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1. Bilateral neuroretinits and exudative retinal detachment with multifocal subretinal deposits secondary to Bartonella henselae infection

Author

Efrat Fleissig, Fiona Kim, Douglas Kenneth Sigford, and Charles C. Barr

Subjects
Neuroretinitis, Retinal detachment, Bartonella henselae, Subretinal deposits, Ophthalmology, RE1-994
Abstract

Purpose: to describe a case of bilateral neuroretinitis with bullous retinal detachment and multiple subretinal lesions, in a 10-year-old immunocompetent girl. Observations: A broad workup for infectious, inflammatory and masquerade etiologies was done for the patient, resulting in positive IgM and IgG for Bartonella henselae. The patient demonstrated improvement in the visual acuity, and rapid resolution of the retinal detachment and subretinal lesions in both eyes in response to systemic rifampin, doxycycline and corticosteroids. Conclusions and Importance: Bartonella henselae neuroretinitis may present as an acute form of bullous retinal detachment with multiple subretinal lesions and markedly reduced vision. Significant visual improvement may occur with prompt treatment with a combination of systemic antibiotics and corticosteroids.

Published
2021
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2. Disseminated Nocardiosis with retinal abscess in a patient treated for bullous pemphigoid

Author

Sidharth Puri, Amir Hadayer, Andrea Breaux, and Charles C. Barr

Subjects
Ophthalmology, RE1-994
Abstract

Purpose: To report a case of disseminated Nocardiosis with retinal and intracranial lesions. Observations: A 49-year-old woman immunosuppressed because of treatment given for bullous pemphigoid presented with altered mental status and multiple intracranial lesions on imaging. The patient was found to have multiple retinal lesions in both eyes, including a subretinal abscess in the right eye. The patient underwent brain biopsy, confirming Nocardia farcinica histopathologically and in culture. Conclusions and Importance: Ocular Nocardiosis is a rare disease with varying prognosis that requires prompt diagnosis to ensure appropriate medical therapy. Keywords: Abscess, Nocardia, Nocardiosis, Retina

Published
2018
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4. Prediction for 2-Year Vision Outcomes Using Early Morphologic and Functional Responses in the Comparison of Age-related Macular Degeneration Treatments Trials

Author

Katie Xue, Peiying Hua, Maureen G. Maguire, Ebenezer Daniel, Glenn J. Jaffe, Juan E. Grunwald, Gui-shuang Ying, David F. Williams, Sara Beardsley, Steven Bennett, Herbert Cantrill, Carmen Chan-Tram, Holly Cheshier, Kathyrn Damato, John Davies, Sundeep Dev, Julianne Enloe, Gennaro Follano, Peggy Gilbert, Jill Johnson, Tori Jones, Lisa Mayleben, Robert Mittra, Martha Moos, Ryan Neist, Neal Oestreich, Polly Quiram, Robert Ramsay, Edwin Ryan, Stephanie Schindeldecker, John Snater, Trenise Steele, Dwight Selders, Jessica Tonsfeldt, Shelly Valardi, Gary Edd Fish, Hank A. Aguado, Sally Arceneaux, Jean Arnwine, Kim Bell, Tina Bell, Bob Boleman, Patricia Bradley, David Callanan, Lori Coors, Jodi Creighton, Timothy Crew, Kimberly Cummings, Christopher Dock, Karen Duignan, Dwain Fuller, Keith Gray, Betsy Hendrix, Nicholas Hesse, Diana Jaramillo, Bradley Jost, Sandy Lash, Laura Lonsdale, Michael Mackens, Karin Mutz, Michael Potts, Brenda Sanchez, William Snyder, Wayne Solley, Carrie Tarter, Robert Wang, Patrick Williams, Stephen L. Perkins, Nicholas Anderson, Ann Arnold, Paul Blais, Joseph Googe, Tina T. Higdon, Cecile Hunt, Mary Johnson, James Miller, Misty Moore, Charity K. Morris, Christopher Morris, Sarah Oelrich, Kristina Oliver, Vicky Seitz, Jerry Whetstone, Bernard H. Doft, Jay Bedel, Robert Bergren, Ann Borthwick, Paul Conrad, Amanda Fec, Christina Fulwylie, Willia Ingram, Shawnique Latham, Gina Lester, Judy Liu, Louis Lobes, Nicole M. Lucko, Holly Mechling, Lori Merlotti, Keith McBroom, Karl Olsen, Danielle Puskas, Pamela Rath, Maria Schmucker, Lynn Schueckler, Christina Schultz, Heather Shultz, David Steinberg, Avni Vyas, Kim Whale, Kimberly Yeckel, David H. Orth, Linda S. Arredondo, Susan Brown, Barbara J. Ciscato, Joseph M. Civantos, Celeste Figliulo, Sohail Hasan, Belinda Kosinski, Dan Muir, Kiersten Nelson, Kirk Packo, John S. Pollack, Kourous Rezaei, Gina Shelton, Shannya Townsend-Patrick, Marian Walsh, H. Richard McDonald, Nina Ansari, Amanda Bye, Arthur D. Fu, Sean Grout, Chad Indermill, Robert N. Johnson, J. Michael Jumper, Silvia Linares, Brandon J. Lujan, Ames Munden, Meredith Persons, Rosa Rodriguez, Jennifer M. Rose, Brandi Teske, Yesmin Urias, Stephen Young, Richard F. Dreyer, Howard Daniel, Michele Connaughton, Irvin Handelman, Stephen Hobbs, Christine Hoerner, Dawn Hudson, Marcia Kopfer, Michael Lee, Craig Lemley, Joe Logan, Colin Ma, Christophe Mallet, Amanda Milliron, Mark Peters, Harry Wohlsein, Joel A. Pearlman, Margo Andrews, Melissa Bartlett, Nanette Carlson, Emily Cox, Robert Equi, Marta Gonzalez, Sophia Griffin, Fran Hogue, Lance Kennedy, Lana Kryuchkov, Carmen Lopez, Danny Lopez, Bertha Luevano, Erin McKenna, Arun Patel, Brian Reed, Nyla Secor, Iris R. Sison, Tony Tsai, Nina Varghis, Brooke Waller, Robert Wendel, Reina Yebra, Daniel B. Roth, Jane Deinzer, Howard Fine, Flory Green, Stuart Green, Bruce Keyser, Steven Leff, Amy Leviton, Amy Martir, Kristin Mosenthine, Starr Muscle, Linda Okoren, Sandy Parker, Jonathan Prenner, Nancy Price, Deana Rogers, Linda Rosas, Alex Schlosser, Loretta Studenko, Thea Tantum, Harold Wheatley, Michael T. Trese, Thomas Aaberg, Denis Bezaire, Craig Bridges, Doug Bryant, Antonio Capone, Michelle Coleman, Christina Consolo, Cindy Cook, Candice DuLong, Bruce Garretson, Tracy Grooten, Julie Hammersley, Tarek Hassan, Heather Jessick, Nanette Jones, Crystal Kinsman, Jennifer Krumlauf, Sandy Lewis, Heather Locke, Alan Margherio, Debra Markus, Tanya Marsh, Serena Neal, Amy Noffke, Kean Oh, Clarence Pence, Lisa Preston, Paul Raphaelian, Virginia R. Regan, Peter Roberts, Alan Ruby, Ramin Sarrafizadeh, Marissa Scherf, Sarita Scott, Scott Sneed, Lisa Staples, Brad Terry, Matthew T. Trese, Joan Videtich, George Williams, Mary Zajechowski, Daniel P. Joseph, Kevin Blinder, Lynda Boyd, Sarah Buckley, Meaghan Crow, Amanda Dinatale, Nicholas Engelbrecht, Bridget Forke, Dana Gabel, Gilbert Grand, Jennifer Grillion-Cerone, Nancy Holekamp, Charlotte Kelly, Ginny Nobel, Kelly Pepple, Matt Raeber, P. Kumar Rao, Tammy Ressel, Steven Schremp, Merrilee Sgorlon, Shantia Shears, Matthew Thomas, Cathy Timma, Annette Vaughn, Carolyn Walters, Rhonda Weeks, Jarrod Wehmeier, Tim Wright, Daniel M. Berinstein, Aida Ayyad, Mohammed K. Barazi, Erica Bickhart, Tracey Brady, Lisa Byank, Alysia Cronise, Vanessa Denny, Courtney Dunn, Michael Flory, Robert Frantz, Richard A. Garfinkel, William Gilbert, Michael M. Lai, Alexander Melamud, Janine Newgen, Shamekia Newton, Debbie Oliver, Michael Osman, Reginald Sanders, Manfred von Fricken, Pravin Dugel, Sandra Arenas, Gabe Balea, Dayna Bartoli, John Bucci, Jennifer A. Cornelius, Scheleen Dickens, Don Doherty, Heather Dunlap, David Goldenberg, Karim Jamal, Norma Jimenez, Nicole Kavanagh, Derek Kunimoto, John Martin, Jessica Miner, Sarah Mobley, Donald Park, Edward Quinlan, Jack Sipperley, Carol Slagle, Danielle Smith, Miguelina Yafchak, Rohana Yager, Christina J. Flaxel, Steven Bailey, Peter Francis, Chris Howell, Thomas Hwang, Shirley Ira, Michael Klein, Andreas Lauer, Teresa Liesegang, Ann Lundquist, Sarah Nolte, Susan K. Nolte, Scott Pickell, Susan Pope, Joseph Rossi, Mitchell Schain, Peter Steinkamp, Maureen D. Toomey, Debora Vahrenwald, Kelly West, Baker Hubbard, Stacey Andelman, Chris Bergstrom, Judy Brower, Blaine Cribbs, Linda Curtis, Jannah Dobbs, Lindreth DuBois, Jessica Gaultney, Deborah Gibbs, Debora Jordan, Donna Leef, Daniel F. Martin, Robert Myles, Timothy Olsen, Bryan Schwent, Sunil Srivastava, Rhonda Waldron, Andrew N. Antoszyk, Uma Balasubramaniam, Danielle Brooks, Justin Brown, David Browning, Loraine Clark, Sarah Ennis, Susannah Held, Jennifer V. Helms, Jenna Herby, Angie Karow, Pearl Leotaud, Caterina Massimino, Donna McClain, Michael McOwen, Jennifer Mindel, Candace Pereira, Rachel Pierce, Michele Powers, Angela Price, Jason Rohrer, Jason Sanders, Robert L. Avery, Kelly Avery, Jessica Basefsky, Liz Beckner, Alessandro Castellarin, Stephen Couvillion, Jack Giust, Matthew Giust, Maan Nasir, Dante Pieramici, Melvin Rabena, Sarah Risard, Robert See, Jerry Smith, Lisha Wan, Sophie J. Bakri, Nakhleh Abu-Yaghi, Andrew Barkmeier, Karin Berg, Jean Burrington, Albert Edwards, Shannon Goddard, Shannon Howard, Raymond Iezzi, Denise Lewison, Thomas Link, Colin A. McCannel, Joan Overend, John Pach, Margaret Ruszczyk, Ryan Shultz, Cindy Stephan, Diane Vogen, Reagan H. Bradford, Vanessa Bergman, Russ Burris, Amanda Butt, Beth Daniels, Connie Dwiggins, Stephen Fransen, Tiffany Guerrero, Darin Haivala, Amy Harris, Sonny Icks, Ronald Kingsley, Lena Redden, Rob Richmond, Brittany Ross, Kammerin White, Misty Youngberg, Trexler M. Topping, Steve Bennett, Sandy Chong, Mary Ciotti, Tina Cleary, Emily Corey, Dennis Donovan, Albert Frederick, Lesley Freese, Margaret Graham, Natalya Gud, Taneika Howard, Mike Jones, Michael Morley, Katie Moses, Jen Stone, Robin Ty, Torsten Wiegand, Lindsey Williams, Beth Winder, Carl C. Awh, Michelle Amonette, Everton Arrindell, Dena Beck, Brandon Busbee, Amy Dilback, Sara Downs, Allison Guidry, Gary Gutow, Jackey Hardin, Sarah Hines, Emily Hutchins, Kim LaCivita, Ashley Lester, Larry Malott, MaryAnn McCain, Jayme Miracle, Kenneth Moffat, Lacy Palazzotta, Kelly Robinson, Peter Sonkin, Alecia Travis, Roy Trent Wallace, Kelly J. Winters, Julia Wray, April E. Harris, Mari Bunnell, Katrina Crooks, Rebecca Fitzgerald, Cameron Javid, Corin Kew, Erica Kill, Patricia Kline, Janet Kreienkamp, Maricruz Martinez, Roy Ann Moore, Egbert Saavedra, LuAnne Taylor, Mark Walsh, Larry Wilson, Thomas A. Ciulla, Ellen Coyle, Tonya Harrington, Charlotte Harris, Cindi Hood, Ingrid Kerr, Raj Maturi, Dawn Moore, Stephanie Morrow, Jennifer Savage, Bethany Sink, Tom Steele, Neelam Thukral, Janet Wilburn, Joseph P. Walker, Jennifer Banks, Debbie Ciampaglia, Danielle Dyshanowitz, Jennifer Frederick, A. Tom Ghuman, Richard Grodin, Cheryl Kiesel, Eileen Knips, Jonathan McCue, Maria Ortiz, Crystal Peters, Paul Raskauskas, Etienne Schoeman, Ashish Sharma, Glenn Wing, Rebecca Youngblood, Suresh R. Chandra, Michael Altaweel, Barbara Blodi, Kathryn Burke, Kristine A. Dietzman, Justin Gottlieb, Gene Knutson, Denise Krolnik, T. Michael Nork, Shelly Olson, John Peterson, Sandra Reed, Barbara Soderling, Guy Somers, Thomas Stevens, Angela Wealti, Srilaxmi Bearelly, Brenda Branchaud, Joyce W. Bryant, Sara Crowell, Sharon Fekrat, Merritt Gammage, Cheala Harrison, Sarah Jones, Noreen McClain, Brooks McCuen, Prithvi Mruthyunjaya, Jeanne Queen, Neeru Sarin, Cindy Skalak, Marriner Skelly, Ivan Suner, Ronnie Tomany, Lauren Welch, Susanna S. Park, Allison Cassidy, Karishma Chandra, Idalew Good, Katrina Imson, null Sashi, null Kaur, Helen Metzler, Lawrence Morse, Ellen Redenbo, Marisa Salvador, David Telander, Mark Thomas, Cindy Wallace, Charles C. Barr, Amanda Battcher, Michelle Bottorff, Mary Chasteen, Kelly Clark, Diane Denning, Debra Schoen, Amy Schultz, Evie Tempel, Lisa Wheeler, Greg K. Whittington, Thomas W. Stone, Todd Blevins, Michelle Buck, Lynn Cruz, Wanda Heath, Diana Holcomb, Rick Isernhagen, Terri Kidd, John Kitchens, Cathy Sears, Ed Slade, Jeanne Van Arsdall, Brenda VanHoose, Jenny Wolfe, William Wood, John Zilis, Carol Crooks, Larry Disney, Mimi Liu, Stephen Petty, Sandra Sall, James C. Folk, Tracy Aly, Abby Brotherton, Douglas Critser, Connie J. Hinz, Stefani Karakas, Valerie Kirschner, Cheyanne Lester, Cindy Montague, Stephen Russell, Heather Stockman, Barbara Taylor, Randy Verdick, Jean Walshire, John T. Thompson, Barbara Connell, Maryanth Constantine, John L. Davis, null Gwen Holsapple, Lisa Hunter, C. Nicki Lenane, Robin Mitchell, Leslie Russel, Raymond Sjaarda, David M. Brown, Matthew Benz, Llewellyn Burns, JoLene G. Carranza, Richard Fish, Debra Goates, Shayla Hay, Theresa Jeffers, Eric Kegley, Dallas Kubecka, Stacy McGilvra, Beau Richter, Veronica Sneed, Cary Stoever, Isabell Tellez, Tien Wong, Ivana Kim, Christopher Andreoli, Leslie Barresi, Sarah Brett, Charlene Callahan, Karen Capaccioli, William Carli, Matthew Coppola, Nicholas Emmanuel, Claudia Evans, Anna Fagan, Marcia Grillo, John Head, Troy Kieser, Elaine Lee, Ursula Lord, Edward Miretsky, Kate Palitsch, Todd Petrin, Liz Reader, Svetlana Reznichenko, Mary Robertson, Justin Smith, Demetrios Vavvas, John Wells, Cassie Cahill, W. Lloyd Clark, Kayla Henry, David Johnson, Peggy Miller, LaDetrick Oliver, Robbin Spivey, Tiffany Swinford, Mallie Taylor, Michael Lambert, Kris Chase, Debbie Fredrickson, Joseph Khawly, Valerie Lazarte, Donald Lowd, Pam Miller, Arthur Willis, Philip J. Ferrone, Miguel Almonte, Rachel Arnott, Ingrid Aviles, Sheri Carbon, Michael Chitjian, Kristen DAmore, Christin Elliott, David Fastenberg, Barry Golub, Kenneth Graham, AnnMarie Lavorna, Laura Murphy, Amanda Palomo, Christina Puglisi, David Rhee, Juan Romero, Brett Rosenblatt, Glenda Salcedo, Marianne Schlameuss, Eric Shakin, Vasanti Sookhai, Richard Kaiser, Elizabeth Affel, Gary Brown, Christina Centinaro, Deborah Fine, Mitchell Fineman, Michele Formoso, Sunir Garg, Lisa Grande, Carolyn Herbert, Allen Ho, Jason Hsu, Maryann Jay, Lisa Lavetsky, Elaine Liebenbaum, Joseph Maguire, Julia Monsonego, Lucia O’Connor, Lisa Pierce, Carl Regillo, Maria Rosario, Marc Spirn, James Vander, Jennifer Walsh, Frederick H. Davidorf, Amanda Barnett, Susie Chang, John Christoforidis, Joy Elliott, Heather Justice, Alan Letson, Kathryne McKinney, Jeri Perry, Jill A. Salerno, Scott Savage, Stephen Shelley, Lawrence J. Singerman, Joseph Coney, John DuBois, Kimberly DuBois, Gregg Greanoff, Dianne Himmelman, Mary Ilc, Elizabeth McNamara, Michael Novak, Scott Pendergast, Susan Rath, Sheila Smith-Brewer, Vivian Tanner, Diane E. Weiss, Hernando Zegarra, Lawrence Halperin, Patricia Aramayo, Mandeep Dhalla, Brian Fernandez, Cindy Fernandez, Jaclyn Lopez, Monica Lopez, Jamie Mariano, Kellie Murphy, Clifford Sherley, Rita Veksler, Firas Rahhal, Razmig Babikian, David Boyer, Sepideh Hami, Jeff Kessinger, Janet Kurokouchi, Saba Mukarram, Sarah Pachman, Eric Protacio, Julio Sierra, Homayoun Tabandeh, Adam Zamboni, Michael Elman, Jennifer Belz, Tammy Butcher, Theresa Cain, Teresa Coffey, Dena Firestone, Nancy Gore, Pamela Singletary, Peter Sotirakos, JoAnn Starr, Travis A. Meredith, Cassandra J. Barnhart, Debra Cantrell, RonaLyn Esquejo-Leon, Odette Houghton, Harpreet Kaur, Fatoumatta NDure, Ronald Glatzer, Leonard Joffe, and Reid Schindler

Subjects
Ophthalmology
Published
2023
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5. Long-Term Follow-Up of Outer Retinal Layers in Patients with Epiretinal Membranes

Author

Douglas K. Sigford, Charles C. Barr, Harpal Singh Sandhu, and Efrat Fleissig

Subjects
Fovea Centralis, medicine.medical_specialty, business.industry, Long term follow up, Visual Acuity, Epiretinal Membrane, Retinal, General Medicine, Sensory Systems, Ophthalmology, chemistry.chemical_compound, Membrane, chemistry, Vitrectomy, Humans, Medicine, In patient, business, Tomography, Optical Coherence, Follow-Up Studies, Retrospective Studies
Abstract

Purpose: This study aimed to investigate the long-term effect of observed epiretinal membranes on the outer retinal layers and visual acuity. Methods: It is a retrospective observational study. Subjects with an epiretinal membrane and consecutive optical coherence tomography scans were followed for changes in visual acuity, central macular thickness, ellipsoid zone loss, and outer foveal thickness (OFT). Results: The study consisted of 24 eyes of 22 patients, with a mean follow-up of 5 ± 1.6 years. The mean visual acuity was slightly worse at the last follow-up (0.22 ± 0.36 LogMAR [20/33] vs. 0.27 ± 0.36 LogMAR [20/36], p = 0.05). Ellipsoid zone loss was found in 37.5% of eyes. Vision loss was associated with initial size of ellipsoid disruption (p = 0.048) and age (p = 0.027). A decrease in OFT was associated with an initially larger zone of ellipsoid disruption (p = 0.006) and an initially thicker OFT (p = 0.011). An epiretinal membrane associated with vitreomacular adhesion within 1,000 μm of the foveal center at baseline was associated with ellipsoid zone loss (p = 0.012) but not with a change in visual acuity. Conclusions: Ellipsoid zone changes were common in this study and tended to enlarge over time. Epiretinal membranes associated with vitreomacular adhesion within 1,000 μm of the foveal center may be a risk factor for ellipsoid zone loss.

Published
2021
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6. Vitamin Analysis Comparison Study

Author

Efrat Fleissig, Eddie Apenbrinck, Charles C. Barr, and Xiang Zhang

Subjects
Vitamin, Dose, National brand, medicine.medical_treatment, Ascorbic Acid, Gas Chromatography-Mass Spectrometry, Macular Degeneration, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Humans, Vitamin E, Medicine, Prospective Studies, Food science, 030304 developmental biology, 0303 health sciences, Vitamin C, business.industry, Spectrophotometry, Atomic, Reproducibility of Results, Vitamins, Zinc, Ophthalmology, Cross-Sectional Studies, Systemic toxicity, chemistry, 030221 ophthalmology & optometry, Comparison study, Multivitamin, business, Biomarkers
Abstract

Purpose We compared and analyzed the concentrations of vitamin C, vitamin E, zinc, and copper in both national and regional brands of dietary supplements recommended for patients who are at risk for macular degeneration. Design Prospective cross-sectional study. Methods National brand name and generic multivitamin formulations for age-related macular degeneration were obtained. Comparative analysis of the vitamin C and vitamin E content was performed by gas chromatography-mass spectrometry and the zinc and copper content was analyzed by atomic absorption spectroscopy in an institutional chemistry laboratory. Results All national brand name vitamins, both tablet and gel capsule formulations, and generic brands in tablet form were relatively accurate in their product labeling. For most of the samples tested, the measured quantities of vitamin C, vitamin E, zinc, and copper were slightly higher than labeled but not to an amount that would cause any systemic toxicity if taken at the recommended dosages. Conclusions Physicians may recommend national brand name vitamins and generic brands in tablet form to their patients with some confidence; however, the content may have some inaccuracies regarding labeling.

Published
2021
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7. Lighting conditions and perceived visual function in ophthalmic conditions

Author

Eddie Appenbrick, Charles C. Barr, Guy N. Brock, and Efrat Fleissig

Subjects
Visual acuity, genetic structures, business.industry, Macular degeneration, medicine.disease, eye diseases, Sensory Systems, Odds, 03 medical and health sciences, Cellular and Molecular Neuroscience, Ophthalmology, 0302 clinical medicine, Visual function, 030221 ophthalmology & optometry, Medicine, Optometry, In patient, medicine.symptom, Prospective cohort study, business, 030217 neurology & neurosurgery, Bright light, Multinomial logistic regression
Abstract

To determine the influence of different lighting conditions on perceived visual function in patients of different age, gender, race, and in various ophthalmic diseases. A prospective study. A survey given to patients seen in general ophthalmic and retina clinics. Patients were asked four questions: Is your vision better, worse, or the same in (1) bright light vs dim light, (2) indoors or outdoors, (3) beginning or end of the day, and (4) sunny or cloudy day? Parameters tested were age, race, gender, visual acuity, and a variety of ophthalmic conditions. Multivariable models for each question were fit using multinomial regression. Association was considered significant if p < 0.05. A total of 722 patients were enrolled in the study. Patients with lower vision (LogMAR ≥ 0.3) were more likely to indicate they either had better vision indoors or outdoors compared with better vision patients (LogMAR < 0.1). Patients with pseudophakia were also more likely to indicate they had better vision on a cloudy day (OR = 1.9). White patients had double the odds of selecting bright light compared with others. Males were less likely than females to indicate better vision indoors (OR = 0.62). There were no significant associations with age-related macular degeneration (AMD) in the multivariable model. Most patients did not note any difference in lighting conditions, and although there is explanatory rational for some of the findings in this study, those questions concerning lighting conditions or time of day are not useful for screening of disease. Gender and ethnicity were found to have associations with lighting preferences which needs to be further studied.

Published
2020
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8. Outcomes After the Use of Silicone Oil in Complex Retinal Detachment Repair

Author

Charles C. Barr, Efrat Fleissig, and Omar Abu Saleh

Subjects
medicine.medical_specialty, Visual acuity, genetic structures, business.industry, Retinal detachment repair, Retinal detachment, Vitreoretinal surgery, medicine.disease, eye diseases, Silicone oil, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Ophthalmology, 030221 ophthalmology & optometry, medicine, Original Manuscripts, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Purpose: This study compares visual acuity (VA), anatomic outcomes, and complications in eyes that underwent complex retinal detachment (RD) repair in which silicone oil (SO) was retained vs removed. Methods: A retrospective chart review of patients undergoing vitrectomy with SO tamponade. The eyes were divided into 2 groups based upon SO removal or retention. Main outcome measures were corrected VA, anatomic outcomes, and the presence of SO-related complications. Results: Fifty-seven eyes with removed SO and 53 eyes with retained SO were identified. In both groups, the mean best-corrected VA (BCVA) at the final visit was significantly better than at baseline. In the retained-SO group, vision improved from 1.79 ± 0.6 to 1.2 ± 0.7 logarithm of the minimum angle of resolution (logMAR) (Snellen, 20/1200 to 20/350) at the final visit ( P < .001). In the removed-SO group, mean BCVA improved from 1.84 ± 0.5 at baseline to 1.55 ± 0.6 logMAR units (Snellen, 20/1400 to 20/700) at the visit preceding SO removal ( P < .002) and to 1.43 ± 0.6 logMAR units (Snellen, 20/500) at the final visit ( P < .001). Complication rates were similar in both groups, apart from RD, which occurred more frequently in the removed-SO group ( P = .03). Conclusions: There was similarity in VA and complications among patients with removed or retained SO. Removal of SO may benefit eyes with SO-related complications, but SO retention may decrease the chance of RD and may be indicated in selected cases.

Published
2020
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9. Comparative Efficacy of Intravitreal Triamcinolone and Dexamethasone Intravitreal Implant for Diabetic Macular Edema

Author

Douglas K. Sigford, Wei Wang, Charles C. Barr, Henry J. Kaplan, Madison Kerley, and Harpal Sandhu

Subjects
medicine.medical_specialty, Intravitreal triamcinolone, genetic structures, business.industry, Ophthalmology, Diabetic macular edema, medicine, Dexamethasone Intravitreal Implant, business, eye diseases
Abstract

Purpose: To compare the efficacy, adverse effects, and treatment burden of two injectable corticosteroids, triamcinolone acetonide (Kenalog® or Triesence®) and the dexamethasone intravitreal implant (Ozurdex®), for treating diabetic macular edema (DME). Methods: This was a retrospective review at a single tertiary care center. Eyes treated with either intravitreal triamcinolone two mg (IVTA) or the intravitreal dexamethasone 0.7 mg implant for center-involving DME and with follow up of at least six months were included. Main outcomes were visual acuity (VA), intraocular pressure (IOP), IOP medication use, central macular thickness (CMT), and time to next treatment of any kind.Results: There were 24 eyes in the IVTA group and 15 eyes in the dex group. Baseline mean VA was 20/60 (range 20/30-20/800) in the IVTA group and 20/35 (range 20/20-20/100) in the dex group (p=0.0011). Only the subgroup of pseudophakic IVTA patients experienced a statistically significant increase in vision early on (+2 letters at month 1, +3 letters at month three), though not at month six. Mean IOP increased by 2.5 and 0.20 mmHg at month one in the IVTA and dex groups, respectively (p=0.27). Mean CMT decreased by 143 mm with IVTA and 39 mm with dex at month one (p=0.00025). Mean time to next treatment of any kind was 19 weeks for IVTA and 20.3 weeks for dex (p=0.41). Conclusions: Intravitreal triamcinolone and the intravitreal dexamethasone implant both show similar efficacy at reducing DME and its treatment burden, but neither significantly affected visual acuity over six months.

Published
2021
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10. Lighting conditions and perceived visual function in ophthalmic conditions

Author

Efrat, Fleissig, Eddie, Appenbrick, Guy, Brock, and Charles C, Barr

Subjects
Male, Macular Degeneration, Visual Acuity, Humans, Female, Prospective Studies, Lighting, Vision, Ocular
Abstract

To determine the influence of different lighting conditions on perceived visual function in patients of different age, gender, race, and in various ophthalmic diseases.A prospective study. A survey given to patients seen in general ophthalmic and retina clinics. Patients were asked four questions: Is your vision better, worse, or the same in (1) bright light vs dim light, (2) indoors or outdoors, (3) beginning or end of the day, and (4) sunny or cloudy day? Parameters tested were age, race, gender, visual acuity, and a variety of ophthalmic conditions. Multivariable models for each question were fit using multinomial regression. Association was considered significant if p0.05.A total of 722 patients were enrolled in the study. Patients with lower vision (LogMAR ≥ 0.3) were more likely to indicate they either had better vision indoors or outdoors compared with better vision patients (LogMAR0.1). Patients with pseudophakia were also more likely to indicate they had better vision on a cloudy day (OR = 1.9). White patients had double the odds of selecting bright light compared with others. Males were less likely than females to indicate better vision indoors (OR = 0.62). There were no significant associations with age-related macular degeneration (AMD) in the multivariable model.Most patients did not note any difference in lighting conditions, and although there is explanatory rational for some of the findings in this study, those questions concerning lighting conditions or time of day are not useful for screening of disease. Gender and ethnicity were found to have associations with lighting preferences which needs to be further studied.

Published
2020

11. Outcomes of Surgically Managed Proliferative Diabetic Retinopathy

Author

Charles C. Barr, Amir Hadayer, Brett Mueller, and Janelle Fassbender Adeniran

Subjects
medicine.medical_specialty, Visual acuity, genetic structures, business.industry, medicine.medical_treatment, Vitrectomy, Diabetic retinopathy, medicine.disease, eye diseases, Diabetic traction retinal detachment, Diabetes mellitus, Ophthalmology, Chart review, Vitreous hemorrhage, Diabetic vitreous hemorrhage, Medicine, medicine.symptom, business
Abstract

Purpose: The purpose of this article is to conduct a retrospective chart review of the results of vitrectomy for diabetic vitreous hemorrhage (VH) and diabetic traction retinal detachment (TRD) using small-gauge instruments. Methods: We retrospectively reviewed medical records of all diabetic vitrectomies performed at the University of Louisville from 2012 to 2016 that had at least 6 months of follow-up. Patients included in this study underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy complications. We analyzed the preoperative and 6- and 12-month postoperative visual acuities (VAs) in patients who had vitrectomy for their diabetic retinopathy. We also determined the proportion of patients who had best-corrected visual acuity (BCVA) of 20/40 or better and 20/80 or worse. In the patients who had BCVA of 20/80 or worse, we identified the reasons for the decreased VA. We also report intraocular pressure, demographic characteristics, operative techniques, and complications. Results: We identified 93 eyes that underwent diabetic vitrectomy; 81 eyes of 63 patients had at least 6 months’ follow-up. Of those 81 eyes, 40 eyes had VH only; the average duration of vision loss before surgery was 4.7 months. Forty-one eyes had TRDs with average duration of vision loss before surgery of 7 months. The presenting BCVA was 1.14 logMAR (20/300) in the VH-only group and 1.49 logMAR (20/600) in the TRD group ( P < .09). Six months after surgery, the BCVA was 0.59 logMAR (20/80) in the VH-only group but still 1.37 logMAR (20/500) in the TRD group ( P < .001). By 12 months after surgery (63 eyes), the BCVA was 0.60 logMAR (20/80) vs 1.09 logMAR (20/250), respectively ( P < .02). Technical success was achieved in 79 of 81 eyes. At 12 months after surgery, 22 eyes (55%) in the VH-only group and 19 eyes (46%) in the TRD group gained 15 letters or more (doubling the VA) compared with their presenting VA. In the VH-only group 7 eyes (18%) were 23-gauge (G) PPV, 22 (58%) were 25G PPV, and 9 (24%) were 27G PPV, while in the TRD group 15 (38%) were 20G PPV, 11 (27%) were 23G PPV, and 14 (35%) were 25G PPV. There was no difference in outcome with different gauges. Conclusions: While vitrectomy for complications of diabetic retinopathy was technically successful with small-gauge surgery, visual results were disappointing. Further work is needed to clarify the best timing of surgery to improve visual outcomes.

Published
2018
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12. Single grading vs double grading with adjudication in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study

Author

Ebenezer Daniel, Wei Pan, Graham E. Quinn, Eli Smith, Agnieshka Baumritter, Gui-Shuang Ying, Kelly Wade, Trang B. Duros, Lisa Erbring, Michael X. Repka, Jennifer A. Shepard, David Emmert, C. Mark Herring, Deborah VanderVeen, Suzanne Johnston, Carolyn Wu, Jason Mantagos, Danielle Ledoux, Tamar Winter, Frank Weng, Theresa Mansfield, Don L. Bremer, Mary Lou McGregor, Catherine Olson Jordan, David L. Rogers, Rae R. Fellows, Suzanne Brandt, Brenda Mann, David Wallace, Sharon Freedman, Sarah K. Jones, Du Tran-Viet, Rhonda 'Michelle' Young, Charles C. Barr, Rahul Bhola, Craig Douglas, Peggy Fishman, Michelle Bottorff, Brandi Hubbuch, Rachel Keith, Erick D. Bothun, Inge DeBecker, Jill Anderson, Ann Marie Holleschau, Nichole E. Miller, Darla N. Nyquist, R. Michael Siatkowski, Lucas Trigler, Marilyn Escobedo, Karen Corff, Michelle Huynh, Kelli Satnes, Monte D. Mills, Will Anninger, Gil Binenbaum, Graham Quinn, Karen A. Karp, Denise Pearson, Alice Gong, John Stokes, Clio Armitage Harper, Laurie Weaver, Carmen McHenry, Kathryn Conner, Rosalind Heemer, Elnora Cokley, Robert Hoffman, David Dries, Katie Jo Farnsworth, Deborah Harrison, Bonnie Carlstrom, Cyrie Ann Frye, David Morrison, Sean Donahue, Nancy Benegas, Sandy Owings, Sandra Phillips, Scott Ruark, Anna Ells, Patrick Mitchell, April Ingram, Rosie Sorbie, Maureen Maguire, Mary Brightwell-Arnold, Max Pistilli, Kathleen McWilliams, Sandra Harris, Claressa Whearry, E. Revell Martin, Candace R. Parker Ostroff, Krista Sepielli, Antonio Capone, G. Baker Hubbard, Peter Lloyd, Kerry Davis, G. Carl Gibson, Regina Hansen, Alex R. Kemper, Lisa Prosser, David C. Musch, Stephen P. Christiansen, Ditte J. Hess, Steven M. Kymes, SriniVas R. Sadda, Ryan Spaulding, and Eleanor B. Schron

Subjects
medicine.medical_specialty, Telemedicine, business.industry, Infant, Newborn, Infant, Retinopathy of prematurity, medicine.disease, Sensitivity and Specificity, Article, Ophthalmoscopy, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Image Processing, Computer-Assisted, 030221 ophthalmology & optometry, medicine, Humans, Infant, Very Low Birth Weight, Retinopathy of Prematurity, Grading (education), business
Abstract

To evaluate the sensitivity and specificity of single, independent, nonphysician trained reader (TR) gradings in the Telemedicine Approaches to Evaluating Acute-phase Retinopathy of Prematurity (e-ROP) study.Secondary analyses of image grading results from 1,235 infants of birth weights1251 g. Two of three TRs independently graded image sets; discrepancies were adjudicated by the reading center director (an ophthalmologist) to reach final grading. Sensitivity and specificity of each TR grading and final grading was calculated by comparing gradings to clinical examination results.Of 7,808 double graded image sets, TR1 graded 5,165; TR2, 3,787; and TR3, 6,664. Compared to final grading for referral warranted retinopathy of prematurity (RW-ROP), two TRs had relatively lower sensitivity (TR1, 75% vs 79% [P = 0.03]; TR2, 73% vs 77% [P = 0.02]) and specificity (TR1, 80% vs 83% [P 0.001]; TR2, 82% vs 83% [P = 0.09]). TR3 had similar sensitivity (83% vs 83% [P = 0.78]) and specificity (83% vs 84% [P = 0.02]). Compared to final grading, TR1 had lower sensitivity for zone I ROP (47% vs 56% [P = 0.04]) and stage ≥3 ROP (71% vs 77% [P = 0.002]); TR2 had lower sensitivity for stage ≥3 ROP (69% vs 77% [P 0.001]) and lower specificity for all three components (P 0.001); TR3 had lower sensitivity for detecting plus disease (23% vs 35% [P 0.001]) and similar sensitivity for zone I ROP and stage ≥3 ROP.There is a small but significant decrease in the sensitivity and specificity for RW-ROP when single-reader grading is compared to double adjudicated grading.

Published
2018
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13. Foveal vasculature changes and nonperfusion in patients with diabetes types I and II with no evidence of diabetic retinopathy

Author

Mehreen Adhi, Douglas K. Sigford, Charles C. Barr, and Efrat Fleissig

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Fovea Centralis, Fundus Oculi, Visual Acuity, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Oct angiography, Diabetes mellitus, Ophthalmology, Medicine, Humans, In patient, Diabetes types, Fluorescein Angiography, Aged, Diabetic Retinopathy, business.industry, Retinal Vessels, Diabetic retinopathy, Foveal avascular zone, Middle Aged, medicine.disease, Sensory Systems, Capillaries, 030104 developmental biology, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Regional Blood Flow, 030221 ophthalmology & optometry, Female, Analysis of variance, business, Tomography, Optical Coherence, Retinopathy
Abstract

To analyze the foveal avascular zone (FAZ) in patients with diabetes and no retinopathy vs. controls using OCT angiography (OCT-A). Prospective, observational clinical study. Type I and II diabetics with no retinopathy and healthy control patients underwent OCT-A. The FAZ size and capillary density were calculated using Image J and Adobe Photoshop CS8. Statistical analysis was performed using one-way ANOVA with Tukey’s multiple comparison test and the Pearson correlation test. Fifty-two eyes of 28 diabetic patients and 28 eyes of 16 healthy controls were enrolled. Type I diabetes patients had a longer disease duration than type II (30.3 ± 10.3 vs. 12.3 ± 9.7 years). The mean superficial capillary plexus (SCP) of the FAZ area was 0.27 ± 0.1, 0.36 ± 0.14, and 0.27 ± 0.12 mm2, for the type I, type II, and controls (p = 0.0058) and was significantly larger in type II diabetics (p

Published
2019

15. TISSUE PLASMINOGEN ACTIVATOR FOR SUBFOVEAL HEMORRHAGE DUE TO AGE-RELATED MACULAR DEGENERATION

Author

Charles C. Barr, Janelle M. Fassbender, Shlomit Schaal, and Mark P. Sherman

Subjects
Male, Fovea Centralis, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Sulfur Hexafluoride, Visual Acuity, Vitrectomy, Endotamponade, Tissue plasminogen activator, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Ophthalmology, medicine, Humans, Aged, Retrospective Studies, Aged, 80 and over, Fluorocarbons, business.industry, Subfoveal hemorrhage, Fovea centralis, Retinal Hemorrhage, Retrospective cohort study, Exudates and Transudates, General Medicine, Macular degeneration, medicine.disease, medicine.anatomical_structure, Treatment modality, Tissue Plasminogen Activator, Intravitreal Injections, Wet Macular Degeneration, 030221 ophthalmology & optometry, Female, medicine.symptom, business, Tomography, Optical Coherence, 030217 neurology & neurosurgery, medicine.drug
Abstract

To analyze and compare the effects of three common treatment modalities for a thick subfoveal hemorrhage due to exudative age-related macular degeneration on final visual acuity and the size of the final subretinal scar.Retrospective case series.Single-site, tertiary referral center.Thirty-nine patients with exudative age-related macular degeneration and acute SMH greater than 250 μm.Patients received vitrectomy with a subretinal tissue plasminogen activator (tPA) injection, pneumatic displacement (PD) with intravitreal tPA, or PD without tPA within 2 weeks of presentation.Functional outcome was determined by Snellen visual acuity. Anatomical outcome was determined as the final disciform scar size.Treatment groups did not differ in age, sex, initial visual acuity, the initial area of the thick subfoveal hemorrhage, follow-up duration, lens status, duration of exudative age-related macular degeneration, previous intravitreal bevacizumab injections, or time from last given injection to the acute thick subfoveal hemorrhage. Final visual acuity improved significantly in both the vitrectomy and subretinal tPA injection group (P0.001), and the intravitreal tPA injection group (P = 0.002) but not with PD alone. Patients treated with subretinal tPA achieved 40% ± 54% reduction in final scar area, in contrast to 27% ± 35% decrease in patients treated with intravitreal tPA (P = 0.001).Treatment with tPA improves the functional and anatomical outcomes in patients with thick subfoveal hemorrhage due to subfoveal choroidal neovascular membrane secondary to exudative age-related macular degeneration and was superior to PD without tPA. Vitrectomy with subretinal tPA injection reduced the final disciform scar compared with PD with or without intravitreal tPA.

Published
2016
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16. Changes in Course of Retinopathy of Prematurity from 1986 to 2013

Author

Charles C. Barr, Michael X. Repka, R. Michael Siatkowski, Gui-Shuang Ying, Robert O. Hoffman, Don L. Bremer, Alice K Gong, Jennifer Shepard, Kelly C. Wade, Rae R. Fellows, and Graham E. Quinn

Subjects
congenital, hereditary, and neonatal diseases and abnormalities, Pediatrics, medicine.medical_specialty, Neonatal intensive care unit, business.industry, medicine.medical_treatment, Birth weight, Outcome measures, Gestational age, Cryotherapy, Retinopathy of prematurity, medicine.disease, eye diseases, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, 030225 pediatrics, Secondary analysis, Time course, 030221 ophthalmology & optometry, medicine, business
Abstract

Purpose To compare infant and retinopathy of prematurity (ROP) characteristics from 3 clinical studies conducted over a 27-year period in the United States. Design Secondary analysis of results of 3 clinical studies. Participants Infants with birth weight (BW) Methods Analysis of data from the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) and Early Treatment for Retinopathy of Prematurity (ETROP) trials and the primary data from the Telemedicine Approaches for the Evaluation of Acute-Phase Retinopathy of Prematurity (e-ROP) study. Main Outcome Measures Infant characteristics and onset, severity, and time course of ROP. Results Across the 3 studies, mean (standard deviation) BW and mean gestational age (GA) decreased over time from CRYO-ROP (954 g [185 g], 27.9 weeks [2.2 weeks]) to ETROP (907 g [205 g], 27.4 weeks [2.2 weeks]) to e-ROP (864 g [212 g], 27.0 weeks [2.2 weeks]), with an increase in the percentage of infants enrolled weighing P P = 0.003). Moderately severe ROP (defined as prethreshold or referral warranted) varied (17.8% CRYO, 12.3% ETROP, 19.4% e-ROP; P Conclusions The BW and GA of infants enrolled in ROP studies in the United States have decreased over the past 27 years, whereas ROP prevalence and onset of disease are stable.

Published
2016
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18. Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials

Author

Alex S. Willoughby, Gui-shuang Ying, Cynthia A. Toth, Maureen G. Maguire, Russell E. Burns, Juan E. Grunwald, Ebenezer Daniel, Glenn J. Jaffe, David F. Williams, Sara Beardsley, Steven Bennett, Herbert Cantrill, Carmen Chan-Tram, Holly Cheshier, Kathyrn Damato, John Davies, Sundeep Dev, Julianne Enloe, Gennaro Follano, Peggy Gilbert, Jill Johnson, Tori Jones, Lisa Mayleben, Robert Mittra, Martha Moos, Ryan Neist, Neal Oestreich, Polly Quiram, Robert Ramsay, Edwin Ryan, Stephanie Schindeldecker, John Snater, Trenise Steele, Dwight Selders, Jessica Tonsfeldt, Shelly Valardi, Gary Edd Fish, Hank A. Aguado, Sally Arceneaux, Jean Arnwine, Kim Bell, Tina Bell, Bob Boleman, Patricia Bradley, David Callanan, Lori Coors, Jodi Creighton, Timothy Crew, Kimberly Cummings, Christopher Dock, Karen Duignan, Dwain Fuller, Keith Gray, Betsy Hendrix, Nicholas Hesse, Diana Jaramillo, Bradley Jost, Sandy Lash, Laura Lonsdale, Michael Mackens, Karin Mutz, Michael Potts, Brenda Sanchez, William Snyder, Wayne Solley, Carrie Tarter, Robert Wang, Patrick Williams, Stephen L. Perkins, Nicholas Anderson, Ann Arnold, Paul Blais, Joseph Googe, Tina T. Higdon, Cecile Hunt, Mary Johnson, James Miller, Misty Moore, Charity K. Morris, Christopher Morris, Sarah Oelrich, Kristina Oliver, Vicky Seitz, Jerry Whetstone, Bernard H. Doft, Jay Bedel, Robert Bergren, Ann Borthwick, Paul Conrad, Amanda Fec, Christina Fulwylie, Willia Ingram, Shawnique Latham, Gina Lester, Judy Liu, Louis Lobes, Nicole M. Lucko, Holly Mechling, Lori Merlotti, Keith McBroom, Karl Olsen, Danielle Puskas, Pamela Rath, Maria Schmucker, Lynn Schueckler, Christina Schultz, Heather Shultz, David Steinberg, Avni Vyas, Kim Whale, Kimberly Yeckel, David H. Orth, Linda S. Arredondo, Susan Brown, Barbara J. Ciscato, Joseph M. Civantos, Celeste Figliulo, Sohail Hasan, Belinda Kosinski, Dan Muir, Kiersten Nelson, Kirk Packo, John S. Pollack, Kourous Rezaei, Gina Shelton, Shannya Townsend-Patrick, Marian Walsh, H. Richard McDonald, Nina Ansari, Amanda Bye, Arthur D. Fu, Sean Grout, Chad Indermill, Robert N. Johnson, J. Michael Jumper, Silvia Linares, Brandon J. Lujan, Ames Munden, Meredith Persons, Rosa Rodriguez, Jennifer M. Rose, Brandi Teske, Yesmin Urias, Stephen Young, Richard F. Dreyer, Howard Daniel, Michele Connaughton, Irvin Handelman, Stephen Hobbs, Christine Hoerner, Dawn Hudson, Marcia Kopfer, Michael Lee, Craig Lemley, Joe Logan, Colin Ma, Christophe Mallet, Amanda Milliron, Mark Peters, Harry Wohlsein, Joel A. Pearlman, Margo Andrews, Melissa Bartlett, Nanette Carlson, Emily Cox, Robert Equi, Marta Gonzalez, Sophia Griffin, Fran Hogue, Lance Kennedy, Lana Kryuchkov, Carmen Lopez, Danny Lopez, Bertha Luevano, Erin McKenna, Arun Patel, Brian Reed, Nyla Secor, Iris R. Sison, Tony Tsai, Nina Varghis, Brooke Waller, Robert Wendel, Reina Yebra, Daniel B. Roth, Jane Deinzer, Howard Fine, Flory Green, Stuart Green, Bruce Keyser, Steven Leff, Amy Leviton, Amy Martir, Kristin Mosenthine, Starr Muscle, Linda Okoren, Sandy Parker, Jonathan Prenner, Nancy Price, Deana Rogers, Linda Rosas, Alex Schlosser, Loretta Studenko, Thea Tantum, Harold Wheatley, Michael T. Trese, Thomas Aaberg, Denis Bezaire, Craig Bridges, Doug Bryant, Antonio Capone, Michelle Coleman, Christina Consolo, Cindy Cook, Candice DuLong, Bruce Garretson, Tracy Grooten, Julie Hammersley, Tarek Hassan, Heather Jessick, Nanette Jones, Crystal Kinsman, Jennifer Krumlauf, Sandy Lewis, Heather Locke, Alan Margherio, Debra Markus, Tanya Marsh, Serena Neal, Amy Noffke, Kean Oh, Clarence Pence, Lisa Preston, Paul Raphaelian, Virginia R. Regan, Peter Roberts, Alan Ruby, Ramin Sarrafizadeh, Marissa Scherf, Sarita Scott, Scott Sneed, Lisa Staples, Brad Terry, Matthew T. Trese, Joan Videtich, George Williams, Mary Zajechowski, Daniel P. Joseph, Kevin Blinder, Lynda Boyd, Sarah Buckley, Meaghan Crow, Amanda Dinatale, Nicholas Engelbrecht, Bridget Forke, Dana Gabel, Gilbert Grand, Jennifer Grillion-Cerone, Nancy Holekamp, Charlotte Kelly, Ginny Nobel, Kelly Pepple, Matt Raeber, P. Kumar Rao, Tammy Ressel, Steven Schremp, Merrilee Sgorlon, Shantia Shears, Matthew Thomas, Cathy Timma, Annette Vaughn, Carolyn Walters, Rhonda Weeks, Jarrod Wehmeier, Tim Wright, Daniel M. Berinstein, Aida Ayyad, Mohammed K. Barazi, Erica Bickhart, Tracey Brady, Lisa Byank, Alysia Cronise, Vanessa Denny, Courtney Dunn, Michael Flory, Robert Frantz, Richard A. Garfinkel, William Gilbert, Michael M. Lai, Alexander Melamud, Janine Newgen, Shamekia Newton, Debbie Oliver, Michael Osman, Reginald Sanders, Manfred von Fricken, Pravin Dugel, Sandra Arenas, Gabe Balea, Dayna Bartoli, John Bucci, Jennifer A. Cornelius, Scheleen Dickens, Don Doherty, Heather Dunlap, David Goldenberg, Karim Jamal, Norma Jimenez, Nicole Kavanagh, Derek Kunimoto, John Martin, Jessica Miner, Sarah Mobley, Donald Park, Edward Quinlan, Jack Sipperley, Carol Slagle, Danielle Smith, Miguelina Yafchak, Rohana Yager, Christina J. Flaxel, Steven Bailey, Peter Francis, Chris Howell, Thomas Hwang, Shirley Ira, Michael Klein, Andreas Lauer, Teresa Liesegang, Ann Lundquist, Sarah Nolte, Susan K. Nolte, Scott Pickell, Susan Pope, Joseph Rossi, Mitchell Schain, Peter Steinkamp, Maureen D. Toomey, Debora Vahrenwald, Kelly West, Baker Hubbard, Stacey Andelman, Chris Bergstrom, Judy Brower, Blaine Cribbs, Linda Curtis, Jannah Dobbs, Lindreth DuBois, Jessica Gaultney, Deborah Gibbs, Debora Jordan, Donna Leef, Daniel F. Martin, Robert Myles, Timothy Olsen, Bryan Schwent, Sunil Srivastava, Rhonda Waldron, Andrew N. Antoszyk, Uma Balasubramaniam, Danielle Brooks, Justin Brown, David Browning, Loraine Clark, Sarah Ennis, Susannah Held, Jennifer V. Helms, Jenna Herby, Angie Karow, Pearl Leotaud, Caterina Massimino, Donna McClain, Michael McOwen, Jennifer Mindel, Candace Pereira, Rachel Pierce, Michele Powers, Angela Price, Jason Rohrer, Jason Sanders, Robert L. Avery, Kelly Avery, Jessica Basefsky, Liz Beckner, Alessandro Castellarin, Stephen Couvillion, Jack Giust, Matthew Giust, Maan Nasir, Dante Pieramici, Melvin Rabena, Sarah Risard, Robert See, Jerry Smith, Lisha Wan, Sophie J. Bakri, Nakhleh Abu-Yaghi, Andrew Barkmeier, Karin Berg, Jean Burrington, Albert Edwards, Shannon Goddard, Shannon Howard, Raymond Iezzi, Denise Lewison, Thomas Link, Colin A. McCannel, Joan Overend, John Pach, Margaret Ruszczyk, Ryan Shultz, Cindy Stephan, Diane Vogen, Reagan H. Bradford, Vanessa Bergman, Russ Burris, Amanda Butt, Beth Daniels, Connie Dwiggins, Stephen Fransen, Tiffany Guerrero, Darin Haivala, Amy Harris, Sonny Icks, Ronald Kingsley, Lena Redden, Rob Richmond, Brittany Ross, Kammerin White, Misty Youngberg, Trexler M. Topping, Steve Bennett, Sandy Chong, Mary Ciotti, Tina Cleary, Emily Corey, Dennis Donovan, Albert Frederick, Lesley Freese, Margaret Graham, Natalya Gud, Taneika Howard, Mike Jones, Michael Morley, Katie Moses, Jen Stone, Robin Ty, Torsten Wiegand, Lindsey Williams, Beth Winder, Carl C. Awh, Michelle Amonette, Everton Arrindell, Dena Beck, Brandon Busbee, Amy Dilback, Sara Downs, Allison Guidry, Gary Gutow, Jackey Hardin, Sarah Hines, Emily Hutchins, Kim LaCivita, Ashley Lester, Larry Malott, MaryAnn McCain, Jayme Miracle, Kenneth Moffat, Lacy Palazzotta, Kelly Robinson, Peter Sonkin, Alecia Travis, Roy Trent Wallace, Kelly J. Winters, Julia Wray, April E. Harris, Mari Bunnell, Katrina Crooks, Rebecca Fitzgerald, Cameron Javid, Corin Kew, Erica Kill, Patricia Kline, Janet Kreienkamp, Maricruz Martinez, Roy Ann Moore, Egbert Saavedra, LuAnne Taylor, Mark Walsh, Larry Wilson, Thomas A. Ciulla, Ellen Coyle, Tonya Harrington, Charlotte Harris, Cindi Hood, Ingrid Kerr, Raj Maturi, Dawn Moore, Stephanie Morrow, Jennifer Savage, Bethany Sink, Tom Steele, Neelam Thukral, Janet Wilburn, Joseph P. Walker, Jennifer Banks, Debbie Ciampaglia, Danielle Dyshanowitz, Jennifer Frederick, A. Tom Ghuman, Richard Grodin, Cheryl Kiesel, Eileen Knips, Jonathan McCue, Maria Ortiz, Crystal Peters, Paul Raskauskas, Etienne Schoeman, Ashish Sharma, Glenn Wing, Rebecca Youngblood, Suresh R. Chandra, Michael Altaweel, Barbara Blodi, Kathryn Burke, Kristine A. Dietzman, Justin Gottlieb, Gene Knutson, Denise Krolnik, T. Michael Nork, Shelly Olson, John Peterson, Sandra Reed, Barbara Soderling, Guy Somers, Thomas Stevens, Angela Wealti, Srilaxmi Bearelly, Brenda Branchaud, Joyce W. Bryant, Sara Crowell, Sharon Fekrat, Merritt Gammage, Cheala Harrison, Sarah Jones, Noreen McClain, Brooks McCuen, Prithvi Mruthyunjaya, Jeanne Queen, Neeru Sarin, Cindy Skalak, Marriner Skelly, Ivan Suner, Ronnie Tomany, Lauren Welch, Susanna S. Park, Allison Cassidy, Karishma Chandra, Idalew Good, Katrina Imson, Sashi Kaur, Helen Metzler, Lawrence Morse, Ellen Redenbo, Marisa Salvador, David Telander, Mark Thomas, Cindy Wallace, Charles C. Barr, Amanda Battcher, Michelle Bottorff, Mary Chasteen, Kelly Clark, Diane Denning, Debra Schoen, Amy Schultz, Evie Tempel, Lisa Wheeler, Greg K. Whittington, Thomas W. Stone, Todd Blevins, Michelle Buck, Lynn Cruz, Wanda Heath, Diana Holcomb, Rick Isernhagen, Terri Kidd, John Kitchens, Cathy Sears, Ed Slade, Jeanne Van Arsdall, Brenda VanHoose, Jenny Wolfe, William Wood, John Zilis, Carol Crooks, Larry Disney, Mimi Liu, Stephen Petty, Sandra Sall, James C. Folk, Tracy Aly, Abby Brotherton, Douglas Critser, Connie J. Hinz, Stefani Karakas, Valerie Kirschner, Cheyanne Lester, Cindy Montague, Stephen Russell, Heather Stockman, Barbara Taylor, Randy Verdick, Jean Walshire, John T. Thompson, Barbara Connell, Maryanth Constantine, John L. Davis, Gwen Holsapple, Lisa Hunter, C. Nicki Lenane, Robin Mitchell, Leslie Russel, Raymond Sjaarda, David M. Brown, Matthew Benz, Llewellyn Burns, JoLene G. Carranza, Richard Fish, Debra Goates, Shayla Hay, Theresa Jeffers, Eric Kegley, Dallas Kubecka, Stacy McGilvra, Beau Richter, Veronica Sneed, Cary Stoever, Isabell Tellez, Tien Wong, Ivana Kim, Christopher Andreoli, Leslie Barresi, Sarah Brett, Charlene Callahan, Karen Capaccioli, William Carli, Matthew Coppola, Nicholas Emmanuel, Claudia Evans, Anna Fagan, Marcia Grillo, John Head, Troy Kieser, Elaine Lee, Ursula Lord, Edward Miretsky, Kate Palitsch, Todd Petrin, Liz Reader, Svetlana Reznichenko, Mary Robertson, Justin Smith, Demetrios Vavvas, John Wells, Cassie Cahill, W. Lloyd Clark, Kayla Henry, David Johnson, Peggy Miller, LaDetrick Oliver, Robbin Spivey, Tiffany Swinford, Mallie Taylor, Michael Lambert, Kris Chase, Debbie Fredrickson, Joseph Khawly, Valerie Lazarte, Donald Lowd, Pam Miller, Arthur Willis, Philip J. Ferrone, Miguel Almonte, Rachel Arnott, Ingrid Aviles, Sheri Carbon, Michael Chitjian, Kristen DAmore, Christin Elliott, David Fastenberg, Barry Golub, Kenneth Graham, AnnMarie Lavorna, Laura Murphy, Amanda Palomo, Christina Puglisi, David Rhee, Juan Romero, Brett Rosenblatt, Glenda Salcedo, Marianne Schlameuss, Eric Shakin, Vasanti Sookhai, Richard Kaiser, Elizabeth Affel, Gary Brown, Christina Centinaro, Deborah Fine, Mitchell Fineman, Michele Formoso, Sunir Garg, Lisa Grande, Carolyn Herbert, Allen Ho, Jason Hsu, Maryann Jay, Lisa Lavetsky, Elaine Liebenbaum, Joseph Maguire, Julia Monsonego, Lucia O'Connor, Lisa Pierce, Carl Regillo, Maria Rosario, Marc Spirn, James Vander, Jennifer Walsh, Frederick H. Davidorf, Amanda Barnett, Susie Chang, John Christoforidis, Joy Elliott, Heather Justice, Alan Letson, Kathryne McKinney, Jeri Perry, Jill A. Salerno, Scott Savage, Stephen Shelley, Lawrence J. Singerman, Joseph Coney, John DuBois, Kimberly DuBois, Gregg Greanoff, Dianne Himmelman, Mary Ilc, Elizabeth Mcnamara, Michael Novak, Scott Pendergast, Susan Rath, Sheila Smith-Brewer, Vivian Tanner, Diane E. Weiss, Hernando Zegarra, Lawrence Halperin, Patricia Aramayo, Mandeep Dhalla, Brian Fernandez, Cindy Fernandez, Jaclyn Lopez, Monica Lopez, Jamie Mariano, Kellie Murphy, Clifford Sherley, Rita Veksler, Firas Rahhal, Razmig Babikian, David Boyer, Sepideh Hami, Jeff Kessinger, Janet Kurokouchi, Saba Mukarram, Sarah Pachman, Eric Protacio, Julio Sierra, Homayoun Tabandeh, Adam Zamboni, Michael Elman, Jennifer Belz, Tammy Butcher, Theresa Cain, Teresa Coffey, Dena Firestone, Nancy Gore, Pamela Singletary, Peter Sotirakos, JoAnn Starr, Travis A. Meredith, Cassandra J. Barnhart, Debra Cantrell, RonaLyn Esquejo-Leon, Odette Houghton, Harpreet Kaur, Fatoumatta NDure, Ronald Glatzer, Leonard Joffe, Reid Schindler, Stuart L. Fine, Marilyn Katz, Mary Brightwell-Arnold, Ruchira Glaser, Judith Hall, Sandra Harkins, Jiayan Huang, Alexander Khvatov, Kathy McWilliams, Ellen Peskin, Maxwell Pistilli, Susan Ryan, Allison Schnader, Gui-Shuang Ying, Glenn Jaffe, Jennifer Afrani-Sakyi, Brannon Balsley, Linda S. Bennett, Adam Brooks, Adrienne Brower-Lingsch, Lori Bruce, Russell Burns, Dee Busian, John Choong, Lindsey Cloaninger, Francis Char DeCroos, Emily DuBois, Mays El-Dairi, Sarah Gach, Katelyn Hall, Terry Hawks, ChengChenh Huang, Cindy Heydary, Alexander Ho, Shashi Kini, Michelle McCall, Daaimah Muhammad, Jayne Nicholson, Pamela Rieves, Kelly Shields, Adam Specker, Sandra Stinnett, Sujatha Subramaniam, Patrick Tenbrink, Cynthia Toth, Aaron Towe, Kimberly Welch, Natasha Williams, Katrina Winter, Ellen Young, Judith Alexander, Elisabeth Flannagan, E. Revell Martin, Candace Parker, Krista Sepielli, Tom Shannon, Claressa Whearry, Maryann Redford, Marcia R. Kopfer, Frederick L. Ferris, Joan DuPont, Lawrence M. Friedman, Susan B. Bressler, David L. DeMets, Martin Friedlander, Mark W. Johnson, Anne Lindblad, Douglas W. Losordo, and Franklin G. Miller

Subjects
Vascular Endothelial Growth Factor A, medicine.medical_specialty, Visual acuity, genetic structures, Visual Acuity, Angiogenesis Inhibitors, Retinal Pigment Epithelium, Antibodies, Monoclonal, Humanized, Retina, Article, Cicatrix, Ophthalmology, Geographic Atrophy, Ranibizumab, Medicine, Humans, Prospective Studies, Fluorescein Angiography, External limiting membrane, Prospective cohort study, medicine.diagnostic_test, business.industry, Fundus photography, Macular degeneration, Middle Aged, medicine.disease, Fluorescein angiography, eye diseases, Bevacizumab, Choroidal neovascularization, medicine.anatomical_structure, Intravitreal Injections, Wet Macular Degeneration, sense organs, medicine.symptom, business, Tomography, Optical Coherence, medicine.drug
Abstract

To evaluate the association of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA), and scar in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).Prospective cohort study within a randomized clinical trial.The 1185 CATT participants.Masked readers graded scar and GA on fundus photography and fluorescein angiography and graded SHRM on time-domain and spectral-domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1 mm(2), or outside the center 1mm(2) were obtained on SD OCT images at 56 (n = 76) and 104 (n = 66) weeks.Presence of SHRM, as well as location and size, and associations with VA, scar, and GA.Among CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and to 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved (64% vs. 31%; P0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n = 76) and 104 (n = 66), mean VA letter score was 73.5 (standard error [SE], 2.8), 73.1 (SE, 3.4), 65.3 (SE, 3.5), and 63.9 (SE, 3.7) when SHRM was absent, present outside the central 1 mm(2), present within the central 1 mm(2) but not the foveal center, or present at the foveal center (P = 0.02), respectively. When SHRM was present, the median maximum height under the fovea, within the central 1 mm(2) including the fovea and anywhere within the scan, was 86 μm, 120 μm, and 122 μm, respectively. Visual acuity was decreased with greater SHRM height and width (P0.05).In eyes with neovascular age-related macular degeneration (AMD), SHRM is common and often persists after anti-vascular endothelial growth factor treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM dimensions were associated with worse VA. In eyes with neovascular AMD, SHRM is an important morphologic biomarker.

Published
2015

19. Validated System for Centralized Grading of Retinopathy of Prematurity: Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study

Author

Sharon F. Freedman, Karen A. Karp, Maureen G. Maguire, Will Anninger, Frank Weng, Kerry Davis, Carmen McHenry, E. Revell Martin, Anna L. Ells, Charles C. Barr, Alex R. Kemper, Carolyn Wu, Laurie Weaver, Ditte J. Hess, Rosie Sorbie, R. Michael Siatkowski, Sandy Owings, Inge DeBecker, Steven Kymes, G. Carl Gibson, Agnieshka Baumritter, Krista Sepielli, Lisa Erbring, April Ingram, Catherine O. Jordan, Rosalind Heemer, Ryan Spaulding, Claressa Whearry, Scott Ruark, Regina Hansen, Clio Armitage Harper, Denise J. Pearson, Kelly C. Wade, Michelle Huynh, Rachel J. Keith, Ann M. Holleschau, Lisa A. Prosser, Mary Brightwell-Arnold, Alice K Gong, John Stokes, Antonio Capone, Michelle Bottorff, Jennifer Shepard, David C. Musch, Lucas Trigler, Karen Corff, Peggy Fishman, Du Tran-Viet, Gil Binenbaum, Srinivas R. Sadda, Marilyn B. Escobedo, Deborah Harrison, David Emmert, Stephen P. Christiansen, Bonnie Carlstrom, Katie Jo Farnsworth, Kathleen McWilliams, Don L. Bremer, Eleanor Schron, David G. Morrison, Craig Douglas, Suzanne Johnston, Patrick Mitchell, Brandi Hubbuch, Sarah K. Jones, Deborah K. VanderVeen, Eli Smith, Theresa A. Mansfield, Nancy Benegas, Brenda Mann, Elnora Cokley, Kelli Satnes, Sandra Harris, Suzanne Brandt, Rhonda 'Michelle' Young, Rae R. Fellows, Graham E. Quinn, Ebenezer Daniel, David L. Rogers, Mary Lou McGregor, Robert O. Hoffman, Rahul Bhola, G. Baker Hubbard, Darla N. Nyquist, Nichole E. Miller, David K. Wallace, Jason Mantagos, Candace P. Ostroff, P. Lloyd Hildebrand, C. Mark Herring, Kathryn Conner, David Dries, Sean P. Donahue, Jill S. Anderson, Sandra Phillips, Tamar Winter, Danielle M Ledoux, Erick D. Bothun, Monte D. Mills, Cyrie Ann Frye, Trang B. Duros, and Michael X. Repka

Subjects
Diagnostic Imaging, congenital, hereditary, and neonatal diseases and abnormalities, Pediatrics, medicine.medical_specialty, Telemedicine, Certification, genetic structures, Quality Assurance, Health Care, Birth weight, Allied Health Personnel, Article, medicine, Humans, Infant, Very Low Birth Weight, Retinopathy of Prematurity, Grading (education), Observer Variation, business.industry, Infant, Newborn, Reproducibility of Results, Retinopathy of prematurity, medicine.disease, eye diseases, Plus disease, Ophthalmology, Interobserver Variation, Acute Disease, Optometry, sense organs, Clinical Competence, Educational Measurement, Clinical competence, business, Cohort study
Abstract

Importance Measurable competence derived from comprehensive and advanced training in grading digital images is critical in studies using a reading center to evaluate retinal fundus images from infants at risk for retinopathy of prematurity (ROP). Details of certification for nonphysician trained readers (TRs) have not yet been described. Objective To describe a centralized system for grading ROP digital images by TRs in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study. Design, Setting, and Participants Multicenter observational cohort study conducted from July 1, 2010, to June 30, 2014. The TRs were trained by experienced ROP specialists and certified to detect ROP morphology in digital retinal images under supervision of an ophthalmologist reading center director. An ROP reading center was developed with standard hardware, secure Internet access, and customized image viewing software with an electronic grading form. A detailed protocol for grading was developed. Based on results of TR gradings, a computerized algorithm determined whether referral-warranted ROP (RW-ROP; defined as presence of plus disease, zone I ROP, and stage 3 or worse ROP) was present in digital images from infants with birth weight less than 1251 g enrolled from May 25, 2011, through October 31, 2013. Independent double grading was done by the TRs with adjudication of discrepant fields performed by the reading center director. Exposure Digital retinal images. Main Outcomes and Measures Intragrader and intergrader variability and monitoring for temporal drift. Results Four TRs underwent rigorous training and certification. A total of 5520 image sets were double graded, with 24.5% requiring adjudication for at least 1 component of RW-ROP. For individual RW-ROP components, the adjudication rate was 3.9% for plus disease, 12.4% for zone I ROP, and 16.9% for stage 3 or worse ROP. The weighted κ for intergrader agreement (n = 80 image sets) was 0.72 (95% CI, 0.52-0.93) for RW-ROP, 0.57 (95% CI, 0.37-0.77) for plus disease, 0.43 (95% CI, 0.24-0.63) for zone I ROP, and 0.67 (95% CI, 0.47-0.88) for stage 3 or worse ROP. The weighted κ for grade-regrade agreement was 0.77 (95% CI, 0.57-0.97) for RW-ROP, 0.87 (95% CI, 0.67-1.00) for plus disease, 0.70 (95% CI, 0.51-0.90) for zone I ROP, and 0.77 (95% CI, 0.57-0.97) for stage 3 or worse ROP. Conclusions and Relevance These data suggest that the e-ROP system for training and certifying nonphysicians to grade ROP images under the supervision of a reading center director reliably detects potentially serious ROP with good intragrader and intergrader consistency and minimal temporal drift.

Published
2015

20. CHOROIDAL NEOVASCULARIZATION AFTER INTRAOCULAR FOREIGN BODY INJURY

Author

J. Eric Downing and Charles C. Barr

Subjects
Intraocular foreign body, medicine.medical_specialty, Visual acuity, genetic structures, medicine.diagnostic_test, Bevacizumab, business.industry, medicine.medical_treatment, Computed tomography, Vitrectomy, General Medicine, Fluorescein angiography, eye diseases, Ophthalmology, Choroidal neovascularization, Choroidal neovascular membrane, medicine, sense organs, medicine.symptom, business, medicine.drug
Abstract

PURPOSE To report the use of bevacizumab to treat intraocular foreign body-induced choroidal neovascularization. METHODS An intraocular foreign body was diagnosed clinically and confirmed via optical coherence tomography and head computed tomography. Fluorescein angiography was used to confirm the diagnosis of choroidal neovascular membrane on follow-up examination. The patient was treated with vitrectomy and intravitreal bevacizumab with follow-up at progressive intervals to determine the treatment response. RESULTS The visual acuity was measured at 20/20 1 year after vitrectomy, with no recurrence of choroidal neovascularization. CONCLUSION Intravitreal bevacizumab should be considered a useful alternative or adjunct to photocoagulation for the treatment of choroidal neovascularization due to intraocular foreign body.

Published
2012
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21. Postinjection Endophthalmitis in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Author

Jonathan L. Prenner, Ellen Peskin, Charles C. Barr, Maureen G. Maguire, Travis A. Meredith, Bernard H. Doft, Colin A. McCannel, and Daniel F. Martin

Subjects
Male, Vascular Endothelial Growth Factor A, medicine.medical_specialty, Visual acuity, genetic structures, Bevacizumab, medicine.medical_treatment, Visual Acuity, Angiogenesis Inhibitors, Vitrectomy, Antibodies, Monoclonal, Humanized, Eye Infections, Bacterial, Article, Cohort Studies, Postoperative Complications, Endophthalmitis, Ranibizumab, Ophthalmology, medicine, Humans, Aged, 80 and over, business.industry, Incidence, Incidence (epidemiology), Middle Aged, Macular degeneration, Eye infection, medicine.disease, eye diseases, Anti-Bacterial Agents, Surgery, Treatment Outcome, Intravitreal Injections, Wet Macular Degeneration, Female, medicine.symptom, business, medicine.drug
Abstract

Objective To describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti–vascular endothelial growth factor agents in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) and to assess the effect of prophylactic topical antimicrobials on incidence. Design Cohort study within a randomized clinical trial. Participants Patients enrolled in CATT. Methods Patients with neovascular age-related macular degeneration received intravitreal injections of ranibizumab or bevacizumab under 1 of 3 dosing regimens. The study protocol specified preinjection preparation to include use of a sterile lid speculum and povidone iodine (5%). Use of preinjection and postinjection antibiotics was at the discretion of the treating ophthalmologist. Patients were followed up monthly for 2 years. Main Outcome Measures Development of endophthalmitis and visual acuity. Results Endophthalmitis developed after 11 of 18 509 injections (1 per 1700 [0.06%]; 95% confidence interval, 0.03%–0.11%), and in 11 of 1185 patients (0.93%; 95% confidence interval, 0.52–1.66). Incidence of endophthalmitis was 0.15% among injections with no antibiotic use, 0.08% among injections with preinjection antibiotics only, 0.06% among injections with postinjection antibiotics only, and 0.04% among injections with preinjection and postinjection antibiotics ( P = 0.20). All eyes were treated with intravitreal antibiotics and 4 underwent vitrectomy. Among the 11 affected eyes, the final study visual acuity was 20/40 or better in 4 eyes (36%), 20/50 to 20/80 in 2 eyes (18%), 20/100 to 20/160 in 3 eyes (27%), and worse than 20/800 in 2 eyes (18%). The final visual acuity was within 2 lines of the visual acuity before endophthalmitis in 5 eyes (45%). Conclusions Rates of endophthalmitis were low and similar to those in other large-scale studies. Use of topical antibiotics either before or after injection does not seem to reduce the risk for endophthalmitis.

Published
2015
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22. Management of thick submacular hemorrhage with subretinal tissue plasminogen activator and pneumatic displacement for age-related macular degeneration

Author

Charles C. Barr, Shlomit Schaal, and Eddie Apenbrinck

Subjects
Male, medicine.medical_specialty, business.industry, Retinal Hemorrhage, Endotamponade, Macular degeneration, medicine.disease, Tissue plasminogen activator, Surgery, Ophthalmology, Fibrinolytic Agents, Age related, Tissue Plasminogen Activator, Vitrectomy, medicine, Wet Macular Degeneration, Humans, Displacement (orthopedic surgery), Female, business, medicine.drug
Published
2014

23. Endogenous aspergillus endophthalmitis

Author

Charles C. Barr, Harry W. Flynn, Timothy G. Murray, Jeffrey G. Gross, Walter C. McLean, John H. Killian, Janet L. Davis, Paul D. Weishaar, and Calvin E. Mein

Subjects
Pars plana, medicine.medical_specialty, Visual acuity, genetic structures, business.industry, medicine.medical_treatment, Eye disease, Retinal detachment, Vitrectomy, Eye infection, Aspergillosis, medicine.disease, eye diseases, Surgery, Ophthalmology, medicine.anatomical_structure, Amphotericin B, Medicine, sense organs, medicine.symptom, business, medicine.drug
Abstract

Objective: This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis. Design: The study design was a multicenter retrospective chart review. Participants: Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied. Intervention: Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed. Main Outcome Measures: Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured. Results: All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated. Conclusions: Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

Published
1998
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24. The Endophthalmitis Vitrectomy Study

Author

Mark W. Johnson, Bernard H. Doft, Sheryl F. Kelsey, Michael Barza, Louis A. Wilson, Charles C. Barr, Stephen R. Wisniewski, Andrew K. Vine, Barbara A. Blodi, Susan G. Elner, Laurie M. Jessup, Sharad Khanderia, Carl L. Pierson, Julie Willis, Frances McIver, Sally Stanley, Scott R. Sneed, Antonio Capone, Thomas M. Aaberg, Jennifer I. Lim, Paul Sternberg, Diana S. Coffman, Cameile N. Moore, Susanne K. Gardner, Frederick S. Nolte, Ann Fremstad, Deborah Gibbs, James Gilman, Ray Swords, H.Edith Aguilar, Travis A. Meredith, Vinod Lakhanpal, Faith D. Christian, A. Hood, Richard S. Schwalbe, Emery E. Billings, William Buie, James J. Mallonee, Mary Ann Millar, Sharon Verbeek, Peter A. Campochiaro, Carol B. Palardy, Lois Reynolds, James D. Dick, Dennis Cain, Donald J. D'Amico, Albert R. Frederick, Michael G. Morley, Richard D. Pesavento, Carmen A. Puliafito, Trexler M. Topping, Susan M. Finn, Laura A. Raymond, Ann Sullivan Baker, Barbara Paton, Claudia Evans, Jeffrey Napoli, Christine Kierman, Kathryn Makris, Tom McInnes, Wini T. Reidy, Ruth White, Richard A. Garfinkel, A.Raymond Pilkerton, Robert A. Frantz, Gill B. Abernathy, Jay G. Barbaccia, H.Russell Ensey, Carol A. Ormes, Choong H. Park, Joel Caplan, Kathryn Russell, Robert Toma, Kirk H. Packo, Serge de Bustros, Timothy P. Flood, Louis Glazer, Maggie DeAlba, Evangeline Evanich, Michael A. Montwill, Jeri J. Rothman, Gail Ruderman, Melodie Beard, William Landau, Min H. Shen, Martha Gordon, Sharon Graff, Kathy Kwiatkowski, Loreen Pappas, Douglas Bryant, Don Doherty, Frank Morini, Linda Arredondo, Bruce R. Garretson, Carlos Gerena, Maureen Hunt, Sharon M. Kinnaird, Toni Neri, Thomas A. Rice, Michael A. Novak, Pamela S. Rowe, Scott Jamieson, Deborah Newberry, Glenn R. Rech, Michael J. Dul, Livia Kinser, Krystyna Strozewski, Susan Clark-Rath, Marty DeLisio, David L. Dempsey, Donna Kukula, Anne Pinter-Smith, Sheila Smith-Brewer, Tracey Ludwig, Robert B. Chambers, Frederick H. Davidorf, Cindy S. Taylor, Karen N. Hale, William J. Buesching, Chhanda Chaudhuri, Nanci J. Cover, Gail R. Shortlidge, Michael J. Keating, Scott J. Savage, Paula Andrzejewska, Susan Cometet, Jill D. Milliron, Rob Richmond, Lori Schneider, Debra Weisenberger, Herbert L. Cantrill, Robert C. Ramsay, Amy B. Brallier, Timothy P. Johnson, Edith E. Rossing, Kathleen A. Knauth, Martha M. Monahan, Neal W. Oestreich, Kenneth F. Clark, Anita M. Glennen, David L. Yarian, Stuart N. Green, Steven R. Leff, Leo Masciulli, Margaret M. Lucido, Edward J. Ludwig, Charlotte L. Marano, Linda Peters, Kim Joho, Doris C. Volkert, Finn Andersen, Donna Coffey, Alex Schlosser, Ann Honeywell, Robert N. Mames, William T. Driebe, George A. Stern, Amye Francis, Z.Suzanne Zam, Rhonda Cooper, Darla Gaskins, Diana J. Shamis, Melinda Willingham, Kay Barker, Harry Rosa, Scott M. Friedman, Thomas W. Gardner, George W. Blankenship, Carole J. Coyle, Christopher J. Bero, Cindy Halas, Suzanne Schick, Jean Walker, Denise Cunningham, H.Michael Lambert, Pamela S. Clogston, Pamela M. Frady, S.Neal Gardner, Michael S. Osato, Louise Carr, James Shigley, Pedro F. Lopez, Lawrence P. Chong, Donald A. Frambach, Lupe CisnerosMargaret^Padilla, Edmond Ming Yee, Tamako Nakamura, A.Frances Walonker, Ronald Morales, Tracy Nichols, Maria E. Huete, Peter E. Liggett, Richard R. Ober, Beth Quillen-Thomas, Mark Williams, Steven M. Bloom, Pamela J. Greene, Greg K. Whittington, Mark E. Martin, Glen Watson, Betty Jenkins-Curry, Leigh A. Gilkey, Steven Huelsman, Dennis P. Han, Thomas C. Burton, William F. Mieler, Jose S. Pulido, Frederick H. Reeser, Janet L. Newman, Kathy A. Werner, Paul J. Pisarzewicz, Nina A. Reinerio, Mary Lee K. Walloch, Zuzana Wilmer, Jan Laabs, Ruth Picchiottino, Jim Phillips, Walter Wipplinger, Gary W. Abrams, Dale T. Jurkiewicz, Margaret L. Leet, Paul Mandel, Kim Metzger, Lori Suchla, Denise Zarling, Mark W. Balles, Edwin H. Ryan, William H. Knobloch, Sally M. Cook, Darlette G. Luke, Patricia Ferrieri, Norynne M. Schiminsky, Anne Genia, David A. Philiph, Elizabeth K. Stinson, Linda M. Wright, William C. McMichael, Sandy J. Mielke, Lisa J. Ponwith, Peter Reed Pavan, Scott E. Pautler, Marion L. Coats, Nancy M. Kirk, Sharon M. Millard, Frank C. Castellano, Charlotte R. Edwards, Angela Marquardt, Amy J. McCormack, Michael T. McCormick, Bernard Renshaw, Angela Restuccia, Monica Campbell, Nell Christopher, L.Scott Garrett, Demetrios G. Halkias, Kim Hothersall, Karen Mickler, Thomas S. Minnick, Cheryl Burr, Wyatt Saxon, Miguel A. Arcacha, Steve Carlton, Sonya K. Edison, Marc J. Mallis, Tamre L. Sayers, Thomas W. Sudds, Robert J. Tiberia, Sherry Wolabaugh, Reagan H. Bradford, David W. Parke, Thomas C. Wolf, Janie M. Shofner, Lee E. Tobey, Harold G. Jensen, Dinah Sanchez, Janie Shofner, Russell Burris, Kellie K. Drake, Kay R. Grissom, J.James Rowsey, Charles P. Wilkinson, Gary C. Brown, William E. Benson, Jay L. Federman, Alfred C. Lucier, Joseph I. Maguire, Lov K. Sarin, Eric P. Shakin, Arunan Sivalingam, William Tasman, James F. Vander, Nancy Ward, Clement A. Weisbecker, Caroline L. Agnew, Richard Lambert, Terrance Torner, Kathy Carlson, Gerrie Franchine, Michelle S. Serfass, Robert L. Bergren, Louis A. Lobes, Karl R. Olsen, Jeffrey S. Rinkoff, Donna J. Metz, Margaret N. Leonard, Lisa M. Karenchak, Regis P. Kowalski, Lynn A. Wellman, Linda A. Wilcox, Alan F. Campbell, David R. Steinberg, Gary L. Vagstad, Kimberly A. Flook, Mary M. Good, Beverly J. Keenen, Kim A. Mellinger, Raymond R. Margherio, Morton S. Cox, Patrick L. Murphy, Michael T. Trese, Jane C. Werner, George A. Williams, Patricia E. Manatrey, Janet L. Prote, Richard Lucarotti, Susan Martin, Jeff Band, Grace Bostic, Kristi Gumming, Beth Mitchell, Virginia S. Regan, Craig Bridges, Sam Cox, Gary Houston, John Johnson, Pat Streasik, Betty Wood, Mark S. Blumenkranz, Lisa Cayo, Virginia Kaye, Carmen Luz Valenzuela, Ira K. Orgel, Lon S. Poliner, Paul E. Tornambe, Sarah V. Cannon, Janet L. Nielsen, Anne Carlson, Pauline Chan, Lynne Drake, Martha Grim, Corky Peterson, Lynn A. Borg, Joann Gillyatt, Conny Beyer, Mark E. Hammer, W.Sanderson Grizzard, Theresa L. Shannon, Janet R. Traynom, Melinda J. Collado, Dennis W. McManus, Daniel E. Sweeney, Donald H. Adams, Thomas T. Watson, Michael V. Antworth, Johanna Glacy Araos, Mark A. Greenwald, Mohsen Habib, Sandra K. Myers, Karen M. Ockers, Judy-Ann Thibodeau, Brett Watkins, Philip T. Nelsen, J.Gregory Rosenthal, Fay V. Mintz, Michael Biedenbach, Nicholas J. Leonardy, Sue M. Lawniczak, Chuck Bork, George Hageage, Evelyn B. Hunter, MarLynn J. Marshall, Patricia Roman, Rick Hill, Thomas Hofbauer, Jack Lemanowicz, Howard P. Cupples, Gladys I. Guzman, Richard J. Brodeur, Donald Yee, Edward C. Delaha, Stanley L. Geyer, Stacey Slovis, William J. Shields, Susan Lauber, Karl Michelitsch, Aaron Kassoff, Sharon Watling, JoAnne C. Buehler, Jeffrey McVay, Gale K. Podobinski, Robert L. Sillett, Shirley Groer, Brian Avery, Steven H. Belle, James Boles, Linda Henry, Sarah J. Shema, Linda Titus-Emstoff, Matthew Davis, Yvonne L. Magli, Larry Hubbard, Suzanne Thomas, Donald F. Everett, Richard Mowery, Donald Everett, Kathryn Davis, Stanley Azen, Preston Covey, Brooks McCuen, Andrew Packer, and Jeffrey Robin

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Eye disease, Vitrectomy, Intraocular lens, Eye infection, medicine.disease, Surgery, law.invention, Clinical trial, Ophthalmology, Endophthalmitis, Randomized controlled trial, law, medicine, Complication, business
Abstract

Purpose: The authors determine if specific features of the clinical presentation of acute postoperative endophthalmitis correlate with the microbiologic culture results. Methods: A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation were evaluated as part of a randomized clinical trial. Results of cultures performed on aqueous and vitreous specimens obtained at presentation were categorized as follows: gram-positive coagulase-negative micrococci, "other" gram-positive, gram-negative, and equivocal/no growth. Results: Eleven features of the initial clinical presentation were associated with significant differences in the microbiologic spectrum ( P Conclusions: The presenting characteristics of acute endophthalmitis after cataract surgery may be helpful in predicting the most likely culture results. Such predictions do not appear sufficiently strong to guide the initial empiric choice of intravitreal antibiotics.

Published
1997
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25. Macular Pucker after Successful Surgery for Proliferative Vitreoretinopathy

Author

Alexander R. Irvine, Morton S. Cox, Kenneth R. Diddie, Stanley P. Azen, Mei Ying Lai, Hal M. Freeman, Kathryn L.P. Linton, and Charles C. Barr

Subjects
medicine.medical_specialty, Proliferative vitreoretinopathy, Visual acuity, genetic structures, business.industry, medicine.medical_treatment, Eye disease, Vitrectomy, medicine.disease, eye diseases, Surgery, Ophthalmology, medicine, sense organs, Tamponade, medicine.symptom, business, Complication, Vitreous base, Retinopathy
Abstract

Background: The prevalence of postoperative macular pucker and the factors associated with its development after successful surgery for proliferative vitreoretinopathy (PVR) using silicone oil or gas tamponade are unknown. Methods: The postoperative status of the macula was determined by reviewing the photographs of 336 eyes taken 6 months after randomization. Two hundred eleven eyes with attached maculas were identified and analyzed to determine the prevalence of macular pucker after silicone oil and gas tamponades in eyes without (group 1) and with (group 2) previous vitrectomy surgery. Data obtained at baseline, from the primary study surgery, and from subsequent examinations and repeat surgeries during a follow-up period of 6 months were analyzed for factors associated with postoperative macular pucker. Results: The 6-month-point prevalence rate of postoperative macular pucker was 15% (32 of 211 eyes). Ten of the 32 eyes were new cases of macular pucker. The authors were unable to document a difference in the 6-month-point prevalence of postoperative macular pucker between group 1 and group 2 eyes (13% versus 18%) or between eyes randomized to gas versus silicone oil (19% versus 12%). Postoperative pucker was three times as likely to develop in aphakic/pseudophakic eyes compared with phakic eyes ( P = 0.02). Focal contraction posteriorly causing starfolds, and intravitreal contraction involving the vitreous base or vitreous cavity, were significantly less prevalent in eyes with postoperative macular pucker ( P P = 0.04) were associated significantly with postoperative macular pucker ( P = 0.04). The authors were unable to document an association between postoperative macular pucker and the type of adhesive modality used or the extent of its application. Postoperative visual acuity was significantly better if the macula was not puckered ( P Conclusions: The occurrence of macular pucker after successful surgery for retinal detachments complicated by severe PVR is not influenced by the choice of intraocular tamponade. Certain preoperative factors may be associated with postoperative macular pucker.

Published
1995
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26. Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques

Author

Mark P. Sherman, Charles C. Barr, Henry J. Kaplan, and Shlomit Schaal

Subjects
medicine.medical_specialty, Treatment outcome, Sulfur Hexafluoride, Visual Acuity, Endotamponade, Cryosurgery, Retinal detachment surgery, chemistry.chemical_compound, Vitrectomy, medicine, Humans, Retrospective Studies, Fluorocarbons, business.industry, Follow up studies, Retinal detachment repair, Retinal Detachment, Retinal detachment, Retinal, Retrospective cohort study, General Medicine, medicine.disease, Refractive Errors, Surgery, Ophthalmology, Scleral Buckling, Treatment Outcome, chemistry, business, Follow-Up Studies
Abstract

To compare functional and anatomical outcomes of modern methods of repair of primary retinal detachment.Retrospective interventional comparative case series. A total of 1,226 patients with primary retinal detachment were included in the study. All patients completed 1-year follow-up and were divided into 4 groups: 322 patients underwent scleral buckling surgery, 442 patients underwent pars plana vitrectomy surgery, 316 patients underwent a combination of scleral buckling and vitrectomy surgery, and 56 patients underwent pneumatic retinopexy surgery for the primary repair of retinal detachment. Reattachment success rates, pre- and postoperative visual acuity, complications, and change in refractive error were reviewed.Initial success rate for retinal reattachment was 86% for scleral buckling only, 90% for vitrectomy only, 94% for the combination of scleral buckling and vitrectomy, and 63% for pneumatic retinopexy surgery. Although patients undergoing pneumatic retinopexy had a lower initial success rate, there was no statistically significant difference in initial reattachment rates between the other three groups. There was no statistically significant difference in final visual acuity between the four groups. Complication rates varied among the techniques used.Postoperative visual acuity at 1 year did not differ among the various techniques used to repair primary rhegmatogenous retinal detachments. However, scleral buckling, vitrectomy, or a combination of both resulted in an initially better anatomical success rate and fewer operative procedures than pneumatic retinopexy.

Published
2011

27. Postoperative Intraocular Pressure Abnormalities in the Silicone Study

Author

Mei Ying Lai, Stanley P. Azen, Kathryn L.P. Linton, John S. Lean, Gary W. Abrams, Stephen J. Ryan, Charles C. Barr, and Michael T. Trese

Subjects
Intraocular pressure, Proliferative vitreoretinopathy, medicine.medical_specialty, genetic structures, business.industry, medicine.medical_treatment, Retinal detachment, Postoperative complication, Vitrectomy, medicine.disease, eye diseases, Surgery, Ophthalmology, chemistry.chemical_compound, Silicone, chemistry, medicine, sense organs, Tamponade, business, Retinopathy
Abstract

Background: Chronically abnormal intraocular pressure (IOP) may follow surgery for proliferative vitreoretinopathy (PVR), using either long-acting gas or silicone oil tamponade. Its prevalence and clinical significance are unclear. Methods: In the Silicone Study, 241 eyes with severe (≥_C-3) PVR were treated with vitrectomy, randomized to perfluoropropane gas (C 3 F 8 ) or silicone oil, and followed for 6 months or longer. Chronic IOP abnormalities, based on findings at two consecutive or any three postoperative visits, were defined as (1) low lOP (hypotony), 5 mmHg or less, or (2) elevated IOP, more than 25 mmHg. Results: Eleven (5%) eyes had chronically elevated IOP and 58 (24%) had chronic hypotony. Chronically elevated IOP was more prevalent in eyes randomized to silicone oil than in those randomized to C 3 F 8 gas (8% versus 2%; P 0.05). Chronic hypotony was (1) more prevalent in eyes randomized to C 3 F 8 gas than in those randomized to silicone oil (31% versus 18%; P 0.05); (2) more prevalent in eyes with anatomic failure (48% versus 16%; P 0.01); and (3) correlated with poor postoperative vision (P 0.0001), corneal opacity (P 0.001), and retinal detachment (P 0.001). Factors prognostic of chronic hypotony included preoperative hypotony (P 0.01), diffuse contraction of the retina anterior to the equator (P 0.01), rubeosis (P = 0.02), and large retinal breaks (P = 0.02). In a multivariate analysis, diffuse contraction of the retina anterior to the equator remained an independent factor prognostic of chronic hypotony (odds ratio=4.2), regardless of whether the retina was attached postoperatively. Conclusion: Intraocular pressure abnormalities are a common postoperative complication in eyes with PVR, and may occur with either C 3 F 8 gas or with silicone oil. The presence of diffuse contraction of the retina anterior to the equator should alert the vitrectomy surgeon that the eye is likely to be hypotonus postoperatively.

Published
1993
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28. Visual Loss Complicating OKT3 Monoclonal Antibody Therapy

Author

Charles C. Barr and Omar Dukar

Subjects
Adult, Graft Rejection, Pathology, medicine.medical_specialty, Visual acuity, genetic structures, Fundus Oculi, Interstitial nephritis, Visual Acuity, chemical and pharmacologic phenomena, Blindness, Retina, Ophthalmoscopy, Atrophy, Electroretinography, Humans, Medicine, Fluorescein Angiography, Pigment Epithelium of Eye, Monoclonal antibody therapy, Retinal pigment epithelium, medicine.diagnostic_test, business.industry, medicine.disease, Kidney Transplantation, eye diseases, Transplantation, Ophthalmology, medicine.anatomical_structure, Female, sense organs, medicine.symptom, business, Muromonab-CD3
Abstract

OKT3 is a murine monoclonal antibody used for immunosuppression of solid-organ transplant rejection. We studied severe visual loss after administration of OKT3 in two patients who received renal transplants (one 25-year-old woman with interstitial nephritis and severe hypertension and one 27-year-old woman with diabetic nephropathy). Both patients lost visual acuity to the level of light perception after a second or third dose of OKT3. Ophthalmoscopy disclosed arteriolar constriction, but there was no evidence of optic atrophy. The electroretinogram was extinguished in one patient, indicating an effect on the outer retina or retinal pigment epithelium. Ophthalmologists should be aware that OKT3 may cause profound visual loss in patients who receive organ transplants.

Published
1993
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29. Ophthalmic Aspects Of Orbital Injury

Author

M. Douglas Gossman, Charles C. Barr, and Dale M Roberts

Subjects
medicine.medical_specialty, genetic structures, business.industry, Ocular motility, eye diseases, Surgery, Optic nerve injury, Optic nerve, Medicine, sense organs, Approaches of management, business, Intensive care medicine
Abstract

This article provides information essential to early diagnosis and insight into vision-threatening ocular injuries that commonly accompany facial fractures. It also suggests management of these injuries as it relates to facial fracture repair. The primary focus is on pure ocular and optic nerve injuries. Minor attention is given to ocular motility disturbances and adnexal injuries.

Published
1992
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30. Management of macular holes: a comparison of 1-year outcomes of 3 surgical techniques

Author

Shlomit Schaal and Charles C. Barr

Subjects
Pars plana, Adult, Indocyanine Green, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Visual Acuity, Vitrectomy, Ilm peeling, Cataract, Retina, chemistry.chemical_compound, Postoperative Complications, Ophthalmology, medicine, Humans, Coloring Agents, Macular hole, Aged, Aged, 80 and over, business.industry, Internal limiting membrane, Significant difference, General Medicine, Middle Aged, medicine.disease, Retinal Perforations, eye diseases, body regions, medicine.anatomical_structure, Treatment Outcome, chemistry, sense organs, medicine.symptom, business, Indocyanine green
Abstract

PURPOSE To evaluate the contribution of internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) to hole closure and functional results in patients with idiopathic macular hole. METHODS Two hundred sixty-four patients with macular hole underwent pars plana vitrectomy. Of the 264, 240 patients completed 1-year follow-up and were divided into three groups: no ILM peeling (84 patients), ILM peeling without ICG (66 patients), and ICG-assisted ILM peeling (90 patients). RESULTS Macular holes were closed in 87% of the "no peeling" group, in 75% of the ILM peeling without ICG group, and in 92.3% of the ICG-assisted ILM peeling group. Visual acuity improved 2 Snellen lines in all groups (71%, 68%, and 78%, respectively) after successful surgery. In all 3 groups, 20% gained 4 Snellen lines and 14% reached 20/20 vision. There was no statistically significant difference in outcomes among the three groups. Cataract progression was noted more frequently in the ILM peeling groups. No cases of ICG toxicity were recognized. CONCLUSION ICG-assisted peeling of the ILM increased macular hole closure rate but was not statistically superior to vitrectomy without membrane peeling. The patients who had ILM peeling without ICG had the least favorable results both anatomically and functionally. The visual gain that was recorded for the majority of the patients after successful macular hole surgery was two Snellen lines.

Published
2009

31. Incidence and Early Course of Retlnonathy of Prematurity

Author

Earl A. Palmer, John T. Flynn, Robert J. Hardy, Dale L. Phelps, Cynthia L. Phillips, David B. Schaffer, Betty Tung, Frederick J. Elsas, Jan M. Botsford, Karen W. Braune, George Cassady, John A. Jones, James A. Kimble, Lanning Kline, Douglas Witherspoon, Malinda Young, Alan M. Roth, Byron H. Demorest, Roberta Erickson, William S. Gilbert, Georgia A. Chrousos, David S. Friendly, Mohammad Jaafar, Marshall P. Keys, Martin P. Kolsky, Patricia Ann Mercer, Donna O'Neill, John F. O'Neill, Edward S. Parelhoff, Ed Perraut, A. Raymond Pilkerton, David Plotsky, John Clarkson, Gabrielle Lopez, Marilyn T. Miller, Rama Bhat, Steven B. Cohen, Cathleen Cronin, Mark Daily, Donald A. Gagliano, Richard Gieser, Betty Anne Haldi, Kristine McCulloch, David Mittelman, Tonse N. Raju, David Sheftel, Kathleen Skuran, Daniel B. Sobel, Peggy Squires, Charles Vygantas, Forrest D. Ellis, Steve Archer, Eugene M. Helveston, Ken Julian, Gayle Reed, Richard Schreiner, Charles C. Barr, David N. Adamkin, Craig H. Douglas, Gregory K. Whittington, Shirley Wilkerson, Robert A. Gordon, Carolyn Bushaw, W. Michael DeVoe, James G. Diamond, William L. Gill, Donald R. May, Jane E. Reynolds, Thomas G. Storch, Serge de Bustros, Alethia Alford, Janet Graeber, Michael X. Repka, Michael T. Trese, John D. Baker, Ghaleb F. Hatem, Patricia Manatrey, Doreen Medalis, Robert C. Ramsay, C. Gail Summers, J. Douglas Cameron, Kim Chisholm, Rebecca Heikenen, Donna K. Irlbeck, Alvina M. Janda, Leslie A. Kopietz, Robin Kriedeman, Jane D. Lavoie, Molly Maxwell, Ted R. Pier, William P. Rodman, Patty Witt, Amy Woody, Paul Torrisi, Thaddeus Zak, Kathy Cohen, Rajesh J. Dave, Ernest Guillet, David Hakanson, Robert Hampton, Walter Merriam, Henry S. Metz, Ellen Pronobis, Richard Simon, Robert E. Vanderlinde, Nancy E. Wood, Donald N. Zehl, Edward Buckley, Malcolm M. Anderson, Grace Valentine, Susie Wong, Miles J. Burke, Judith C. Johnson, Gary L. Rogers, Don L. Bremer, Leandro Cordero, Rae R. Fellows, Nancy B. Hansen, Richard E. McClead, Arthur A. Aaby, Raul Banagale, Gerda I. Benda, Nancy D. Binder, William J. Brown, Joseph T. Gilhooly, Shawn Goodman, Robert K. Huston, Susan B. LaFrance, Patrick K. Lewallen, John V. McDonald, David L. Murphy, John W. Reynolds, Joseph Robertson, Andrea C. Tongue, Frank W. Bowen, Maria Delivoria-Papadopoulos, Hemant J. Desai, Gary R. Diamond, Joan M. Giannetta, Michael A. Naidoff, George J. Peckham, Jeanette R. Pleasure, Rachael Porat, Graham E. Quinn, Albert W. Biglan, David R. Brown, Bernard H. Doft, Andrew W. Eller, Louis A. Lobes, Richard A. Saunders, Linda M. Christmann, Tom L. Austin, Lesley Berkeley, James G. Ferguson, Wilson G. McWilliams, Karen W. Miller, Sharada Pai, V. Al Pakalnis, Dilip M. Purohit, Stephen S. Feman, Robert Cotton, James H. Elliott, Amy B. Law, Steven D. Steele, Rand Spencer, Priscilla M. Berry, Gary E. Fish, Dwain G. Fuller, William L. Hutton, Joel Lefer, Jean R. Manning, George E. Sanborn, William B. Snyder, David R. Stager, W.A.J. van Heuven, Marilyn B. Escobedo, Maria G. Montez, James W. Speights, Jane D. Kivlin, Susan Bracken, John Carver, Jack Dolcourt, Robert O. Hoffman, Michael Teske, and A. Thomas Williams

Subjects
congenital, hereditary, and neonatal diseases and abnormalities, Pediatrics, medicine.medical_specialty, genetic structures, business.industry, medicine.medical_treatment, Birth weight, Incidence (epidemiology), Gestational age, Retinopathy of prematurity, Cryotherapy, medicine.disease, eye diseases, Ophthalmology, Postnatal age, Multicenter trial, Medicine, business, Retinopathy
Abstract

In the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (ROP), 4099 infants weighing less than 1251 g at birth underwent sequential ophthalmic examinations, beginning at age 4 to 6 weeks, to monitor the incidence and course of ROP. Overall, 65.8% of the infants developed ROP to some degree; 81.6% for infants of less than 1000 g birth weight. As expected, ROP incidence and severity were higher in lower birth weight and gestational age categories. Black infants appeared less susceptible to ROP, of all severity categories, than nonblack infants. The timing of retinal vascular events correlated more closely with postconceptional age than with postnatal age, implicating the level of maturity more than postnatal environmental influences in governing the timing of these vascular events. These results include the current incidence of various severity stages of ROP found in the United States and provide new. insight into the development of ROP.

Published
1991
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32. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy

Author

Charles C. Barr and Shlomit Schaal

Subjects
Pars plana, Intraocular pressure, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Visual Acuity, Intraocular lens, Vitrectomy, Lens Implantation, Intraocular, Ophthalmology, medicine, Humans, Intraoperative Complications, Intraocular Pressure, Aged, Retrospective Studies, Aged, 80 and over, Phacoemulsification, business.industry, Corneal Edema, Cataract surgery, Lens Subluxation, Middle Aged, eye diseases, Sensory Systems, Surgery, Vitreous Body, medicine.anatomical_structure, Private practice, sense organs, medicine.symptom, business, Follow-Up Studies
Abstract

Purpose To compare the clinical course of patients with retained lens particles after phacoemulsification who had early or late pars plana vitrectomy (PPV) and removal of retained lens fragments or who were managed medically. Settings Private practice and University of Louisville, School of Medicine, Louisville, Kentucky, USA. Methods This retrospective review comprised patients who had cataract fragments dislocated into the vitreous during attempted cataract extraction and intraocular lens implantation over an 8-year period. Patients were divided into 3 groups. The early surgery group was treated with PPV and removal of lens fragments within 1 week of cataract surgery. The late surgery group had PPV more than 2 weeks after cataract surgery. The medical therapy group was managed with topical and systemic medications alone. The visual acuity, degree of corneal edema, inflammation, and intraocular pressure (IOP) were measured. Postoperative follow-up was at 7, 14, and 30 days and 1 year. Results The study evaluated 42 patients (12 early surgery, 15 late surgery, and 15 medical therapy). Demographic characteristics, visual acuity, and mean IOP values at presentation were similar between the 3 groups. Visual acuity was not statistically significantly different between groups at 30 days and 1 year. There was no statistically significant difference in IOP between groups throughout the study period. Conclusions Retained lens fragments were managed conservatively with good visual results. Vitrectomy was effective in patients with retained lens fragments not responding to topical and oral medication. Results indicate that surgery can be successfully delayed in certain patients.

Published
2008

33. Cherry red spot in sialidosis (mucolipidosis type I)

Author

J. Wesley Heroman, Charles C. Barr, and Paul J. Rychwalski

Subjects
Male, medicine.medical_specialty, Adolescent, Neuraminidase, Biology, Macula Lutea, Retinal Diseases, Mucolipidoses, Internal medicine, medicine, Humans, Sialidosis, Skin, Mucolipidosis, Cherry-red spot, Fibroblasts, medicine.disease, Molecular biology, N-Acetylneuraminic Acid, Ophthalmology, Endocrinology, biology.protein, medicine.symptom
Published
2008

34. Outpatient and Abbreviated Hospitalization for Vitreoretinal Surgery

Author

Charles C Barr and Douglas R. Wilson

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine, Vitrectomy, Local anesthesia, Day hospital, Vitreoretinal surgery, business, Scleral buckling, Surgery
Abstract

We retrospectively reviewed 255 consecutive scleral buckling and vitrectomy operations dividing the patients into two groups. One group was managed traditionally with general anesthesia and postoperative hospitalization. The second group was managed with local anesthesia and with no hospitalization or abbreviated hospitalization whenever possible. There was no difference in the technical or functional success rates achieved in the two groups. We conclude that vitreoretinal surgery may be performed safely and effectively on an outpatient basis in selected cases.

Published
1990
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35. THE HISTOPATHOLOGY OF SUCCESSFUL RETINAL REATTACHMENT

Author

Charles C. Barr

Subjects
Retina, medicine.medical_specialty, Visual acuity, genetic structures, business.industry, Enucleation, Retinal detachment, Retinal, Eye Enucleation, General Medicine, medicine.disease, eye diseases, Ophthalmology, chemistry.chemical_compound, medicine.anatomical_structure, chemistry, medicine, sense organs, medicine.symptom, business, Macular edema, Retinal regeneration
Abstract

Fifteen eyes with rhegmatogenous retinal detachment that were successfully reattached with scleral buckling were studied histopathologically after enucleation or autopsy. Postoperative visual acuities ranged from 20/25 to 5/200. Epiretinal membranes were present in 9 of 15 eyes (60%) and cystoid macular edema was present in 4 of 15 (26%). Although the reattached retina was of normal morphology by light microscopy in 9 of 15 eyes, significant atrophy of outer retinal layers was noted in 4 of 15 eyes (26%). In 5 of 13 patients, reduced postoperative vision could be histopathologically correlated with macular edema or lack of retinal regeneration, but there was no compelling histopathologic explanation for reduced vision noted in 5 other cases.

Published
1990
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36. Effect of blood on susceptibility to Staphylococcal endophthalmitis

Author

Luisa M Franco, Charles C. Barr, Emily J Wells, James E. Graham, and Christopher T. D. Price

Subjects
Male, medicine.medical_specialty, Gastroenterology, Eye Infections, Bacterial, Disease susceptibility, Endophthalmitis, Staphylococcus epidermidis, Internal medicine, medicine, Animals, Bacteriological Techniques, biology, business.industry, Significant difference, General Medicine, Eye infection, Staphylococcal Infections, biology.organism_classification, medicine.disease, Specific Pathogen-Free Organisms, Vitreous Body, Ophthalmology, Salt solution, Disease Models, Animal, Blood, Disease Susceptibility, Rabbits, business, Bacteria
Abstract

PURPOSE The authors examined the effect of blood on susceptibility to experimental endophthalmitis. METHODS Forty rabbits received an injection of 5-25 colony-forming units of Staphylococcus epidermidis into the vitreous of the right eye. Twenty of these same eyes received a subsequent intravitreal injection of 0.2 mL blood while the remaining 20 received an intravitreal injection of 0.2 mL of a salt solution. All eyes were examined daily for signs of endophthalmitis. Vitreous cultures were obtained on day 2 from 30 of the 40 rabbits. Twenty rabbits were assigned for culture and euthanasia at day 5 and those remaining were cultured and killed at day 7. RESULTS In rabbits with blood and bacteria, 10 of 15 (67%) were culture positive at 2 days, compared to 2 of 15 (13%) that received salt solution and bacteria (P < 0.01). At days 5 and 7 there was no statistically significant difference in culture results. However, inflammatory scores were significantly higher at days 3-7 in rabbits with blood compared to those with salt solution (P

Published
2007

37. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP)

Author

Michael X, Repka, Betty, Tung, William V, Good, Michael, Shapiro, Antonio, Capone, John D, Baker, Charles C, Barr, Dale L, Phelps, and W A J, van Heuven

Subjects
Male, Infant, Newborn, Retinal Detachment, Visual Acuity, Infant, Gestational Age, Cryosurgery, Ophthalmology, Scleral Buckling, Treatment Outcome, Vitrectomy, Humans, Female, Retinopathy of Prematurity, Laser Therapy, Prospective Studies, Follow-Up Studies
Abstract

To report the structural and visual outcomes of eyes in which retinal detachment developed from retinopathy of prematurity (ROP) in the Early Treatment of Retinopathy of Prematurity (ETROP) Study. Method Infants in the ETROP Study with bilateral high-risk prethreshold ROP had 1 eye randomized to early treatment, with the fellow eye managed conventionally. In infants with asymmetric disease, the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management. When a retinal detachment was detected, observation or vitreoretinal surgery (ie, scleral buckling and/or vitrectomy) was provided at the discretion of the individual investigator. At 9 months corrected age, retinal examinations were performed and visual acuities were assessed by masked testers using grating acuity.The ETROP Study enrolled 401 patients with high-risk prethreshold ROP. Retinal detachments occurred in 89 eyes of 63 patients. Follow-up was available for 78 eyes of 56 patients. The detachments were bilateral in 21 patients (38%) and were classified as stage 4A in 30 eyes, stage 4B in 14 eyes, and stage 5 in 16 eyes. Detachments were not classified in 18 eyes. Twelve eyes of 11 patients were observed and 66 eyes of 52 patients underwent vitreoretinal surgery. Attachment of the macula at 9 months persisted or was achieved in 17 (30%) of 56 eyes after vitrectomy with or without scleral buckle, in 6 (60%) of 10 eyes after scleral buckle only, and in 2 (17%) of 12 eyes followed up without surgery. Favorable visual acuity (or =1.85 cycles/degree) was found in 13 (17%) of the 78 eyes. All 6 eyes that maintained normal visual acuity (or =3.70 cycles/degree) had a stage 4A detachment (1 of 6 managed by observation, 3 of 6 by scleral buckle, and 2 of 18 by vitrectomy). Eleven eyes with stage 5 detachment underwent vitreoretinal surgery, resulting in 6 with no light perception, 3 with light perception only, and 2 with detection of only the low vision card.In the ETROP Study, the outcome of retinal detachment owing to ROP was generally poor. Vitreoretinal surgery for retinal detachment was associated with macular attachment in 16 of 48 eyes. Normal acuity was maintained after surgical repair of stage 4A retinal detachment in 5 (21%) of 24 eyes. Vitreoretinal surgery for stage 5 disease was associated with some structural successes but poor functional outcomes.

Published
2006

38. The early treatment for retinopathy of prematurity study: Structural findings at age 2 years

Author

Edward O'Malley, Scott M. Steidl, George Williams, Brian W. Arthur, Donald Tingley, James D. Reynolds, Richard A. Polin, Bradley V. Davitt, Robert Bergren, Michael X. Repka, John Roarty, Marc Horowitz, Reagan H. Bradford, William V. Good, Joseph Garcia-Prats, Albert M. Maguire, Robert A. Gordon, Sharon F. Freedman, Dottie Inguillo, Susan Bracken, Deborah Alcorn, Kelly A. Hutcheson, Peggy Fishman, Maryann Redford, David Durand, James G. Diamond, O'ine McCabe, Patricia N. Hartsell, James C. MacDonald, Ann M. Holleschau, Sarah K. Jones, Sharon Klamfoth, Linda Stevens, Michael F. Chiang, Cheryl Harris, Donald F. Everett, Y. Trigo, Michael Teske, Earl A. Palmer, Michele L. Parker, Judith Jones, Osode Coki, Soraya Abbasi, Mark W. Preslan, Velma Dobson, Carol R. Taylor, Karl Olsen, Thomas C. Lee, W. A.J. Van Heuven, Sarah MacKinnon, John Connett, Edward F. Donovan, Yesenia Garcia, Terri Mansfield, Charles C. Barr, Kristine Ziemann, David K. Wallace, Maria Castanes, Richard McClead, Steven A. Kane, Robert Peterson, Monte D. Mills, Jonathan M. Holmes, Matthew D. Gearinger, Nancy Dolphin, Rhiannon Johnson, Linda Breuer, Leon Paul Noel, Stephen P. Christiansen, John Baker, Greg Mantych, Mariette Tyedmers, Pat Manatrey, Derek T. Sprunger, Paul Bernstein, Lisa Ogilbee, Mary Anne McCaffree, Ann U. Stout, Elizabeth A. Hynes, Natalie Dweck, Jane Phillips, Gordon Smith, Sally Cook, Graham E. Quinn, Steven Awner, Jerald King, Judith Gancasz, Evelyn A. Paysee, William Keenan, Michelle Quintos, Terri L. Young, Mary Louise Z. Collins, Bernard H. Doft, Betty Tung, Cherylene Behrendt, David A. Plager, Laura B. Enyedi, R. Michael Siatkowski, Joseph M. Miller, Jane C. Edmond, Paul J. Rychwalski, Naval Sondhi, James T. Handa, M. Millicent Peterseim, David G. Hunter, Kenneth P. Cheng, Louis Lobes, Richard P. Golden, Krist Cumming, William L. Gill, George P. Albert, Robert S. Hoffman, Eric Jones, C. Gail Summers, Daniel Neely, Douglas B. Babel, Edmund LaGamma, Kevin Powdrill, David T. Wheeler, R J Hardy, M. Bethany Ball, Donna Ornitz, Jamie G. Koh, Brian J. Forbes, Jeffrey N. Bloom, Deborah S. Neff, Marilyn T. Miller, Leandro Cordero, Don L. Bremer, David Epley, John T. Flynn, Jennifer Shepard, Dale L. Phelps, Susan W. Aucott, Robert E. Leonard, Mary Lou McGregor, Cybil Bean Cassady, Maureen M. Gilmore, Pamela Ann Weber, Antonio Capone, Richard Koty, Argye Hillis, Cynthia H. Cole, Brenda L. MacKinnon, Lawrence M. Kaufman, Brian Nichols, Oscar A. Cruz, Claudia Pedroza, Greg K. Whittington, Gary L. Rogers, David K. Coats, Lori Hutchins Parkman, Ashima Madan, Richard L. Mowery, Richard A. Saunders, Kimberly G. Yen, Beverly Brozanski, Dilip Purohit, Cassandra Horihan, Rajesh Rao, Gregg T. Lueder, Rae R. Fellows, Terri Slagle, Rita Ryan, Michael J. Shapiro, Michael T. Trese, James A. Lemons, Gary David Markowitz, Walter Merriam, Edward Wilson, Gordon Tsai, Maria Genio, Wico W. Lai, Deborah K. VanderVeen, Pamela Donahue, Anthony Fraioli, Richard W. Hertle, Stephanie Davidson, and Michael W. Gaynon

Subjects
medicine.medical_specialty, Side effect, genetic structures, Retinopathy Of Prematurity - Pathology - Surgery - Therapy, medicine.medical_treatment, Posterior pole, Cryotherapy, Cellular and Molecular Neuroscience, chemistry.chemical_compound, Ophthalmology, Retina - Pathology - Surgery, medicine, Humans, Infant, Very Low Birth Weight, Prospective Studies, Prospective cohort study, Retina, business.industry, Clinical Science - Extended Report, Infant, Newborn, Retinal detachment, Retinopathy of prematurity, Retinal, medicine.disease, Sensory Systems, eye diseases, medicine.anatomical_structure, Treatment Outcome, chemistry, Child, Preschool, sense organs, Laser Therapy, business, Infant, Premature, Follow-Up Studies
Abstract

Objective: To determine whether earlier treatment of high-risk, prethreshold retinopathy of prematurity (ROP) improves retinal structural outcome at 2 years of age. Methods: Infants with bilateral high-risk prethreshold ROP had one eye randomly assigned to treatment with peripheral retinal ablation. The fellow eye was managed conventionally, and either treated at threshold ROP or observed if threshold was never reached. In patients with asymmetrical disease, the high-risk, prethreshold eye was randomised to earlier treatment or to conventional management. At 2 years of age, children were examined comprehensively by certified ophthalmologists to determine structural outcomes for their eyes. For the purposes of this study, an unfavourable structural outcome was defined as (1) a posterior retinal fold involving the macula, (2) a retinal detachment involving the macula or (3) retrolental tissue or "mass" obscuring the view of the posterior pole. Results of the 2-year examination were compared with those from the 9 months examination. Results: Data were available on 339 of 374 (90.6%) surviving children. Unfavourable structural outcomes were reduced from 15.4% in conventionally managed eyes to 9.1% in earlier-treated eyes (p = 0.002) at 2 years of age. Ophthalmic side effects (excluding retinal structure) from the ROP or its treatment were similar in the earlier-treated eyes and the conventionally managed eyes. Conclusion: The benefit of earlier treatment of high-risk prethreshold ROP on retinal structure endures to 2 years of age, and is not counterbalanced by any known side effect caused by earlier intervention. Earlier treatment improves the chance for long-term favourable retinal structural outcome in eyes with high-risk prethreshold ROP. Long-term follow-up is planned to determine structural and functional outcomes at 6 years of age., link_to_OA_fulltext

Published
2006

39. Outcomes of Eyes with Lesions Composed of >50% Blood in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Author

Michael M. Altaweel, Ebenezer Daniel, Daniel F. Martin, Robert A. Mittra, Juan E. Grunwald, Michael M. Lai, Alexander Melamud, Lawrence S. Morse, Jiayan Huang, Frederick L. Ferris, Stuart L. Fine, Maureen G. Maguire, David F. Williams, Sara Beardsley, Steven Bennett, Herbert Cantrill, Carmen Chan- Tram, Holly Cheshier, Kathyrn Damato, John Davies, Sundeep Dev, Julianne Enloe, Gennaro Follano, Peggy Gilbert, Jill Johnson, Tori Jones, Lisa Mayleben, Robert Mittra, Martha Moos, Ryan Neist, Neal Oestreich, Polly Quiram, Robert Ramsay, Edwin Ryan, Stephanie Schindeldecker, John Snater, Trenise Steele, Dwight Selders, Jessica Tonsfeldt, Shelly Valardi, Gary Edd Fish, Hank A. Aguado, Sally Arceneaux, Jean Arnwine, Kim Bell, Tina Bell, Bob Boleman, Patricia Bradley, David Callanan, Lori Coors, Jodi Creighton, Timothy Crew, Kimberly Cummings, Christopher Dock, Karen Duignan, Dwain Fuller, Keith Gray, Betsy Hendrix, Nicholas Hesse, Diana Jaramillo, Bradley Jost, Sandy Lash, Laura Lonsdale, Michael Mackens, Karin Mutz, Michael Potts, Brenda Sanchez, William Snyder, Wayne Solley, Carrie Tarter, Robert Wang, Patrick Williams, Stephen L. Perkins, Nicholas Anderson, Ann Arnold, Paul Blais, Joseph Googe, Tina T. Higdon, Cecile Hunt, Mary Johnson, James Miller, Misty Moore, Charity K. Morris, Christopher Morris, Sarah Oelrich, Kristina Oliver, Vicky Seitz, Jerry Whetstone, Bernard H. Doft, Jay Bedel, Robert Bergren, Ann Borthwick, Paul Conrad, Amanda Fec, Christina Fulwylie, Willia Ingram, Shawnique Latham, Gina Lester, Judy Liu, Louis Lobes, Nicole M. Lucko, Holly Mechling, Lori Merlotti, Keith McBroom, Karl Olsen, Danielle Puskas, Pamela Rath, Maria Schmucker, Lynn Schueckler, Christina Schultz, Heather Shultz, David Steinberg, Avni Vyas, Kim Whale, Kimberly Yeckel, David H. Orth, Linda S. Arredondo, Susan Brown, Barbara J. Ciscato, Joseph M. Civantos, Celeste Figliulo, Sohail Hasan, Belinda Kosinski, Dan Muir, Kiersten Nelson, Kirk Packo, John S. Pollack, Kourous Rezaei, Gina Shelton, Shannya Townsend-Patrick, Marian Walsh, H. Richard McDonald, Nina Ansari, Amanda Bye, Arthur D. Fu, Sean Grout, Chad Indermill, Robert N. Johnson, J. Michael Jumper, Silvia Linares, Brandon J. Lujan, Ames Munden, Meredith Persons, Rosa Rodriguez, Jennifer M. Rose, Brandi Teske, Yesmin Urias, Stephen Young, Richard F. Dreyer, Howard Daniel, Michele Connaughton, Irvin Handelman, Stephen Hobbs, Christine Hoerner, Dawn Hudson, Marcia Kopfer, Michael Lee, Craig Lemley, Joe Logan, Colin Ma, Christophe Mallet, Amanda Milliron, Mark Peters, Harry Wohlsein, Joel A. Pearlman, Margo Andrews, Melissa Bartlett, Nanette Carlson, Emily Cox, Robert Equi, Marta Gonzalez, Sophia Griffin, Fran Hogue, Lance Kennedy, Lana Kryuchkov, Carmen Lopez, Danny Lopez, Bertha Luevano, Erin McKenna, Arun Patel, Brian Reed, Nyla Secor, Iris R. Sison, Tony Tsai, Nina Varghis, Brooke Waller, Robert Wendel, Reina Yebra, Daniel B. Roth, Jane Deinzer, Howard Fine, Flory Green, Stuart Green, Bruce Keyser, Steven Leff, Amy Leviton, Amy Martir, Kristin Mosenthine, Starr Muscle, Linda Okoren, Sandy Parker, Jonathan Prenner, Nancy Price, Deana Rogers, Linda Rosas, Alex Schlosser, Loretta Studenko, Thea Tantum, Harold Wheatley, Michael T. Trese, Thomas Aaberg, Denis Bezaire, Craig Bridges, Doug Bryant, Antonio Capone, Michelle Coleman, Christina Consolo, Cindy Cook, Candice DuLong, Bruce Garretson, Tracy Grooten, Julie Hammersley, Tarek Hassan, Heather Jessick, Nanette Jones, Crystal Kinsman, Jennifer Krumlauf, Sandy Lewis, Heather Locke, Alan Margherio, Debra Markus, Tanya Marsh, Serena Neal, Amy Noffke, Kean Oh, Clarence Pence, Lisa Preston, Paul Raphaelian, Virginia R. Regan, Peter Roberts, Alan Ruby, Ramin Sarrafizadeh, Marissa Scherf, Sarita Scott, Scott Sneed, Lisa Staples, Brad Terry, Matthew T. Trese, Joan Videtich, George Williams, Mary Zajechowski, Daniel P. Joseph, Kevin Blinder, Lynda Boyd, Sarah Buckley, Meaghan Crow, Amanda Dinatale, Nicholas Engelbrecht, Bridget Forke, Dana Gabel, Gilbert Grand, Jennifer Grillion-Cerone, Nancy Holekamp, Charlotte Kelly, Ginny Nobel, Kelly Pepple, Matt Raeber, P. Kumar Rao, Tammy Ressel, Steven Schremp, Merrilee Sgorlon, Shantia Shears, Matthew Thomas, Cathy Timma, Annette Vaughn, Carolyn Walters, Rhonda Weeks, Jarrod Wehmeier, Tim Wright, Daniel M. Berinstein, Aida Ayyad, Mohammed K. Barazi, Erica Bickhart, Tracey Brady, Lisa Byank, Alysia Cronise, Vanessa Denny, Courtney Dunn, Michael Flory, Robert Frantz, Richard A. Garfinkel, William Gilbert, Janine Newgen, Shamekia Newton, Debbie Oliver, Michael Osman, Reginald Sanders, Manfred von Fricken, Pravin Dugel, Sandra Arenas, Gabe Balea, Dayna Bartoli, John Bucci, Jennifer A. Cornelius, Scheleen Dickens, Don Doherty, Heather Dunlap, David Goldenberg, Karim Jamal, Norma Jimenez, Nicole Kavanagh, Derek Kunimoto, John Martin, Jessica Miner, Sarah Mobley, Donald Park, Edward Quinlan, Jack Sipperley, Carol Slagle, Danielle Smith, Miguelina Yafchak, Rohana Yager, Christina J. Flaxel, Steven Bailey, Peter Francis, Chris Howell, Thomas Hwang, Shirley Ira, Michael Klein, Andreas Lauer, Teresa Liesegang, Ann Lundquist, Sarah Nolte, Susan K. Nolte, Scott Pickell, Susan Pope, Joseph Rossi, Mitchell Schain, Peter Steinkamp, Maureen D. Toomey, Debora Vahrenwald, Kelly West, Baker Hubbard, Stacey Andelman, Chris Bergstrom, Judy Brower, Blaine Cribbs, Linda Curtis, Jannah Dobbs, Lindreth DuBois, Jessica Gaultney, Deborah Gibbs, Debora Jordan, Donna Leef, Robert Myles, Timothy Olsen, Bryan Schwent, Sunil Srivastava, Rhonda Waldron, Andrew N. Antoszyk, Uma Balasubramaniam, Danielle Brooks, Justin Brown, David Browning, Loraine Clark, Sarah Ennis, Susannah Held, Jennifer V. Helms, Jenna Herby, Angie Karow, Pearl Leotaud, Caterina Massimino, Donna McClain, Michael McOwen, Jennifer Mindel, Candace Pereira, Rachel Pierce, Michele Powers, Angela Price, Jason Rohrer, Jason Sanders, Robert L. Avery, Kelly Avery, Jessica Basefsky, Liz Beckner, Alessandro Castellarin, Stephen Couvillion, Jack Giust, Matthew Giust, Maan Nasir, Dante Pieramici, Melvin Rabena, Sarah Risard, Robert See, Jerry Smith, Lisha Wan, Sophie J. Bakri, Nakhleh Abu-Yaghi, Andrew Barkmeier, Karin Berg, Jean Burrington, Albert Edwards, Shannon Goddard, Shannon Howard, Raymond Iezzi, Denise Lewison, Thomas Link, Colin A. McCannel, Joan Overend, John Pach, Margaret Ruszczyk, Ryan Shultz, Cindy Stephan, Diane Vogen, Reagan H. Bradford, Vanessa Bergman, Russ Burris, Amanda Butt, Beth Daniels, Connie Dwiggins, Stephen Fransen, Tiffany Guerrero, Darin Haivala, Amy Harris, Sonny Icks, Ronald Kingsley, Lena Redden, Rob Richmond, Brittany Ross, Kammerin White, Misty Youngberg, Trexler M. Topping, Steve Bennett, Sandy Chong, Mary Ciotti, Tina Cleary, Emily Corey, Dennis Donovan, Albert Frederick, Lesley Freese, Margaret Graham, Natalya Gud, Taneika Howard, Mike Jones, Michael Morley, Katie Moses, Jen Stone, Robin Ty, Torsten Wiegand, Lindsey Williams, Beth Winder, Carl C. Awh, Michelle Amonette, Everton Arrindell, Dena Beck, Brandon Busbee, Amy Dilback, Sara Downs, Allison Guidry, Gary Gutow, Jackey Hardin, Sarah Hines, Emily Hutchins, Kim LaCivita, Ashley Lester, Larry Malott, MaryAnn McCain, Jayme Miracle, Kenneth Moffat, Lacy Palazzotta, Kelly Robinson, Peter Sonkin, Alecia Travis, Roy Trent Wallace, Kelly J. Winters, Julia Wray, April E. Harris, Mari Bunnell, Katrina Crooks, Rebecca Fitzgerald, Cameron Javid, Corin Kew, Erica Kill, Patricia Kline, Janet Kreienkamp, Maricruz Martinez, Roy Ann Moore, Egbert Saavedra, LuAnne Taylor, Mark Walsh, Larry Wilson, Thomas A. Ciulla, Ellen Coyle, Tonya Harrington, Charlotte Harris, Cindi Hood, Ingrid Kerr, Raj Maturi, Dawn Moore, Stephanie Morrow, Jennifer Savage, Bethany Sink, Tom Steele, Neelam Thukral, Janet Wilburn, Joseph P. Walker, Jennifer Banks, Debbie Ciampaglia, Danielle Dyshanowitz, Jennifer Frederick, A. Tom Ghuman, Richard Grodin, Cheryl Kiesel, Eileen Knips, Jonathan McCue, Maria Ortiz, Crystal Peters, Paul Raskauskas, Etienne Schoeman, Ashish Sharma, Glenn Wing, Rebecca Youngblood, Suresh R. Chandra, Michael Altaweel, Barbara Blodi, Kathryn Burke, Kristine A. Dietzman, Justin Gottlieb, Gene Knutson, Denise Krolnik, T. Michael Nork, Shelly Olson, John Peterson, Sandra Reed, Barbara Soderling, Guy Somers, Thomas Stevens, Angela Wealti, Srilaxmi Bearelly, Brenda Branchaud, Joyce W. Bryant, Sara Crowell, Sharon Fekrat, Merritt Gammage, Cheala Harrison, Sarah Jones, Noreen McClain, Brooks McCuen, Prithvi Mruthyunjaya, Jeanne Queen, Neeru Sarin, Cindy Skalak, Marriner Skelly, Ivan Suner, Ronnie Tomany, Lauren Welch, Susanna S. Park, Allison Cassidy, Karishma Chandra, Idalew Good, Katrina Imson, Sashi Kaur, Helen Metzler, Lawrence Morse, Ellen Redenbo, Marisa Salvador, David Telander, Mark Thomas, Cindy Wallace, Charles C. Barr, Amanda Battcher, Michelle Bottorff, Mary Chasteen, Kelly Clark, Diane Denning, Debra Schoen, Amy Schultz, Evie Tempel, Lisa Wheeler, Greg K. Whittington, Thomas W. Stone, Todd Blevins, Michelle Buck, Lynn Cruz, Wanda Heath, Diana Holcomb, Rick Isernhagen, Terri Kidd, John Kitchens, Cathy Sears, Ed Slade, Jeanne Van Arsdall, Brenda VanHoose, Jenny Wolfe, William Wood, John Zilis, Carol Crooks, Larry Disney, Mimi Liu, Stephen Petty, Sandra Sall, James C. Folk, Tracy Aly, Abby Brotherton, Douglas Critser, Connie J. Hinz, Stefani Karakas, Valerie Kirschner, Cheyanne Lester, Cindy Montague, Stephen Russell, Heather Stockman, Barbara Taylor, Randy Verdick, Jean Walshire, John T. Thompson, Barbara Connell, Maryanth Constantine, John L. Davis, Gwen Holsapple, Lisa Hunter, C. Nicki Lenane, Robin Mitchell, Leslie Russel, Raymond Sjaarda, David M. Brown, Matthew Benz, Llewellyn Burns, JoLene G. Carranza, Richard Fish, Debra Goates, Shayla Hay, Theresa Jeffers, Eric Kegley, Dallas Kubecka, Stacy McGilvra, Beau Richter, Veronica Sneed, Cary Stoever, Isabell Tellez, Tien Wong, Ivana Kim, Christopher Andreoli, Leslie Barresi, Sarah Brett, Charlene Callahan, Karen Capaccioli, William Carli, Matthew Coppola, Nicholas Emmanuel, Claudia Evans, Anna Fagan, Marcia Grillo, John Head, Troy Kieser, Elaine Lee, Ursula Lord, Edward Miretsky, Kate Palitsch, Todd Petrin, Liz Reader, Svetlana Reznichenko, Mary Robertson, Justin Smith, Demetrios Vavvas, John Wells, Cassie Cahill, W. Lloyd Clark, Kayla Henry, David Johnson, Peggy Miller, LaDetrick Oliver, Robbin Spivey, Tiffany Swinford, Mallie Taylor, Michael Lambert, Kris Chase, Debbie Fredrickson, Joseph Khawly, Valerie Lazarte, Donald Lowd, Pam Miller, Arthur Willis, Philip J. Ferrone, Miguel Almonte, Rachel Arnott, Ingrid Aviles, Sheri Carbon, Michael Chitjian, Kristen D’Amore, Christin Elliott, David Fastenberg, Barry Golub, Kenneth Graham, AnnMarie Lavorna, Laura Murphy, Amanda Palomo, Christina Puglisi, David Rhee, Juan Romero, Brett Rosenblatt, Glenda Salcedo, Marianne Schlameuss, Eric Shakin, Vasanti Sookhai, Richard Kaiser, Elizabeth Affel, Gary Brown, Christina Centinaro, Deborah Fine, Mitchell Fineman, Michele Formoso, Sunir Garg, Lisa Grande, Carolyn Herbert, Allen Ho, Jason Hsu, Maryann Jay, Lisa Lavetsky, Elaine Liebenbaum, Joseph Maguire, Julia Monsonego, Lucia O’Connor, Lisa Pierce, Carl Regillo, Maria Rosario, Marc Spirn, James Vander, Jennifer Walsh, Frederick H. Davidorf, Amanda Barnett, Susie Chang, John Christoforidis, Joy Elliott, Heather Justice, Alan Letson, Kathryne McKinney, Jeri Perry, Jill A. Salerno, Scott Savage, Stephen Shelley, Lawrence J. Singerman, Joseph Coney, John DuBois, Kimberly DuBois, Gregg Greanoff, Dianne Himmelman, Mary Ilc, Elizabeth McNamara, Michael Novak, Scott Pendergast, Susan Rath, Sheila Smith-Brewer, Vivian Tanner, Diane E. Weiss, Hernando Zegarra, null Lawrence Halperin, Patricia Aramayo, Mandeep Dhalla, Brian Fernandez, Cindy Fernandez, Jaclyn Lopez, Monica Lopez, Jamie Mariano, Kellie Murphy, Clifford Sherley, Rita Veksler, Firas Rahhal, Razmig Babikian, David Boyer, Sepideh Hami, Jeff Kessinger, Janet Kurokouchi, Saba Mukarram, Sarah Pachman, Eric Protacio, Julio Sierra, Homayoun Tabandeh, Adam Zamboni, Michael Elman, Jennifer Belz, Tammy Butcher, Theresa Cain, Teresa Coffey, Dena Firestone, Nancy Gore, Pamela Singletary, Peter Sotirakos, JoAnn Starr, Travis A. Meredith, Cassandra J. Barnhart, Debra Cantrell, RonaLyn Esquejo-Leon, Odette Houghton, Harpreet Kaur, Fatoumatta N’Dure, Ronald Glatzer, Leonard Joffe, Reid Schindler, Marilyn Katz, Mary Brightwell-Arnold, Ruchira Glaser, Judith Hall, Sandra Harkins, Alexander Khvatov, Kathy McWilliams, Ellen Peskin, Maxwell Pistilli, Susan Ryan, Allison Schnader, Gui-Shuang Ying, Glenn Jaffe, Jennifer Afrani-Sakyi, Brannon Balsley, Linda S. Bennett, Adam Brooks, Adrienne Brower-Lingsch, Lori Bruce, Russell Burns, Dee Busian, John Choong, Lindsey Cloaninger, Francis Char DeCroos, Emily DuBois, Mays El-Dairi, Sarah Gach, Katelyn Hall, Terry Hawks, ChengChenh Huang, Cindy Heydary, Alexander Ho, Shashi Kini, Michelle McCall, Daaimah Muhammad, Jayne Nicholson, Pamela Rieves, Kelly Shields, Adam Specker, Sandra Stinnett, Sujatha Subramaniam, Patrick Tenbrink, Cynthia Toth, Aaron Towe, Kimberly Welch, Natasha Williams, Katrina Winter, Ellen Young, Judith Alexander, Elisabeth Flannagan, E. Revell Martin, Candace Parker, Krista Sepielli, Tom Shannon, Claressa Whearry, Maryann Redford, Marcia R. Kopfer, Joan DuPont, Lawrence M. Friedman, Susan B. Bressler, David L. DeMets, Martin Friedlander, Mark W. Johnson, Anne Lindblad, Douglas W. Losordo, and Franklin G. Miller

Subjects
Male, Vascular Endothelial Growth Factor A, medicine.medical_specialty, Visual acuity, genetic structures, Visual Acuity, Angiogenesis Inhibitors, Fundus (eye), Antibodies, Monoclonal, Humanized, Article, Cohort Studies, Lesion, Pro re nata, Ranibizumab, Ophthalmology, medicine, Humans, Prospective Studies, Fluorescein Angiography, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Retinal Hemorrhage, Macular degeneration, medicine.disease, Choroidal Neovascularization, eye diseases, Bevacizumab, Treatment Outcome, Choroidal neovascularization, Intravitreal Injections, Wet Macular Degeneration, Female, sense organs, medicine.symptom, business, Tomography, Optical Coherence, Follow-Up Studies, medicine.drug
Abstract

To compare baseline characteristics, treatment frequency, visual acuity (VA), and morphologic outcomes of eyes with50% of the lesion composed of blood (B50 group) versus all other eyes (Other group) enrolled in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).Prospective cohort study within a multicenter randomized clinical trial.CATT patients with neovascular age-related macular degeneration (AMD).Treatment for the study eye was assigned randomly to either ranibizumab or bevacizumab and to 3 different dosing regimens over a 2-year period. Reading center graders evaluated baseline and follow-up morphology in color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT). Masked examiners tested VA.Morphologic features and VA at 1 and 2 years.The B50 group consisted of 84 of 1185 (7.1%) patients enrolled in CATT. Baseline lesion characteristics differed between groups. In the B50 group, choroidal neovascularization size was smaller (0.73 vs 1.83 disc areas [DA]; P0.001), total lesion size was greater (4.55 vs 2.31 DA; P0.001), total retinal thickness was greater (524 vs 455 μm; P = 0.02), and mean VA was worse (56.0 vs 60.9 letters; P = 0.002). Increases in mean VA were similar in the B50 and Other groups at 1 year (+9.3 vs +7.2 letters; P = 0.22) and at 2 years (9.0 vs 6.1 letters; P = 0.17). Eyes treated PRN received a similar number of injections in the 2 groups (12.2 vs 13.4; P = 0.27). Mean lesion size in the B50 group decreased by 1.2 DA at both 1 and 2 years (primarily owing to resolution of hemorrhage) and increased in the Other group by 0.33 DA at 1 year and 0.91 DA at 2 years (P 0.001). Leakage on FA and fluid on OCT were similar between groups at 1 and 2 years.In CATT, the B50 group had a visual prognosis similar to the Other group. Lesion size decreased markedly through 2 years. Eyes like those enrolled in CATT with neovascular AMD lesions composed of50% blood can be managed similarly to those with less or no blood.

Published
2015
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40. The incidence of corneal abnormalities in the Silicone Study. Silicone Study Report 7

Author

Alexander R. Irvine, Stanley P. Azen, Stephen J. Ryan, Mei Ying Lai, Gary W. Abrams, Michael T. Trese, Charles C. Barr, and William L. Hutton

Subjects
Adult, medicine.medical_specialty, Proliferative vitreoretinopathy, genetic structures, medicine.medical_treatment, Corneal Touch, Sulfur Hexafluoride, Vitrectomy, Aphakia, Corneal Diseases, Cornea, Postoperative Complications, Risk Factors, Ophthalmology, medicine, Humans, Silicone Oils, Aged, Aged, 80 and over, Rubeosis iridis, Fluorocarbons, business.industry, Incidence, Vitreoretinopathy, Proliferative, Retinal Detachment, Corneal Transplant, Retinal detachment, Middle Aged, medicine.disease, Prognosis, eye diseases, Surgery, Iridectomy, sense organs, business, Follow-Up Studies
Abstract

Objective: To determine factors that were prognostic of corneal abnormalities in eyes following surgery for severe proliferative vitreoretinopathy. Design: Subgroup analysis of the Silicone Study. Settings: Community and university-based ophthalmology clinics. Materials: Eyes with attached maculae at the 24-month follow-up examination that did not have a preexisting corneal abnormality. Interventions: Vitrectomy surgery with long-acting gas or silicone oil. Outcome Measures: Epithelial and/or stromal edema, corneal opacity and/or previous corneal transplant. Results: The incidence of corneal abnormalities at 24 months was 27% and did not differ significantly between treatment groups. Prognostic factors were preoperative aphakia or pseudophakia (P=.003), preoperative iris neovascularization (P=.006), reoperation (P=.001), the absence of a fluid/gas exchange (P=.03), corneal touch by silicone oil (P=.02), and the presence of aqueous cells (P=.009) or aqueous flare (P=.08). In a multivariate analysis, independent prognostic factors were iris neovascularization (relative risk [RR]=13.1), aphakia or pseudophakia (RR=3.0), postoperative aqueous flare (RR=5.4), and reoperations (RR=3.4). Corneal abnormalities were correlated with poor visual acuity and hypotony (P Conclusions: To our knowledge, this is the first study to document that the incidence rates of corneal abnormalities are equivalent between oil and gas. The incidence of corneal abnormalities in gas-filled eyes was higher than expected, and remained high in oil-filled eyes, despite the use of an inferior iridectomy. Successful surgical repair of the retinal detachment with a single operation, and prevention and early management of corneal touch by silicone oil should help to prevent corneal abnormalities. If rubeosis iridis or severe aqueous flare is present, preoperative treatment with intense topical and possibly periocular steroids might reduce inflammation, which might mediate corneal damage.

Published
1995

42. Adenocarcinoma of retinal pigment epithelium arising from a juxtapapillary histoplasmosis scar

Author

Ralph C. Eagle, Jerry A. Shields, Charles C. Barr, David E. Jones, and Carol L. Shields

Subjects
Pathology, medicine.medical_specialty, Choroiditis, Eye disease, Adenocarcinoma, Histoplasmosis, Cytokeratin, Cicatrix, Retinal Diseases, Medicine, Humans, Neoplastic transformation, Pigment Epithelium of Eye, Aged, Retina, Retinal pigment epithelium, business.industry, Eye Neoplasms, medicine.disease, Epithelium, Ophthalmology, medicine.anatomical_structure, Female, sense organs, business, Eye Infections, Fungal
Abstract

A 66-year-old woman underwent a transocular fine-needle aspiration biopsy for an enlarging mass arising from a juxtapapillary histoplasmosis scar in the left eye. The cytologic study revealed pigmented malignant cells, suggesting that the lesion was either a malignant choroidal melanoma or an adenocarcinoma of the retinal pigment epithelium. The eye was enucleated and histopathologic studies revealed findings suggestive of an adenocarcinoma of the retinal pigment epithelium. Immunohistochemical stains were positive for cytokeratin and were negative for melanoma-specific antigen, supporting an epithelial origin of the neoplasm. It is possible that the tumor developed as a neoplastic transformation of a reactive proliferation of the retinal pigment epithelium in a histoplasmosis scar. The possible association between a chorioretinal scar and the development of a tumor of the pigment epithelium is discussed herein.

Published
1994

43. Blood levels in macular cystoid spaces and their relationship to retinal vein obstruction

Author

Michelle E. Reyes, Charles C. Barr, and John W. Gamel

Subjects
Adult, medicine.medical_specialty, Central retinal vein, Retinal Vein, genetic structures, Diabetic macular edema, Aphakia, Postcataract, Macular Edema, Ophthalmology, Retinal Vein Occlusion, medicine, Humans, In patient, Macular edema, Aged, Retrospective Studies, Aged, 80 and over, Diabetic Retinopathy, business.industry, Incidence, General Medicine, Middle Aged, medicine.disease, eye diseases, medicine.anatomical_structure, Vein obstruction, sense organs, business
Abstract

BACKGROUND Blood levels in macular cystoid spaces are commonly seen in patients with branch or central retinal vein obstruction, but have not been previously reported. METHODS To determine blood levels in cystoid spaces, a retrospective study was conducted of 102 eyes with branch retinal vein obstruction, 54 eyes with central retinal vein obstruction, 207 eyes with clinically significant diabetic macular edema, and 109 eyes with aphakic or pseudophakic cystoid macular edema seen over a 5-year period. RESULTS Definite blood levels in cystoid spaces were found in 26 eyes (25%) with branch vein obstruction and in 4 eyes (8%) with central vein obstruction. In contrast, this clinical change was detected in only 1 of 207 eyes (1%) with diabetic cystoid macular edema, and in only 2 of 109 eyes (2%) with aphakic or pseudophakic cystoid macular edema (P < 0.001). When blood levels in cystoid spaces were detected in patients with branch vein obstruction, the site of obstruction tended to be superotemporal (P < 0.05). CONCLUSION Blood levels in cystoid spaces are an important sign of retinal vein obstruction, and may help establish the diagnosis in certain cases.

Published
1994

44. Does Venous Air Embolism Occur During Air/Fluid Exchange?

Author

Jaafar El-Annan and Charles C. Barr

Subjects
Male, Catheterization, Central Venous, medicine.medical_specialty, business.industry, Venous air embolism, Fluid exchange, Ophthalmology, Internal medicine, Cardiology, medicine, Embolism, Air, Humans, Intraoperative Complications, business
Published
2011
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48. Evaluation of the tourniquet test as a predictor of diabetic retinopathy

Author

John W. Gamel, Jahangir Cyrus, Martha C. Wilson, Charles C. Barr, and Theodore N. Lynch

Subjects
Male, medicine.medical_specialty, Heart Diseases, Endocrinology, Diabetes and Metabolism, Eye disease, Blood Pressure, macromolecular substances, Fundus (eye), Endocrinology, Ophthalmology, Diabetes mellitus, Internal Medicine, medicine, Diabetes Mellitus, Humans, Sex Characteristics, Capillary Fragility, Diabetic Retinopathy, medicine.diagnostic_test, business.industry, Age Factors, Diabetic retinopathy, Tourniquets, Fluorescein angiography, medicine.disease, Prognosis, Surgery, Capillary fragility, Tourniquet test, Regression Analysis, Female, business, Retinopathy
Abstract

Medical practitioners often have difficulty in assessing the presence or severity of diabetic retinopathy. The tourniquet test is a method of assessing diabetic capillary fragility that has been felt to reliably correlate with background and proliferative diabetic retinopathy. We studied 100 consecutive diabetic patients and 50 age-matched controls in a masked fashion, using fundus photographs and fluorescein angiography to correlate the amount of capillary fragility with the presence and severity of background and proliferative diabetic retinopathy. Although the severity of diabetic capillary fragility did correlate with the presence and severity of diabetic retinopathy (p less than 0.001), this test was not as good an indicator of diabetic retinopathy as were other risk factors such as duration of diabetes (p much less than 0.001). The tourniquet test is unreliable in predicting the presence or severity of diabetic retinopathy because of its high false negative response rate.

Published
1991

49. Visual acuity in infants after vitrectomy for severe retinopathy of prematurity

Author

Earl A. Palmer, Charles C. Barr, Barry R. Davis, Velma Dobson, Michael T. Trese, Joseph E. Robertson, Graham E. Quinn, and John T. Flynn

Subjects
Male, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Eye disease, Visual Acuity, Cryotherapy, Vitrectomy, Gestational Age, Cryosurgery, chemistry.chemical_compound, Postoperative Complications, Multicenter trial, Ophthalmology, medicine, Humans, Retinopathy of Prematurity, Postoperative Care, business.industry, Infant, Newborn, Retinal Detachment, Retinal detachment, Infant, Retinopathy of prematurity, Retinal, General Medicine, medicine.disease, Prognosis, Pattern vision, eye diseases, Surgery, chemistry, Female, sense organs, medicine.symptom, business, Retinopathy
Abstract

During the course of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP), 98 infants (129 eyes) from the randomized segment of the trial developed total retinal detachment from retinopathy of prematurity (ROP) before the 1-year examination. The authors report as a case series the results of acuity card assessment of monocular grating acuity at 1 year in 53 infants (71 eyes) postvitrectomy and in 45 infants (58 eyes) who had retinal detachments but who did not undergo retinal reattachment surgery. The decision to undertake and the surgical technique used for a retinal reattachment procedure was not part of the randomized CRYO-ROP trial. Two eyes of one infant had pattern vision at the lowest measurable threshold after vitrectomy. None of the remaining eyes that had undergone vitrectomy and none of the eyes that did not undergo vitrectomy showed evidence of pattern vision. The relatively poor visual outcomes in this case series suggest that efforts are well-spent in attempting to prevent retinal detachment in ROP.

Published
1991

50. Penetrating pellet fragmentation. A complication of ocular shotgun injury

Author

Jerry G. Ford and Charles C. Barr

Subjects
Adult, Male, medicine.medical_specialty, genetic structures, Injury control, Adolescent, Eye disease, information science, Visual Acuity, Poison control, Shotgun, Cornea, Shotgun pellet, Vitrectomy, medicine, Humans, natural sciences, business.industry, Retinal Detachment, medicine.disease, Prognosis, Retinal Perforations, eye diseases, Eye Injuries, Penetrating, Surgery, Ophthalmology, Scleral Buckling, Eye Foreign Bodies, Single lead, Wounds, Gunshot, sense organs, Foreign body, Complication, business, Sclera, Corneal Injuries
Abstract

• In three patients who had double-perforating ocular shotgun injuries, a single lead shotgun pellet apparently fragmented after striking the eye, resulting in two separate intraocular impact sites. The importance of detecting double-perforating eye injury and becoming aware of this potential complication with ocular shotgun injuries is emphasized.

Published
1990

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