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Biomedical subjects

L E Magargal

Publications and source records attributed to L E Magargal.

At least 37 records · Page 2Linked to original sources
PubMed1988

Resolved incomplete central retinal-artery obstruction simulating ischemic optic neuropathy.

To our knowledge, this is the first reported case of an embolic three-fourths central retinal-artery obstruction with isolated sparing of the superior temporal branch artery. Multiple nonfoveolar-sparing cilioretinal arteries were also present. As a result of the unusual obstruction distribution, ischemic optic neuropathy was simulated after a five-month interval. Patients who are not seen acutely after a retinal-artery obstruction may be diagnosed and managed incorrectly if this variation from the usual condition is not recognized.

Aged↗
PubMed1988

Central retinal-artery occlusion in proliferative sickle-cell retinopathy after retrobulbar injection.

Central retinal-artery obstruction (CRAO) is a devastating complication after retrobulbar anesthesia, a procedure which was previously recommended routinely to immobilize the eye and reduce discomfort during laser surgery. Recent developments in treatment technique, involving scatter laser applications given over several sessions with smaller spot sizes and shorter durations, have virtually eliminated the need for retrobulbar injections and the risks of retrobulbar hemorrhage, which can cause increased intraocular pressure and culminate in closure of the arterial circulation. We present the case of a patient with proliferative sickle retinopathy who sustained such a complication after direct photocoagulation treatment of sea-fans elsewhere and offer alternative treatment techniques which we have used for the past ten years that eliminate this hazard.

Adult↗
PubMed1987

Proliferative sickle cell retinopathy under age 20: a review.

Of the 256 sickle patients with hemaglobinopathies SC, SS and S-thal referred to the Wills Eye Hospital Retina Vascular Service from 1966 through 1983, 64 (50%) of the 128 males and 71 (55%) of the 128 females were less than 20 years old. Proliferative sickle retinopathy (PSR) was documented by fluorescein angiography in five of the males (8%) and two of the females (3%) under age 20. Included in this series is a 13-year-old black girl with homozygous sickle cell anemia (HbSS), to our knowledge the youngest reported case of PSR in an SS patient. This report emphasizes the importance of ophthalmic examinations in teenage sickle patients to detect and treat proliferative disease.

Adolescent↗
PubMed1987

Peripheral multifield scanning fluorescein angiography for the evaluation of proliferative sickle cell retinopathy.

Evaluation of proliferative sickle cell retinopathy requires detailed studies of the retina periphery, including pre-treatment documentation of active neovascular (sea fan) lesions. Multifield angiography of the periphery (MAP) is recommended for the analysis of these lesions. This method is also valuable for the pre- and post-treatment quantitative angiographic evaluation of peripheral circumferential retinal scatter photocoagulation (PCRP).

Anemia, Sickle Cell↗
PubMed1987

Review of choroidal osteoma: successful krypton red laser photocoagulation of an associated subretinal neovascular membrane involving the fovea.

Laser treatment of a subretinal neovascular membrane associated with a unilateral choroidal osteoma in a 28-year-old woman is described. To our knowledge, this is the first reported use of krypton red laser photocoagulation for the initial treatment of a subfoveal neovascular membrane in this setting. Early recognition of the membrane allowed treatment prior to involvement of the central fovea. Follow-up has shown obliteration of the membrane without recurrence and 20/20 vision. We emphasize recognition of this unusual tumor, self-monitoring with an Amsler grid, and early treatment of subretinal neovascularization in this high risk group of young patients.

Adult↗
PubMed1987

Ocular ischemic syndrome: long-term ocular complications.

Acute retinal arterial occlusive events in the eye are generally easily recognized and the association with embolic material, often from ulcerative lesion of the ipsilateral carotid vessels, usually can be established by noninvasive imaging techniques. In contrast, chronic retinal and choroidal circulatory impairments from ophthalmic artery insufficiency is usually due to high-grade, hemodynamically-significant carotid occlusive disease which can be difficult to recognize because of the diverse clinical features and presentations. We present herein the experience of the senior author (LEM) in the diagnosis and management of these complex cases.

Aged↗
PubMed1987

Subretinal neovascular membranes associated with choroidal nonperfusion and retinal ischemia.

This is the first well-documented case of co-existent underlying choroidal nonperfusion in an eye with a subretinal neovascular membrane that was subsequently treated with krypton red laser photocoagulation by the senior author (LEM). The possible role of chronic macular ischemia secondary to choroidal circulatory impairment is discussed in relationship to other well-established risk factors. Perhaps treatment to improve macular oxygenation would be a reasonable alternative to eradication of the neovascularization by direct laser photocoagulation.

Aged↗
PubMed1987

Panretinal photocoagulation for radiation-induced ocular ischemia.

We present preliminary findings on the effectiveness of panretinal photocoagulation in preventing neovascular glaucoma in eyes with radiation-induced ocular ischemia. Our study group consisted of 20 patients who developed radiation-induced ocular ischemia following cobalt-60 plaque radiotherapy for a choroidal or ciliary body melanoma. Eleven of the 20 patients were treated by panretinal photocoagulation shortly after the diagnosis of ocular ischemia, but nine patients were left untreated. In this non-randomized study, the rate of development of neovascular glaucoma was significantly lower (p = 0.024) for the 11 photocoagulated patients than for the nine who were left untreated.

Adult↗
PubMed1987

The idling retina: reversible visual loss in central retinal artery obstruction.

Based on experimental studies, sustained total central retinal artery obstruction (CRAO) lasting more than one and one-half hours has been considered to cause irreversible retinal damage. We have seen five cases of patients with pure CRAO that lasted longer than one and one-half hours who regained significant visual acuity. Three of the patients had a completely spontaneous improvement in visual acuity to 20/50 or better. In addition, the other two patients regained significant vision to 20/80 or better with a modified treatment regimen of acetazolamide, inhalation of 5% CO2 and 95% O2, and aspirin. No foveola-sparing cilioretinal arteries were present in any of the cases. We introduce the concept of reversible retinal ischemia following unsustained CRAO to account for these unexpected improvements in visual acuity.

Acetazolamide↗
PubMed1986

Peripheral circumferential retinal scatter photocoagulation for the treatment of proliferative sickle retinopathy. An update.

Forty-four patients (70 eyes, 220 sea fans) with proliferative sickle retinopathy (PSR) received peripheral circumferential retinal scatter photocoagulation (PCRP) to the peripheral zones of retinal capillary nonperfusion. With an average follow-up of 3.3 years, 33% of preexisting sea fans regressed completely, 46% regressed partially, 19% remained stable, and 2% showed progression. De novo neovascularization developed after treatment in only one eye (1.4%). Ninety-five percent of patients treated had a final visual acuity of 20/30 or better and only one patient (2%) developed a nonresolving vitreous hemorrhage requiring vitrectomy surgery. These results confirm the authors' previous report and continue to compare favorably to the natural history of PSR in which de novo lesions developed in 58%, and 12% of eyes ended with a visual acuity of 20/200 or less. PCRP seems preferable to other techniques in reducing the risk of nonresolving vitreous hemorrhage and/or traction retinal detachment, although randomized controlled studies are needed to conclusively assess the safety and efficacy of this strategy in treating PSR.

Adolescent↗
PubMed1986

Acute obstruction of the retinal and choroidal circulations.

The cases of eight patients (10 eyes) with the equivalent of an acute ophthalmic artery obstruction (simultaneous impairment of both the retinal and choroidal circulations) are described. Ophthalmoscopic features included intense opacification of the retina in the posterior pole; variable absence of a cherry red spot, and the subsequent development of optic atrophy and pigment epithelial changes. Fluorescein angiographic signs encompassed delayed retinal and choroid filling, as well as leakage at the level of the retinal pigment epithelium (RPE). Electroretinography (ERG) disclosed absence of both the a- and b-waves. The entity carries a grim visual prognosis, as all ten eyes initially had no perception of light; improvement to light perception occurred in one instance.

Acute Disease↗
PubMed1986

Traumatic extrusion of posterior chamber lenses: clinical and experimental correlations.

Five cases of traumatic expulsion of posterior chamber intraocular lens implants are presented. The syndrome is characterized by expulsion of the lens, iris damage, and intraocular hemorrhage. In experiments with donor human eyes we were able to reproduce the syndrome with 0.68 joules of energy, which is well below that encountered in common environmental situations.

Eye↗
PubMed1986

Proliferative sickle retinopathy and neovascularization of the disc: regression following treatment with peripheral retinal scatter laser photocoagulation.

Proliferative sickle retinopathy (PSR) is usually described as a peripheral neovascular tuft in a "sea fan" like configuration. While neovascularization of the disc (NVD) is a common finding in proliferative diabetic retinopathy (PDR), to our knowledge only one other case has been reported of NVD in an S-C patient in the absence of other contributing conditions. PSR has been shown to regress after treating hypoxic peripheral retina with peripheral circumferential retinal scatter photocoagulation (PCRSP). The following is a case report of an S-C patient with PSR and NVD/NVR which was originally treated elsewhere with scatter argon laser photocoagulation from the vascular arcades to just behind the equator. The peripheral "sea fan" and NVD did not regress. PCRSP to the zone of peripheral ischemia was then performed, and regression of the NVD and peripheral "sea fan" was achieved. This case illustrates the importance of concentrating laser treatment to the zones of retinal ischemia to achieve regression of associated neovascularization.

Anemia, Sickle Cell↗
PubMed1986

Fundus-iris fluorescein angiography: evaluation of its use in the diagnosis of rubeosis iridis.

Fundus-iris fluorescein angiography is a technique that allows iris angiography and retinal angiography to be performed simultaneously, using a single injection of dye and a standard retinal fundus camera. We analyzed the ability of this technique to detect rubeosis iridis. In a study of 200 randomly selected angiograms on 400 eyes, the technique was able to detect 97.2% of all eyes with rubeosis iridis (sensitivity), with a false-positive rate of 1%. In 26 eyes (36.6% of all eyes with rubeosis), it was able to detect rubeosis prior to the development of vessels visible by slit-lamp biomicroscopy. The test was able to correctly identify 98.8% of the eyes without rubeosis (specificity), with a false-negative rate of 0.5%. This technique can be performed routinely as part of retinal angiography.

Aged↗
PubMed1986

Temporal branch retinal vein obstruction: a review.

Two hundred forty-six eyes with temporal branch retinal vein obstruction (TBRVO) were studied prospectively. Of the 85 eyes not receiving laser treatment, 35 (41%) presented with greater than or equal to 20/50 vision and 89% remained in this group; whereas, 29 eyes (34%) presented with less than or equal to 20/200 vision and only 17% improved. Of the 161 eyes receiving laser, 40 (25%) had greater than or equal to 20/50 vision pre-treatment and 75% remained in this group; whereas, 64 eyes (40%) had less than or equal to 20/200 vision pre-treatment and 50% improved. The average final VA (20/70 vs 20/100), risk of developing neovascularization in ischemic TBRVO (3% vs 34%) and risk of vitreous hemorrhage in proliferative TBRVO (10% vs 57%) were all significantly better in treated eyes (p less than or equal to 0.01).

Aged↗