Anaphylactic reaction to intravitreal cefazolin.
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Biomedical subjects
Publications and source records attributed to M F Kraushar.
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We attempted to simultaneously increase visualization of epimacular membranes and minimize retinal phototoxicity by filtering the light of the endoilluminator during vitreous surgery. The monochromatic filters we employed to eliminate short wavelengths were not useful because they reduced the level of illumination. We advise using the lowest level of illumination possible and an ultraviolet/infrared filter over the light source when working close to the retinal surface. The filter can be adapted to replace the fluorescein filter in the Ocutome console to facilitate insertion and withdrawal.
A prospective study of 440 eyes of 220 patients following successful operations for primary rhegmatogenous retinal detachment (132 eyes) and prophylactic operations for retinal breaks (103 eyes) revealed an incidence of preretinal macular fibrosis (PRMF) of 47% after scleral buckling surgery and 42% after prophylactic laser or cryopexy. The incidence of PRMF was significantly greater in aphakic vs phakic detachments, in detachments with operculated vs horseshoe breaks, in detachments with horseshoe breaks vs lattice degeneration, in detachments involving the macula, after scleral buckling with cryotherapy vs diathermy, and after prophylactic treatment of retinal breaks of fellow eyes with retinal detachment or retinal breaks that had developed postoperative PRMF. Analysis of the data suggests that PRMF is most likely a result of the retinal break, detachment, and subsequent treatment.
We examined two eyes from two noninsulin-dependent diabetic patients that developed vitreous hemorrhage secondary to retinal neovascularization after branch retinal arterial obstruction. Although there was no ophthalmoscopic evidence of diabetic retinopathy, diabetes mellitus may have predisposed the retinas to a neovascular response, which was precipitated by the arterial obstruction.
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The best method for preventing medical malpractice litigation is the nurturing and maintenance of the physician-patient relationship. This relationship can be developed by means of care and compassion for the patient as a person and patient education through a free and open discussion of informed consent. The relationship can be maintained by recognizing "poor result/litigious patient" situations with one's own patients as well as with patients of other physicians.
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One hundred twenty-one medical malpractice claims against ophthalmologists are analyzed with respect to the specific allegation, the ophthalmic cause of litigation, and disposition. Failure or delay in diagnosis was responsible for 35% of claims and 63% of patient indemnification. Allegations of failure to diagnose most commonly concerned retinal detachment. While an identical number of claims were closed with payment because of errors in treatment, the indemnity for these claims was less by a factor of nearly half. The greatest number of claims alleging negligent treatment involved complications of cataract surgery.
Among the small group of diseases in which the pathology is limited to the fovea are foveal cyst or hole, pseudovitelliform maculopathy, solar maculopathy, and retinal burn induced by the illumination of the operating microscope. A brief discussion of each of the above is presented to provide help in diagnosis, management, and, wherever possible, prophylaxis.
Refractive corneal surgery (a collective term used to describe a variety of surgical procedures that alter the refractive status of the eye through the surgical modification of corneal curvature) shows promise for use in situations where current methods of optical correction do not meet the patient's needs. This article reviews our experiences with the retinal evaluation of patients who have undergone corneal refractive surgery and offers recommendations for the treatment of retinal pathology after such surgery.
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We examined ten eyes with pseudohypopyon in seven patients with Best's vitelliform macular dystrophy. Fluorescein angiography showed hyperfluorescent defects in the retinal pigment of the superior half of the lesion in all ten eyes. The electro-oculographic findings were abnormal in all four patients who underwent this test. The fluid shifted slightly in two of six patients whose heads were turned to the side for an hour or longer, indicating that the material was probably located between the retinal pigment epithelium and the sensory retina. The volume of the hypopyon increased in one eye.
A case is presented in which Stargardt's macular dystrophy was found together with the peripheral changes of retinitis pigmentosa. The association of these two conditions, along with their occurrence in a 16-year-old patient, is rare.
Visual loss secondary to macular disease can be differentiated from optic nerve lesions relatively easily in the office by simple and reliable noninvasive means. The diagnosis of a medically or surgically treatable lesion can obviate for the patient the often unnecessary anxiety and expense of more extensive studies.