Late-onset bleb-related panophthalmitis with orbital abscess caused by Pseudomonas stutzeri.
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Abscess↗
Biomedical subjects
J M Liebmann
Publications and source records attributed to J M Liebmann.
Iris and ciliary body melanomas: ultrasound biomicroscopy with histopathologic correlation.
OBJECTIVE: To correlate ultrasound biomicroscopic images of iris and ciliary body melanomas with their histopathologic features. METHODS: Ultrasound biomicroscopy was performed in 3 cases of iris melanoma and in 3 cases of ciliary body melanoma. Cross-sectional ultrasound biomicroscopic images were compared with findings from clinical examination and light microscopy to evaluate associations between their histopathologic, surface, and internal ultrasound characteristics. Unique images of intrastomal and obscured posterior tumor margins were visualized by ultrasound biomicroscopy. RESULTS: Results of this study revealed that ultrasound biomicroscopy offers an accurate method to evaluate tumor shape, reflectivity, and local invasion. Neoplastic tissue had only medium echogenicity. Enlarged vessels were correlated to echolucent spaces in the iris stroma. Anterior tumor margins were found within the iris stroma, within the anterior chamber angle, and on the endothelial surface of the cornea. Posterior tumor extension was noted to encroach onto the lens, into the sclera, and serous peripheral retinal detachments were associated with ciliary body tumors. CONCLUSION: Ultrasound biomicroscopic images correlated well with histopathologic features of anterior uveal melanomas including shape, reflectivity, and local extension. Arch Ophthalmol. 2000;118:1515-1521
Aged↗
Risk factors for glaucoma filtering bleb infections.
OBJECTIVE: To determine risk factors for bleb-related ocular infection after glaucoma filtering surgery. METHODS: A case-control study comparing all consecutive cases of glaucoma filtering bleb-related infections (55 eyes of 55 patients) with matched control eyes between January 1, 1990, and June 30, 1998, was performed. Bleb-related infection was classified as blebitis when a mucopurulent infiltrate was identified within the bleb and associated with mild to moderate anterior segment inflammation. Eyes with endophthalmitis had hypopyon, cells in the anterior vitreous cavity, or a positive vitreous biopsy sampling result. A control was selected for each case based on matching of the surgeon, date and type of glaucoma surgery, and type of antifibrotic agent used. Multivariate, matched, case-control logistic regression analysis was performed using age, race, sex, diagnosis, number of previous incisional operations, filtering bleb location, and presence of bleb leak to determine which variables were associated with bleb-related infection. RESULTS: The odds of an eye with a bleb-related infection being seen with a concomitant late-onset bleb leak are 25.8 times the odds of a noninfected eye having a late-onset bleb leak at any time in the postoperative period (P<.001; 95% confidence interval, 2.3-294.1). Other risk factors for bleb-related infection included younger age (P = .05), black race (P = .03), diagnosis of primary open-angle glaucoma (P = .03), and inferior location of the filtering bleb (P = .04). CONCLUSIONS: Late-onset bleb leakage is a significant risk factor for bleb-related infection. The risk of infection may warrant closure of late-onset bleb leaks in selected eyes.
Aged↗
Assessment of retinal nerve fiber layer internal reflectivity in eyes with and without glaucoma using optical coherence tomography.
OBJECTIVE: To assess the internal reflectivity of the retinal nerve fiber layer in normal, ocular hypertensive, and glaucomatous eyes using optical coherence tomography. METHODS: All patients underwent complete ophthalmic examination and achromatic automated perimetry. Intraocular pressure was 21 mm Hg or less for low-tension glaucoma and normal eyes and at least 25 mm Hg on 2 separate occasions in ocular hypertensive and high-tension glaucoma eyes. All glaucomatous eyes had characteristic glaucomatous optic neuropathy and associated achromatic automated perimetry defect. Relative retinal nerve fiber layer internal reflectivity was measured on optical coherence tomography images using a software program of our own design. RESULTS: We enrolled 98 eyes (19 normal, 34 ocular hypertensive, 17 high-tension glaucoma, and 28 low-tension glaucoma). Relative internal reflectivity was less in eyes with glaucoma than in normal (P<.001, t test) and ocular hypertensive eyes (P<.001, t test). There was no difference in relative internal reflectivity between normal and ocular hypertensive eyes (P =.32) and between eyes with high-tension glaucoma and low-tension glaucoma (P =.43). Internal reflectivity correlated with mean deviation on achromated automatic perimetry (r(2) = 0.49, P<.001, quadratic regression analysis). CONCLUSION: Relative retinal nerve fiber layer internal reflectivity may provide useful information about the extent of retinal nerve fiber layer injury in glaucoma. Arch Ophthalmol. 2000;118:1044-1047
Adult↗
Optical coherence tomography and scanning laser polarimetry in normal, ocular hypertensive, and glaucomatous eyes.
PURPOSE: To evaluate the relationship between visual function and retinal nerve fiber layer measurements obtained with scanning laser polarimetry and optical coherence tomography in a masked, prospective trial. METHODS: Consecutive normal, ocular hypertensive, and glaucomatous subjects who met inclusion and exclusion criteria were evaluated. Complete ophthalmologic examination, disk photography, scanning laser polarimetry, optical coherence tomography, and automated achromatic perimetry were performed. RESULTS: Seventy-eight eyes of 78 patients (17 normal, 23 ocular hypertensive, and 38 glaucomatous) were enrolled (mean age, 56.8+/-11.5 years; range, 26 to 75 years). Eyes with glaucoma had significantly greater neural network scores on scanning laser polarimetry and lower maximum modulation, ellipse modulation, and mean retinal nerve fiber layer thickness measured with optical coherence tomography compared with normal and ocular hypertensive eyes, respectively (all P<.005). Significant associations were observed between neural network number (r = -.51, r = .03), maximum modulation (r = .39, r = -.32), ellipse modulation (r = .36, r = -.28), and optical coherence tomography-generated retinal nerve fiber layer thickness (r = .68, r = -.59) and visual field mean deviation and corrected pattern standard deviation, respectively. All scanning laser polarimetry parameters were significantly associated with optical coherence tomography-generated retinal nerve fiber layer thickness. CONCLUSION: Optical coherence tomography and scanning laser polarimetry were capable of differentiating glaucomatous from nonglaucomatous populations in this cohort; however considerable measurement overlap was observed among normal, ocular hypertensive, and glaucomatous eyes. Retinal nerve fiber layer structural measurements demonstrated good correlation with visual function, and retinal nerve fiber layer thickness by optical coherence tomography correlated with retardation measurements by scanning laser polarimetry.
Adult↗
Scanning laser polarimetry measurements after laser-assisted in situ keratomileusis.
PURPOSE: To evaluate the effect of laser-assisted in situ keratomileusis on retinal nerve fiber layer thickness measurements obtained with scanning laser polarimetry. METHODS: Thirteen consecutive eyes (13 patients) undergoing laser-assisted in situ keratomileusis were enrolled in this prospective study. Scanning laser polarimetry (NFA-GDx; Laser Diagnostic Technologies, Inc, San Diego, California) examination was performed 1 week before and 1 to 8 weeks after laser-assisted in situ keratomileusis surgery. Intraocular pressure was normal at all preoperative and postoperative examinations. Total mean, and superior, temporal, inferior, and nasal mean retinal nerve fiber layer thickness values before and after laser-assisted in situ keratomileusis were compared by Student paired t test. RESULTS: Mean +/- SD patient age was 34.6 +/- 10.9 years (range, 20 to 56 years). Mean +/- SD preoperative spherical equivalent refractive error was -6.6 +/- 3.1 diopters (range, -3.25 to -13.25 diopters) and mean +/- SD spherical equivalent refractive surgical correction was -6.2 +/- 3.0 diopters (range, -2.9 to -12.25 diopters). Total mean retinal nerve fiber layer and superior, inferior, temporal, and nasal mean retinal nerve fiber layer thicknesses were thinner after laser-assisted in situ keratomileusis (P =.01, for all comparisons, paired t test). CONCLUSIONS: Measurements of the retinal nerve fiber layer with scanning laser polarimetry depend on a corneal compensator inherent in the device. Keratorefractive surgery may affect scanning laser polarimetry measurements.
Adult↗
Combined exfoliation and pigment dispersion: paradigm of an overlap syndrome.
OBJECTIVE: To describe a series of patients with combined pigment dispersion syndrome (PDS) and exfoliation syndrome (XFS) and to introduce a concept, the overlap syndrome, to aid in assessing multiple risk factors for glaucomatous damage. DESIGN: Clinic-based, cross-sectional study. SETTING: New York Eye and Ear Infirmary. PARTICIPANTS: Twenty-six patients identified from the glaucoma database as having combined pigment dispersion syndrome-glaucoma and exfoliation syndrome-glaucoma. MAIN OUTCOME MEASURES: Quantification of patients with both pigment dispersion syndrome-glaucoma (PDS/PG) and exfoliation syndrome-glaucoma (XFS/XFG) and its clinical implications. RESULTS: Among the 26 patients (all white) having both XFS/XFG and PDS/PG, the average age was 64.3 +/- 9.8 years and 19 of 26 were men. All patients had bilateral PDS/PG. Bilateral XFS/XFG was present in 9 of 26 patients and, of the 17 patients with unilateral involvement, the left eye was affected in 13. CONCLUSIONS: Both XFS and PDS are common. Middle-aged patients with known PDS/PG should be suspected of having the onset of XFS if one eye escapes intraocular pressure control. Patients with unilateral XFG at presentation may also have signs of PDS/PG, often remitted. We define the term overlap syndrome to describe the sequential appearance over time of two or more risk factors for glaucomatous damage. The appearance of a new risk factor in a patient whose condition has been stable can alter the course and prognosis of the disease. This concept should prove useful in dealing with secondary and normal-tension glaucomas.
Aged↗
Low-dose 5-fluorouracil trabeculectomy as initial surgery in uncomplicated glaucoma: long-term followup.
OBJECTIVE: To compare the effectiveness of trabeculectomy with adjunctive, low-dose, subconjunctival 5-fluorouracil (5-FU) to trabeculectomy alone in patients with uncomplicated glaucoma undergoing their first incisional surgical procedure. DESIGN: Retrospective, nonrandomized comparative trial. PARTICIPANTS: Consecutive series of 52 patients and 74 control subjects. INTERVENTION: Trabeculectomy was performed in all patients. Study patients received adjunctive, subconjunctival injections of 5-FU up to 14 days from the date of surgery. MAIN OUTCOME MEASURES: Intraocular pressure, number of postoperative antiglaucoma medications, interventions, and complications were evaluated. RESULTS: Mean followup for all patients was 58.1 +/- 44.1 months (range, 1.1-159.9 months). Mean followup for successful eyes was 55.9 +/- 47.1 months (range, 7.6-159.9 months). The cumulative 5-year success (intraocular pressure [IOP] < or = 21 mmHg) was 77.8% in the 5-FU group and 62.2% in the control group (P = 0.02, Wilcoxon test. Complete success (IOP < or = 21 mmHg without medications) at 5 years was lower in both the 5-FU group (72.3%) and the control group (51.3%). Postoperative mean IOP at 5 years for all successful patients was lower in eyes receiving 5-FU (10.7 +/- 3.6 mmHg vs. 16.0 +/- 6.1 mmHg [P = 0.02, t-test]). For those patients considered to be complete successes, there was no difference in IOP between the two groups of patients at any evaluated time interval. Patients in the 5-FU group were using 0.7 +/- 1.1 medications at final followup compared with 1.8 +/- 1.4 medications in the control group (P = < 0.0001, t test). Bleb-related ocular infection occurred in 6.3% of patients and was more common in patients receiving 5-FU than controls (6 of 52 vs 2 of 74, respectively; P = 0.05, Fischer's exact test). CONCLUSIONS: Adjunctive, low-dose 5-FU at the time of initial surgery in uncomplicated glaucoma improves long-term IOP control and reduces the need for postoperative, antiglaucoma therapy. Eyes receiving 5-FU are at greater risk of developing late bleb-related ocular infection.
Adolescent↗
Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas.
PURPOSE: To evaluate the effectiveness and safety of trabeculectomy with mitomycin-C (MMC) in the management of childhood glaucomas. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: All patients less than 18 years of age who underwent trabeculectomy with MMC from June 1991 through October 1997 were included. METHODS: The medical records of 29 consecutive patients (29 eyes) were reviewed. Data collected during routine patient follow-up were analyzed. Surgical outcome was evaluated using Kaplan-Meier life-table analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included intraocular pressure (IOP) control, visual acuity, and identification of complications. Successful IOP control was defined as 5 mmHg < or = final IOP < or = 21 mmHg, with or without antiglaucoma medications and without further glaucoma surgery or loss of light perception. Outcomes for the group of patients with primary infantile glaucoma were compared with those for the group with secondary glaucomas. RESULTS: Mean patient age was 6.4 +/- 4.4 years (range, 0.2-15.3 years). A variety of primary and secondary glaucomas were represented. Mitomycin-C (0.5 mg/ml) on a surgical sponge was applied to the episcleral surface for an average of 3.8 +/- 1.0 minutes (range, 1.5-5.0 minutes). Mean follow-up time for patients categorized as successes was 25.1 +/- 16.0 months (range, 5.5-59.7 months). The 12-, 24-, and 36-month life-table success rates for IOP control were 82%, 59%, and 59% respectively. There was no difference between the primary infantile glaucoma group and the secondary glaucoma group with respect to length of follow-up, rate of successful IOP control, and incidence of complications. Five patients (17%) experienced late bleb-related infection (BRI) at an average of 27.9 +/- 18.1 months (range, 5.4-55.5 months) after surgery. Other complications included hyphema, retinal detachment, late-onset bleb leak, flat anterior chamber, chronic hypotony, decompression retinopathy, suture abscess, and phthisis. CONCLUSIONS: Trabeculectomy with MMC may be useful in the management of childhood glaucomas in which goniotomy, trabeculotomy, or both have failed. However, the high incidence of BRI in this series over an extended follow-up interval dictates caution in using MMC as an adjunct in pediatric trabeculectomy.
Adolescent↗
Quantitative assessment of the anterior segment using ultrasound biomicroscopy.
The development of ocular imaging devices has progressed rapidly during the past 10 years. Ultrasound biomicroscopy has revolutionized the evaluation of the anterior segment of the eye. The qualitative information gathered using this technology has contributed to our understanding of the pathophysiology of angle-closure glaucoma, pigmentary glaucoma, and a variety of other anterior segment disorders. However, the area of quantitative analysis of ultrasound biomicroscopic images remains largely to be developed. This review describes the role of ultrasound biomicroscopy in the measurement of the anatomic structures and their configurations within the anterior segment. Included are previously published and established methods as well as methods in their early stages of development. Application of quantitative image analysis techniques should yield significant information about mechanisms of appositional angle closure, dynamic functions of the iris, accommodation, and presbyopia.
Anterior Eye Segment↗
Structural-functional relationships of the optic nerve in glaucoma.
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Disease Progression↗
Bleb related ocular infection: a feature of the HELP syndrome. Hypotony, endophthalmitis, leak, pain.
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Antimetabolites↗
An attempt to detect glaucomatous damage to the inner retina with the multifocal ERG.
PURPOSE: To detect glaucomatous damage to the inner retina using the multifocal electroretinogram (mERG). METHODS: The stimulus array consisted of 103 hexagons with a mean luminance of 100 cd/m2 and a contrast of 50%. The mERG was recorded from 13 control subjects, 18 patients with open-angle glaucoma (OAG), 4 glaucoma suspects, and one patient with ischemic optic neuropathy (ION). Individual responses, as well as responses summed within quadrants or across the entire array, were measured in a number of ways. Humphrey visual fields were obtained for all patients, and the mean total deviation (MD) values for the 18 patients with OAG ranged from -2.2 to -18.2 with a mean (SD) of -7.3 (4.5). RESULTS: The mERG measure that best discriminated between the patients and the control subjects was the ratio of the amplitude at 8 msec after the peak response to the amplitude at the peak. Although the value of this ratio fell below the median of the control group for 16 of the 18 OAG patients, only 6 of these patients had ratios that fell below the normal range. Other measures of first- and second-order kernels did not do as well. Both within and across patients, the correlation between local field loss and the mERG ratio measure was poor. Furthermore, although in some patients the mERG waveform is clearly different from normal, in other patients (including the patient with ION) the waveform approximates the normal even in visual field areas with substantial sensitivity loss. CONCLUSIONS: Because glaucomatous damage is known to affect the ganglion cell axon, these data suggest that damage to ganglion cell axons is not a sufficient condition to produce changes in the mERG as measured here and that in patients with clear changes in mERG waveforms, these changes do not appear to be well localized and local waveforms are poorly correlated with local changes in field sensitivity.
Adult↗
An interocular comparison of the multifocal VEP: a possible technique for detecting local damage to the optic nerve.
PURPOSE: To develop a quantitative measure of local damage to the ganglion cells/optic nerve based on an interocular comparison of multifocal visual evoked potentials (mVEP). METHODS: Multifocal VEPs were recorded from both eyes of six normal subjects and four patients; each eye was stimulated separately. Two of the patients had glaucoma, one had ischemic optic neuropathy, and one had unilateral optic neuritis. All four patients had considerably more damage in one eye than in the other, as indicated by their Humphrey visual fields. The multi-input procedure of Sutter was used to obtain 60 VEP responses to a scaled checkerboard pattern. The amplitude in each response was obtained using a root mean square measure of response magnitude. For each of the 60 pairs of responses, a ratio between the amplitude of the responses from the two eyes was obtained as a measure of the relative health of one eye compared with the other. The mean and SD of this ratio measure for the control group were used to specify confidence intervals for each of the 60 locations. All patients had Humphrey 24-2 visual fields performed. To allow a comparison of the mVEPs to the visual fields, a procedure was developed for displaying the results of both tests on a common set of coordinates. RESULTS: Except for a small interocular difference in timing attributable to nasotemporal retinal differences, the pairs of mVEP responses from the two eyes of the control subjects were essentially identical. Many of the pairs of responses from the patients were significantly different. In general, there was reasonably good agreement with the Humphrey 24-2 visual field data. Although some regions with visual field defects were not detected in the mVEP due to small responses from the better eye, other abnormalities were detected that were hard to discern in the visual fields. CONCLUSIONS: Local monocular damage to the ganglion cell/optic nerve can be quantitatively measured by an interocular comparison of the mVEP.
Adult↗
Late closure of argon laser iridotomies following regrowth of iris pigment epithelium.
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Aged↗
Iridolenticular contact decreases following laser iridotomy for pigment dispersion syndrome.
OBJECTIVE: To evaluate changes in anterior segment anatomy after laser iridotomy for pigment dispersion syndrome. METHODS: Ultrasound biomicroscopy was performed on 7 eyes of 7 untreated patients with reverse pupillary block and pigment dispersion syndrome. A radially oriented image with the probe perpendicular to the eye in the superior meridian was obtained before and at least 1 week after laser iridotomy in each eye. We assessed changes in angle recess area and iris-lens contact distance. RESULTS: Mean +/- SD patient age was 31.3 +/- 5.7 years and mean +/- SD refractive error was -5.0 +/- 3.9 diopters. Angle recess area (mean +/- SD, 0.78 +/- 0.28 vs 0.35 +/- 0.11 mm2; P=.001, paired t test) and iris-lens contact distance (2.05 +/- 0.28 vs 0.79 +/- 0.13 mm; P<.001) decreased following iridotomy. Central anterior chamber depth did not change. CONCLUSION: Flattening of the iris following laser iridotomy for pigment dispersion syndrome causes a decrease in iris-lens contact and angle width while lens position remains constant.
Adult↗
Hyphema associated with pupillary dilation in a patient with exfoliation glaucoma and warfarin therapy.
PURPOSE: To describe an unusual hemorrhagic complication associated with pupillary dilation in a patient with exfoliation glaucoma taking anticoagulation therapy. METHODS: A 78-year-old woman with bilateral exfoliation glaucoma who was receiving warfarin, 2 mg daily, for systemic anticoagulation developed acute visual loss in the right eye several hours after pupillary dilation. RESULT: Examination disclosed bilateral advanced exfoliation glaucoma, localized vascularized iridolenticular adhesions in the right eye, and a 4-mm layered hyphema in the right eye. CONCLUSION: Patients with exfoliation glaucoma and vascularized posterior synechiae who are receiving anticoagulation therapy are at increased risk for visually significant spontaneous hyphema after pupillary dilation.
Aged↗
Noninfectious crystalline keratopathy after postoperative subconjunctival 5-fluorouracil.
PURPOSE: To describe a case of transient, noninfectious crystalline keratopathy after postoperative subconjunctival 5-fluorouracil. METHOD: Case report. Slit-lamp biomicroscopic examinations were performed during serial office examinations. RESULTS: A 69-year-old woman underwent an uncomplicated trabeculectomy with adjunctive sponge 5-fluorouracil application for 5 minutes in her left eye. Postoperative treatment included topical prednisolone acetate, ciprofloxacin, and scopolamine. She was initially examined with intrastromal corneal crystalline deposits 5 days after her first postoperative subconjunctival injection of 5-fluorouracil. The deposits completely disappeared 4 days later without addition to or change in treatment. CONCLUSION: Transient, noninfectious, crystalline, intrastromal corneal deposits may develop after adjunctive subconjunctival 5-fluorouracil administration.
Aged↗