excellent prognosis and does not require re-treatment, from recurrent choroidal neovascularization, which usually must be treated promptly to avoid loss in visual acuity.
Adult↗
Visual loss after successful photocoagulation of choroidal neovascularization.
A retrospective study was performed on 75 eyes with presumed ocular histoplasmosis syndrome and 59 eyes with aging macular degeneration to determine risk factors for visual loss in the early postoperative period after successful laser photocoagulation of primary and recurrent choroidal neovascular membranes (CNVMs). Despite successful obliteration of neovascularization, visual loss of two lines or greater occurred in 18.8% of eyes with presumed ocular histoplasmosis syndrome and 40.4% of eyes with aging macular degeneration (mean follow-up, 33.6 weeks). Factors which predicted visual loss after treatment included a short distance of CNVMs from the foveal center (P = 0.002), good preoperative visual acuity (P = 0.003), increased area of CNVM (P = 0.025), and postoperative internal limiting membrane wrinkling (P = 0.017). Eyes with CNVMs greater than 0.8 mm2 in area or less than 0.6 mm from the foveal center had at least twice the frequencies of visual loss of eyes without these characteristics.
Adult↗
Laser iris retraction for angle-closure glaucoma after retinal detachment surgery.
Twelve patients with retinal detachment with postoperative angle closure due to ciliary body edema, refractory to topical cycloplegics and corticosteroids, were managed by peripheral iris retraction with argon laser photocoagulation. This gonioscopic procedure results in immediate visualization of angle structures and prompt reduction of intraocular pressure (IOP). Routine tonometry and appropriate gonioscopy are essential to diagnose this form of glaucoma, which does not have a pupillary block component. Timely use of laser iris retraction reduces the risk of chronic glaucoma secondary to synechial closure. In this series, only two of ten patients, not previously known to have glaucoma, require long-term medication to control IOP.
Aged↗
Results and complications of pneumatic retinopexy.
Fifty-one patients with primary rhegmatogenous retinal detachment (RD) were treated by pneumatic retinopexy. The overall success rate for reattachment with one operation was 63%. Of the 34 phakic eyes, 25 (74%) were reattached; of the 17 aphakic or pseudophakic eyes, seven (41%) were reattached (P less than 0.05). Postoperative complications included the development of new tears (22%), inadequate closure of the original tear, shifting and delayed absorption of subretinal fluid, and opening of previously closed tears. Pneumatic retinopexy is a valuable new technique; however, careful patient selection and postoperative management is required.
Aged↗
Branch retinal artery occlusion after dye yellow photocoagulation of an arterial macroaneurysm.
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Aged↗
Accurate gentamicin solution for intravitreal injection.
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Gentamicins↗
Metastatic tumors to the eye and orbit. Patient survival and clinical characteristics.
A review of the charts of 112 patients (141 eyes) presenting with a metastasis to the eye or orbit revealed that breast cancer was the most common primary tumor (49.1%). The median survival time (MST) following choroidal metastasis for all stages of breast cancer was 314 days. The MST after choroidal metastasis in patients thought to have stage I or II breast cancer, prior to diagnosis of the metastasis, was longer than that of patients with stage III or IV cancer (873 vs 139 days, respectively). Lung cancer metastasized to the eye and orbit earlier than did breast cancer (276 vs 1266 days, respectively) and had a shorter MST following this metastasis (188 vs 666 days, respectively). When age was considered as a continuous variable, the data indicated that older patients with breast metastases survived longer than did younger patients. Echography demonstrated that choroidal metastases from breast tumors were thicker than those from lung tumors (3.70 vs 2.59 mm, respectively).
Age Factors↗
Occlusion of bridging or avulsed retinal vessels by repeated photocoagulation.
A technique is described for occlusion of bridging vessels associated with retinal breaks, and recurring vitreous hemorrhage. Argon laser photocoagulation, applied around and to the vessel in repeated sessions, produces scarring and progressive thinning of the retina until laser energy absorbed in the deep pigmented layers can reach the vessel and occlude it. Seventeen patients presenting with vitreous hemorrhage from bridging vessels were treated. Vitreous hemorrhage recurred in only two patients, one of whom had not returned for completion of treatment. The authors conclude that repeated argon laser photocoagulation is a safe, simple, and effective method for preventing recurrent vitreous hemorrhage from bridging vessels.
Aged↗
Bacterial scleral abscesses after retinal buckling operations. Pathogenesis, management, and laboratory investigations.
Between 1971 and 1985, 28 patients were treated for a scleral abscess after a scleral buckle procedure. Twenty-six of the patients had the original surgery performed between those years during which a total of 4480 buckling procedures were performed. Therefore, the incidence of scleral abscess after buckling procedures was 0.58% (26/4480). All 28 patients had excessive pain, conjunctival chemosis and proptosis, a creamy white area of retina on the buckle, and a variable amount of vitreous inflammation. Seventeen of these patients had an especially severe scleral abscess with inflammatory vitreous opacification, which precluded visualization of the retinal vessels or allowed at most a hazy view of the optic nervehead or the scleral buckle. A review of these 17 severely involved patients showed that, in most cases (13 of 17), the vitreous inflammation was sterile. Therefore, most patients can be managed simply with immediate removal of the buckle along with topical and systemic antibiotics. A laboratory investigation showed that a cell-free millipore filtrate of Staphylococcus aureus culture in trypticase soy broth caused prominent but self-limited inflammation when injected intravitreally. Therefore, bacterial toxins or secretions could be the cause of the prominent vitreous inflammation in most patients with scleral abscesses. In another experiment, sponge exoplants, which had been soaked in a highly concentrated culture of S. aureus, were sutured episclerally in rabbits. A scleral abscess developed in 19 of 23 rabbit eyes with these infective sponges. Progressive scleral abscesses, which closely resembled those seen in humans, developed in 14 of the 23 eyes.(ABSTRACT TRUNCATED AT 250 WORDS)
Abscess↗
In vivo comparison of phenylephrine and phenylephrine oxazolidine instilled in the monkey eye.
The ocular and cardiovascular effects as well as aqueous humor and plasma concentrations of 10% phenylephrine HCl and 1% phenylephrine oxazolidine (prodrug) were compared in cynomolgus monkeys. A volume of 25 microliters of either drug was administered to one eye followed by blood pressure, pulse, and pupillary measurements at 10 min intervals up to 60 minutes. Careful slit lamp examinations of the anterior segment, indirect ophthalmoscopy of the vitreous and retina, and ERGs were performed at 60 minutes. Four plasma determinations of phenylephrine following administration of either drug were made between 5 and 60 minutes. Measurement of phenylephrine in aqueous humor was also determined at 60 minutes following all other measurements. The maximal pupillary dilation after administration of 1% prodrug (mean + s.d. = 4.4 + 0.5 mm, n = 12) was slightly greater than after administration of phenylephrine 10% (mean + s.d. = 3.9 + 0.8 mm, n = 12). The differences in pupillary diameter from 20 through 40 minutes were statistically greater for the prodrug. The greater pupillary diameter at the earlier times resulted in an onset of pupillary dilation approximately 15 minutes earlier for the 1% prodrug. There was no ocular toxicity from either drug. Neither drug resulted in any ERG changes compared to baseline. Significantly higher aqueous humor levels along with lower plasma levels were detected and found to be statistically different following administration of the 1% prodrug when compared to 10% phenylephrine.
Animals↗
Relative afferent pupillary defect in eyes with retinal detachment.
Relative afferent pupillary defects were measured before and after surgery in 38 patients with unilateral rhegmatogenous retinal detachment. All 38 patients were measured preoperatively and the mean (+/- SD) pupillary defect was 1.4 +/- 0.7 log units. The afferent pupillary defect decreased in 36 of the 38 patients after successful scleral buckling operations (postoperative mean = 0.4 +/- 0.3 log units). Twenty patients had defects postoperatively of 0.3 log units or less, and seven of these had no measurable defects at all. A prediction model, using the variables of total number of peripheral quadrants detached and whether the macula was detached, yielded the following prediction equation: Relative afferent pupillary defect (log units) = 0.35 X (total quadrants) + 0.68 X macula detachment. This means that the detachment of each peripheral quadrant of retina caused about 0.35 log units of defect, whereas detachment of the macula caused 0.68 log units. The standard error of this estimate was rather large (+/- .65 log units); therefore, the size of the afferent pupillary defect can only roughly predict the extent of the retinal detachment and vice versa.
Humans↗