Bilateral serous retinal detachment in thrombotic thrombocytopenic purpura.
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Adult↗
Biomedical subjects
M M Slusher
Publications and source records attributed to M M Slusher.
Intraretinal foreign bodies. Management and observations.
Foreign bodies embedded in the retina and choroid such that they cannot be extracted by a magnet and require vitreous surgical techniques for removal comprise a distinct sub-type of retained intraocular foreign body (IOFB). A retrospective evaluation of 16 such intraretinal foreign bodies (IRFBs), suggests that these injuries are frequently accompanied by extensive ocular damage, including corneal perforation, disruption of the lens, significant vitreous hemorrhage, retinal and choroidal hemorrhage and retinal detachment, all of which require immediate surgical attention. Delayed cataract and retinal detachment are often observed in these cases. More than 60% of this series developed macular pucker after IRFB removal. Visual outcomes were discouraging, with seven patients (44%) retaining only 20/200 or worse visual acuity. This review suggests that the structural and visual outcomes of such eyes are uncertain, are the products of complex processes involving numerous technical elements other than sophisticated surgery and prompt removal of the foreign body.
Adult↗
The use of intravitreal air in selected retinal detachments.
Statistically controlled studies substantiating the current widespread acceptance of intravitreal air injection as an adjunct to traditional or standard scleral buckling techniques in the repair of rhegmatogenous retinal detachment are unavailable. The surgical success rate of a prospectively chosen group of patients who received intravitreal air was compared with that of a retrospectively chosen but comparable group of patients who did not receive air injection in their detachment repair. The 100% retinal reattachment rate in the air group at six weeks was found to be statistically significant for comparable configurations of retinal detachment and superiorly located breaks in patients without significant proliferative vitreoretinopathy.
Aged↗
Release of scientific information to the news media.
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Animals↗
The spectrum of cavitary optic disc anomalies in a family.
The current classification of cavitary optic disc anomalies including the morphologically related entities--optic nerve pit, morning glory disc anomaly, coloboma of the optic nerve, and retinochoroidal coloboma involving the optic nerve--is inexact and confusing. Traditionally, these disc abnormalities have been regarded as distinct morphologic anomalies. Thirty-five members of a five-generation kindred with autosomal dominantly inherited optic disc anomalies were examined. Observed abnormalities in this pedigree comprised a spectrum of morphologic variants ranging from large anomalous discs to typical pits and colobomas. The findings in this family suggest a variable expression of a single autosomal dominant defect rather than the chance occurrence of three separate, distinct, but morphologically similar entities occurring in a single pedigree.
Chromosome Aberrations↗
Epiretinal membrane release and posterior vitreous detachment.
The spontaneous release of epiretinal membranes is a rare clinical phenomenon, the mechanism of which is poorly understood. The authors present three patients with epiretinal macular membranes associated with peripheral retinal lesions, in whom spontaneous release of the membrane occurred in conjunction with detachment of the posterior vitreous. In each patient, the membrane remained attached to the posterior vitreous face, and in each eye there was a decrease in retinal striae and an improvement in vision. The authors postulate that posterior vitreous separation was the mechanism by which these membranes detached from the macula.
Adult↗
Multiple evanescent white dot syndrome.
Three patients had documented fundus changes conforming to those of the recently described multiple evanescent white dot (MEWD) syndrome. All three patients were unilaterally affected with variously sized, soft, single, and coalescent white lesions at the level of the RPE and the deep retina. Fluorescein angiography demonstrated early staining and hyperfluorescence of the white dots and delayed staining around the optic disc. Some degree of optic disc edema could be seen in all three eyes, two of which had corresponding field defects. In all three eyes, characteristic "stippling," or granularity, of the affected macula developed rapidly and vitreal cells were observed. One eye had signs of previous perivascular inflammation. ERG studies performed on one patient indicated a reduction in the a-wave and depression of the ERP, findings that correlated with the clinical observations of RPE affectation.
Adult↗
Congenital retinal arteriovenous anastomoses.
We report a rare type of retinal vascular abnormality--retinal arteriovenous anastomoses--and discuss the associated pathoanatomy and hemodynamics of the retinal vascular anomaly itself as demonstrated by fluorescein angiography. We emphasize our preference for using infused computed tomographic scanning rather than cerebral arteriography to rule out the existence of associated intracranial vascular lesions in such cases.
Adult↗
Extended-wear lenses, biofilm, and bacterial adhesion.
While medical scientific knowledge pertaining to bacterial adhesion to biomaterials has become a rapidly growing field in most areas of medicine, its significance in ophthalmic infections has not been emphasized. Corneal bacterial ulceration in patients wearing extended-wear contact lenses has become a problem of epidemic proportions. The designation of the contact lens itself as a suitable substratum for bacterial colonization and as a source of subsequent inoculum to compromised epithelial cells are important factors in the pathophysiology of corneal ulcer formation. We demonstrate polysaccharide- (biofilm-)mediated adhesion to two ophthalmic pathogens (Pseudomonas aeruginosa and Staphylococcus epidermidis) to the surface of a typical extended-wear contact lens in vitro using cytochemistry and scanning and transmission electron microscopic techniques. This interaction between the biomaterial and bacterial organisms, which represents a favorable self-protective environment for propagation and inoculation, is a previously overlooked area of importance in the mechanism of corneal ulceration associated with hydrophilic (soft) contact lenses.
Bacterial Adhesion↗
Pseudophakic choroidal detachment with cyclodialysis cyst.
Two cases of spontaneous pseudophakic ciliochoroidal detachment, associated with extracapsular cataract extraction, posterior chamber intraocular lens implantation with intact posterior capsules, and small cyclodialysis clefts are documented. In both patients, the choroidal detachments occurred in a delayed fashion following uncomplicated cataract surgery and both presented with characteristic ocular hypotony. Although one patient required surgical management, both patients regained excellent vision after closure of the clefts and resolution of the ciliochoroidal detachments.
Aged↗
Management of intraretinal foreign bodies.
Closed posterior intraocular microsurgery with vitreous instruments and bimanual surgical techniques have markedly altered the management of intraocular foreign bodies (IOFB). This paper presents an approach to 14 metallic intraretinal foreign bodies (IRFB) that could not be removed by conventional methods. In all cases, posterior vitrectomy was required to visualize the foreign body or to facilitate its removal through a pars plana incision with intraocular forceps under microscopic visualization. Although successful removal of the intraretinal foreign body was possible in all 14 patients, central visual acuity of 20/400 or better was obtainable in only 40% of this series. An important observation in these patients was a tendency to macular pucker from subsequent epiretinal membrane formation and retinal detachment with massive periretinal proliferation (MPP), which occurred in 90% of these eyes. Despite an obviously enhanced ability to remove foreign bodies from the retina, made possible by vitreous instruments and surgical techniques, the magnitude of the secondary complications in this variety of ocular trauma suggests a poor visual prognosis for such injuries.
Adolescent↗
Microsurgical management of retinal detachment in eyes with pupillary membranes.
A one-stage approach to the combined problem of retinal detachment and pupillary membranes, aided by fiberoptic endoillumination and microscopic viewing through a corneal contact lens, permits simultaneous removal of the pupillary membrane and cortical vitreous along with microsurgical examination of the peripheral retina and closure of all breaks. Four cases of complicated retinal detachment that were treated in this manner are presented. In two, the presence of pupillary membranes was further complicated by vitreoretinal traction. Although it is a departure from traditional techniques of retinal attachment, such a microsurgical approach is surely an additional, and perhaps an advantageous, way in which to perform these complicated surgical procedures.
Aged↗
Rubella retinopathy and subretinal neovascularization.
A case of rubella retinopathy associated with macular scarring from subretinal neovascularization is presented. Ophthalmoscopic findings included diffuse mottling of the retinal pigment epithelium throughout the macula and into the postequatorial areas, atrophic "rings" around both optic discs, and a solid white and slightly raised macular cicatrix in the right eye. The patient has been followed for three years; her visual acuity remains at 20/20 and there has been no change in the appearance of her retinae. Rubella retinopathy should be considered in the differential diagnosis of young patients with subretinal neovascularization.
Adolescent↗
Anterior segment biopsy using vitreous surgical instruments.
An unusual pupillary membrane was removed using closed microsurgical techniques and vitreous instruments. The recent development of automated intraocular scissors, as an addition to vitreous surgical instruments, provided the means of membrane biopsy and the establishment of the rare diagnosis of stromalization of the anterior chamber. The introduction of this concept and technical capability into the management of this and related cases suggests a means of obtaining certain types of intraocular tissue for pathological study en bloc.
Aged↗
Choroidoretinal vascular anastomoses.
Three cases of choroidoretinal anastomosis had unusual etiologic and hemodynamic features. In two cases the anastomoses, one caused by ocular histoplasmosis and one by diabetic maculopathy, shunted retinal venous drainage into the choroid. In the third case, the congenital arterial choroidoretinal anastomosis should probably be termed retinochoroidal arteriovenous anastomosis. Prospective photographic and fluorangiographic studies of these patients suggest that our understanding of many basic features of retinal-choroidal circulatory hemodynamics is incomplete.
Adult↗
Ophthalmomyiasis interna posterior. Subretinal tracks and intraocular larvae.
Only seven cases of identifiable intraocular botfly larva infestation have been reported in North America--five since 1969. Two additional cases, both from the same institution, are documented here. The offending maggot or larva was visible in both instances. The findings in each case were diagnostically and morphologically striking. The characteristic funduscopic finding of subretinal tracks, along with the appearance of the larva--encysted in one patient and free-floating in the other-deserves emphasis, since this condition is not always benign and may not be as rare as previously assumed.
Adolescent↗
Familial exudative vitreoretinopathy.
At age 26 years a woman who had been blind in the left eye from birth had visual acuity of R.E.: 6/18 (20/60); L.E.: 6/120 (20/400), with 40 prism diopters of left exotropia. The left eye showed a decreased anteroposterior diameter of the globe and a complete retinal detachment behind a cataractous lens. The right eye had a posterior subcapsular lens opacity severe vitreous fibrosis, dragging of the optic disk, and intraretinal and subretinal exudation with a fibrovascular mass in the temporal retina. The patient's 3-year-old daughter had 45 to 50 prism diopters of exotropia, a pendular nystagmus with intraretinal and subretinal dragging of each disk, and early degeneration and band formation in the periphery of each fundus.
Adult↗
Ophthalmic findings in dural arteriovenous shunts.
Five cases of dural carotid arteriovenous shunts in the region of the cavernous sinus are reported. Discussion of the specific carotid angiographic features stresses the pathophysiologic characteristics of these shunts in relation to the ophthalmic findings. In all cases, the meningohypophyseal artery was involved as the sole or predominant source of the afferent arterial supply, and the degree of proptosis, epibulbar congestion and secondary glaucoma correlated with retrograde filling of the superior ophthalmic vein from the cavernous sinus. The ophthalmologist's early recognition of this entity as a "spontaneous" pathologic occurrence is important, since he is intimately involved in its diagnosis and long-term management.
Aged↗