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Biomedical subjects

R L Green

Publications and source records attributed to R L Green.

At least 37 records · Page 2Linked to original sources
PubMed1995

Choroidal effusion as a mechanism for transient myopia induced by hydrochlorothiazide and triamterene.

PURPOSE: We treated a case of transient myopia in a patient being treated with hydrochlorothiazide and triamterene for tinnitus. METHODS: The patient underwent gonioscopic, ophthalmoscopic, and echographic examinations. RESULTS: Examination showed anterior chamber flattening and echography disclosed bilateral 360-degree shallow choroidal detachments. CONCLUSION: All of the patient's symptoms and signs resolved after the cessation of drug therapy.

Adult↗
PubMed1995

Echographic evaluation of primary cysts of the iris pigment epithelium.

PURPOSE: Primary cysts of the iris pigment epithelium frequently appear to be focal elevations of the peripheral iris. To differentiate them from other anterior segment tumors requires the ability to assess the distribution, tissue characteristics, and progression of such lesions, which we accomplished by using anterior segment echography. METHODS: We reviewed the medical records of 49 consecutive patients referred to the Doheny Eye Institute for echographic evaluation of focal bulging of the peripheral iris. Echography of the anterior segment was performed on each patient by using an immersion technique. Clinical examination was also performed on 20 (41%) patients at the time of initial examination. RESULTS: We identified 52 iris pigment epithelial cysts in 52 eyes of the 49 patients studied. All lesions were single, localized to the posterior iris surface, and demonstrated a well-circumscribed, echolucent structure on B-scan echography. Average maximal sagittal thickness was 1.6 +/- 0.4 mm. Cysts were most frequently located in the inferotemporal quadrant (31%). Minimal increase in size or regression of lesions was noted in the nine patients (ten eyes) for whom follow-up echographic examinations were available. CONCLUSIONS: Primary iris pigment epithelial cysts possess characteristic features with regard to location, size, and internal structure, which can be accurately documented with echography. Clinically evident lesions tend to be between 1 and 4 mm in maximum sagittal thickness, conform to the contour of posterior chamber structures without distortion, produce anterior bulging of the peripheral iris, are preferentially located in the inferotemporal quadrant, and demonstrate limited potential for growth.

Adolescent↗
PubMed1994

Echographic findings in infectious endophthalmitis.

OBJECTIVE: To correlate the initial echographic findings in eyes with infectious endophthalmitis with the visual prognosis and causative microorganism. DESIGN: A retrospective review of the clinical and standardized ocular echographic findings in eyes with infectious endophthalmitis was performed. SETTING: University-based ophthalmology department. STUDY PARTICIPANTS: One hundred thirty-seven eyes (136 patients) with infectious endophthalmitis that were evaluated by the ocular echography service of the Doheny Eye Institute, Los Angeles, Calif, between January 1, 1981, and December 31, 1992. RESULTS: Four findings on initial echography were associated with poor initial vision: dense vitreous opacities, retinal detachment, macular detachment, and choroidal detachment. Five findings on initial echography correlated with poor final vision: dense vitreous opacities, vitreous membranes, the presence of retinal detachment, the extent of retinal detachment, and the presence of choroidal detachment. Change (decrease) in vision during the follow-up period was associated with the presence of combined vitreous and subhyaloid opacities, retinal detachment, and choroidal detachment. All eyes with initially clear vitreous on ocular echography had either early streptococcal or culture-negative endophthalmitis. Advanced streptococcal endophthalmitis correlated with the most severe vitreous inflammation, vitreous membranes, and the most extensive posterior vitreous detachment, whereas gram-negative endophthalmitis correlated with choroidal detachment on initial echography. Stepwise logistic regression analysis revealed that the presence of choroidal detachment, not gram-negative microorganisms, was the principal predictor of poor visual outcome in these eyes. CONCLUSION: Ocular echography is a useful method in the clinical evaluation and treatment of infectious endophthalmitis, especially in eyes with opaque media.

Adolescent↗
PubMed1994

Encircling panretinal laser photocoagulation may prevent macular detachment after vitrectomy for proliferative diabetic retinopathy.

Macular detachment due to peripheral retinal tears that occur after pars plana vitrectomy for proliferative diabetic retinopathy can result in severe visual loss despite successful retinal reattachment. The authors reviewed the records of three patients who developed peripheral sclerotomy-related rhegmatogenous retinal detachments one to six months after vitrectomy for proliferative diabetic retinopathy, despite the absence of detectable sclerotomy-related retinal tears by indirect ophthalmoscopy and scleral depression at the conclusion of surgery. All three patients had received standard panretinal laser photocoagulation in a complete encircling pattern either prior to or during the initial vitrectomy. Clinically or echographically, each patient was seen to have a partial or complete annual peripheral sclerotomy-related rhegmatogenous retinal detachment delimited to the equator. In each of these three cases, posterior extension of the peripheral retinal detachment into the macular area was prevented by the most anterior row of the photocoagulation scars. Standard panretinal laser photocoagulation applied in a complete encircling pattern may be useful in the prophylaxis of macular detachment from sclerotomy-related retinal tears that occur after vitrectomy for proliferative diabetic retinopathy.

Aged↗
PubMed1994

Echographic findings in hemorrhagic disciform lesions.

PURPOSE: To examine the potential role of ocular echography in the evaluation of hemorrhagic disciform disease. METHODS: Using standardized ocular echography, the authors examined 85 eyes of 85 patients with hemorrhagic disciform lesions. RESULTS: Hemorrhagic disciform lesions are located in the subretinal pigment epithelial space and appear echographically as solid chorioretinal elevations characterized by a bumpy, lobulated surface with indistinct peripheral margins, irregular internal structure, and medium to high internal reflectivity. These lesions could be reliably differentiated from associated subretinal or suprachoroidal hemorrhage by ocular echography when the maximal height of the lesion was 1 mm or greater. CONCLUSIONS: Hemorrhagic disciform disease is usually complex with distinct components that may not be discernible on biomicroscopic or angiographic examination, in part because of overlying subretinal hemorrhage. Ocular echography provides a readily available clinical tool to define the components of hemorrhagic disciform disease more precisely. Improved characterization of hemorrhagic disciform lesions may improve understanding of the natural history and response to therapy of hemorrhagic age-related macular degeneration.

Aged↗
PubMed1994

Sustained regression of a primary choroidal melanoma under the influence of a therapeutic melanoma vaccine.

PURPOSE: To determine whether active specific immunotherapy with lysates of cutaneous melanoma cells, administered with immunologic adjuvant DETOX (Ribi ImmunoChem Research, Inc, Hamilton, MT), is effective in shrinking a primary choroidal melanoma, in an elderly patient already blind in the nontumorous eye. An 81-year-old man was referred with a primary choroidal melanoma of the left eye, with virtual blindness of the right eye due to macular degeneration. He was begun on active specific immunotherapy with an experimental melanoma vaccine (melanoma theraccine) and DETOX on weeks 1, 2, 3, 4, and 6, respected after a hiatus of 2 weeks. After a response was noted, monthly injections were given. RESULTS: The patient had a significant shrinkage of his choroidal melanoma from a height of 4.2 mm to 2.4 mm within 2 months. This was sustained by continual treatment for 21 months until September 1991. After the patient failed to return for 9 months while recuperating from a stroke, the lesion regrew to a height of 3.7 mm and developed an additional lobe. On resumption of monthly treatments, the lesion shrank to 3.4 mm within 3 months, lost the additional lobe, and has since remained stable. No metastases have been found over a period of nearly 4 years on quarterly computed tomographic (CT) scanning of the chest and abdomen, and magnetic resonance imaging of the head. CONCLUSION: Active specific immunotherapy with cutaneous melanoma lysates has caused a clinically useful protracted regression of a primary choroidal melanoma in an elderly patient in whom surgery and radiation therapy were contraindicated. This may represent the first case of a primary choroidal melanoma, and perhaps the only primary tumor, successfully treated with systemic immunotherapy alone. A formal trial of active specific immunotherapy for primary choroidal melanoma in selected patients may be warranted.

Adjuvants, Immunologic↗
PubMed1993

Effects of caffeine and gender on physiology and performance: further tests of a biobehavioral model.

The present study extended testing of our biobehavioral model describing the effects of arousal and caffeine to include an examination of gender differences and their interactions with habitual and acute caffeine ingestion. Males and females selected as high or low habitual caffeine users were randomly assigned to receive either caffeine or a placebo and exposed to novel and repetitive recall tasks and to simple auditory stimuli. Electrodermal activity and recall task performance were recorded. The four major factors examined, including habitual caffeine use, acute ingestion, gender, and stimulus novelty, affected behavior, physiology, or both. Results showed that habitual caffeine usage systematically affected tonic arousal (skin conductance level) and improved recall task performance. Acute caffeine ingestion increased phasic arousal (skin conductance response amplitude) and reduced habituation rates. Gender interacted with other factors to significantly affect both tonic and phasic arousal, and females performed better than males on the recall tasks. These results were partially supportive of the theoretical model, and further work is needed to examine the interactions of acute and chronic caffeine intake with gender and novelty.

Adult↗
PubMed1993

Echographic evaluation of glaucoma shunts.

BACKGROUND: It is frequently impossible to determine by clinical examination alone if a filtering bleb is present over the equatorial plate(s) of a glaucoma shunt. This uncertainty can result in management dilemmas when patients with these devices have elevated intraocular pressures (IOPs). The authors describe how standardized echography can be used to determine if fluid is present around the plates and to characterize the blebs. METHODS: Four hundred twenty-seven plates in 269 patients who had undergone single- or double-plate Molteno implantation underwent standardized echography (both A- and B-scan examinations) to determine if blebs were present around the plates, primarily when results of slit-lamp examinations had been inconclusive. Bleb sizes, locations, and characteristics also were evaluated. RESULTS: Sixty-five percent of the plates had associated blebs, which were graded according to their sizes (small, medium, and large, in 29%, 44%, and 27% of plates with blebs, respectively). Fluid (which appeared as an echolucent area) could be seen underlying and/or overlying the plates (which appeared as echodense lines). Larger blebs were often associated with scleral flattening. Although bleb sizes did not necessarily correlate with the levels of IOP control, the presence of a bleb on ultrasound was indicative of tube patency. CONCLUSION: Standardized echography was invaluable in the postoperative management of patients who had undergone Molteno implantation because it demonstrated the presence or absence of blebs and characterized them when results of slit-lamp examinations had been inconclusive. This technique also can be used to evaluate similarly designed aqueous shunting devices.

Adult↗
PubMed1993

Pseudo-Brown's syndrome as a complication of glaucoma drainage implant surgery.

Two cases of pseudo-Brown's syndrome occurring after superior nasal implantation of glaucoma filtering devices are described. We hypothesize that this restriction in ocular motility was due to the mechanical effects of large filtering blebs or increased inflammation and scar formation in the superior nasal quadrant. Serial ultrasound examinations of our patients demonstrated development of a large bleb, coincidental with the disturbance in motility. Because of the risk of strabismus, we no longer recommend placing large implant devices in the superior nasal quadrant in eyes that have good vision.

Aged↗
PubMed1991

Massive suprachoroidal hemorrhage with central retinal apposition. A clinical and echographic study.

We reviewed the charts of 18 patients diagnosed with a massive suprachoroidal hemorrhage (MSCH) with central retinal apposition (kissing configuration). Four cases occurred intraoperatively (expulsive), eight after a surgical procedure (delayed), and six associated with blunt or perforating injury (traumatic). In this study, echography was used to monitor the course of MSCH; the mean time for clot lysis was 14 days, and the mean duration of central retinal apposition was 15 days. The expulsive MSCHs were all allowed to resolve spontaneously, with good initial visual outcome in three of the four eyes in which they occurred. In the delayed MSCH group, the majority of patients attained their prehemorrhage visual acuity, with or without early surgical intervention. In the traumatic MSCH group, retinal detachment was a constant complication in all patients. All six patients in the traumatic MSCH group had a poor visual outcome, despite early surgical intervention in five patients. The results of this study suggest that not all MSCHs need to be drained surgically and that, when surgical drainage is indicated, echography may be a useful adjunct in determining the optimal time of drainage.

Adult↗
PubMed1991

Echographic characteristics of ocular toxocariasis.

Ocular toxocariasis most commonly presents as one of three distinct clinical syndromes: endophthalmitis, localized posterior granuloma, or peripheral granuloma. Using standardized echography, the authors studied 11 toxocariasis patients presenting with one of these syndromes. Common echographic findings were noted in ten of these patients, and included: (1) a solid, high-reflective peripheral mass, (2) a vitreous band or membranes extending between the posterior pole and the mass, and (3) a traction retinal detachment or fold from the posterior pole to the mass. These findings were present in patients presenting with leukocoria or endophthalmitis, as well as in patients in whom the peripheral nematode lesion could be visualized clinically. In combination with the history, clinical examination, and enzyme-linked immunosorbent assay (ELISA), standardized echography may be useful in establishing the diagnosis of ocular toxocariasis in cases of leukocoria in which nematode endophthalmitis is suspected.

Adolescent↗
PubMed1991

Papillopathies associated with unusual calcifications in the retrolaminar optic nerve.

We examined three patients with optic disc edema and peripapillary hemorrhages. Each was found by standard echography to have calcified nodules within the retrobulbar portion of the optic nerves. These nodules were located approximately 2 mm posterior to the lamina cribrosa. Each patient had unilateral congestion of the optic nerve head with dilated, tortuous retinal veins that appeared much like a partial central retinal vein occlusion; one patient subsequently developed optic atrophy. The central location of the calcifications within the anterior aspect of the optic nerves suggests that each nodule may have been situated within the central retinal vein or artery. Calcifications within the retrolaminar space may be associated with some etiologies of unilateral congestion of the optic nerve head.

Adult↗
PubMed1990

Echographic features of the Vogt-Koyanagi-Harada syndrome.

Vogt-Koyanagi-Harada (VKH) syndrome represents a spectrum of bilateral panuveitis with associated central nervous system and dermatologic manifestations. The diagnosis is based on clinical and angiographic findings, but some of the characteristic features may be either absent or difficult to visualize in the presence of opaque media. With the use of standardized echography (standardized A-scan and contact B-scan echography), we examined nine patients with clear media and clinical evidence of VKH syndrome. Consistent echographic findings included (1) diffuse, low to medium reflective thickening of the choroid posteriorly; (2) serous retinal detachment, located inferiorly or in the posterior pole; (3) mild vitreous opacities with no posterior vitreous detachment; and (4) thickening of the sclera and/or episclera posteriorly. Resolution of these findings occurred with systemic corticosteroid therapy. Standardized echography should be considered an important diagnostic tool in VKH syndrome, especially when visualization of the fundus is poor or when clinical presentation is atypical.

Adolescent↗
PubMed1990

Pars plana vitrectomy for acute retinal detachment in penetrating ocular injuries.

We studied 41 eyes with acute retinal detachment after penetrating ocular trauma in a retrospective cohort analysis. Pars plana vitrectomy was performed in 28 eyes, while the remaining 13 eyes had only primary repair and closure of the wound. The two groups differed in the type of trauma (more gunshot wounds in the vitrectomy group and more blunt injuries in the nonvitrectomized group). Visual success (visual acuity of 5/200 or better) was observed in 10 (37%) of the eyes treated by vitrectomy compared with one (8%) of the eyes in the nonvitrectomy group. Anatomic success was achieved in 21 (75%) of the eyes in the vitrectomy group but in only one (8%) of those in the nonvitrectomy group. Enucleation or phthisis was observed in seven (54%) of the eyes in the nonvitrectomy group compared with only five (18%) in the vitrectomy group. Significant prognostic factors for anatomic outcome in the vitrectomy group were the location of the laceration and the presence of the lens.

Acute Disease↗