Staphylococcus aureus conjunctivitis and sepsis in a neutropenic patient.
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Aged↗
Biomedical subjects
T A Weingeist
Publications and source records attributed to T A Weingeist.
Rural endophthalmitis.
The antibiotic regimens recommended for empiric use in posttraumatic endophthalmitis are based on data collected from medical centers in large metropolitan areas. In rural areas, trauma resulting in endophthalmitis frequently involves injuries with perforating objects that are contaminated with organic matter. These rural cases therefore may not be comparable with endophthalmitis occurring after nonrural injuries. A 10-year retrospective analysis was performed to investigate the incidence of rural endophthalmitis as well as determine the type of causative organisms. Endophthalmitis developed in 24 (30%) of 80 patients with rural penetrating trauma, compared with 23 (11%) of 204 patients with nonrural penetrating trauma. Of 24 patients, Bacillus spp were isolated in 11 (46%), followed by gram-negative rods in 7, Staphylococcus epidermidis in 6, and streptococcal species in 5. In 10 (42%) of these 24 patients with rural trauma, more than one organism was isolated. Bacillus spp were involved in six (60%) of ten of these mixed infections. Based on these findings, the authors suggest an intravitreal regimen of gentamicin along with either vancomycin or clindamycin for the empiric therapy of rural endophthalmitis.
Adolescent↗
The treatment of serous macular detachment secondary to choroidal melanomas and nevi.
The authors successfully treated with laser photocoagulation five patients who had a serous macular detachment secondary to leakage from a pigmented choroidal tumor. Three patients had dye leakage on fluorescein angiography from a choroidal neovascular membrane. The subretinal fluid resolved in all three patients after the neovascular membrane was obliterated by either krypton red (2 patients) or argon green (1 patient) laser photocoagulation. The other two patients had prominent leakage from a localized choroidal neovascular membrane as well as mild diffuse leakage over the entire tumor. Focal argon laser treatment to the neovascular membrane alone did not cause permanent resolution of the subretinal fluid. The fluid did resolve, however, after the entire area of diffuse leakage was retreated with photocoagulation. In one of the patients who received both focal and confluent laser treatment, the choroidal tumor grew in a collar-button fashion through Bruch's membrane at the original site of focal treatment. This eye was enucleated, and results of histopathologic examination showed a choroidal melanoma.
Aged↗
Visual success and vitreoretinal surgery.
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Diabetic Retinopathy↗
Complications after proton beam therapy for uveal malignant melanoma. A clinical and histopathologic study of five cases.
Proton beam therapy for uveal malignant melanoma has been advocated as effective therapy because of documented reduction in tumor size and few clinical complications. However, some eyes have been removed because of adverse effects. The authors report the clinical courses and pathologic findings of five eyes enucleated after proton beam irradiation. Neovascular glaucoma had developed in three eyes, two eyes had vitreous hemorrhage, and two had extraocular extension. The tumors in the radiation treatment field showed continued postirradiation growth clinically in four of the five eyes, and mitotic activity histologically in all five cases. Two and one half years after irradiation, and nearly 2 years after subsequent enucleation, one of those two patients had biopsy-proven liver metastases, and later died. Despite the considerable success rate of proton beam irradiation, the potential for clinical complications and subsequent tumor growth remains.
Adult↗
Results and complications of pneumatic retinopexy.
Fifty-one patients with primary rhegmatogenous retinal detachment (RD) were treated by pneumatic retinopexy. The overall success rate for reattachment with one operation was 63%. Of the 34 phakic eyes, 25 (74%) were reattached; of the 17 aphakic or pseudophakic eyes, seven (41%) were reattached (P less than 0.05). Postoperative complications included the development of new tears (22%), inadequate closure of the original tear, shifting and delayed absorption of subretinal fluid, and opening of previously closed tears. Pneumatic retinopexy is a valuable new technique; however, careful patient selection and postoperative management is required.
Aged↗
Pars plana management of ectopia lentis in children.
Although the removal of the lens from patients with ectopia lentis has long been associated with a high rate of surgical complications, the surgical outlook for these patients is improving now that more sophisticated surgical modalities are available. We treated a series of eight consecutive patients with pars plana lensectomy (12 eyes) whose visual acuity could not be satisfactorily improved with optimal optical correction (phakic or aphakic). Visual acuity could not be improved in any of the subjects. Preoperative visual acuities ranged from 5/400 to 20/70. Eleven of 12 eyes maintained a visual acuity of 20/40 or better postoperatively over follow-up periods ranging from 1.0 to 6.3 years (mean, 5.1 years). There have been no significant surgical complications.
Adolescent↗
Aqueous vs viscous phenylephrine. I. Systemic absorption and cardiovascular effects.
We studied 30 patients undergoing vitreoretinal surgery to compare the systemic absorption and cardiovascular effects of 2.5% aqueous and 2.5% viscous (21 cp) ophthalmic solutions of phenylephrine hydrochloride. No significant differences were noted in the plasma levels or changes in blood pressure between the two groups, although there was a tendency toward higher mean plasma levels and blood pressures in groups receiving 2.5% aqueous phenylephrine hydrochloride. Maximum plasma levels were achieved within the first 20 minutes following topical application of phenylephrine eye drops, irrespective of the nature of the vehicle. This finding emphasizes the importance of monitoring these patients, especially those at high risk for any adverse cardiovascular effects during the first 20 to 30 minutes following instillation of phenylephrine eye drops. The patients in our study were supine and under general anesthesia. Therefore, there was no effect by lid blinking, the lacrimal pump, or gravity, which would ordinarily increase absorption by the nasal mucosa through the nasolacrimal system. By eliminating these variable factors, such as lid blinking, the study was performed in a stable and controlled manner, but the results may not be directly applicable to an upright awake patient.
Adult↗
The gross examination of eyes removed for choroidal and ciliary body melanomas.
Because the traditional gross examination technique used by most ophthalmic pathologists requires cutting into the eye without directly visualizing the tumor, pathologists cannot be certain that the slides generated reflect the areas or dimensions of clinical concern. An alternate laboratory technique permits the pathologist to examine the tumor from the clinician's perspective. If the tumor is confined to the posterior pole, the anterior segment is removed first; if the tumor extends anterior to the equator, the calotte opposite the tumor apex is removed permitting direct observation of the tumor. Sections of the tumor can be obtained corresponding to the largest tumor dimensions and other areas of clinical interest to obtain precise clinicopathologic correlations. All portions of the eye not involved by tumor are also studied to complete the examination.
Choroid Neoplasms↗
Terson's syndrome. Clinicopathologic correlations.
In seven cases of Terson's syndrome, an elevated, dome-shaped, membrane was detected in the posterior pole by ophthalmoscopy, echography, or during pars plana vitrectomy. Light and electron microscopic examination of two additional eyes obtained postmortem from an acute case of Terson's syndrome revealed that the posterior vitreous face was elevated by blood and that the internal limiting membrane of the retina was intact and in its normal position. In two chronic cases, a dome-shaped epiretinal membrane was excised from the macula during vitrectomy. Light and ultrastructural studies demonstrated that the membranes consisted of glial cells and basement membrane material. The dome-shaped structure observed in eyes with Terson's syndrome is due to the formation of a subhyaloid hemorrhage. The partially detached posterior hyaloid face created by this hemorrhage provides a scaffold for cellular proliferation and the development of an elevated epiretinal membrane in long-standing cases. Echographically, this membrane resembles a retinal detachment in B-scans, but can be clearly distinguished from retina with standardized A-scan.
Adult↗
Sodium hyaluronate (Healon) in closed vitrectomy.
Healon was implanted into the vitreous cavity of 33 eyes at the conclusion of pars plana vitrectomy. In aphakic eyes, Healon diffused rapidly into the anterior chamber, reducing the length of effective tamponade posteriorly and causing marked elevations of intraocular pressure. In phakic diabetic eyes, Healon appeared to trap hemorrhage mechanically from bleeding fibrovascular stumps posteriorly. It may therefore reduce the risk of opacifying vitreous hemorrhage after vitrectomy in phakic eyes with active neovascularization.
Humans↗
Procoagulant effects of intraocular sodium hyaluronate.
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Animals↗
Glaucoma screening as part of the routine physical examination. What to look for and how to use the Schiotz tonometer.
Glaucoma is a leading cause of visual loss in the United States. The primary care physician can effectively screen patients at risk by performing Schiotz tonometry, checking the visual fields, and examining the fundus. Patients with elevated intraocular pressure, grossly abnormal visual fields, or abnormal optic disks should be referred to an ophthalmologist for confirmation of diagnosis and for therapy.
Adult↗
Hematoporphyrin photoradiation therapy for intraocular and orbital malignant melanoma.
Photoradiation therapy (PRT) is a new technique that is currently under investigation for the treatment of a variety of solid malignant tumors. The technique involves systemic administration of hematoporphyrin derivative (HpD), a photosensitizing compound that is preferentially retained by malignant cells and photoactivation of the neoplasm with red light (630 nm) to achieve selective destruction of cancer cells. We used HpD PRT for seven patients with malignant melanoma of the uvea and conclude that initial results of HpD PRT for uveal malignant melanoma are encouraging and justify further investigation.
Eye Neoplasms↗
Neovascular glaucoma after photoradiation therapy for uveal melanoma.
We describe two patients (two eyes) with neovascular glaucoma following photoradiation therapy (PRT) for ciliary body and iris melanoma. Histopathologic examination in one eye eight months after treatment disclosed widespread tumor necrosis. The second patient with iris melanoma showed total clinical disappearance of the lesion and regression of iris neovascularization six months later. The cause of the neovascular glaucoma is uncertain. The marked tumor necrosis induced by PRT might have resulted in release of a vasoproliferative factor that, in turn, led to the development of rubeosis and neovascular glaucoma.
Aged↗
Combined hamartomas of the retina and retinal pigment epithelium.
Combined hamartomas of the retina and retinal pigment epithelium are rare fundus lesions. By combining cases seen by members of The Macula Society, clinical data was collected on 60 patients with combined hamartomas. We reviewed the clinical presentations, ophthalmoscopic, and fluorescein angiographic features and differential diagnosis of this tumor. Of 41 patients with adequate follow-up information, 10 (24%) lost at least two lines of visual acuity, usually due to tractional distortion of the fovea, and four (10%) had improved visual acuity following either amblyopia therapy or vitreous surgery for macular traction.
Adolescent↗
Diabetic vitrectomy.
Diabetic vitrectomy is usually performed to remove vitreous blood or to relieve traction of the macula. In addition to removing vitreous opacities and severing all anteroposterior connections of the posterior hyaloid face with a cutting and sucking probe, tangential traction in and around the macula is eliminated by sectioning preretinal membranes with intraocular scissors. Complications are significant in terms of both their incidence and their consequences. They include choroidal or subretinal infusion, peripheral and posterior retinal breaks, intraoperative bleeding, and neovascular glaucoma. Proper management can minimize the occurrence and adverse effects of these complications. If prognostic factors are favorable, visual improvement occurs in 78 to 59% of eyes postoperatively. Preoperative iris neovascularization, florid proliferative diabetic retinopathy, long-standing detachment of the macula, and iatrogenic retinal breaks are all correlated with significantly lower success rates. Three independent studies have shown that if visual improvement is present 6 months postoperatively, the results are usually long-standing [2, 8, 20].
Cataract↗
Diabetic rubeosis and panretinal photocoagulation.
Iris fluorescein angiography was used to perform the first prospective, controlled, masked evaluation of the effect of panretinal photocoagulation on diabetic rubeosis. Eyes with rubeosis had iris fluorescein angiograms five to seven weeks apart. Eyes either had laser treatment immediately after the first angiogram or had no laser treatment between angiograms. The rubeosis was said to have improved if all three masked readers independently selected the angiogram performed last as having the less severe rubeosis. In eyes with severe rubeosis, only two of 11 (18%) spontaneously improved whereas 11 of 15 (73%) improved following laser therapy. In eyes with mild rubeosis, one of ten improved spontaneously and one of ten improved following laser therapy. Iris fluorescein angiography documented regression of severe but not mild rubeosis following panretinal photocoagulation.
Clinical Trials as Topic↗