Argon laser photocoagulation of choroidal neovascular membranes.
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Biomedical subjects
Publications and source records attributed to M L Klein.
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To determine the clinical course of untreated retinal pigment epithelial detachment we reviewed data from 50 eyes of 42 patients followed up for an average of 29 months without photocoagulation. In 14 eyes with avascular lesions, in patients under 50 years of age, all had a final vision of 20/30 or better. None developed neovascularisation or haemorrhage. In 17 eyes with avascular lesions in patients aged over 50, 8 (47%) flattened spontaneously. Five (24%) developed neovascularisation, 2 of which became haemorrhagic, with vision of less than 20/200. In 19 senile eyes with vascular lesions 14 (74%) had a final vision of 20/200 or less. The prognosis in eyes with pigment epithelial detachments is related to the age of the patient and the presence of choroidal neovascularisation. Photocoagulation is seldom needed for pigment epithelial detachments in young patients. Its value in senile eyes is unproved.
Fundus color photographs and retinal fluorescein angiograms were obtained from 48 nonhuman primates of three macaque species. Yellow pigmentation of the macula was present in monkeys fed a standard laboratory diet containing xanthophylls but was absent in animals maintained on semipurified or liquid formula diets with no xanthophyll content. Plasma levels of xanthophylls ranged from 0.5 to 2.4 microliters/ml in monkeys receiving the standard diet but were undetectable in animals raised on semipurified or liquid formula diets. Fluorescein angiograms revealed foveal areas of hyperfluorescence in almost all monkeys; however, the degree of hyperfluorescence was significantly greater in monkeys maintained on the semipurified or liquid formula diets.
Thirty-three patients with central vein occlusion were evaluated for the effects of scatter xenon arc panretinal photocoagulation. Thirty-four eyes (2 eyes of 1 patient) were randomly divided into a treatment (15 eyes) and a nontreatment group (19 eyes). The average follow-up per eye has been 29 months. The visual prognosis was not significantly better in either group. There was no difference in the development of fundus neovascularisation between groups. None of the patients in the treated group developed rubeosis or neovascular glaucoma. Two patients in the nontreatment group initially had rubeosis and 3 developed it after entry. All 5 involved eyes developed neovascular glaucoma. A significantly greater amount of central retinal capillary drop-out was present in the untreated eyes that developed rubeosis than those untreated eyes which did not. The eyes in the treated group had a similar range of capillary drop-out area, but none of these eyes developed rubeosis or neovascular glaucoma. Panretinal photocoagulation prevented the development of rubeosis and neovascular glaucoma in susceptible eyes.
We performed argon laser photocoagulation on 31 eyes of 30 patients with presumed ocular histoplasmosis. Nineteen of 25 eyes (76%) with neovascular membranes 0.25 disk diameter or further from the fovea had 6/12 (20/40) or better vision after an average follow-up period of 20 months. Twenty-two of these eyes (88%) had the same or improved visual acuity during this period. When compared to a similar group of untreated eyes, the apparent advantage of photocoagulation in preserving visual acuity was not statistically significant.
Sixty-four eyes of 60 patients with ocular histoplasmosis, and choroidal neovascularization documented by fluorescein angiography, and not treated with photocoagulation, were followed for an average of 29 months. The primary determinant of visual outcome was the proximity of the neovascular membrane to the fovea. Sixty-four percent of eyes with membranes 0.25 disk diameter or greater from the fovea had a final visual acuity of 6/12 (20/40) or better, and 71% of such eyes maintained or improved initial visual acuity. All eyes with subfoveal neovascularization had a poor visual result. Other factors related to visual prognosis included initial visual acuity, size of the neovascular membrane, size of sensory retinal detachment, and presence of hemorrhage.
Of 84 patients with unilateral disciform macular degeneration, 36 were followed up for one to four years (average, 22 months). The fellow eye in 13 cases developed disciform lesions during that follow-up period. A significantly greater number of drusen were found in the fellow eyes of patients with unilateral disciform macular degeneration than in the eyes of a comparable control group of patients (P less than .001). Furthermore, the eyes with unilateral disciform macular degeneration that developed disciform lesions in the other eye were characterized as a group by a significantly larger number of drusen than those that did not. We postulate that drusen are precursors of disciform macular degeneration in fellow eyes and are probably manifestations of the same exudative process.
Two patients who had lost central vision in one eye due to a histoplasmic disciform macular scar received prophylactic argon laser photocoagulation to one or more atrophic lesions (histo spots) in the second macula in an effort to reduce the risk of developing active neovascularization in the second eye. Despite this prophylactic treatment, both patients developed a choroidal neovascular membrane from the photocoagulation scar.
Twenty patients with central retinal vein occlusion were randomly divided into two groups in a prospective study to evaluate the effects of xenon are photocoagulation in central retinal vein occlusion. The patients in one group were treated with 360 degrees scatter xenon photocoagulation and the others received no treatment. The average follow-up was 18 months. There were no cases of rubeosis or neovascular glaucoma in the treated group. Two patients in the untreated group developed rubeosis with subsequent neovascular glaucoma. There was no significant difference in the visual prognosis or in fundus neovascularization between the groups.
Acute intermittent porphyria was diagnosed in a child who presented with an acute abdomen and neurological signs of the age of four months. The diagnosis was confirmed by the absence of uroporphyrinogen synthetase in the erythrocytes. The rarity of the disorder at this age is emphasised.
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Explore the source record for details and available documents.
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The epidermolysis bullosa-pyloric atresia-obstructive uropathy (EB-PA-OU) association is a rare, but well-described multisystem disease. While the prognosis at this time is still poor, an increasing number of patients are surviving to adolescence with aggressive care. It is important to understand this syndrome in order to anticipate medical complications and offer preventive strategies where possible. Prompt and expectant management of obstructive uropathy is crucial in these patients. Evidence of ureterovesicular obstruction may require bowel diversion, as excision of the obstructed ureterovesicular junction with reimplantation is often associated with a high risk of reobstruction. Many newborns succumb to sepsis or dehydration and electrolyte imbalance. Those infants who survive need close monitoring for the development of obstructive uropathy, failure to thrive, protein-losing enteropathy, respiratory compromise, and increased susceptibility to invasive infections. Once a clinical diagnosis is made, mutational analysis can confirm it and facilitate genetic counseling, as recurrence risks are 25% for this autosomal recessive condition. Mutational analysis enables direct genetic testing and accurate prenatal diagnosis. As more patients are studied, genotype/phenotype correlations may be possible.
We describe the CT appearance of toxic dilatation in a patient with Crohn disease. The CT manifestations of this uncommon but important entity have not been previously described. The involved portion of the colon was mildly dilated and demonstrated pseudopolyp formation. Bowel wall thickening in this segment was minimal as expected in toxic dilatation. Intramural gas was identified representing pneumatosis intestinalis, an ominous sign in this condition.