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Biomedical subjects

S L Fine

Publications and source records attributed to S L Fine.

At least 55 records · Page 3Linked to original sources
PubMed1990

Choroidal neovascularization after laser photocoagulation for diabetic macular edema.

Choroidal neovascular membranes (CNVMs) developed in eight patients after photocoagulation for clinically significant diabetic macular edema (DME). The CNVMs developed in areas where Bruch's membrane was ruptured and were diagnosed 2 weeks to 5 months after treatment. Only six patients had symptoms. The CNVMs were treated in four patients; final visual acuity was poor in all eight patients. This serious complication that follows laser treatment for DME may be related to the use of repeated small-size, short-duration laser or intense laser burns, or both.

Aged↗
PubMed1989

Choroidal neovascular membrane and other chorioretinal complications of acquired syphilis.

We reviewed ten patients who had posterior segment complications of acquired syphilis. Five of these patients had a neovascular membrane of the choroid associated with secondary or tertiary syphilis. Vision was stabilized after laser photocoagulation in one patient who had a choroidal neovascular membrane. Five additional patients had ocular manifestations including uveitis, optic neuritis, neuroretinitis, chorioretinitis, retinal hemorrhages, arterial and venous occlusion, vasculitis, and retinitis. Treatment of chorioretinal complications of syphilis with intravenous penicillin, if initiated early in the course of the disease, may result in excellent visual recovery.

Adult↗
PubMed1989

The grading and prevalence of macular degeneration in Chesapeake Bay watermen.

A new grading scheme was developed to classify the fundus features of macular degeneration. This scheme identifies the earliest fundus changes associated with macular degeneration, as well as specific drusen characteristics felt to be associated with an increased risk of developing the exudative forms of this disease. Agreement between two graders using this scheme indicated good interobserver reliability. Using this scheme, fundus photographs of 777 participants were graded in a population-based study of watermen from the eastern shore of Maryland. The prevalence of at least one druse within 1500 microns of the foveal center was extremely common (over 80% in each age group over 30 years of age) and not age related. The prevalence of large, confluent, or soft drusen was relatively uncommon and was age related; by the eighth decade, 26% of all participants had large or soft drusen, and 17% of them had confluent drusen. These latter characteristics are more likely to be markers of early changes consistent with age-related macular degeneration rather than simply the presence of a few drusen.

Adult↗
PubMed1989

Exposure to sunlight and other risk factors for age-related macular degeneration.

As some ultraviolet (UV) radiation is transmitted by the ocular media, there is a growing concern that there may be a possible relationship between long-term exposure to ultraviolet radiation and increased risk of age-related macular degeneration. To address this question, a survey was conducted of 838 Maryland watermen who had well-characterized ocular UV-A and UV-B exposure. Fundus photographs were taken and graded for presence of exudative disease, geographic atrophy, focal hyperpigmentation of the retinal pigment epithelium, and drusen that were large and/or confluent. None of the subjects in these analyses were aphakic. The results suggested that age-related macular degeneration was not associated with cumulative exposure to either UV-A or UV-B. Age and the presence of nuclear opacity were independently associated with an increased risk of macular degeneration. Thus, we found that in phakic subjects, even with high levels of sunlight exposure, there was no evidence of increased risk of age-related macular degeneration associated with UV-B or UV-A exposure.

Adult↗
PubMed1989

The use of fundus photographs and fluorescein angiograms in the identification and treatment of choroidal neovascularization in the Macular Photocoagulation Study. The Macular Photocoagulation Study Group.

The Macular Photocoagulation Study (MPS) Fundus Photograph Reading Center has developed a standard set of methods for assessing color photographs and fluorescein angiograms on study patients. For pretreatment angiograms, these methods are used to determine the location and extent of the choroidal neovascularization. For posttreatment color fundus photographs, these methods are used to assess the extent and intensity of treatment. Although these methods were developed to judge eligibility and treatment of patients enrolled in the MPS, they provide an excellent way for all treating ophthalmologists to evaluate their patients' angiograms and to assess immediately the intensity and extent of laser photocoagulation. The technique requires a microfilm reader or slide projection device to determine the completeness of treatment. The authors superimpose independent drawings made from pre- and posttreatment photographs. The techniques described can be applied readily in clinical practice. Since persistent neovascularization is highly correlated with incomplete and/or inadequate photocoagulation treatment, clinicians may adopt these Reading Center techniques to minimize the frequency of persistent neovascularization and, possibly, to reduce the frequency of visual loss in treated eyes.

Choroid↗
PubMed1989

Diminished foveal sensitivity may predict the development of advanced age-related macular degeneration.

Visual function testing was performed on one eye with drusen from each of 18 elderly patients in 1984. Eleven patients had advanced age-related macular degeneration (AMD) in the fellow eye, and seven had only bilateral drusen. These patients were all followed prospectively (median, 45 months), at which time one eye had a new vessel membrane, three eyes had pigment epithelial detachments, and one eye had geographic atrophy. Only two of these five eyes had AMD-related visual loss in the fellow eye in 1984. The degree of loss of foveal dark-adapted sensitivity in 1984 predicted which patients developed advanced AMD with 100% sensitivity and 92% specificity. The presence of high-risk drusen characteristics in 1984 predicted the development of advanced AMD with 100% sensitivity but only 55% specificity. For this small group of patients, foveal dark-adapted sensitivity loss was an excellent predictor of the subsequent development of advanced AMD in eyes with drusen. A prospective study of a large group of patients with drusen is being undertaken to validate this finding.

Aged↗
PubMed1989

Clinicopathologic findings in a patient with serpiginous choroiditis and treated choroidal neovascularization.

We present the ocular clinicopathologic features of the left eye of a patient who, during a 29-year period, developed the characteristic features of progressive serpiginous choroiditis. Two areas of choroidal neovascularization were successfully treated by laser photocoagulation. The larger area of neovascularization, located in and inferior to the maculopapillary bundle area and treated with argon laser, resulted in a scar composed of hyperplastic retinal pigment with persistence of neovascularization and full-thickness destruction of the retina. A smaller area of neovascularization, located temporal to the fovea and treated by krypton laser, resulted in a fibrous scar with obliteration of the new vessels and preservation of the inner retinal layers. A diffuse and focal infiltrate of lymphocytes was present in the choroid. Often, larger aggregates of lymphocytes were present at the margin of the serpiginous lesions. The serpiginous lesions were characterized by loss of retinal pigment epithelium and the photoreceptor cell layer. The margins of most lesions had variable degrees of hyperplastic retinal pigment epithelium and some had defects in Bruch's membrane, through which fibroglial scar tissue extended into the choroid.

Choroid↗
PubMed1989

Retinal laser photocoagulation. Effect of rate of energy delivery.

Three monkeys were treated with krypton red laser photocoagulation in a manner simulating treatment of a choroidal neovascular membrane. One eye of each monkey was treated by employing immediately the power level needed to produce a lesion judged biomicroscopically to be of sufficient intensity (Method A). The fellow eye was treated by starting with lower power levels and then gradually increasing to the level needed to produce a similar-appearing lesion (Method B). Parameters of spot size and treatment duration were kept constant. Animals were sacrificed three days, eight days, and four months after treatment. Both methods of treatments spared the overlying ganglion cell layer in all fundus locations, but Method A induced cell loss in the inner nuclear layer while Method B spared it. Since reaching the clinical endpoint for Method B required fewer spots at the highest power level, the number of spots at the highest power level is probably the most important factor in determining degree of inner retinal absorption. Since both methods of treatment resulted in satisfactory closure in the choriocapillaries, the histopathologic differences may not be clinically important.

Animals↗
PubMed1989

Vitrectomy when asteroid hyalosis prevents laser photocoagulation.

Asteroid hyalosis is a relatively common disorder of the vitreous that rarely causes visual impairment. However, funduscopic examination and laser photocoagulation can be difficult because of reflections off the asteroid bodies. Although vitrectomy is rarely indicated for impaired visual acuity, we report three cases in which pars plana vitrectomy was necessary to permit required retinal laser photocoagulation. In two patients with proliferative diabetic retinopathy and a third patient with subretinal neovascularization marked asteroid hyalosis precluded photocoagulation by standard techniques.

Aged↗
PubMed1988

Contrast sensitivity in age-related macular degeneration.

Low-contrast charts were used to investigate the possibility that patients with drusen have visual deficits not detected by standard Snellen charts. We compared performance on Regan letter charts between 52 eyes with drusen and Snellen acuity of 20/20 and 27 control eyes. The drusen group read fewer letters than the control group on all of the charts tested. This difference increased as the contrast of the charts decreased. The loss of performance on all of the Regan charts correlated with drusen severity. Twenty-one eyes with drusen and normal Snellen acuity also were tested with a Ginsburg contrast sensitivity chart and compared with age-matched normal controls. The results showed a loss of contrast sensitivity at high spatial frequencies and a loss of peak contrast sensitivity with increasing drusen severity. These results suggest that in patients with drusen, low-contrast charts may be useful for measuring visual loss not detected by standard Snellen charts.

Adult↗
PubMed1988

Choroidopathy in systemic lupus erythematosus.

Choroidopathy in association with systemic lupus erythematosus (SLE) is a clinically unusual manifestation, previously described in only six patients, to our knowledge. We have followed up six patients with SLE and choroidopathy manifested by multifocal, serous elevations of the retinal pigment epithelium and sensory retina. In four patients, macular involvement was present, and they suffered visual loss. Two eyes of two patients progressed to large, bullous, exudative retinal detachments. In the three patients in whom control of the systemic disease was achieved, the serous detachments resolved. The pathogenesis is most likely related to choroidal vascular disease with resultant pigment epithelial damage and serous fluid leakage beneath the retina.

Adult↗
PubMed1988

Laser treatment for choroidal neovascularization outside randomized clinical trials.

This study was undertaken to determine whether the treatment benefit reported in randomized trials for patients with extrafoveal choroidal neovascular membranes (NVMs) secondary to age-related macular degeneration (AMD) or the ocular histoplasmosis syndrome (OHS) can be duplicated in other clinical settings. The visual results and recurrence rates in treated extrafoveal NVMs of 70 patients with AMD and 21 patients with OHS were similar to those reported by the Macular Photocoagulation Study Group, in which all treated patients received argon blue-green laser photocoagulation after the administration of retrobulbar anesthesia. In this study, 78% (71/90) of the patients were treated with krypton laser and only 35% (32/90) had retrobulbar anesthesia. These results suggest, but do not prove, that the wavelength of the laser used or the administration of retrobulbar anesthesia may not be critical variables in determining the success of treatment in patients with extra-foveal NVMs.

Argon↗
PubMed1988

The evolution of argon laser photocoagulation scars in patients with the ocular histoplasmosis syndrome.

In 34 patients (35 eyes) with successfully treated histoplasmic choroidal neovascular membranes with a mean follow-up of 10.1 years, neither the neovascular membrane size nor the distance to the center of the foveal avascular zone (FAZ) affected final visual acuity. For a subgroup of 18 patients who had a two-year follow-up visit, the average chorioretinal scar expanded in area 50.1% per year for the first two years and 4.6% per year thereafter. This corresponded to a migration rate toward the FAZ of 152 micron/y for the first two years and 22 micron/y thereafter. After ten years, the average scar was 3.23 times larger than the initial treatment area and 480 micron closer to the FAZ than the initial treatment edge. Of the eight patients whose scars expanded to involve the center of the FAZ, six had final visual acuities either equal to or better than the initial visual acuities.

Adult↗
PubMed1988

Natural course of poorly defined choroidal neovascularization associated with macular degeneration.

We obtained follow-up data on 84 eyes with age-related macular degeneration and poorly defined angiographic leakage presumed to represent choroidal neovascularization. A poorly defined neovascular membrane was presumed to be present when subsensory retinal fluid was present in association with choroidal leakage on fluorescein angiography and in which the extent of leakage was not well defined. Among the 84 eyes, the average initial visual acuity was 20/80. In 75 (89%) of 84 eyes, the leakage involved the foveal center at initial presentation. At follow-up (average, 28 months; range, six to 53 months), the average visual acuity was 20/250; the final acuity declined at least three but less than six lines in 18 eyes (21%) and six or more lines in 35 eyes (42%). There was a statistically significant difference in the percentage of eyes that developed moderate or severe visual loss among eyes that progressed to disciform scarring compared with eyes that continued to manifest poorly defined leakage without evidence of scarring. Given that most severe visual loss associated with macular degeneration can be attributed to consequences of neovascular membranes and that many membranes associated with age-related macular degeneration are poorly defined, our study results support the possibility that poorly defined neovascular membranes represent a major cause of severe visual loss among the elderly in the United States.

Aged↗