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Biomedical subjects

P Sternberg

Publications and source records attributed to P Sternberg.

At least 55 records · Page 3Linked to original sources
PubMed1995

Serous retinal detachment of the macula associated with cat scratch disease.

PURPOSE: We studied an unusual ocular manifestation of cat scratch disease. METHODS: We examined a patient who had a serous retinal detachment of the macula with vision loss out of proportion to her retinal findings. RESULTS: The patient was found to have cat scratch disease by antibody titers. CONCLUSION: Cat scratch disease should be considered in patients with a serous neurosensory retinal detachment of the macula and a history of cat exposure or systemic signs or symptoms consistent with the disease.

Adult↗
PubMed1995

Selective use of indocyanine green angiography for occult choroidal neovascularization.

PURPOSE: Indocyanine green angiography is useful in situations where fluorescein angiography shows occult choroidal neovascularization or pigment epithelial detachment. We sought to determine how often the selective application of indocyanine green angiography results in useful information for eyes with occult choroidal neovascularization. METHODS: We reviewed 153 consecutive indocyanine green angiograms and identified 77 in which corresponding fluorescein angiograms showed occult choroidal neovascularization or pigment epithelial detachment. We examined the indocyanine green angiograms to detect areas of hyperfluorescence and to classify the margins of hyperfluorescence as well demarcated or poorly demarcated. RESULTS: Of 77 eyes, 42 (55%) eyes had occult choroidal neovascularization by fluorescein angiography, seven (9%) eyes had both classic and occult choroidal neovascularization by fluorescein angiography, and 28 (36%) eyes had pigment epithelial detachments. Of 42 eyes with occult choroidal neovascularization by fluorescein angiography, 21 (50%) had well-demarcated margins, 13 (31%) had poorly demarcated margins, and eight (19%) had no detectable hyperfluorescence by indocyanine green angiography. Of seven eyes with both classic and occult choroidal neovascularization by fluorescein angiography, two had both poorly demarcated and well-demarcated borders, two had only poorly demarcated borders, and three had well-demarcated borders by indocyanine green. The indocyanine green angiogram showed 23 (82%) of 28 pigment epithelial detachments to have well-demarcated borders of hyperfluorescence; 13 (57%) of 23 were treated. CONCLUSION: Indocyanine green angiography adds clinically useful information to fluorescein angiography by demonstrating well-demarcated areas of hyperfluorescence in 50% of eyes selected because of diagnosis of occult choroidal neovascularization and in 82% of eyes selected because of pigment epithelial detachment.

Choroid↗
PubMed1995

Submacular hemorrhage removal.

PURPOSE: To determine whether pars plana vitrectomy combined with tissue plasminogen activator for evacuation of submacular hemorrhage results in improved visual acuity. METHODS: Retrospective review of 18 patients who received a subretinal injection of tissue plasminogen activator during a pars plana vitrectomy to evacuate dense submacular hemorrhages. RESULTS: Diagnoses included age-related macular degeneration (16 patients), ruptured macroaneurysm (1 patient), and penetrating ocular trauma (1 patient). Preoperative visual acuity ranged from 20/200 to counting fingers (median visual acuity, counting fingers). Follow-up ranged from 10 to 104 weeks (median, 33 weeks). Best postoperative visual acuity ranged from 20/30 to counting fingers (median, 20/300). Best postoperative visual acuity improved two or more lines in 11 (61%) of 18 eyes, remained unchanged in 4 (22%) of 18 eyes, and decreased two or more lines in 3 (17%) of 18 eyes (P = 0.10, Wilcoxon sign-rank test). Final visual acuity ranged from 20/40 to light perception (median, counting fingers). Final visual acuity improved two or more lines in 5 (28%) of 18 eyes, remained unchanged in 6 (33%) of 18 eyes, and decreased two or more lines in 7 (39%) of 18 eyes (P = 0.53, Wilcoxon sign-rank test). CONCLUSIONS: Pars plana vitrectomy to evacuate massive subretinal hemorrhage can improve visual acuity, but final visual acuity is limited by the underlying disease.

Adult↗
PubMed1994

Synthesis and transport of glutathione by cultured human retinal pigment epithelial cells.

PURPOSE: To characterize synthesis and transport of glutathione (GSH) by cultured human retinal pigment epithelial (RPE) cells. METHODS: Cultured human RPE cells were depleted of glutathione, then incubated with various concentrations of cysteine, glutamate, and glycine or with glutathione. High-performance liquid chromatography was used to measure intracellular glutathione with time. RESULTS: After depletion with diethylmaleate, intracellular glutathione was resynthesized from the amino acid precursors within 60 minutes. The addition of buthionine sulfoximine, a known inhibitor of GSH synthesis, completely eliminated the observed increase. Similar incubation with exogenous GSH failed to increase the intracellular GSH concentration. CONCLUSION: Cultured human RPE cells are able to rapidly synthesize glutathione from exogenously administered amino acids, but they are incapable of direct GSH uptake.

Adult↗
PubMed1993

Diode-laser photocoagulation for zone 1 threshold retinopathy of prematurity.

We used the diode-laser indirect ophthalmoscope in the treatment of 17 (30 eyes) infants with zone 1 (a circle centered on the optic disk with a radius of twice the distance from the disk to the fovea) threshold retinopathy of prematurity (at least five continuous or eight cumulative 30-degree sectors [clock hours] of ridge with extraretinal fibrovascular proliferation in the presence of plus disease). Mean follow-up was 31.2 weeks. Two eyes (6.7%) required retreatment of missed areas that had persistent plus disease (enlarged posterior veins and tortuous arterioles). A favorable outcome was attained in 25 eyes (83.3%). Five eyes (16.7%) developed retinal detachments, three of which remained stable at Stage 4A (extrafoveal retinal detachment) and two of which ultimately progressed to Stage 5 (total retinal detachment). Both eyes that went on to Stage 5 had severe posterior pole hemorrhages at the time of treatment. Two eyes that developed retinal detachments (one, stage 4A and one, stage 5) had rhegmatogenous components. Among 14 infants followed up for more than three months, four developed nystagmus, and six developed strabismus. In contrast to cryoablation, diode-laser photoablation of the peripheral retina was found to be an effective treatment for threshold retinopathy of prematurity located in zone 1. Portability and ease of use of the laser system, precision of treatment, and minimal postprocedural adnexal inflammation are further advantages of this therapeutic modality.

Female↗
PubMed1993

Pneumococcal endophthalmitis associated with nasolacrimal obstruction.

Pneumococcal endophthalmitis can be a devastating postoperative infection after cataract extraction or penetrating keratoplasty. Streptococcus pneumoniae was isolated as the causative agent in three of the 124 patients (2%) who were treated for endophthalmitis at our institution between 1984 and 1990. Two of the three patients lost light perception in the affected eye. All three patients had previously unrecognized or untreated chronic nasolacrimal obstruction of varying causes. We studied the role of pneumococcal lacrimal conjunctivitis in the pathogenesis of the postoperative pneumococcal endophthalmitis in these patients.

Aged↗
PubMed1993

Ultrastructural features of surgically excised subretinal neovascular membranes in the ocular histoplasmosis syndrome.

We evaluated the ultrastructural features of seven surgically excised submacular neovascular membranes from seven patients with the ocular histoplasmosis syndrome. Excised neovascular membranes were composed of fibrovascular tissue interposed between Bruch's membrane and the retinal pigment epithelium. Cellular components present in the membranes included, in decreasing order of frequency, retinal pigment epithelium, vascular endothelium, photoreceptor cells, macrophages, erythrocytes, ghost erythrocytes, fibrocytes, myofibroblasts, glial cells, smooth-muscle cells, and lymphocytes. Extracellular constituents of the neovascular membranes included 20 to 25-nm collagen fibrils, fibrin, 10-nm collagen fibrils, and fragments of Bruch's membrane and choroid. Our findings are consistent with the concept that subretinal neovascular membranes in the ocular histoplasmosis syndrome represent a nonspecific healing response to a local stimulus or injury.

Adolescent↗
PubMed1993

Well-defined subfoveal choroidal neovascular membranes in age-related macular degeneration.

PURPOSE: The purpose of this study is to correlate the clinical, angiographic and ultrastructural features of well-defined subfoveal neovascular membranes. METHODS: Fundus photographs and fluorescein angiograms of five well-defined subfoveal neovascular membranes associated with age-related macular degeneration and exudative retinal detachment were obtained. The subfoveal membranes were surgically excised via the pars plana. The center and peripheral portions of each membrane were evaluated by transmission electron microscopy for cellular and extracellular constituents. RESULTS: Each subretinal neovascular membrane was composed of two distinct regions demonstrated by fluorescein angiography. The first component, the core, contained a brighter central area of hyperfluorescent leakage surrounded by a partial or complete cuff of elevated blocked choroidal fluorescence. Results of ultrastructural examination showed that the core was composed of a fibrovascular membrane characterized by endothelium-lined vascular channels with associated retinal pigment epithelium. The second region of the membrane, the rim, is previously unreported and is described in detail. It appeared as a minimally elevated, smooth, subretinal annular rim of hyperfluorescent staining that surrounded the core and was composed of fibrin, photoreceptor outer segments, and macrophages. CONCLUSIONS: Well-defined subfoveal neovascular membranes can be appreciated with fluorescein angiography and are composed of a central core of subfoveal choroidal neovascularization surrounded by a peripheral rim composed of fibrin, photoreceptor outer segments, and macrophages.

Aged↗
PubMed1993

Protection of retinal pigment epithelium from oxidative injury by glutathione and precursors.

PURPOSE: This study was performed to examine the effect of exogenous glutathione (GSH) or its precursor amino acids on oxidative injury in cultured human retinal pigment epithelium (RPE). METHODS: Cultured human RPE cells were suspended in Krebs-Henseleit medium, and 150 microM t-butylhydroperoxide was added. Cell viability was assessed by 0.2% trypan blue exclusion 30, 60, and 120 minutes after the addition of GSH or its amino acid precursors. RESULTS: Added GSH provided protection at concentrations of 0.01 mM and higher. The amino acid precursors for GSH, glutamate, cysteine, and glycine also protected against injury, but this required at least 0.1 mM of each amino acid. Inhibition of intracellular GSH synthesis by inclusion of 1 mM buthionine sulfoximine eliminated the protection by added amino acids but did not alter the protection by added GSH. CONCLUSIONS: These results indicate that protection by the amino acid precursors is mediated through synthesis of GSH, and they also show that exogenous GSH can provide protection against oxidative injury.

Amino Acids↗
PubMed1992

Vogt-Koyanagi-Harada syndrome in patients with Cherokee Indian ancestry.

Eight patients with Vogt-Koyanagi-Harada syndrome who have Cherokee Indian ancestry ranged from 17 to 49 years of age. Five of the patients were black, three were white. Visual acuity at the time of initial examination ranged from 20/20 to counting fingers. Clinical findings included granulomatous iridocyclitis in six patients, vitreitis in seven patients, disk edema in five patients, exudative retinal detachment in six patients, and multifocal choroidal lesions in all eight patients. All of the patients were treated with systemic corticosteroids, and they recovered visual acuity of 20/40 or better. The seven patients assayed had the HLA-DRw52 haplotype, including five who were homozygous for this allele. This finding may add to the increasing evidence that a class II HLA antigen at a D-related locus may predispose carriers to the development of Vogt-Koyanagi-Harada syndrome.

Adolescent↗
PubMed1992

Immunohistochemical and histochemical properties of surgically excised subretinal neovascular membranes in age-related macular degeneration.

The immunohistochemical and histochemical properties of 16 surgically excised subretinal neovascular membranes from 16 patients with age-related macular degeneration were studied. Primary antisera to c-retinaldehyde-binding protein; leukocyte common antigen; factor VIII-related antigen; S-100 protein; glial fibrillary acid protein; muscle-specific actin; neuron-specific enolase; collagen types I, II, III, IV, and V; laminin; and fibronectin were used for immunohistochemical characterization of the membranes. Histochemical staining for lipid and mucopolysaccharide was performed. The results of the staining in conjunction with histologic examination showed the cellular components of the membranes to be composed of retinal pigment epithelium, inflammatory cells, vascular endothelium, glial cells, myofibroblasts, photoreceptor cells, and fibrocytes. The extracellular matrix of the membranes contained collagen types I, III, IV, and V; fibronectin; laminin; mucopolysaccharide; and lipid. These findings are consistent with the concept that subretinal neovascular membranes in age-related macular degeneration are composed of localized intra-Bruch's membrane granulation tissue proliferation associated with diffuse drusen.

Aged↗
PubMed1992

Pathogenetic mechanisms in anterior proliferative vitreoretinopathy.

A clinicopathologic study of ten consecutive patients (ten eyes) undergoing surgery for rhegmatogenous retinal detachment with anterior proliferative vitreoretinopathy and a subsequent histopathologic, immunohistochemical, and ultrastructural study of ten enucleated eyes with anterior proliferative vitreoretinopathy were performed in order to elucidate relevant pathogenetic mechanisms. Our findings suggest that the pathogenetic evolution of anterior proliferative vitreoretinopathy occurs in three consecutive stages: (1) traction on the ciliary body and peripheral retina induced by fibrocellular contraction of the vitreous base; (2) incorporation of tractionally denuded components of the ciliary body and peripheral retina into the fibrocellular membranes overlying the vitreous base; and (3) proliferation of the incorporated components and fibrovascular ingrowth from the uvea, the retina, or both, into the fibrocellular membranes. Tractional disruption of the epithelium of the ciliary body pars plicata and breakdown of the ciliary blood-aqueous barrier are the principal pathogenetic mechanisms of chronic intractable hypotony and the post-vitrectomy fibrin syndrome in anterior proliferative vitreoretinopathy.

Adult↗
PubMed1992

Examination of macular vitreoretinal interface disorders with monochromatic photography.

Monochromatic light accentuates details of different retinal layers because of its variable absorption and reflectance by structures both within and above these layers. Monochromatic photography was used to examine macular vitreoretinal interface abnormalities in 19 patients. Short wavelength photographs (490 nm) provided the best detail of inner retinal abnormalities, including epiretinal membranes, vitreoretinal traction, and the internal surface of confluent macular edema (pseudocyst). Although 540-nm red-free photography provided acceptable photographs, it did not provide optimal detail of inner or deep retinal abnormalities. Longer wavelengths, 585 and 610 nm, best disclosed the extent of deep retinal abnormalities, including the extent of confluent macular edema (pseudocysts) and retinal detachment that surrounded macular holes. The addition of short- and long-wave-length photography to traditional red-free photography may provide better localization, understanding, and documentation of the three-dimensional relationships in macular vitreoretinal interface disorders.

Eye Diseases↗
PubMed1992

Surgical excision of subfoveal neovascular membranes in age-related macular degeneration.

We studied the results of surgical excision of ten consecutive subfoveal choroidal neovascular membranes in ten patients with age-related macular degeneration. The criteria for surgical eligibility included the following: (1) a clearly identifiable subfoveal membrane occupying the entire foveal avascular zone, (2) a visual acuity of 20/200 or worse, (3) minimal subretinal hemorrhage, and (4) an associated exudative macular detachment. Six of the ten patients showed visual improvement at one-month and three-month follow-up visits and seven showed visual improvement by the six-month examination. All ten maculae remained attached without recurrence of subfoveal neovascular membranes throughout the follow-up period. These results suggested that surgical excision is a viable alternative to laser photocoagulation in patients with subfoveal neovascularization in age-related macular degeneration.

Aged↗