396 results on '"Duker JS"'
Search Results
352. Branch retinal arterial occlusion caused by a preretinal arterial loop.
- Author
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Reichel E, Duker JS, Puliafito CA, Hedges TR 3rd, and Caplan L
- Subjects
- Adolescent, Arterial Occlusive Diseases pathology, Female, Humans, Arterial Occlusive Diseases congenital, Retinal Artery abnormalities
- Published
- 1994
- Full Text
- View/download PDF
353. Diabetic vitrectomy.
- Author
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Reichel E and Duker JS
- Subjects
- Diabetic Retinopathy etiology, Diabetic Retinopathy physiopathology, Humans, Postoperative Care, Silicone Oils adverse effects, Treatment Outcome, Vitreous Hemorrhage therapy, Diabetic Retinopathy surgery, Vitrectomy adverse effects
- Abstract
Proliferative diabetic retinopathy is one of the leading causes of permanent vision loss. Vitrectomy for the complications of proliferative changes has resulted in preservation of vision. Recent studies have focused on the cellular and structural changes in patients with proliferative changes. Data obtained from the early Treatment of Diabetic Retinopathy Study show that the rate of vitrectomy is reduced in eyes that have early-scatter photocoagulation in comparison with those that have deferral of treatment. The efficacy and complications of silicone oil tamponade have been more carefully evaluated with respect to complex detachments associated with proliferative diabetic retinopathy.
- Published
- 1994
- Full Text
- View/download PDF
354. Combined central retinal vein occlusion and cilioretinal artery occlusion associated with prolonged retinal arterial filling.
- Author
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Keyser BJ, Duker JS, Brown GC, Sergott RC, and Bosley TM
- Subjects
- Adult, Fluorescein Angiography, Fundus Oculi, Humans, Male, Methylprednisolone therapeutic use, Middle Aged, Recurrence, Regional Blood Flow, Retinal Artery pathology, Retinal Artery Occlusion drug therapy, Retinal Artery Occlusion physiopathology, Retinal Vein Occlusion drug therapy, Retinal Vein Occlusion physiopathology, Visual Acuity, Retinal Artery physiopathology, Retinal Artery Occlusion complications, Retinal Vein Occlusion complications
- Abstract
We examined four healthy men who developed cilioretinal artery occlusion associated with central retinal vein occlusion. Unlike previously reported patients with this clinical entity, there appeared to be abnormal central retinal artery inflow, as evidenced by prolonged, irregular filling of the branch retinal arteries with intravenous fluorescein angiography. The patients were treated with systemic corticosteroids. All of the patients had initial improvement in vision. However, three of the four patients had recurrent episodes of visual loss. The final visual acuity was 20/40 or better in three of the four patients.
- Published
- 1994
- Full Text
- View/download PDF
355. Indocyanine green dye-enhanced diode laser photocoagulation of poorly defined subfoveal choroidal neovascularization.
- Author
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Reichel E, Puliafito CA, Duker JS, and Guyer DR
- Subjects
- Aged, Aged, 80 and over, Choroid surgery, Female, Follow-Up Studies, Humans, Indocyanine Green, Male, Visual Acuity, Choroid blood supply, Fovea Centralis surgery, Laser Coagulation methods, Neovascularization, Pathologic surgery
- Abstract
Indocyanine green (ICG) is a dye with an absorption peak (795 to 810 nm) similar to the emission peak of the diode laser (805 nm). Therefore, ICG dye-enhanced diode laser photocoagulation may permit the selective ablation of ICG-retaining choroidal neovascular membranes (CNVM) with relative sparing of the neighboring neurosensory retina. Ten patients with poorly defined subfoveal CNVM were treated with ICG dye-enhanced diode laser photocoagulation and followed for an average of 15 months. One of the 10 patients experienced an immediate significant drop in visual acuity after photocoagulation. Obliteration of the CNVM at the site of laser photocoagulation was confirmed by fluorescein angiography and ICG angiography. Subfoveal chorioretinal scar formation was noted postoperatively in all 10 patients. At last follow up, 9 of these 10 patients had no more than a two-line increase or decrease in visual acuity. These preliminary results suggest that poorly defined subfoveal CNVM can be successfully treated by ICG dye-enhanced diode laser photocoagulation with minimal adverse affect on visual acuity in most cases.
- Published
- 1994
356. Successful treatment of rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome.
- Author
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Morley MG, Duker JS, and Zacks C
- Subjects
- Acyclovir therapeutic use, Adult, Female, Ganciclovir therapeutic use, Humans, Necrosis, Retinal Diseases microbiology, Acquired Immunodeficiency Syndrome complications, Retinal Diseases drug therapy
- Published
- 1994
- Full Text
- View/download PDF
357. Exudative retinopathy of adults: a late sequela of retinopathy of prematurity.
- Author
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Brown MM, Brown GC, Duker JS, Tasman WS, and Augsburger JJ
- Subjects
- Adult, Cryosurgery, Exudates and Transudates, Female, Fluorescein Angiography, Fundus Oculi, Humans, Infant, Newborn, Laser Therapy, Male, Retinal Detachment surgery, Scleral Buckling, Visual Acuity, Vitrectomy, Retinal Detachment etiology, Retinopathy of Prematurity complications
- Abstract
The cases of 11 patients with a unilateral, retinal detachment associated with hard exudate and other late sequelae of retinopathy of prematurity are described. The abnormality was first noted in the second to fourth decades of life. Ten of the patients were women and one was a man. The source of the hard exudate was thought to be telangiectatic retinal vascular abnormalities. Among the ten treated eyes, four demonstrated an improvement in visual acuity. In two cases a mass lesion was also noted in the fundus.
- Published
- 1994
- Full Text
- View/download PDF
358. Retinal pigment epitheliopathy after macular hole surgery.
- Author
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Duker JS
- Subjects
- Female, Fluorescein Angiography, Fundus Oculi, Humans, Middle Aged, Retinal Diseases etiology, Sulfur Hexafluoride administration & dosage, Visual Acuity, Vitrectomy, Pigment Epithelium of Eye, Postoperative Complications etiology, Retinal Perforations surgery
- Published
- 1993
359. Lipid exudation in age-related macular degeneration.
- Author
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Lozano-Rechy D, Duker JS, and Jalkh AE
- Subjects
- Aged, Aged, 80 and over, Female, Fluorescein Angiography, Fundus Oculi, Humans, Macular Degeneration physiopathology, Male, Middle Aged, Retinal Detachment etiology, Retinal Detachment pathology, Retinal Detachment physiopathology, Retinal Neovascularization complications, Retinal Neovascularization physiopathology, Retrospective Studies, Visual Acuity, Exudates and Transudates, Lipids, Macular Degeneration complications, Retinal Neovascularization pathology
- Abstract
We reviewed the relationship between lipid exudation and subretinal neovascular membranes associated with age-related macular degeneration. The records of 500 consecutive patients with subretinal neovascular membranes caused by age-related macular degeneration were examined. Seventy-five patients (15%) (85 eyes) manifested lipid exudation in conjunction with subretinal neovascularization. Twelve patients (2.4%) (13 eyes) had a massive lipid exudative response with extensive serous retinal detachment (resembling Coats' disease). Of the 85 eyes with subretinal neovascular membranes and lipid exudation, 71 (84%) had a subretinal neovascular membrane that was classified as ill defined. Improvement of vision with or without treatment was seen in only 14 of these 85 eyes (16.4%). After comparing these 85 eyes to 94 eyes from 76 patients with age-related macular degeneration and subretinal neovascular membranes but no lipid exudation, we found that a subretinal neovascular membrane associated with lipid exudation was more likely to be ill defined (71 eyes [84%] vs 35 eyes [37%]; P = .0001), was more frequently associated with retinal pigment epithelial detachment (30 eyes [35%] vs 15 eyes [16%]; P = .0029), and was more likely not to have stabilization of visual acuity (14 eyes [16%] vs 31 eyes [33%]; P = .025).
- Published
- 1993
- Full Text
- View/download PDF
360. Globe perforation associated with retrobulbar and peribulbar anesthesia.
- Author
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Ginsburg RN and Duker JS
- Subjects
- Adrenal Cortex Hormones, Aged, Anesthesia, Local methods, Cataract Extraction methods, Equipment Safety, Eye Injuries, Penetrating therapy, Female, Humans, Macula Lutea injuries, Needles adverse effects, Optic Nerve Injuries, Prognosis, Risk Factors, Anesthesia, Local adverse effects, Eye Injuries, Penetrating prevention & control
- Published
- 1993
- Full Text
- View/download PDF
361. Combined central retinal artery-central vein obstruction.
- Author
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Brown GC, Duker JS, Lehman R, and Eagle RC Jr
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Follow-Up Studies, Fundus Oculi, Humans, Iris blood supply, Iris pathology, Iris Diseases etiology, Iris Diseases pathology, Male, Middle Aged, Neovascularization, Pathologic etiology, Neovascularization, Pathologic pathology, Optic Nerve Diseases etiology, Optic Nerve Diseases pathology, Retinal Artery Occlusion pathology, Retinal Hemorrhage etiology, Retinal Hemorrhage pathology, Retinal Vein Occlusion pathology, Visual Acuity, Retinal Artery Occlusion complications, Retinal Vein Occlusion complications
- Abstract
The cases of 23 patients with unilateral combined central retinal artery-central retinal vein obstruction are described. Criteria for the abnormality included: a history of relatively sudden visual loss; superficial retinal whitening in the posterior pole in combination with a cherry spot; and intraretinal blood, generally associated with dilated and/or tortuous retinal veins. In five instances (22%) the obstructions developed after retrobulbar injection. Among the 21 patients with followup for at least 6 months, or until the onset of neovascularization of the iris, 17 (81%) developed rubeosis iridis. Late histopathology was obtained in two eyes. Hemorrhagic necrosis of the retina was observed in some areas of the posterior pole and attenuation of the inner retinal layers, similar to that seen with late central retinal artery obstruction, was noted elsewhere. Periphlebitis of the central retinal vein within the optic nerve was found in each case.
- Published
- 1993
- Full Text
- View/download PDF
362. Indocyanine green angiography and dye-enhanced diode laser photocoagulation.
- Author
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Guyer DR, Duker JS, and Puliafito CA
- Subjects
- Humans, Neovascularization, Pathologic diagnosis, Angiography methods, Choroid blood supply, Indocyanine Green, Laser Coagulation methods, Neovascularization, Pathologic surgery
- Published
- 1992
- Full Text
- View/download PDF
363. Repair of retinitis-related retinal detachments with silicone oil in patients with acquired immunodeficiency syndrome.
- Author
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Regillo CD, Vander JF, Duker JS, Fischer DH, Belmont JB, and Kleiner R
- Subjects
- Adult, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Retinal Detachment etiology, Retinal Detachment surgery, Retinitis drug therapy, Treatment Outcome, Visual Acuity, Vitrectomy, Acquired Immunodeficiency Syndrome complications, Cytomegalovirus Infections complications, Eye Infections, Viral complications, Retinal Detachment therapy, Retinitis complications, Silicone Oils therapeutic use
- Abstract
To provide prompt visual rehabilitation and to reduce the need for repeated operations, we performed vitrectomy with silicone oil tamponade in 16 consecutive eyes with retinal detachments related to cytomegalovirus retinitis and acute retinal necrosis in 13 patients with acquired immunodeficiency syndrome. In all 16 eyes (100%), retinas were reattached with one operation. Preservation of ambulatory vision was achieved in six of eight eyes (75%; mean follow-up, 14.6 weeks). No patient with hand motion visual acuity or worse preoperatively recovered ambulatory vision. Visual acuity recovery was limited by optic nerve disease in five eyes (31%). Silicone oil-related side effects did not adversely affect visual outcome in any eye. Six patients (46%) have since died (mean, 4.4 months postoperatively). These data indicated that successful surgical repair of these detachments can be consistently achieved with this approach. The prognosis for ambulatory vision is strongly related to preoperative visual acuity.
- Published
- 1992
- Full Text
- View/download PDF
364. Long-term stability and visual outcome after favorable initial response of proliferative diabetic retinopathy to panretinal photocoagulation.
- Author
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Vander JF, Duker JS, Benson WE, Brown GC, McNamara JA, and Rosenstein RB
- Subjects
- Adult, Aged, Diabetic Retinopathy physiopathology, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Prognosis, Recurrence, Risk Factors, Treatment Outcome, Vitrectomy, Vitreous Hemorrhage etiology, Diabetic Retinopathy surgery, Light Coagulation, Visual Acuity
- Abstract
The authors assessed the relationship between early objective response to panretinal photocoagulation (PRP) and the subsequent long-term visual outcome in 59 eyes of 59 consecutive patients who developed proliferative diabetic retinopathy while under the care of a retinal specialist. Thirty five eyes (59%) had regression of high-risk retinopathy characteristics within 3 months of treatment. Eighteen of these eyes (52%) had a final visual acuity of 20/20 or better with a mean follow-up of more than 4 years. Only 2 of the 24 nonresponder eyes (8%) had visual acuity of 20/20 or better. Thirteen of the responder eyes (37%) sustained a delayed vitreous hemorrhage, which was usually self-limited. Three responders underwent vitrectomy with excellent visual results. The authors conclude that the beneficial effect of PRP on visual outcome is directly related to the regression of retinopathy risk factors and that the long-term visual prognosis in high-risk eyes manifesting a favorable initial response to PRP is excellent.
- Published
- 1991
- Full Text
- View/download PDF
365. Retrobulbar bupivacaine irrigation for postoperative pain after scleral buckling surgery. A prospective study.
- Author
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Duker JS, Nielsen J, Vander JF, Rosenstein RB, and Benson WE
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Double-Blind Method, Female, Humans, Male, Middle Aged, Orbit, Prospective Studies, Surveys and Questionnaires, Therapeutic Irrigation, Bupivacaine administration & dosage, Pain, Postoperative drug therapy, Retinal Detachment surgery, Scleral Buckling
- Abstract
The authors conducted a prospective, randomized, double-masked clinical trial to determine if retrobulbar irrigation with bupivacaine hydrochloride 0.75% (Marcaine) has an effect on postoperative pain after scleral buckling surgery. Fifty consecutive patients undergoing scleral buckling under general anesthesia were randomized to receive either bupivacaine or balanced salt solution as a retrobulbar irrigation at the end of their retinal detachment procedure. Of the 25 patients who received bupivacaine, only three (12%) required parenteral pain relief in the first 24 hours after surgery. This was statistically significant when compared with the 18 (72%) of 25 patients requiring parenteral pain relief in the placebo group (P less than 0.0001). In addition, when questioned about their perception of the degree of postoperative pain, patients in the control group rated their level of pain as significantly more severe than did patients in the bupivacaine group. The authors conclude that retrobulbar irrigation with bupivacaine is a safe and effective way to achieve postoperative pain relief after surgery for scleral buckling.
- Published
- 1991
- Full Text
- View/download PDF
366. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome.
- Author
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Duker JS, Belmont JB, Benson WE, Brooks HL Jr, Brown GC, Federman JL, Fischer DH, and Tasman WS
- Subjects
- Adult, Aged, Aged, 80 and over, Conjunctival Diseases etiology, Conjunctival Diseases surgery, Cryosurgery, Eye Hemorrhage etiology, Eye Hemorrhage surgery, Eye Injuries, Penetrating surgery, Female, Fundus Oculi, Humans, Laser Therapy, Male, Middle Aged, Orbit, Prognosis, Retinal Diseases etiology, Retinal Diseases surgery, Scleral Buckling, Ultrasonography, Visual Acuity, Vitrectomy, Vitreous Hemorrhage diagnostic imaging, Vitreous Hemorrhage surgery, Anesthesia, Local adverse effects, Eye Injuries, Penetrating etiology
- Abstract
The authors report a series of 20 eyes from 20 patients in whom inadvertent perforation of the globe occurred during local anesthesia for ocular surgery. Perforation resulted from retrobulbar anesthesia in 18 eyes and from peribulbar anesthesia in 2 eyes. Nine (45%) of 20 eyes had an axial length greater than or equal to 26.00 mm. Combining this figure with axial length data for the general population and estimates for the risk of globe perforation during local anesthesia yields an approximate incidence of perforation in eyes with axial length greater than or equal to 26.00 mm of 1 in 140 injections. Proliferative vitreoretinopathy (PVR) developed in 8 of the 20 eyes (40%) in this series. Overall, 15 (75%) of the 20 eyes were successfully repaired, and, in five eyes (25%), the final visual acuity was 20/70 or better.
- Published
- 1991
- Full Text
- View/download PDF
367. Prevalence and association of asteroid hyalosis with systemic diseases.
- Author
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Bergren RL, Brown GC, and Duker JS
- Subjects
- Adult, Aged, Aged, 80 and over, Arteriosclerosis complications, Eye Diseases complications, Eye Diseases epidemiology, Female, Humans, Hyperopia complications, Hypertension complications, Male, Middle Aged, Philadelphia epidemiology, Prevalence, Diabetes Complications, Vitreous Body
- Abstract
We performed a cross-sectional study of 12,205 patients, which identified 101 patients (0.83%) with asteroid hyalosis. These patients were examined for associated systemic and ocular conditions. Diabetes mellitus was found in 29 of the patients with asteroid hyalosis (29%), as compared to ten of 101 (10%) control subjects (P = .0007). An increased prevalence of systemic arterial hypertension (61 of 101 [60%] patients with asteroid hyalosis compared with 29 of 101 [29%] control subjects; P = .0001) and atherosclerotic vascular disease (30 of 101 [30%] patients with asteroid hyalosis compared with 13 of 101 [13%] control subjects; P = .006) was also discovered in the asteroid hyalosis group. Additionally, patients with asteroid hyalosis were found to be more hyperopic than control subjects (P = .009).
- Published
- 1991
- Full Text
- View/download PDF
368. A prospective study of acute central retinal artery obstruction. The incidence of secondary ocular neovascularization.
- Author
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Duker JS, Sivalingam A, Brown GC, and Reber R
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Carotid Artery Diseases complications, Female, Glaucoma, Neovascular etiology, Humans, Incidence, Male, Middle Aged, Prospective Studies, Risk Factors, Iris blood supply, Neovascularization, Pathologic, Optic Disk blood supply, Retinal Artery Occlusion complications
- Abstract
We conducted a prospective study to determine the incidence of ocular neo-vascularization following acute central retinal artery obstruction. Only patients initially evaluated within 7 days of visual loss were eligible. Any patient with pre-existing ocular neovascularization or clinical evidence of the ocular ischemic syndrome noted at the initial evaluation was excluded. During the 18-month study, 33 consecutive patients were enrolled. Six patients subsequently developed neovascularization of the iris, an incidence of 18.2%. In these six patients, neovascularization of the iris appeared as early as 12 days to as late as 15 weeks following the artery obstructions. Five of the six patients (15.2% of the total) later developed neovascular glaucoma. Another patient in this series developed neovascularization of the optic disc without neovascularization of the iris, an incidence of 3.0%. Only two of the seven patients with ocular neovascularization had ipsilateral hemodynamically significant carotid artery disease as determined by noninvasive carotid artery testing. This study confirms results of previous retrospective studies that the incidence of ocular neovascularization after central retinal artery obstruction is higher than commonly thought. It also shows that, in the majority of cases, carotid artery disease is not responsible for the neovascularization seen after central retinal artery obstruction.
- Published
- 1991
- Full Text
- View/download PDF
369. Diagnosis and management of the acute retinal necrosis (ARN) syndrome.
- Author
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Duker JS and Blumenkranz MS
- Subjects
- Diagnosis, Differential, Eye pathology, Humans, Retinal Necrosis Syndrome, Acute etiology, Retinal Necrosis Syndrome, Acute pathology, Retinal Necrosis Syndrome, Acute diagnosis, Retinal Necrosis Syndrome, Acute therapy
- Abstract
The acute retinal necrosis (ARN) syndrome represents a specific pattern of clinical presentation for certain herpes virus infections in the posterior segment of the eye. The classically described triad of the ARN syndrome consists of (1) an arteritis and phlebitis of the retinal and choroidal vasculature, (2) a confluent, necrotizing retinitis that preferentially affects the peripheral retina, and (3) a moderate to severe vitritis. Anterior segment inflammation, optic neuritis, and late retinal detachment are also common features of this disorder. Definitive evidence now implicates at least two members of the herpes virus family; varicella zoster virus and herpes simplex virus as causative agents. This paper summarizes the clinical presentation, as well as the currently recommended treatment regimen for the ARN syndrome, highlighting recent advances that have resulted in a significant improvement in the visual prognosis for affected patients.
- Published
- 1991
- Full Text
- View/download PDF
370. Rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome.
- Author
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Duker JS and Shakin EP
- Subjects
- Aged, Female, Humans, Retinal Detachment complications, Retinal Detachment surgery, Retinal Necrosis Syndrome, Acute pathology, Retinal Necrosis Syndrome, Acute therapy, Acquired Immunodeficiency Syndrome complications, Retinal Necrosis Syndrome, Acute complications
- Published
- 1991
- Full Text
- View/download PDF
371. Rapidly progressive acute retinal necrosis secondary to herpes simplex virus, type 1.
- Author
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Duker JS, Nielsen JC, Eagle RC Jr, Bosley TM, Granadier R, and Benson WE
- Subjects
- Adult, Antigens, Viral blood, Enzyme-Linked Immunosorbent Assay, Fluorescein Angiography, Fundus Oculi, Humans, Male, Necrosis, Retinal Detachment etiology, Retinal Detachment pathology, Retinal Diseases pathology, Simplexvirus isolation & purification, Simplexvirus ultrastructure, Visual Acuity, Vitrectomy, Vitreous Body microbiology, Vitreous Body ultrastructure, Keratitis, Dendritic complications, Retinal Diseases etiology
- Abstract
A systemically healthy 22-year-old man presented with unilateral acute retinal necrosis (ARN) that featured diffuse retinal whitening throughout the posterior retina, exudative retinal detachment, and a visual acuity of no light perception. Diagnostic vitrectomy revealed necrotic retinal cells containing intranuclear inclusions visible with light microscopy. On electron microscopy, viral particles consistent with a herpes family virus were detected. Culture of the vitrectomy specimen showed herpes simplex, type 1 (HSV 1) and rising convalescent serum ELISA titers to HSV 1 confirmed a recent infection. This case of ARN is unusual for its severity, early macular involvement, and development of exudative retinal detachment. In addition, it represents one of the few reported cases in which HSV 1 has been confirmed by both vitreous culture and serum titers as the etiologic agent. A review of the literature suggests that posterior segment inflammatory conditions secondary to HSV 1 can be associated with exudative retinal detachment, a clinical finding that may help differentiate such conditions from other infectious causes of chorioretinitis.
- Published
- 1990
- Full Text
- View/download PDF
372. Visual prognosis correlated with the presence of internal-limiting membrane in histopathologic specimens obtained from epiretinal membrane surgery.
- Author
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Sivalingam A, Eagle RC Jr, Duker JS, Brown GC, Benson WE, Annesley WH Jr, and Federman J
- Subjects
- Follow-Up Studies, Humans, Membranes pathology, Prognosis, Retinal Diseases surgery, Retinal Diseases pathology, Visual Acuity, Vitrectomy
- Abstract
Forty-one patients with a unilateral, macular epiretinal membrane (ERM) underwent pars plana vitrectomy and membrane peeling to improve the visual acuity. The authors retrospectively reviewed the histopathology of the vitrectomy specimen in each instance to determine whether the presence of internal-limiting membrane (ILM) had an adverse effect on visual acuity. Eleven specimens contained long segment of ILM, as determined by light microscopy. With a minimum of 6 months of follow-up, none of these 11 eyes achieved a visual acuity of better than 20/60. Of 30 eyes that did not have ILM present, 41% achieved a visual acuity of 20/60 or better. Overall, 29% of the eyes in the entire series achieved 20/60 or better visual acuity. The difference between the group with ILM versus that without ILM was statistically significant (P = 0.01). The presence of long segments of ILM within the histopathologic specimen after vitreous surgery for removal of a macular ERM appears to indicate a less favorable visual outcome.
- Published
- 1990
- Full Text
- View/download PDF
373. Asymmetric proliferative diabetic retinopathy and carotid artery disease.
- Author
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Duker JS, Brown GC, Bosley TM, Colt CA, and Reber R
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Fundus Oculi, Humans, Male, Middle Aged, Prospective Studies, Visual Acuity, Carotid Artery Diseases complications, Diabetic Retinopathy complications
- Abstract
The authors prospectively evaluated 387 consecutive patients with proliferative diabetic retinopathy (PDR) for asymmetry in posterior segment neovascularization and its relationship to carotid artery disease. For the purpose of this study, asymmetry is defined as the presence of PDR with high-risk characteristics (as per the Diabetic Retinopathy Study) in one eye, with neither proliferative nor preproliferative changes in the opposite eye. Over the 2-year time period of the study, 20 (5.2%) of 387 patients manifested asymmetric PDR by this definition. All 20 patients underwent carotid artery noninvasive testing and 4 (20%) were found to have hemodynamically significant carotid artery disease. Two of the four patients had their proliferative retinopathy ipsilateral to their severe carotid artery stenosis. This finding does not support the hypothesis that a hemodynamically significant carotid artery stenosis protects against the development of PDR.
- Published
- 1990
- Full Text
- View/download PDF
374. Quadrantic venous-stasis retinopathy secondary to an embolic branch retinal artery obstruction.
- Author
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Duker JS, Magargal LE, and Stubbs GW
- Subjects
- Aged, Calcinosis complications, Female, Fluorescein Angiography, Follow-Up Studies, Fundus Oculi, Humans, Retinal Diseases physiopathology, Syndrome, Visual Acuity, Visual Fields, Embolism complications, Retinal Artery Occlusion complications, Retinal Diseases etiology, Retinal Vein physiopathology
- Abstract
Venous-stasis retinopathy is a term used to describe the posterior segment findings of the ocular ischemic syndrome. These include midperipheral blot retinal hemorrhages, dilated retinal veins, attenuated arterioles, peripheral retinal microaneurysms, macular edema, as well as retinal and optic disc neovascularization. The authors recently evaluated a 71-year-old woman who presented with an asymptomatic calcific embolus in her right infero-temporal branch retinal artery. Classic venous-stasis retinopathy that was limited to the territory of the obstructed arteriole was present concurrently. This case appears to demonstrate that chronic retinal hypoperfusion and resultant venous-stasis retinopathy can be produced by not only high-grade, fixed stenosis but also by embolic disease.
- Published
- 1990
- Full Text
- View/download PDF
375. Combined branch retinal artery and central retinal vein obstruction.
- Author
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Duker JS, Cohen MS, Brown GC, Sergott RC, and McNamara JA
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Fundus Oculi, Humans, Iris blood supply, Iris surgery, Light Coagulation, Male, Middle Aged, Neovascularization, Pathologic pathology, Retinal Artery Occlusion pathology, Retinal Hemorrhage etiology, Retinal Vein Occlusion pathology, Visual Acuity, Retinal Artery Occlusion complications, Retinal Vein Occlusion complications
- Abstract
We observed seven patients with the unusual combination of a central retinal vein obstruction in conjunction with a simultaneous branch retinal artery obstruction. The patients presented with sectoral retinal whitening, as well as diffuse peripapillary and superficial retinal hemorrhages. In five of the seven patients, the retinal hemorrhages appeared most florid in the territory of the obstructed arteriole, resulting initially in the consideration that these cases represented a combined branch retinal artery and branch retinal vein obstruction. In all cases, however, the presence of dilated, tortuous veins with diffuse retinal hemorrhages, in addition to generalized delay in arteriovenous transit on fluorescein angiography, localized the venous blockage to the central retinal vein. No intra-arterial retinal emboli were visualized. Initially, five of the seven patients suffered markedly diminished visual function; although visual acuity returned to near normal in all but two patients. In the two patients with non-resolving, markedly impaired visual acuity, neovascularization of the iris complicated the clinical course. Both of these patients were treated with panretinal photocoagulation, with resolution of the iris neovascularization. These seven patients highlight another variation of combined arterial and venous retinal vascular disease.
- Published
- 1990
- Full Text
- View/download PDF
376. Iris neovascularization associated with obstruction of the central retinal artery.
- Author
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Duker JS and Brown GC
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Iris blood supply, Neovascularization, Pathologic diagnosis, Retinal Artery Occlusion complications
- Abstract
The authors retrospectively reviewed 168 cases of central retinal artery obstruction (CRAO) to determine the rate of occurrence of iris neovascularization (NVI) and to identify any factors that may predispose to its development. Twenty-eight well-documented cases of NVI after CRAO were detected, an occurrence rate of 16.6%. After evaluating the intravenous fluorescein angiograms of these patients, the authors conclude that an extreme prolongation of the retinal arteriovenous transit time is an independent risk factor for the subsequent development of NVI. Twelve of 18 eyes (66.6%) in the NVI group, versus seven of 29 eyes (24.1%) in the control group, showed such prolongation (P less than 0.02).
- Published
- 1988
- Full Text
- View/download PDF
377. Cytomegalovirus retinitis in an infant with acquired immunodeficiency syndrome.
- Author
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Levin AV, Zeichner S, Duker JS, Starr SE, Augsburger JJ, and Kronwith S
- Subjects
- Humans, Infant, Male, Acquired Immunodeficiency Syndrome complications, Cytomegalovirus Infections complications, Retinitis complications
- Abstract
A case of cytomegalovirus retinitis in an infant with acquired immunodeficiency syndrome (AIDS) is described. Although well recognized as an ocular manifestation of AIDS in adults, only one case of the necrotic retinitis caused by cytomegalovirus has been described in a child with AIDS. Intravenous treatment with ganciclovir resulted in substantial ocular improvement, despite the advanced nature of the disease in one eye in which there was also secondary neovascular glaucoma. Home maintenance treatment was used via Broviac catheter. The patient later died following pulmonary infection with Pneumocystis carinii.
- Published
- 1989
378. Infantile endogenous Candida endophthalmitis presenting as a cataract.
- Author
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Clinch TE, Duker JS, Eagle RC Jr, Calhoun JH, Augsburger JJ, and Fischer DH
- Subjects
- Amphotericin B therapeutic use, Candida albicans isolation & purification, Candidiasis epidemiology, Candidiasis therapy, Cataract pathology, Cataract Extraction, Endophthalmitis epidemiology, Endophthalmitis therapy, Eye Infections, Fungal therapy, Humans, Incidence, Infant, Infant, Newborn, Male, Vitrectomy, Candidiasis pathology, Cataract etiology, Endophthalmitis pathology, Eye Infections, Fungal pathology
- Abstract
The most common pathogen to cause endogenous endophthalmitis is the fungus Candida albicans. Most cases involve adults who are either immunosuppressed or have a history of repeated or prolonged extracorporeal access to their circulatory system. Endogenous Candida endophthalmitis can occur in infants as well, particularly when prematurity, broad spectrum antibiotic therapy, or prior surgery are present as predisposing factors. We report the clinical and histopathological findings of an infant who developed a unilateral, sectoral lens opacity four months after undergoing treatment for disseminated candidiasis. The diagnosis of localized intralenticular fungal abscess with associated endophthalmitis was made via histopathologic examination of the aspirated lens material. Treatment with systemic antifungal agents successfully preserved the eye. In addition, we review and summarize the previously reported cases of Candida endophthalmitis in patients under one year of age.
- Published
- 1989
- Full Text
- View/download PDF
379. A modification in the frontalis suspension procedure.
- Author
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Duker JS and Nelson LB
- Subjects
- Humans, Surgical Instruments, Blepharoptosis surgery
- Published
- 1988
- Full Text
- View/download PDF
380. Anterior location of the crossing artery in branch retinal vein obstruction.
- Author
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Duker JS and Brown GC
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Humans, Male, Middle Aged, Photography, Retinal Hemorrhage pathology, Retinal Vein pathology, Retrospective Studies, Retinal Artery pathology, Retinal Vein Occlusion pathology
- Abstract
We evaluated retrospectively the cases of 25 patients (26 eyes) with a recent, temporal, branch retinal vein obstruction to determine the relative anatomic position of the obstructed vein in relation to its crossing artery. In 26 (100%) of 26 eyes, the artery lay anterior to the vein, toward the vitreous cavity. A control group was obtained by evaluating the relative anatomic position between the branch retinal artery and vein at an equivalent crossing site along the opposite vascular arcade within the same eye. In the control crossing sites, the artery lay anterior to the vein 65% (15/23) of the time. We conclude that the likelihood that the artery will lie anterior to the obstructed vein at the site of blockage in a branch retinal vein obstruction is substantially greater than what would be expected by chance alone. This anatomic relationship between artery and vein probably plays a role in the cause of a branch retinal vein obstruction and may have therapeutic significance in light of a recent report concerning surgical treatment of such obstructions.
- Published
- 1989
- Full Text
- View/download PDF
381. Proliferative sarcoid retinopathy.
- Author
-
Duker JS, Brown GC, and McNamara JA
- Subjects
- Adult, Female, Fluorescein Angiography, Humans, Iris blood supply, Light Coagulation, Male, Middle Aged, Optic Disk blood supply, Neovascularization, Pathologic physiopathology, Retina blood supply, Sarcoidosis physiopathology
- Abstract
Sarcoidosis is a well-established cause of ocular neovascularization. A review of the literature, however; shows that it has been implicated as the cause for retinal neovascularization in only a limited number of patients. In this article, the authors report the clinical features of proliferative sarcoid retinopathy in seven additional patients (11 eyes). All 11 eyes displayed retinal neovascularization. In addition, two of the eyes had optic disc neovascularization, whereas iris neovascularization developed in one. In all cases, the new retinal vessels were associated with concomitant peripheral retinal capillary nonperfusion. These findings support the theory that in sarcoidosis, capillary nonperfusion secondary to microvascular shutdown, rather than a direct effect of inflammation, is the stimulus for the formation of retinal neovascularization.
- Published
- 1988
- Full Text
- View/download PDF
382. Occult plastic intraocular foreign body.
- Author
-
Duker JS and Fischer DH
- Subjects
- Adult, Corneal Injuries, Diagnosis, Differential, Eye Foreign Bodies surgery, Humans, Male, Eye Foreign Bodies diagnosis, Polyvinyl Chloride, Polyvinyls
- Abstract
A 34-year-old man was evaluated for posttraumatic endophthalmitis with hypopyon. A previous CT scan of the orbit along with B-scan ultrasonogram failed to confirm the presence of an intraocular foreign body. Nevertheless, at the time of vitrectomy, a polyvinyl chloride (PVC) plastic foreign body was encountered. The atypical posttraumatic uveitis that developed was apparently secondary to the PVC material, as the inflammation cleared rapidly following removal of the foreign body. This case illustrates the necessity for maintaining a high level of suspicion for the possibility of an intraocular foreign body in the event of ocular trauma, even in the presence of unconfirming ancillary tests.
- Published
- 1989
383. Noncontiguous local recurrence of posterior uveal melanoma after cobalt 60 episcleral plaque therapy.
- Author
-
Duker JS, Augsburger JJ, and Shields JA
- Subjects
- Adult, Aged, Choroid Neoplasms pathology, Female, Humans, Liver Neoplasms secondary, Male, Melanoma pathology, Melanoma secondary, Brachytherapy, Choroid Neoplasms radiotherapy, Cobalt Radioisotopes therapeutic use, Melanoma radiotherapy, Neoplasm Recurrence, Local
- Abstract
Four patients with posterior uveal melanomas treated by cobalt 60 episcleral plaque therapy developed the intraocular recurrence of choroidal melanoma at a site distant from and noncontiguous to their original lesions. Three of the four patients died of metastatic melanoma. The proportion of eyes with posterior uveal melanoma treated with cobalt 60 brachytherapy who subsequently develop this type of local recurrence appears to be low (0.68%).
- Published
- 1989
- Full Text
- View/download PDF
384. Peripheral retinal neovascularization associated with hemoglobin C beta zero thalassemia.
- Author
-
Duker JS, Brown GC, and Ballas SK
- Subjects
- Aged, Female, Humans, Retinal Diseases complications, Hemoglobin C Disease complications, Neovascularization, Pathologic, Retinal Vessels, Thalassemia complications
- Published
- 1989
- Full Text
- View/download PDF
385. Late bacterial endophthalmitis following retinal detachment surgery.
- Author
-
Duker JS and Belmont JB
- Subjects
- Aged, Female, Humans, Macular Edema etiology, Male, Middle Aged, Proteus mirabilis isolation & purification, Scleral Buckling, Uveitis etiology, Visual Acuity, Vitrectomy, Vitreous Body microbiology, Endophthalmitis etiology, Eye Infections, Bacterial etiology, Postoperative Complications, Proteus Infections etiology, Retinal Detachment surgery
- Abstract
We report two cases of late postoperative bacterial endophthalmitis that occurred following retinal detachment repair. Both patients presented months after their scleral buckling procedures with a subacute uveitis. Over a period of one to two weeks, the inflammation gradually increased, until the classic clinical appearance of fulminant bacterial endophthalmitis was present. In an effort to treat the infection, a pars plana vitrectomy was performed in both cases. At the time of vitreous surgery, intrusion of the scleral buckling elements into the globe was observed, suggesting a possible means of entry for the infectious agent. Removal of the buckling elements, repair of the scleral defects, and injection of intravitreal antibiotics were performed as therapeutic interventions. Vitreous cultures were positive in both cases for Proteus mirabilis. Postoperatively the retina remained attached in both instances, and, in one case, the visual acuity returned to 20/20.
- Published
- 1989
- Full Text
- View/download PDF
386. Ocular lymphoid hyperplasia.
- Author
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Duker JS, Shields JA, and Eagle RC Jr
- Subjects
- Aged, Biopsy, Conjunctiva pathology, Diagnosis, Differential, Eye Diseases pathology, Female, Fluorescein Angiography, Humans, Hyperplasia, Photography, Eye Diseases diagnosis, Lymphoid Tissue
- Published
- 1989
- Full Text
- View/download PDF
387. Semiconductor diode laser endophotocoagulation.
- Author
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Duker JS, Federman JL, Schubert H, and Talbot C
- Subjects
- Animals, Evaluation Studies as Topic, Rabbits, Semiconductors, Lasers, Light Coagulation instrumentation, Retina surgery
- Abstract
We successfully used a semiconductor diode laser to deliver endophotocoagulation burns to the retina of a rabbit. The diode laser employed emits light at a wavelength of 817 nm (near infrared). It has a power output of up to 1.0 W in the continuous-wave mode, equivalent to the capability of current argon laser endophotocoagulators. A standard, commercially available fiberoptic endophotocoagulation probe was used to deliver the laser burns. We used power settings ranging from 300 mW to 400 mW and exposure times of 0.1 to 0.2 seconds to produce chorioretinal burns that appeared clinically and histopathologically indistinguishable from those induced with conventional wavelengths. This new laser system has the decided advantages over traditional endophotocoagulators of being much smaller, less costly, and requiring no water cooling, without sacrificing power output or ease of delivery.
- Published
- 1989
388. Intraocular large cell lymphoma presenting as massive thickening of the uveal tract.
- Author
-
Duker JS, Shields JA, and Ross M
- Subjects
- Diagnosis, Differential, Eye Neoplasms surgery, Female, Humans, Lymphoma, Non-Hodgkin surgery, Middle Aged, Prednisolone analogs & derivatives, Prednisolone therapeutic use, Uveitis, Anterior drug therapy, Uveitis, Anterior physiopathology, Visual Acuity, Eye Neoplasms pathology, Lymphoma, Non-Hodgkin pathology, Uveitis, Anterior pathology
- Abstract
A 46-year-old woman with a history of biopsy-proven extranodal large cell lymphoma of the maxillary sinus presented four months after this condition was diagnosed with signs of unilateral iritis. After an initial response to topical corticosteroid therapy, the iritis relapsed, the eye rapidly becoming blind and painful. Histopathological examination of the enucleated globe showed a diffuse infiltration of the entire uveal tract by malignant lymphocytes consistent with large cell lymphoma. Systemic examination revealed no concurrent foci of malignancy. This dramatic presentation of ocular involvement is quite unusual for large cell lymphoma.
- Published
- 1987
389. Ocular findings in a new heritable syndrome of brain, eye, and urogenital abnormalities.
- Author
-
Duker JS, Weiss JS, Siber M, Bieber FR, and Albert DM
- Subjects
- Abnormalities, Multiple genetics, Child, Preschool, Genetic Diseases, Inborn pathology, Humans, Infant, Infant, Newborn, Male, Syndrome, Abnormalities, Multiple pathology, Brain abnormalities, Eye Abnormalities, Urogenital Abnormalities
- Abstract
We studied the clinical and histopathologic ocular findings in four related males with a newly recognized syndrome consisting of microphthalmos, microencephaly, mental retardation, agenesis of the corpus callosum, hypospadius, and cryptorchidism with X-linked recessive inheritance. The ocular abnormalities include microphthalmos, corneal pannus and hypoplasia, cataracts, uveal hypoplasia, retinal dysplasia, optic nerve hypoplasia, and congenital blepharoptosis. In case 4, a female twin who died in utero (at 15 weeks' gestation) showed none of the ocular abnormalities.
- Published
- 1985
- Full Text
- View/download PDF
390. Ocular ischemic syndrome secondary to carotid artery dissection.
- Author
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Duker JS and Belmont JB
- Subjects
- Humans, Male, Middle Aged, Syndrome, Carotid Artery Diseases complications, Eye blood supply, Ischemia etiology, Retinal Diseases etiology
- Published
- 1988
- Full Text
- View/download PDF
391. Retinal vasculitis in Crohn's disease.
- Author
-
Duker JS, Brown GC, and Brooks L
- Subjects
- Adult, Colitis complications, Cyclophosphamide therapeutic use, Female, Fluorescein Angiography, Humans, Ophthalmoscopy, Prednisone therapeutic use, Ultrasonography, Vasculitis diagnosis, Vasculitis drug therapy, Crohn Disease complications, Retinal Vessels, Vasculitis complications
- Abstract
Although systemic vasculitis is a prominent part of the extraintestinal complications of Crohn's disease, the association of a retinal vasculitis with this chronic granulomatous disease of the gastrointestinal system is rare. We examined a 26-year-old woman with biopsy-proven Crohn's disease who developed a severe bilateral, obliterative retinal arteritis and phlebitis, leading to a marked loss of vision. Treatment with systemic corticosteroids and cyclophosphamide succeeded in halting progression of the disease.
- Published
- 1987
- Full Text
- View/download PDF
392. The efficacy of panretinal photocoagulation for neovascularization of the iris after central retinal artery obstruction.
- Author
-
Duker JS and Brown GC
- Subjects
- Aged, Aged, 80 and over, Female, Glaucoma etiology, Glaucoma physiopathology, Humans, Intraocular Pressure, Laser Therapy, Male, Middle Aged, Neovascularization, Pathologic etiology, Iris blood supply, Light Coagulation, Neovascularization, Pathologic surgery, Retina surgery, Retinal Artery Occlusion complications
- Abstract
Panretinal photocoagulation (PRP) is widely used for a variety of ischemic ocular conditions. In diseases that produce neovascularization of the iris (NVI), such as diabetes mellitus and central retinal vein obstruction, a judiciously timed PRP can reduce the incidence of neovascular glaucoma. Neovascularization of the iris can occur after central retinal artery obstruction (CRAO) as well. In this article, the authors report the outcome of 17 patients who received PRP to treat rubeosis iridis secondary to CRAO. Eleven of the 17 patients (65%) showed regression of NVI after PRP. Although the uncontrolled and retrospective nature of this study precludes drawing definitive conclusions from these data, PRP appears to be effective in reducing the incidence of neovascular glaucoma, if it is delivered before the development of elevated intraocular pressure (IOP). Once neovascular glaucoma occurs, additional modalities appear to be necessary in order to adequately control the elevated IOP.
- Published
- 1989
- Full Text
- View/download PDF
393. Optic neuritis with secondary retinal venous stasis.
- Author
-
Duker JS, Sergott RC, Savino PJ, and Bosley TM
- Subjects
- Adolescent, Adult, Female, Fluorescein Angiography, Fundus Oculi, Humans, Male, Middle Aged, Retinal Diseases etiology, Visual Acuity, Visual Fields, Optic Neuritis complications, Retinal Vein, Retinal Vein Occlusion etiology
- Abstract
The authors report five cases of optic neuritis accompanied by secondary impairment of retinal venous outflow producing the clinical appearance of impending or actual central retinal vein occlusion. In four of five cases, intravenous fluorescein angiography showed delayed venous filling with venous dilation and tortuosity. Decreased visual function was entirely attributable to optic nerve involvement because the clinical and angiographic examinations revealed no evidence of capillary nonperfusion, macular edema, or macular hemorrhage. The visual outcome of the patients paralleled that expected with optic neuritis. The authors believe that optic nerve inflammation associated with secondary impairment of retinal venous outflow is a distinct but uncommon entity. Because of its ophthalmoscopic appearance, this variety of optic neuritis may be confused with either papillophlebitis or central retinal venous occlusion in young patients.
- Published
- 1989
- Full Text
- View/download PDF
394. Neovascularization of the optic disc associated with obstruction of the central retinal artery.
- Author
-
Duker JS and Brown GC
- Subjects
- Adult, Aged, Female, Fundus Oculi, Humans, Light Coagulation, Male, Neovascularization, Pathologic pathology, Neovascularization, Pathologic physiopathology, Retrospective Studies, Visual Acuity, Neovascularization, Pathologic etiology, Optic Disk blood supply, Retinal Artery Occlusion complications
- Abstract
Neovascularization of the optic disc (NVD) has, to the authors' knowledge, rarely been reported in association with acute obstruction of the central retinal artery (CRAO). The authors recently retrospectively reviewed 168 cases of CRAO. In this group, NVD developed in three patients soon after their CRAO, an occurrence rate of 1.8%. Rubeosis iridis also developed in two of these three patients. Although all three patients had either atherosclerotic carotid artery disease, diabetes mellitus, or both, in none of the cases was there clinical evidence implicating these diseases as the direct cause for the NVD. All three eyes received panretinal laser photocoagulation, with eventual resolution of the new vessels.
- Published
- 1989
- Full Text
- View/download PDF
395. Recovery following acute obstruction of the retinal and choroidal circulations. A case history.
- Author
-
Duker JS and Brown GC
- Subjects
- Aged, Fluorescein Angiography, Humans, Male, Reperfusion, Retina blood supply, Visual Acuity, Choroid blood supply, Ischemia physiopathology, Ophthalmic Artery pathology, Retinal Artery Occlusion physiopathology
- Abstract
The authors report a 70-year-old man who presented with a combined obstruction of both the central retinal artery and the lateral posterior ciliary artery that spontaneously reperfused after 4 days of documented ischemia. Despite this prolonged period of decreased perfusion, visual acuity improved from light perception to 20/30 with the re-establishment of normal retinal and choroidal blood flow as documented with intravenous fluorescein angiography. The theory of retinal tolerance time to obstruction of the central retinal artery and its bearing on possible therapeutic interventions are discussed.
- Published
- 1988
- Full Text
- View/download PDF
396. Angioid streaks associated with abetalipoproteinemia. Case report.
- Author
-
Duker JS, Belmont J, and Bosley TM
- Subjects
- Adult, Humans, Male, Pigment Epithelium of Eye pathology, Abetalipoproteinemia pathology, Retina pathology
- Published
- 1987
- Full Text
- View/download PDF
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