Cyanoacrylate adhesive in retinal detachment surgery.
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Animals↗
Biomedical subjects
J C Folk
Publications and source records attributed to J C Folk.
Multifocal choroiditis associated with progressive subretinal fibrosis.
Five patients (all female, 14 to 34 years old) had an unusual form of multifocal choroiditis resulting in progressive subretinal fibrosis. This condition differed from other multifocal choroidal diseases such as acute multifocal placoid pigment epitheliopathy, birdshot retinochoroidopathy, and punctate inner choroiditis. Instead of forming atrophic or pigmented chorioretinal scars, the acute lesion healed with the formation of discrete, sharply angulated subretinal scars. In the macula the lesions coalesced, forming broad zones of subretinal fibrosis. Serous and hemorrhagic macular detachment may occur during the course of the disease with fluorescein angiographic features suggesting subretinal neovascularization. Subretinal neovascularization could not, however, explain the widespread scarring. Although progressive subretinal fibrosis may be considered an unusual outcome for a variety of other diseases, we believe that it is a distinct clinical entity distinguishable from other multifocal choroidal diseases. Retinal pigment epithelial hyperplasia may cause the condition.
Adolescent↗
Aqueous vs viscous phenylephrine. I. Systemic absorption and cardiovascular effects.
We studied 30 patients undergoing vitreoretinal surgery to compare the systemic absorption and cardiovascular effects of 2.5% aqueous and 2.5% viscous (21 cp) ophthalmic solutions of phenylephrine hydrochloride. No significant differences were noted in the plasma levels or changes in blood pressure between the two groups, although there was a tendency toward higher mean plasma levels and blood pressures in groups receiving 2.5% aqueous phenylephrine hydrochloride. Maximum plasma levels were achieved within the first 20 minutes following topical application of phenylephrine eye drops, irrespective of the nature of the vehicle. This finding emphasizes the importance of monitoring these patients, especially those at high risk for any adverse cardiovascular effects during the first 20 to 30 minutes following instillation of phenylephrine eye drops. The patients in our study were supine and under general anesthesia. Therefore, there was no effect by lid blinking, the lacrimal pump, or gravity, which would ordinarily increase absorption by the nasal mucosa through the nasolacrimal system. By eliminating these variable factors, such as lid blinking, the study was performed in a stable and controlled manner, but the results may not be directly applicable to an upright awake patient.
Adult↗
Aqueous vs viscous phenylephrine. II. Mydriatic effects.
We performed four studies to determine whether there is a difference in the mydriatic effect of 2.5% aqueous vs 2.5% viscous phenylephrine hydrochloride solutions. The first study was performed under "room light" conditions, and the mean (+/- SD) dilation at one hour was 0.87 +/- 1.18 mm for the aqueous and 0.86 +/- 1.14 mm for the viscous solutions. The second study was performed in a darkened room, and the mean dilation at one hour was slightly greater than in room light but was still minimal (aqueous, 1.14 +/- 1.00 mm; viscous, 1.07 +/- 1.11 mm). In the third study, patients were pretreated with a topical anesthetic (0.5% proparacaine hydrochloride), and the mean one-hour dilation was approximately twice (aqueous, 2.30 +/- 0.81 mm; viscous, 2.41 +/- 0.88 mm) that found in patients who were not pretreated with proparacaine. In the fourth study, the two phenylephrine solutions were used in combination with 1% tropicamide, and the mean one-hour dilation was 3.8 +/- 0.82 mm for the aqueous and 3.8 +/- 0.98 mm for the viscous solutions. Our studies show that there is no difference in the mydriatic effect of 2.5% aqueous vs 2.5% viscous phenylephrine solutions when used alone or in combination with 0.5% proparacaine or 1% tropicamide.
Adult↗
Terson's syndrome. Clinicopathologic correlations.
In seven cases of Terson's syndrome, an elevated, dome-shaped, membrane was detected in the posterior pole by ophthalmoscopy, echography, or during pars plana vitrectomy. Light and electron microscopic examination of two additional eyes obtained postmortem from an acute case of Terson's syndrome revealed that the posterior vitreous face was elevated by blood and that the internal limiting membrane of the retina was intact and in its normal position. In two chronic cases, a dome-shaped epiretinal membrane was excised from the macula during vitrectomy. Light and ultrastructural studies demonstrated that the membranes consisted of glial cells and basement membrane material. The dome-shaped structure observed in eyes with Terson's syndrome is due to the formation of a subhyaloid hemorrhage. The partially detached posterior hyaloid face created by this hemorrhage provides a scaffold for cellular proliferation and the development of an elevated epiretinal membrane in long-standing cases. Echographically, this membrane resembles a retinal detachment in B-scans, but can be clearly distinguished from retina with standardized A-scan.
Adult↗
Internal limiting membrane wrinkling after argon and krypton laser photocoagulation of choroidal neovascularization.
A retrospective study was performed to determine the prevalence and risk factors for internal limiting membrane (ILM) wrinkling following successful argon and krypton laser photocoagulation of choroidal neovascular membranes. The study included 139 eyes with presumed ocular histoplasmosis syndrome (POHS) and age-related macular degeneration (AMD). Argon treated eyes with POHS had a significantly higher prevalence of ILM wrinkling (30/63, 47.6%) than those with AMD (6/40, 15%, P = 0.0007). Krypton treated eyes also demonstrated a higher prevalence of ILM wrinkling in eyes with POHS (3/12, 25%) than in eyes with AMD (2/19, 10.5%) but this difference was not significant. In general, argon-treated eyes had a greater prevalence of ILM wrinkling than krypton treated eyes (35.0% vs 16.1%, P = 0.046). Factors which appeared to increase the risk of ILM wrinkling included intensity of treatment, area of the neovascular membrane, and the presence of subretinal blood.
Adult↗
Sodium hyaluronate (Healon) in closed vitrectomy.
Healon was implanted into the vitreous cavity of 33 eyes at the conclusion of pars plana vitrectomy. In aphakic eyes, Healon diffused rapidly into the anterior chamber, reducing the length of effective tamponade posteriorly and causing marked elevations of intraocular pressure. In phakic diabetic eyes, Healon appeared to trap hemorrhage mechanically from bleeding fibrovascular stumps posteriorly. It may therefore reduce the risk of opacifying vitreous hemorrhage after vitrectomy in phakic eyes with active neovascularization.
Humans↗
Procoagulant effects of intraocular sodium hyaluronate.
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Animals↗
Differentiation between recently resolved optic neuritis and central serous retinopathy. Use of tests of visual function.
A test battery was performed on 13 patients with resolved central serous retinopathy and on 13 patients with resolved optic neuritis to see whether the tests would help to distinguish between the two conditions. We found that the most useful discriminators were the relative afferent pupillary defect, followed by the visual evoked potential latency and the critical flicker frequency. The total error score on the Farnsworth-Munsell 100-Hue Test and the nature of the color vision defect were not helpful in separating the two diseases.
Adult↗
Experiments on the absorption of argon and krypton laser by blood.
Experiments were performed to determine the absorption by and transmission through blood of argon blue-green (ABG) and green (AG) and krypton red (KR) laser light. Krypton was transmitted better through intact erythrocytes than argon. The difference between krypton and argon was greater if the erythrocytes contained oxygenated hemoglobin (Hb) than deoxygenated Hb. None of the wavelengths penetrated well a confluent blood specimen only 4 cells thick. Branch retinal vein occlusions were created in monkeys causing scattered areas of retinal hemorrhage. Argon burns placed in areas of retinal hemorrhage caused much inner or full thickness retinal damage. Krypton passed through the inner retinal hemorrhage without causing damage and created a burn at the level of the retinal pigment epithelium and inner choroid. Preretinal hemorrhages were created in rabbits by perforating Bruch's membrane with a high intensity krypton burn. Argon burns placed over the preretinal hemorrhages were absorbed much more than krypton burns. Neither argon or krypton however could penetrate even moderately thick preretinal hemorrhages to cause an underlying retinal burn.
Adult↗
Aging macular degeneration. Clinical features of treatable disease.
Argon laser treatment reduces visual loss in patients with aged macular degeneration and extrafoveal subretinal neovascular membranes (SRNVM). Ophthalmologists must now educate patients concerning the symptoms of subretinal neovascularization and give them an Amsler grid. If a patient develops symptoms he should be examined promptly. High quality fluorescein angiograms and meticulous contact lens examinations of the macula should be performed to detect subtle neovascularization. Ophthalmologists must be familiar with the clinical and fluorescein angiographic changes of drusen, retinal pigment epithelial atrophy, and retinal pigment epithelial detachments in order to differentiate them from subretinal neovascular membranes.
Aged↗
Treatment of macular hole retinal detachments with intravitreal gas.
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Adult↗
Toxocara canis infection of the eye. Correlation of clinical observations with developing pathology in the primate model.
A primate model for the study of Toxocara canis infection was created by intravitreal, periocular, systemic, and intracarotid injection of viable larvae in cynomolgus monkeys. The results were as follows: (1) Intravitreal larvae caused retinal hemorrhages, perivasculitis, mild vitritis, and retinal nodules. (2) Apparently viable larvae without inflammatory reaction were found in the vitreous, retina, and optic nerves up to nine months after intravitreal inoculation. (3) Other larvae were surrounded by an acute inflammatory granuloma or a chronic fibrotic granuloma, but they did not appear to be necrotic. (4) Toxocara canis larvae apparently had the ability to move through ocular tissue, to leave the site of tissue reaction, and to exit via the optic nerve. Viable larvae were found in the retina up to 15 months after inoculation. (5) Culture fluid containing Toxocara proteins stimulated a severe retinal vasculitis. Dead larvae caused little reaction. (6) Positive aqueous and vitreous enzyme-linked immunosorbent assay titers were found in the most severely inflamed eyes, which often harbored live larvae.
Animals↗
Visual function abnormalities in central serous retinopathy.
Eighteen patients with central serous retinopathy (CSR) underwent a battery of visual function tests when first seen and after resolution of the subretinal fluid. Eyes with CSR had minimal relative afferent pupillary defects, reduced critical flicker-fusion thresholds, prolonged visual evoked potential (VEP) latencies, increased errors on the Farnsworth-Munsell 100-hue (FM 100) test, and depressed central visual fields (Octopus). The afferent pupillary defect and critical flicker-fusion thresholds were the first to improve after resolution of the subretinal fluid. Next in rate of improvement were the visual acuity, the VEP latency, and the FM 100 test results. The threshold of the central Octopus at fixation improved the slowest and was still abnormal during long-term follow-up, indicating a prolonged depression in the threshold of central field sensitivity after resolution of the CSR. Many of these abnormalities are also seen in patients with optic nerve disease.
Adult↗
Punctate inner choroidopathy.
Ten moderately myopic women had blurred vision, light flashes, or paracentral scotomas associated with small yellow-white lesions of the inner choroid and pigment epithelium. Most lesions had an overlying serous detachment, were hyperfluorescent, and leaked fluorescein during the acute phase. The lesions healed into atrophic scars and became progressively more pigmented with time. Subretinal neovascular membranes later developed from scars in six patients. Vision was usually only minimally affected unless the lesions were subfoveal or unless choroidal neovascular membranes subsequently occurred. Extensive laboratory studies were noncontributory.
Adult↗
Presumed toxoplasmic papillitis.
Six patients with ocular toxoplasmosis are described whose only active site of inflammation was at the optic nervehead. These patients presented with severe papillitis, vitreous inflammation, and sector or nerve fiber bundle field defects. Because of the papillitis and the absence of other typical foci of retinitis to suggest toxoplasmosis in these patients, the initial diagnoses were usually incorrect. These cases are presented to familiarize ophthalmologists with this unusual cause of papillitis.
Adolescent↗
Anterior neovascularization.
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Anterior Eye Segment↗
Diabetic rubeosis and panretinal photocoagulation.
Iris fluorescein angiography was used to perform the first prospective, controlled, masked evaluation of the effect of panretinal photocoagulation on diabetic rubeosis. Eyes with rubeosis had iris fluorescein angiograms five to seven weeks apart. Eyes either had laser treatment immediately after the first angiogram or had no laser treatment between angiograms. The rubeosis was said to have improved if all three masked readers independently selected the angiogram performed last as having the less severe rubeosis. In eyes with severe rubeosis, only two of 11 (18%) spontaneously improved whereas 11 of 15 (73%) improved following laser therapy. In eyes with mild rubeosis, one of ten improved spontaneously and one of ten improved following laser therapy. Iris fluorescein angiography documented regression of severe but not mild rubeosis following panretinal photocoagulation.
Clinical Trials as Topic↗