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Biomedical subjects

P Sternberg

Publications and source records attributed to P Sternberg.

At least 73 records · Page 4Linked to original sources
PubMed1992

Retinal manifestations of ocular lymphoma (reticulum cell sarcoma).

BACKGROUND: Diagnosis and treatment of ocular large cell lymphoma may lessen visual loss and prolong life. Although reports in the literature have described retinal infiltrates in eyes with large cell lymphoma, they have focused on the more prominent vitreous and subretinal pigment epithelial findings. Eyes with retinal infiltrates and hemorrhagic retinal necrosis are usually believed to harbor a microbial infection. The authors describe 5 patients, aged 57 to 85 years, with ocular lymphoma in whom the most prominent initial findings were in the retina. METHOD: Patients presented with findings suggestive of an infectious retinal necrosis. When the initial therapy failed, investigators performed a vitreous biopsy. Two patients had a concomitant retinal biopsy. Radiation therapy was given to four patients. RESULTS: All five patients had vitreous cells. Three patients had prominent perivascular exudate. Four patients had grayish-white retinal infiltrates, and three patients had associated retinal hemorrhage. Three patients had subretinal small white spots. An edematous thickened retina developed in three patients, and hemorrhagic retinal necrosis developed in three patients. The initial diagnosis was believed to be acute retinal necrosis (ARN) in three patients, toxoplasmosis in one patient, and frosted branch angiitis in one patient. Vitreous biopsy was positive in two patients but negative in three patients. In two of these three patients, the diagnosis was established by retinal biopsy. CONCLUSION: Ocular lymphoma should be considered in the differential diagnosis of retinal vasculitis or necrotizing retinitis in a middle-aged or older patient. Retinal biopsy may be helpful in establishing the diagnosis.

Aged↗
PubMed1992

Management of threshold retinopathy of prematurity.

The Cryotherapy for Retinopathy of Prematurity Study demonstrated the benefit of intervention for threshold disease. The authors reviewed their experience with cryotherapy, investigating the questions of treatment for bilateral disease. Between 1985 and 1990, 71 eyes from 41 infants with threshold retinopathy of prematurity were treated. Of the 65 eyes with a minimum of 3 months follow-up, only 7 eyes (11%) progressed to stage 4, although an additional 8 eyes (13%) developed a posterior retinal fold. Although the overall results are comparable to those repeated by the Cryotherapy for Retinopathy of Prematurity Study, the authors recommend treating both eyes if they reach threshold, and treating the two eyes at the same sitting.

Cryosurgery↗
PubMed1991

Bone marrow transplant retinopathy.

Five of eight patients (62%) who survived at least six months after autologous or allogeneic bone marrow transplantation for acute leukemia developed occlusive microvascular retinopathy. Treatable retinal microangiopathy included a high incidence (80%) of clinically significant macular edema and one case of proliferative retinopathy with subhyaloid hemorrhage. The bone marrow transplant protocol required high-dose cytarabine hydrochloride and 1,200 cGy of total body irradiation. The development of radiation retinopathy after such low doses of teletherapy suggests that high-dose chemotherapy may increase the susceptibility for the development of retinopathy at otherwise safe radiation doses.

Adolescent↗
PubMed1991

Pathologic features of surgically excised subretinal neovascular membranes in age-related macular degeneration.

The histopathologic features of ten consecutive surgically excised subfoveal neovascular membranes from patients with age-related macular degeneration were examined. Ultrastructural features included the following in decreasing order of frequency: endothelium-lined vascular channels, new collagen, fibrocytes, retinal pigment epithelium, erythrocytes, and myofibroblasts. Chronic inflammatory cells were frequently evident and included macrophages, lymphocytes, and plasma cells. Basal laminar deposit or diffuse drusen were observed in six of the membranes. Photoreceptors and Bruch's membrane were each observed in three of the specimens, but were not associated with decreased postoperative visual acuity. Fibrin was observed in eight membranes, either within the stroma of the membrane or in association with subretinal hemorrhage.

Age Factors↗
PubMed1991

Decrease in the risk of bilateral acute retinal necrosis by acyclovir therapy.

We reviewed the course of 54 patients who had unilateral acute retinal necrosis at initial examination. Thirty-one patients were treated with acyclovir, whereas 23 were not. Of the 31 patients treated with acyclovir, 27 (87.1%) had fellow eyes that remained disease-free throughout a median follow-up of 12 months. Of the 23 patients not treated with acyclovir, seven (30.4%) had fellow eyes that remained disease-free throughout a median follow-up of 11 months. Survival analysis indicated that the fellow eyes of the group of patients treated with acyclovir were more likely to remain disease-free than the fellow eyes of the group not treated with acyclovir (P = .0013). Two years after initial onset, the proportion of fellow eyes that remained disease-free was 75.3% for the group treated with acyclovir and 35.1% for the group not treated with acyclovir. These results suggest that acyclovir treatment reduces the risk of involvement of the fellow eye in patients with acute retinal necrosis.

Acyclovir↗
PubMed1991

Molteno implants and operating microscope-induced retinal phototoxicity. A clinicopathologic report.

The right eye of a 75-year-old man with a history of cataract extraction, three penetrating keratoplasties, laser trabeculoplasty, two Molteno implants, and an operating microscope-induced retinal phototoxic lesion was studied post mortem. Histopathologic examination of the anterior segment showed evidence of penetrating keratoplasty, cataract surgery, and two Molteno implants with minimal associated tissue response. Ultrastructural examination showed a loose collagenous matrix surrounding the Molteno reservoirs, suggesting aqueous percolation from the reservoirs into the conjunctiva. Posteriorly, in the area of the phototoxic operating microscope-induced lesion, a nodule of retinal pigment epithelial hyperplasia with overlying atrophy of the photoreceptor cell layer of the neurosensory retina was noted. The retina also contained cystoid macular edema and an extensive preretinal membrane that was clinically unexpected.

Aged↗
PubMed1991

Perforating (through-and-through) injuries of the globe. Surgical results with vitrectomy.

Fifty-one eyes of 48 patients with perforating (through-and-through) injuries of the globe were treated with vitrectomy during a 12-year period. Functional success was obtained in 32 eyes (63%), anatomic success was obtained in nine eyes (17%), and treatment failed in 10 eyes (20%). In 16 eyes (32%), 20/20 to 20/100 visual acuity was obtained; in 17 eyes (33%), 20/200 to 5/200 visual acuity was obtained; and in 18 eyes (35%), less than 5/200 visual acuity was obtained. The mechanism of injury was an important prognostic indicator of final visual outcome. Eight (62%) of 13 eyes that sustained knife or nail injuries achieved a final visual acuity of 20/50 or better, while only six (16%) of 38 eyes [corrected] with missile injuries achieved a similar level of acuity. Final visual outcome correlated well with the state of the macula and was not predicted by preoperative visual acuity. Despite improvement in surgical techniques and instrumentation, no trend toward improved visual outcomes was identified during the 12-year period.

Adolescent↗
PubMed1991

Management of posterior segment ocular trauma.

Ocular trauma is a leading cause of visual impairment in the United States. Despite advances in treatment, almost half the patients with posterior, penetrating ocular injuries have permanent, severe visual loss. There is controversy with regard to the optimal role and timing of vitrectomy in the management of posterior segment injuries, as well as the proper management of magnetic intraocular foreign bodies. Improvements in surgical instrumentation and technique, combined with an increased understanding of posterior segment pathobiology, continue to modify the indications for treatment. Each of these issues is discussed in light of recent contributions to the literature.

Eye Foreign Bodies↗
PubMed1990

Complications of tissue plasminogen activator therapy after vitrectomy for diabetes.

Human recombinant tissue plasminogen activator (25 micrograms) was injected into seven eyes of six patients who had developed massive fibrin deposition after vitrectomy surgery for diabetes. Six eyes had developed pupillary membranes and recurrence of tractional retinal detachment from fibrin membranes, and one eye had developed only a pupillary membrane. All pupillary membranes resolved within one hour of administration of tissue plasminogen activator, and five tractional retinal detachments resolved within 24 hours. All eyes developed evidence of intraocular bleeding after tissue plasminogen activator injection. Subsequently, six of seven eyes developed recurrence of fibrin accumulation and tractional retinal detachment.

Adult↗
PubMed1990

Retinal detachment in penetrating keratoplasty patients.

We reviewed the records of 23 patients who had retinal detachment after penetrating keratoplasty. Seventeen retinas (74%) were reattached successfully. Of the six failures, four patients had hemorrhagic choroidal detachment at the time of keratoplasty. When these complex retinal detachments are subtracted, 17 of 19 patients (89%) had successful retinal reattachments. Of the 17 successes, only seven patients had visual acuity of 20/200 or better. Retinal detachments after penetrating keratoplasty can be repaired with a high rate of success, but visual results remain disappointing.

Cataract Extraction↗
PubMed1990

The effect of tissue plasminogen activator on retinal bleeding.

Tissue plasminogen activator is a potent thrombolytic agent that recently has been used to treat postvitrectomy fibrin formation. However, a recent report noted anterior and posterior segment bleeding following intracameral tissue plasminogen activator injection. In this study, we performed lensectomy and vitrectomy in 20 rabbits. A retinal blood vessel was incised to stimulate intraocular hemorrhage; bleeding was controlled and vitreous hemorrhage aspirated. Postoperatively, one eye received a 0.1-mL injection of tissue plasminogen activator (25 micrograms); the other received balanced salt solution. The eyes receiving tissue plasminogen activator had a 28% incidence of increased anterior chamber blood and a 61% incidence of increased intravitreal blood. There was no evidence of postinjection bleeding in eyes receiving balanced salt solution. Most cases of bleeding occurred within 24 hours of tissue plasminogen activator injection. Administration of tissue plasminogen activator in the setting of segmented blood vessels may lead to intraocular hemorrhage.

Animals↗
PubMed1990

Controversies in the management of posterior segment ocular trauma.

Despite steady advances in surgical instrumentation and technique, ocular trauma continues to be a leading cause of visual loss in the United States. Almost half of the patients with posterior penetrating injuries are left with severe visual impairment. Controversy persists over the optimal management of the injured eye, including the proper use of prophylactic antibiotics, prophylactic cryopexy, and prophylactic scleral buckling. The role and timing of vitrectomy surgery in severe ocular trauma also remain topics of considerable debate, as does the role of vitrectomy in the management of magnetic intraocular foreign bodies. Each of these issues is discussed, with particular emphasis on conflicting views presented in the relevant literature.

Anti-Bacterial Agents↗
PubMed1990

Ophthalmological and other toxicities related to cytosine arabinoside and total body irradiation as preparative regimen for bone marrow transplantation.

Cytosine arabinoside, 3 g/m2, every 12 h for 6 days, followed by fractionated total body irradiation, 200 cGy twice daily for 3 days, was administered to 39 adult patients undergoing bone marrow transplantation. Allogeneic transplant patients received cyclosporin and methotrexate for prophylaxis of graft-versus-host disease. There were 21 autologous transplants (16 with acute leukemia, four with an advanced stage of chronic myelocytic leukemia, and one with lymphoma) and 18 allogeneic transplants (14 with acute leukemia, two with an advanced stage of chronic myelocytic leukemia and two with myelodysplastic syndrome). Toxicities were compared between the two groups. There was a significantly greater degree and duration of mucositis and a greater frequency of radiation-type retinopathy developing in the allogeneic group, predominantly in those having had radiation for prophylaxis or treatment of central nervous system leukemia. Seven of 11 acute leukemic patients who received autologous transplants in remission survive. Two of seven acute leukemias who received allogeneic transplants while in remission survive. Although the increased morbidity, retinitis and mucositis, observed in the allogeneic group indicates that this regimen when combined with methotrexate and cyclosporin is too toxic, the results in autologous transplantation in acute leukemia in remission are encouraging.

Bone Marrow Transplantation↗
PubMed1990

Establishment of human retinal pigment epithelial cell lines by oncogenes.

The primary human retinal pigment epithelial cells were transfected with oncogenic sequences derived from viruses and cellular homologues of retroviral oncogenes 'protooncogenes' linked to simian virus 40 (SV-40) and retroviral promoters. Foci of cells were noted between 2 to 4 weeks after transfection. Individual colonies of cells were expanded from cultures transfected with SV-40 virion DNA, SV-40 large T antigen gene, Ha-ras oncogene, human and mouse c-myc and adenovirus E1A gene. Established cell lines tested were positive for the specific oncogene sequences by Southern hybridization and also expressed the protein as assayed by immunofluorescence and immunoblot analysis. Cell lines established with SV-40 large T antigen, and SV-40 virion DNA, exhibited epithelioid morphology up to the 25th passage and later became more rounded. However, all cell lines established with other oncogenes continued to retain epithelial morphology. Functional analysis of the cell lines demonstrated the presence of polarity and the ability to phagocytize rod outer segments, characteristics of retinal pigment epithelial cells. The use of oncogenes with immortalization/transformation potential may allow the establishment of cell lines from ocular tissues for analysing the biochemical basis of a disease like retinitis pigmentosa.

Antigens, Polyomavirus Transforming↗