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Biomedical subjects

W R Freeman

Publications and source records attributed to W R Freeman.

At least 181 records · Page 10Linked to original sources
PubMed1990

Pathologic observations made by retinal biopsy.

The authors report four cases in which retinal biopsy findings yielded unexpected or previously unreported diagnoses in patients with inflammatory retinitis. The tissue diagnoses included Wegener's retinal vasculitis in an immunosuppressed patient with a clinical diagnosis of cytomegalovirus retinitis, a novel viral form in the retina of a patient with cytomegalovirus retinitis, a case of acute retinal necrosis due to cytomegalovirus infection in an immunologically normal adult, and a case of ganciclovir-resistant herpes family viral retinitis. These cases illustrate the use of retinal biopsy in obtaining tissue for diagnosis and guiding treatment in selected cases of retinitis.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The 30-degree curved endolaser probe.

Straight, 30-, and 45-degree endolaser probes were compared to determine the optimal curve for peripheral endolaser photocoagulation during pars plana vitrectomy. The 30-degree probes allowed panretinal laser coverage in phakic eyes, thereby negating the need for peripheral cryopexy which may cause increased inflammation and contribute to the development of proliferative vitreoretinopathy. The 30-degree probe was less likely to strike the lens inadvertently, produced a more consistent burn, was more versatile in posterior treatments, and had a longer fiberoptic core life than the 45-degree probe. It was impossible to treat the peripheral retina using the straight probe without hitting the lens during phakic pars plana vitrectomy.

Equipment Design↗
PubMed1990

Combined penetrating keratoplasty and vitreoretinal surgery with the Eckardt temporary keratoprosthesis.

The Eckardt style temporary keratoprosthesis was used in six cases of five eyes undergoing simultaneous penetrating keratoplasty and pars plana vitrectomy. This device provided excellent visualization of posterior and peripheral intraocular structures and maintained a closed system during surgery. Corneal grafts remained clear in 80% of the cases, and macular attachment was achieved with either silicone oil or perfluoropropane gas in 50% of cases followed for at least 6 months. Visual function remained the same or improved in three eyes. Suggested refinements to the placement of this device include enlarging the trephination to 6.75 mm and the use of 8-0 nylon sutures to prevent cheesewiring of the soft silicone rim. A plano contact lens required during surgery to visualize the retina did not minify the image. Since the optical cylinder of the Eckardt temporary keratoprosthesis is shorter than that of a Landers-Foulks keratoprosthesis of similar diameter, it provides greater peripheral visualization. It is, however, less durable.

Adult↗
PubMed1990

Posttraumatic yellow maculopathy.

Blunt trauma to the eye may cause several types of macular abnormalities, including commotio retinae, macular hole, intraretinal and subretinal hemorrhage, and choroidal rupture. In most cases the diagnosis is readily apparent; however, the complex appearance of simultaneous hemorrhage, pigmentary change, and ruptured tissue planes may be confusing. The authors present two cases of blunt trauma in young males that resulted in a subretinal hemorrhage that became yellow and was initially misinterpreted as a vitelliform lesion. A history of trauma should be sought in any patient with the clinical appearance of a yellow subretinal lesion.

Adult↗
PubMed1989

Severe visual loss related to isolated peripapillary retinal and optic nerve head cytomegalovirus infection.

We examined ten patients from a consecutive series of 73 patients with either isolated cytomegalovirus papillitis or limited cytomegalovirus retinitis contiguous with the optic disk. Patients with peripheral retinitis and other areas of retinitis were excluded. All patients were treated with ganciclovir. Two distinct types of cytomegalovirus infection of the peripapillary area were identified. Type I was characterized by spread of limited retinitis to the optic disk margin, good central visual acuity, and permanent arcuate and altitudinal visual field defects that enlarged and became more complete as the retinitis progressed toward the disk. Type II appeared to be a true cytomegalovirus infection of the optic nerve characterized by primary, isolated papillitis with peripapillary retinitis, an early afferent pupillary defect, and good initial visual acuity, which rapidly deteriorated despite prompt antiviral therapy. Peripapillary cytomegalovirus retinitis appears to be an important and underreported cause of visual morbidity in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The agar-albumin sandwich technique for processing retinal biopsy specimens.

Retinal biopsy may be useful procedure in the diagnosis of certain cases of infectious retinitis complicated by retinal detachment. The small, delicate pieces of retina obtained by retinal biopsy are difficult to handle and prepare for histologic processing. The tissue is friable, may curl upon itself, and is often lost during normal processing. Routine methods for handling small biopsy specimens of other tissues are inadequate for preparing retinal specimens. We developed an agar-albumin tissue mount for the sterile recovery and transport of small pieces of retina from the operative field to the laboratory. The agar-albumin sandwich mount facilitates tissue processing without interfering with histologic sectioning or interpretation. The ability to recover small, friable pieces of retina in a manner that allows good histologic examination is essential if retinal biopsy specimens are to be used in the diagnosis and management of patients with infectious retinitis where the causative agent is unclear.

Agar↗
PubMed1989

Confocal laser tomographic analysis of the retina in eyes with macular hole formation and other focal macular diseases.

To study the retinal surface in the human eye in normal and diseased states we used laser scanning tomography. The confocal arrangement of the laser tomographic scanner permits examination of retinal topography in the axis perpendicular to the retinal surface. The eyes examined with the laser tomographic scanner included normal eyes, eyes with macular holes, impending macular holes, radiation retinopathy, macular edema, photocoagulation scars, subfoveal scars, and serous detachment of the fovea associated with subretinal neovascularization. The laser tomographic scanner is a new method that allows measurements of the topography of the internal limiting membrane in the macular area and may improve our understanding of the pathophysiologic characteristics and treatment of a variety of disorders of the macula.

Adult↗
PubMed1989

Optic neuropathy associated with cryptococcal arachnoiditis in AIDS patients.

We studied two cases of bilateral visual loss secondary to an optic neuropathy in patients with cryptococcal meningitis. In both cases a history of visual loss after the onset of an episode of cryptococcal meningitis was elicited. Visual fields were consistent with optic nerve disease. The patients' visual loss appeared to be the result of perineuritic adhesive arachnoiditis. Although no surgical interventions were carried out in our patients, medical or surgical intervention may be useful to prevent or relieve constrictive arachnoiditis and preserve vision in selected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Prevalence and significance of acquired immunodeficiency syndrome-related retinal microvasculopathy.

We performed ophthalmologic examinations on 127 subjects with or at risk for human immunodeficiency virus (HIV) infection over a one-year period to determine the prevalence and significance of retinal cotton-wool spots and hemorrhages (AIDS-related retinal microvasculopathy). Of 26 asymptomatic homosexual men, of whom 13 were HIV seronegative and 13 were HIV seropositive, none manifested this retinopathy. Three of 34 patients (9%) with AIDS-related complex and 29 of 67 patients (43%) with AIDS manifested retinopathy on the initial examination. This difference in the prevalence of retinopathy between groups was statistically significant (P less than .05). Patients with AIDS demonstrated 7.2 times greater odds of manifesting retinopathy than patients with AIDS-related complex (P less than .05). Within the group of patients with AIDS, the T helper (CD4) to suppressor (CD8) cell ratio was significantly associated with retinopathy at the initial ocular examination. The CD4:CD8 ratio of the total group of AIDS and AIDS-related complex patients with retinopathy was significantly lower than that of patients without retinopathy (P less than .05). There was no significant association between retinopathy and any specific past or concurrent opportunistic infection or neoplasm. The presence of retinopathy was not associated with symptoms in any patient. The lesions of AIDS-related retinal microvasculopathy may be an important finding in the evaluation of patients suspected to have HIV-related disease.

AIDS-Related Complex↗
PubMed1989

Pneumocystis carinii choroidopathy. A new clinical entity.

A 43-year-old black woman with acquired immunodeficiency syndrome developed bilateral multifocal choroidopathy characterized by slowly enlarging round to oval lesions in the posterior pole and midperiphery. Systemic evaluation revealed no evidence of mycobacterial, fungal, or spirochetal disease. Fluorescein angiography of the lesions showed early hypofluorescence with late staining of the lesions, which appeared deep to the retinal circulation. There was no evidence of retinal involvement. Over a 4-month period of observation, the lesions appeared to enlarge slowly, with no evidence of vitreous cells or debris in the overlying retina. A transscleral choroidal biopsy was performed, and electron microscopy showed numerous cystic structures characteristic of Pneumocystis carinii within necrotic choroid. The lack of inflammatory changes clinically, by fluorescein angiography, and histopathologically was striking.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Endoretinal biopsy in immunosuppressed and healthy patients with retinitis. Indications, utility, and techniques.

Endoretinal biopsies were taken using pars plana vitrectomy techniques in 13 eyes with inflammatory or infectious retinitis complicated by retinal detachment (RD). The surgical technique has evolved over a 4-year period. The authors review the surgical technique including techniques of removal of the vitreous, appropriate hemostasis, selection of the biopsy site, and atraumatic removal of the tissue from the vitreous cavity. Careful processing of the material for histopathology, immunopathology, and electron microscopy is necessary and has provided useful information in patient diagnosis and management. The authors have used the technique in cases of rhegmatogenous RD complicating presumed viral retinitis. The technique has proven to be useful in confirming the clinical diagnosis and is relatively safe when used in selected cases.

Biopsy↗
PubMed1989

Useful adjuncts for vitreoretinal surgery.

Many vitreoretinal procedures are performed in offices and hospitals where cost control is important. We describe three useful devices and techniques that facilitate these procedures at minimal expense and often greater convenience. These include an accurate method for localising the pars plana without the use of callipers, an inexpensive, reliable, pressure regulated air pump for fluid-air exchange, and an easy method for intraocular injection of silicone oil through 20 gauge instrumentation without the need for expensive pumps. These procedures and techniques should prove to be useful in the treatment of vitreoretinal disease.

Air Pressure↗
PubMed1989

Retinopathy before the diagnosis of AIDS.

We reviewed the records of ocular examinations of patients referred or examined for inflammatory retinal disease over a two-year period and found 18 cases in which retinopathy was documented before the diagnosis of acquired immunodeficiency syndrome (AIDS). Seventeen patients were either homosexual men or intravenous drug abusers. Although 13 patients had AIDS-related complex, no patients met the Centers for Disease Control criteria for AIDS before their ophthalmologic examination. In all 18 cases, the diagnosis of severe immunodeficiency suggestive of infection by the human immunodeficiency virus (HIV) was made by the ophthalmologist. These ophthalmologic findings included five patients with asymptomatic retinal cotton-wool patches, two patients with endogenous Staphylococcus epidermidis bacterial endophthalmitis, and 11 cases of isolated cytomegalovirus retinitis. All patients were ambulatory outpatients at the time of ophthalmologic examination. Noninfectious retinopathy and intraocular opportunistic infections suggest the diagnosis of HIV infection and AIDS, and the ophthalmologist may play an important role in early diagnosis of this disease.

AIDS-Related Complex↗
PubMed1988

Atypical retinitis in patients with the acquired immunodeficiency syndrome.

We examined three patients with AIDS who had large, sharply demarcated areas of thinned retina consistent with inactive cytomegalovirus retinitis and who were not treated with ganciclovir. These lesions appeared identical to clinically inactive areas of cytomegalovirus retinitis after effective antiviral treatment. All patients were receiving azidothymidine or ribavirin, or both, which have activity against the human immunodeficiency virus and which may improve immune function. All patients also received oral acyclovir at doses ineffective against cytomegalovirus retinitis.

Acquired Immunodeficiency Syndrome↗
PubMed1988

New posteriorly located retinal breaks after pneumatic retinopexy.

Pneumatic retinopexy is a new procedure that is effective in treating many uncomplicated cases of rhegmatogenous retinal detachment (RD). It may be done in the office using a cryoprobe or laser and an expanding gas bubble and for this reason has become popular among RD surgeons. Reports of associated complications are limited. Three patients who had remarkably posterior retinal breaks after pneumatic retinopexy are presented with evidence that these breaks are a direct complication of this procedure. A possible explanation as to the pathogenesis of pneumatic retinopexy-associated posteriorly located retinal tears, as well as suggestions regarding prophylactic measures that may be taken to avoid this complication, are also presented.

Adult↗
PubMed1988

Demonstration of cytomegalovirus retinitis by in situ DNA hybridization.

Five cases of the acquired immune deficiency syndrome (AIDS), each exhibiting retinitis, were studied by DNA hybridization technique to detect viral infection. Five involved eyes were obtained at the time of autopsy from three patients who had received no treatment for the retinitis. Retinal biopsy specimens were obtained at the time of surgery from two other patients who developed retinal detachments after being treated with ganciclovir (dihydroxy propoxymethyl guanine). DNA hybridization revealed cytomegalovirus in retina and retinal pigment epithelium in all five specimens from patients who had not been treated with ganciclovir. No hybridization occurred in the two retinal biopsy specimens obtained from the ganciclovir-treated patients. These results suggest that in situ DNA hybridization is a highly specific and easily interpretable means of establishing the tissue diagnosis of viral retinitis.

Cytomegalovirus↗