50 results on '"Mieler WF"'
Search Results
2. Dark Retinal Lesion in a Young Asymptomatic Man.
- Author
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Haq Z, Andreoli MT, and Mieler WF
- Published
- 2017
- Full Text
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3. Asymptomatic Intraocular Mass.
- Author
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Andreoli MT, Farooq AV, and Mieler WF
- Subjects
- Adult, Animals, Asymptomatic Infections, Cysticercosis physiopathology, Cysticercus isolation & purification, Cysts diagnosis, Diagnosis, Differential, Eye Infections, Parasitic physiopathology, Humans, Male, Microscopy, Acoustic, Retinal Diseases physiopathology, Retinoschisis diagnosis, Ultrasonography, Cysticercosis diagnostic imaging, Eye Infections, Parasitic diagnostic imaging, Retinal Diseases diagnostic imaging
- Published
- 2016
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- View/download PDF
4. Toxoplasmosis-associated neovascular lesions treated successfully with ranibizumab and antiparasitic therapy.
- Author
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Benevento JD, Jager RD, Noble AG, Latkany P, Mieler WF, Sautter M, Meyers S, Mets M, Grassi MA, Rabiah P, Boyer K, Swisher C, and McLeod R
- Subjects
- Adult, Antibodies, Monoclonal, Humanized, Child, Choroidal Neovascularization diagnosis, Choroidal Neovascularization parasitology, Drug Therapy, Combination, Fluorescein Angiography, Humans, Injections, Leucovorin therapeutic use, Male, Pyrimethamine therapeutic use, Ranibizumab, Retinal Hemorrhage diagnosis, Retinal Hemorrhage parasitology, Sulfadiazine therapeutic use, Tomography, Optical Coherence, Toxoplasmosis, Ocular diagnosis, Toxoplasmosis, Ocular parasitology, Visual Acuity, Vitreous Body, Antibodies, Monoclonal therapeutic use, Antiprotozoal Agents therapeutic use, Choroidal Neovascularization drug therapy, Retinal Hemorrhage drug therapy, Toxoplasmosis, Ocular drug therapy
- Published
- 2008
- Full Text
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5. Aqueous and vitreous concentrations following topical administration of 1% voriconazole in humans.
- Author
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Vemulakonda GA, Hariprasad SM, Mieler WF, Prince RA, Shah GK, and Van Gelder RN
- Subjects
- Administration, Topical, Adult, Aged, Biological Availability, Candida drug effects, Chromatography, High Pressure Liquid, Humans, Microbial Sensitivity Tests, Middle Aged, Prospective Studies, Vitrectomy, Voriconazole, Antifungal Agents pharmacokinetics, Aqueous Humor metabolism, Pyrimidines pharmacokinetics, Triazoles pharmacokinetics, Vitreous Body metabolism
- Abstract
Objective: To determine the penetration of 1% voriconazole solution into the aqueous and vitreous following topical administration., Methods: A prospective nonrandomized study of 13 patients scheduled for pars plana vitrectomy surgery. Aqueous and vitreous samples were obtained and analyzed after topical administration of 1% voriconazole every 2 hours for 24 hours before surgery. Drug concentration quantitation was performed using high-performance liquid chromatography., Results: The mean (SD) sampling time after topical administration of the last voriconazole dose was 24 (14) minutes. The mean (SD) voriconazole concentrations in the aqueous and vitreous were 6.49 (3.04) microg/mL and 0.16 (0.08) microg/mL, respectively. Aqueous concentrations exceeded the minimum inhibitory concentration at which 90% of isolates are inhibited (MIC(90)) for a wide spectrum of fungi and mold, including Aspergillus, Fusarium, and Candida species. Vitreous concentrations of voriconazole exceeded the MIC(90) for Candida albicans., Conclusion: Topically administered voriconazole achieves therapeutic concentrations in the aqueous of the noninflamed human eye for many fungi and molds and achieves therapeutic levels in the vitreous for Candida species. Topical voriconazole may be a useful agent for the management of fungal keratitis and for prophylaxis against the development of fungal endophthalmitis.
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- 2008
- Full Text
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6. Ocular findings in a patient with hemophagocytic syndrome.
- Author
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Lee EW and Mieler WF
- Subjects
- Adult, Fatal Outcome, Female, Fluorescein Angiography, Hepatomegaly diagnosis, Hepatomegaly surgery, Histiocytes pathology, Humans, Liver pathology, Spleen pathology, Splenectomy, Splenomegaly diagnosis, Splenomegaly surgery, Lymphohistiocytosis, Hemophagocytic diagnosis, Macular Edema diagnosis, Pigment Epithelium of Eye pathology, Retinal Detachment diagnosis
- Published
- 2006
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7. Vitreous and aqueous penetration of orally administered moxifloxacin in humans.
- Author
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Hariprasad SM, Shah GK, Mieler WF, Feiner L, Blinder KJ, Holekamp NM, Gao H, and Prince RA
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Biological Availability, Chromatography, High Pressure Liquid, Fluoroquinolones, Humans, Microbial Sensitivity Tests, Middle Aged, Moxifloxacin, Prospective Studies, Tablets, Vitrectomy, Anti-Bacterial Agents pharmacokinetics, Aqueous Humor metabolism, Aza Compounds pharmacokinetics, Quinolines pharmacokinetics, Vitreous Body metabolism
- Abstract
Objective: To investigate intraocular penetration of moxifloxacin hydrochloride after oral administration., Methods: Prospective study of 15 patients scheduled for vitrectomy between September and November 2004 at the Barnes Retina Institute, St Louis, MO. Aqueous, vitreous, and serum samples were analyzed from 15 patients after oral administration of 2 tablets containing 400 mg of moxifloxacin. Assays were performed using high-performance liquid chromatography., Results: The mean +/- SD moxifloxacin concentrations in plasma (n = 15), vitreous (n = 13), and aqueous (n = 13) samples were 3.56 +/- 1.31 microg/mL, 1.34 +/- 0.66 microg/mL, and 1.58 +/- 0.80 microg/mL, respectively. Mean +/- SD sampling times after oral administration of the second moxifloxacin tablet for plasma, vitreous, and aqueous were 2.94 +/- 0.81 hours, 3.77 +/- 0.92 hours, and 3.71 +/- 0.89 hours, respectively. The percentages of plasma moxifloxacin concentration in the vitreous and aqueous were 37.6% and 44.3%, respectively. Minimal inhibitory concentrations against 90% levels were exceeded against a wide spectrum of gram-positive and gram-negative pathogens in the vitreous and aqueous., Conclusions: Moxifloxacin has a spectrum of coverage that encompasses the most common organisms in endophthalmitis. The pharmacokinetic findings of this investigation reveal that orally administered moxifloxacin achieves therapeutic levels in the noninflamed eye. Because of their broad spectrum of coverage, low minimal inhibitory concentration against 90% levels, good tolerability, and excellent oral bioavailability, fourth-generation fluoroquinolones may represent a major advance for managing posterior segment infections.
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- 2006
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8. Acute endophthalmitis incidence: intravitreal triamcinolone.
- Author
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Westfall AC, Osborn A, Kuhl D, Benz MS, Mieler WF, and Holz ER
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- Acute Disease, Endophthalmitis chemically induced, Endophthalmitis microbiology, Glucocorticoids adverse effects, Humans, Incidence, Injections, Retinal Diseases drug therapy, Retrospective Studies, Texas epidemiology, Triamcinolone Acetonide adverse effects, Endophthalmitis epidemiology, Glucocorticoids administration & dosage, Triamcinolone Acetonide administration & dosage, Vitreous Body drug effects
- Abstract
Objective: To report the incidence of acute postinjection endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA) as an office procedure., Methods: Retrospective, noncomparative, consecutive, interventional case series of all patients who had received IVTA at 2 clinical centers between January 1, 2000, and January 30, 2004., Results: A total of 1006 eyes received IVTA. None of the eyes developed acute, culture-positive, postoperative endophthalmitis in the 6 weeks following the procedure. One patient developed acute, culture-negative, postoperative endophthalmitis 4 days after receiving IVTA, resulting in an incidence of 0.10%. In this case, the presenting symptoms were decreased vision and acute conjunctival erythema. The case was notable for the absence of pain or hypopyon., Conclusion: Although acute postoperative endophthalmitis may follow IVTA, our experience suggests that this is a relatively uncommon event.
- Published
- 2005
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9. Penetration pharmacokinetics of topically administered 0.5% moxifloxacin ophthalmic solution in human aqueous and vitreous.
- Author
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Hariprasad SM, Blinder KJ, Shah GK, Apte RS, Rosenblatt B, Holekamp NM, Thomas MA, Mieler WF, Chi J, and Prince RA
- Subjects
- Administration, Topical, Aged, Aged, 80 and over, Biological Availability, Chromatography, High Pressure Liquid, Fluoroquinolones, Humans, Microbial Sensitivity Tests, Middle Aged, Moxifloxacin, Ophthalmic Solutions pharmacokinetics, Prospective Studies, Vitrectomy, Anti-Bacterial Agents pharmacokinetics, Aqueous Humor metabolism, Aza Compounds pharmacokinetics, Quinolines pharmacokinetics, Vitreous Body metabolism
- Abstract
Objective: To investigate the penetration of 0.5% moxifloxacin hydrochloride into the aqueous and vitreous after topical administration in humans., Methods: A prospective, nonrandomized study of 20 patients scheduled for vitrectomy surgery between September 1 and December 31, 2003. Aqueous and vitreous samples were obtained and analyzed after topical administration of 0.5% moxifloxacin hydrochloride, every 2 hours (q2h) or every 6 hours (q6h), for 3 days before surgery. Assays were performed using high-performance liquid chromatography., Results: Mean +/- SD moxifloxacin concentrations in the q2h group for the aqueous (n = 9) and vitreous (n = 10) were 2.28 +/- 1.23 and 0.11 +/- 0.05 microg/mL, respectively. Mean +/- SD moxifloxacin concentrations in the q6h group for the aqueous (n = 10) and vitreous (n = 9) were 0.88 +/- 0.88 and 0.06 +/- 0.06 microg/mL, respectively. The minimum inhibitory concentration for 90% of isolates (MIC(90)) was far exceeded in the aqueous for a wide spectrum of key pathogens, whereas it was not exceeded in the vitreous for several organisms. However, the minimum inhibitory concentration for 50% of the isolates was exceeded in the q2h vitreous group for Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Bacillus cereus, and other gram-negative pathogens., Conclusions: The Endophthalmitis Vitrectomy Study revealed that 94.2% of isolates from postoperative endophthalmitis are gram-positive pathogens. Moxifloxacin has a spectrum of coverage that appropriately encompasses the most common organisms in endophthalmitis. The pharmacokinetic findings of this investigation show that relatively high aqueous levels can be achieved after topical administration. Further studies will help define the precise role of 0.5% moxifloxacin ophthalmic solution in the treatment of or prophylaxis against intraocular infections.
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- 2005
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10. Intravitreal voriconazole: an electroretinographic and histopathologic study.
- Author
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Gao H, Pennesi ME, Shah K, Qiao X, Hariprasad SM, Mieler WF, Wu SM, and Holz ER
- Subjects
- Animals, Endophthalmitis drug therapy, Endophthalmitis microbiology, Eye Infections, Fungal drug therapy, Injections, Ophthalmic Solutions toxicity, Rats, Rats, Sprague-Dawley, Vitreous Body, Voriconazole, Antifungal Agents toxicity, Electroretinography drug effects, Pyrimidines toxicity, Retina drug effects, Retina pathology, Triazoles toxicity
- Abstract
Background: Voriconazole, a novel triazole antifungal agent, presents potent activity against a broad spectrum of yeast and molds., Objective: To determine whether voriconazole could be safely used as an intravitreal agent in the treatment of fungal endophthalmitis., Methods: Retinal toxicity of voriconazole was examined in a rodent animal model. Voriconazole solutions were serially diluted and injected intravitreally into the eyes of normal adult Sprague-Dawley rats so that the final intravitreal concentrations were 5 microg/mL, 10 microg/mL, 25 microg/mL, 50 microg/mL, and 500 microg/mL (n = 3 for each concentration group). Saline was injected into the fellow eyes of all animals as controls. Three weeks after injections, electroretinograms were measured, and eyes were subsequently enucleated for histologic examination., Results: In electroretinographic studies, maximum scotopic b-wave, intensity needed for half saturation, and saturated a-wave amplitude were measured. There was no statistically significant difference in these parameters recorded between control eyes and voriconazole-injected eyes in any concentration groups. Histologic examination with light microscopy did not reveal any retinal abnormality in the eyes with 5 to 25 microg/mL of intravitreal voriconazole. In the eyes with 50 microg/mL and 500 microg/mL of voriconazole, small foci of retinal necrosis were occasionally observed in the outer retina, especially in the eyes with 500 microg/mL of voriconazole., Conclusions: Our results demonstrate that intravitreal voriconazole of up to 25 microg/mL [corrected] causes no electroretinographic change or histologic abnormality in rat retinas. This indicates that voriconazole is a safe antifungal agent for intravitreal injection in rodents and may be used in the treatment of human fungal endophthalmitis following further study.
- Published
- 2004
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11. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans.
- Author
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Hariprasad SM, Mieler WF, Holz ER, Gao H, Kim JE, Chi J, and Prince RA
- Subjects
- Administration, Oral, Adult, Aged, Aged, 80 and over, Biological Availability, Biological Transport, Chromatography, High Pressure Liquid, Female, Fungi drug effects, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Prospective Studies, Vitrectomy, Voriconazole, Antifungal Agents pharmacokinetics, Aqueous Humor metabolism, Pyrimidines pharmacokinetics, Triazoles pharmacokinetics, Vitreous Body metabolism
- Abstract
Objective: To investigate the penetration of voriconazole, a new-generation triazole antifungal agent, into the vitreous and aqueous humor after oral administration., Methods: A prospective, nonrandomized clinical study included 14 patients scheduled for elective pars plana vitrectomy surgery between December 1, 2002, and February 28, 2003, at the Cullen Eye Institute, Houston, Tex. Aqueous, vitreous, and plasma samples were obtained and analyzed from 14 patients after oral administration of two 400-mg doses of voriconazole taken 12 hours apart before surgery. Assays were performed by means of high-performance liquid chromatography., Results: Mean +/- SD voriconazole concentrations in plasma (n = 14), vitreous (n = 14), and aqueous (n = 11) were 2.13 +/- 0.93 microg/mL, 0.81 +/- 0.31 microg/mL, and 1.13 +/- 0.57 microg/mL, respectively. Mean +/- SD sampling times after oral administration of the second voriconazole dose for plasma, vitreous, and aqueous were 2.4 +/- 0.6 hours, 3.0 +/- 0.5 hours, and 2.9 +/- 0.5 hours, respectively. The percentages of plasma voriconazole concentration achieved in the vitreous and aqueous were 38.1% and 53.0%, respectively. Mean vitreous and aqueous minimum inhibitory concentrations for 90% of isolates (MIC(90)) were achieved against a wide spectrum of yeasts and molds, including Aspergillus species and Candida species, along with many other organisms., Conclusions: Orally administered voriconazole achieves therapeutic aqueous and vitreous levels in the noninflamed human eye, and the activity spectrum appears to appropriately encompass the most frequently encountered mycotic species involved in the various causes of fungal endophthalmitis. Because of its broad spectrum of coverage, low MIC(90) levels for the organisms of concern, good tolerability, and excellent bioavailability with oral administration, it may represent a major advance in the prophylaxis or management of exogenous or endogenous fungal endophthalmitis.
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- 2004
- Full Text
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12. Exudative complications after photodynamic therapy.
- Author
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Holz ER, Linares L, Mieler WF, and Weinberg DV
- Subjects
- Aged, Aged, 80 and over, Choroidal Neovascularization drug therapy, Choroidal Neovascularization etiology, Coloring Agents, Exudates and Transudates, Fluorescein Angiography, Humans, Indocyanine Green, Macular Degeneration complications, Macular Degeneration drug therapy, Male, Papilledema diagnosis, Papilledema physiopathology, Photosensitizing Agents adverse effects, Porphyrins adverse effects, Retinal Hemorrhage diagnosis, Retinal Hemorrhage physiopathology, Retinal Vessels pathology, Verteporfin, Visual Acuity, Papilledema chemically induced, Photochemotherapy adverse effects, Retinal Hemorrhage chemically induced, Retinal Vessels drug effects
- Published
- 2003
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13. Vitreous and aqueous penetration of orally administered gatifloxacin in humans.
- Author
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Hariprasad SM, Mieler WF, and Holz ER
- Subjects
- Administration, Oral, Adult, Aged, Aged, 80 and over, Biological Availability, Chromatography, High Pressure Liquid, Female, Gatifloxacin, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Prospective Studies, Vitrectomy, Anti-Infective Agents pharmacokinetics, Aqueous Humor metabolism, Fluoroquinolones, Vitreous Body metabolism
- Abstract
Objective: To investigate the penetration of gatifloxacin, a novel extended-spectrum fourth-generation fluoroquinolone antibiotic, into the vitreous and aqueous humor after oral administration., Methods: A prospective, nonrandomized study of 24 consecutive patients scheduled for pars plana vitrectomy between September 2001 and May 2002 at the Cullen Eye Institute. Aqueous, vitreous, and serum samples were obtained and analyzed from 24 patients after administration of two 400-mg gatifloxacin tablets taken 12 hours apart before the operation. Assays were performed using high-performance liquid chromatography., Results: Mean +/- SD gatifloxacin concentrations in serum (n = 23), vitreous (n = 23), and aqueous (n = 11) were 5.14 +/- 1.36 micro g/mL, 1.34 +/- 0.34 micro g/mL, and 1.08 +/- 0.54 micro g/mL respectively. Mean +/- SD sampling times after oral administration of the second gatifloxacin tablet for serum, vitreous, and aqueous were 3.2 +/- 1.0 hours, 4.0 +/- 1.0 hours, and 3.9 +/- 1.1 hours, respectively. The percentages of serum gatifloxacin concentration achieved in the vitreous and aqueous were 26.17% and 21.02%, respectively. Mean inhibitory vitreous and aqueous MIC(90 ) levels were achieved against many pathogens, including Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Propionibacterium acnes, Haemophilus influenzae, Escherichia coli, Bacillus cereus, Proteus mirabilis, and other organisms., Conclusions: Orally administered gatifloxacin achieves therapeutic levels in the noninflamed human eye, and the activity spectrum appropriately encompass the bacterial species most frequently involved in the various causes of endophthalmitis. Because of its broad-spectrum coverage, low MIC(90) levels for the organisms of concern, and good tolerability, gatifloxacin represents a major advance in the prophylaxis or treatment of postoperative, posttraumatic, and bleb-associated bacterial endophthalmitis.
- Published
- 2003
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14. Twenty-year follow-up for scleral buckling.
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Schwartz SG, Kuhl DP, McPherson AR, Holz ER, and Mieler WF
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- Cryosurgery, Follow-Up Studies, Humans, Retinal Detachment surgery, Retrospective Studies, Treatment Outcome, Visual Acuity, Scleral Buckling
- Abstract
Objective: To the report 20-year follow-up data for patients receiving a scleral buckle for treatment of a primary rhegmatogenous retinal detachment (RRD)., Methods: Nonconsecutive, retrospective case series. We identified 227 eyes with primary RRD who were treated with a scleral buckle, and for whom at least 20 years of follow-up data were available. Results were classified into 3 subgroups: retina reattached with 1 procedure; retina reattached with 1 or more additional vitreoretinal procedures; or retina detached at 20 years., Results: One hundred eighty-six eyes (82%) achieved retinal reattachment with 1 scleral buckling procedure and with a median final visual acuity of 20/40 at 20 years of follow-up. An additional 30 eyes (13%) achieved retinal reattachment after 1 or more additional vitreoretinal procedures, with a median final visual acuity of 20/50. Eleven eyes (5%) were detached at the 20-year follow-up examination, with a final visual acuity in all eyes of no light perception., Conclusions: Scleral buckling for primary RRD achieves anatomical efficacy and preservation of central vision in the majority of eyes at 20 years' follow-up. The 1-operation success rate was 82%, overall success rate was 95%, and median final visual acuity was 20/40. This study may serve as a basis for comparison with the long-term results of other surgical techniques used in the treatment of primary RRDs.
- Published
- 2002
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15. Intravitreal hemoglobin spherulosis: a rare complication of subretinal hemorrhage.
- Author
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Schwartz SG, Mieler WF, Holz ER, Esmaeli B, Ragsdale PS, and Font RL
- Subjects
- Adult, Fatal Outcome, Hematologic Diseases diagnosis, Humans, Leukemia, Myelogenous, Chronic, BCR-ABL Positive complications, Male, Thrombocytopenia complications, Vitreous Hemorrhage complications, Hematologic Diseases etiology, Hemoglobins, Retinal Hemorrhage complications, Spherocytes pathology, Vitreous Body pathology
- Published
- 2002
16. Ocular injuries: is it possible to further limit the occurrence rate?
- Author
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Mieler WF
- Subjects
- Ambulatory Care statistics & numerical data, Eye Injuries epidemiology, Hospitalization statistics & numerical data, Humans, Incidence, United States epidemiology, Eye Injuries prevention & control, Military Personnel statistics & numerical data
- Published
- 2001
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17. Bilateral combined occlusion of the central retinal artery and vein secondary to thrombotic thrombocytopenic purpura.
- Author
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Schwartz SG, McPherson AR, Mieler WF, Sessoms SL, Moake JL, and Holz ER
- Subjects
- Adult, Blindness etiology, Female, Humans, Purpura, Thrombotic Thrombocytopenic pathology, Retinal Artery Occlusion pathology, Retinal Vein Occlusion pathology, Retinal Vessels pathology, Visual Acuity, Purpura, Thrombotic Thrombocytopenic complications, Retinal Artery Occlusion etiology, Retinal Vein Occlusion etiology
- Published
- 2000
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18. Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus.
- Author
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Mittra RA, Borrillo JL, Dev S, Mieler WF, and Koenig SB
- Subjects
- Cataract complications, Cataract physiopathology, Diabetes Complications, Diabetes Mellitus drug therapy, Diabetic Retinopathy etiology, Disease Progression, Female, Humans, Hypoglycemic Agents therapeutic use, Insulin therapeutic use, Intraoperative Complications, Male, Middle Aged, Multivariate Analysis, Postoperative Complications, Diabetes Mellitus physiopathology, Diabetic Retinopathy physiopathology, Phacoemulsification, Visual Acuity physiology
- Abstract
Objectives: To determine the rate of progression of diabetic retinopathy after phacoemulsification surgery, and whether surgeon experience and/or surgical duration adversely affect visual outcome., Methods: A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery during a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied by means of univariate and stepwise multivariate logistic regression analyses. Resident and private cases were compared., Results: Visual acuity improved by 2 or more lines in 117 eyes (78%); 93 eyes (62%) had a final visual acuity of at least 20/40. Retinopathy progression was seen in 37 eyes (25%) with 6 to 10 months of follow-up. Preoperative nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and limited surgical experience were statistically associated with retinopathy progression and poor visual outcome., Conclusions: The visual results and rate of retinopathy progression after phacoemulsification surgery in our series did not differ significantly from those reported that used other techniques. Nonproliferative and proliferative diabetic retinopathy and surgical inexperience resulted in an increased rate of retinopathy progression. Arch Ophthalmol. 2000;118:912-917
- Published
- 2000
19. Nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms.
- Author
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McCabe CM, Flynn HW Jr, McLean WC, Brod RD, McDonald HR, Johnson MW, Williams GA, and Mieler WF
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- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Fundus Oculi, Humans, Male, Middle Aged, Pigment Epithelium of Eye pathology, Retinal Hemorrhage etiology, Visual Acuity, Aneurysm complications, Macula Lutea blood supply, Retinal Artery pathology, Retinal Diseases complications, Retinal Hemorrhage therapy
- Abstract
Objective: To report visual acuity outcomes of nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms., Methods: Forty-one patients at multiple centers with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone were reviewed. Time to clearance of macular hemorrhage, visual acuity at final follow-up, and presence or absence of macular pigmentary changes after absorption of the hemorrhage were recorded for each patient., Results: On initial examination, visual acuity was 20/200 or worse in all except 4 patients (3 with 20/70, 1 with 20/80). At an average follow-up of 15. 7 months, a final visual acuity of 20/40 or better was achieved in 15 eyes (37%), between 20/50 and 20/100 in 12 (29%), and 20/200 or worse in 14 (34%). Macular pigmentary abnormalities were noted after clearance of the hemorrhage in 23 (56%) of 41 cases, and these eyes generally had worse visual acuity outcomes., Conclusions: In eyes with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone, good visual acuity outcomes can often be achieved. Poorer visual acuity outcomes are associated with macular pigmentary changes after resorption of blood. Arch Ophthalmol. 2000;118:780-785
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- 2000
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20. Treatment choice and quality of life in patients with choroidal melanoma.
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Cruickshanks KJ, Fryback DG, Nondahl DM, Robinson N, Keesey U, Dalton DS, Robertson DM, Chandra SR, Mieler WF, Zakov ZN, Custer PL, Del Priore LV, and Albert DM
- Subjects
- Aged, Choroid Neoplasms mortality, Female, Follow-Up Studies, Health Status Indicators, Humans, Male, Melanoma mortality, Middle Aged, Surveys and Questionnaires, Survival Rate, Visual Acuity, Brachytherapy, Choroid Neoplasms therapy, Eye Enucleation, Melanoma therapy, Quality of Life
- Abstract
Objective: To determine if quality of life differs between patients with choroidal melanoma treated with enucleation and those treated with radiation therapy., Materials and Methods: Patients treated for choroidal melanoma at 5 Midwest centers were asked to participate. There were 65 participants treated with enucleation and 82 treated with radiation therapy. Quality of life was assessed using the Medical Outcome Study Short Form 36 and the National Eye Institute Visual Function Questionnaire and by the Time-Tradeoff interview method., Results: The average length of follow-up was 4.9 years for the group treated with radiation therapy and 6.3 years for the group treated with enucleation (P = .05). After adjusting for age, sex, years of follow-up, and the number of chronic conditions, there were few differences in any of the quality-of-life measures by treatment status. Participants in the group treated with radiation therapy were more likely to have higher (better) scores on the Vitality and Mental Component subscales of the Medical Outcome Study Short Form 36 than participants treated with enucleation. There were no differences on the National Eye Institute Visual Function Questionnaire or the Time-Tradeoff measures of quality of life., Conclusion: Choice of treatment for choroidal melanoma does not seem to be associated with large differences in quality of life in long-term follow-up.
- Published
- 1999
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21. Visual outcomes following lensectomy and vitrectomy for combined anterior and posterior persistent hyperplastic primary vitreous.
- Author
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Mittra RA, Huynh LT, Ruttum MS, Mieler WF, Connor TB, Han DP, Pulido JS, and Dev S
- Subjects
- Amblyopia therapy, Aphakia, Postcataract therapy, Child, Contact Lenses, Hydrophilic, Eye blood supply, Eye embryology, Eye Abnormalities complications, Eye Abnormalities physiopathology, Eye Diseases complications, Eye Diseases congenital, Eye Diseases surgery, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Lens Implantation, Intraocular, Male, Retrospective Studies, Vitreous Body physiopathology, Cataract Extraction, Eye Abnormalities surgery, Visual Acuity physiology, Vitrectomy, Vitreous Body blood supply
- Abstract
Objective: To determine the visual outcome after surgery for persistent hyperplastic primary vitreous using modern vitreoretinal techniques., Design: Retrospective medical record review during a 5-year period (June 1992 to June 1997). Information recorded for each patient included age, medical history, sex, results of preoperative ocular examination, age at diagnosis, procedure performed, intraoperative and postoperative complications, location and number of sclerotomy sites, type of aphakic rehabilitation, amblyopic therapy given, final visual acuity, and length of follow-up., Results: Fourteen patients who underwent surgical management of combined anterior and posterior persistent hyperplastic primary vitreous were identified. Eleven patients underwent aphakic rehabilitation and aggressive amblyopic therapy consisting of occlusive therapy for several waking hours each day. One additional older patient received aphakic rehabilitation only. Ten eyes (71%) achieved a visual acuity of 20/300 or better, and 8 (57%) obtained a final visual acuity of 20/100 or better. Average length of follow-up was 22 months (range, 4-57 months). Nine patients were fitted with an aphakic soft contact lens, 2 older patients had a posterior chamber intraocular lens placed at the time of vitrectomy, and 1 patient wore aphakic spectacles., Conclusions: With modern vitreoretinal techniques, aphakic rehabilitation, and aggressive amblyopic therapy, useful vision can be obtained in the majority of patients with combined anterior and posterior persistent hyperplastic primary vitreous.
- Published
- 1998
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22. Acute macular edema associated with an infected scleral buckle.
- Author
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Dev S, Mieler WF, Mittra RA, and Prasad A
- Subjects
- Acute Disease, Aged, Anti-Bacterial Agents therapeutic use, Edema pathology, Eye Infections, Bacterial pathology, Eye Infections, Bacterial therapy, Fluorescein Angiography, Foreign-Body Migration complications, Foreign-Body Migration pathology, Foreign-Body Migration therapy, Humans, Male, Prosthesis-Related Infections pathology, Prosthesis-Related Infections therapy, Reoperation, Retinal Diseases pathology, Vision Disorders etiology, Vision Disorders pathology, Edema etiology, Eye Infections, Bacterial complications, Macula Lutea pathology, Prosthesis-Related Infections complications, Retinal Diseases etiology, Scleral Buckling instrumentation
- Published
- 1998
23. Long-term follow-up of iatrogenic phototoxicity.
- Author
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Postel EA, Pulido JS, Byrnes GA, Heier J, Waterhouse W, Han DP, Mieler WF, Guse C, and Wipplinger W
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- Aged, Aged, 80 and over, Anterior Eye Segment surgery, Female, Follow-Up Studies, Fundus Oculi, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Visual Acuity, Vitrectomy, Iatrogenic Disease, Light adverse effects, Radiation Injuries etiology, Retina radiation effects
- Abstract
Objective: To evaluate the outcomes of a group of patients who suffered iatrogenic phototoxic injury., Methods: The medical records of 24 patients (24 eyes) with iatrogenic phototoxicity from 3 medical centers were reviewed. We report the findings from long-term follow-up of these patients with particular attention to visual outcome, type and duration of procedure, and location of the phototoxic lesion., Results: Phototoxic injury occurred after anterior segment surgery in 20 eyes and after vitrectomy in 4 eyes. The mean duration of surgery was 109 minutes; there was no statistically significant difference in duration between the anterior segment procedures and the vitrectomies. Mean final visual acuity was 20/40 for all cases (range, 20/15 to counting fingers) and 20/25 for all anterior segment cases. In vitrectomized eyes, the mean final visual acuity was 20/900. Phototoxic lesions tended to spare the fovea after anterior segment surgery and involve the foveal center after vitrectomy., Conclusions: In general, patients who suffer phototoxicity do well, and the prognosis is good for extrafoveal lesions. Foveal injury, which often occurs with vitrectomy, usually leads to a worse visual outcome. The development of choroidal neovascularization may have an effect on the ultimate visual outcome as well.
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- 1998
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24. The role and timing of pars plana vitrectomy in penetrating ocular trauma.
- Author
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Mieler WF and Mittra RA
- Subjects
- Animals, Humans, Time Factors, Eye Injuries, Penetrating surgery, Vitrectomy
- Published
- 1997
- Full Text
- View/download PDF
25. Idiopathic sclerochoroidal calcification in a 41-year-old woman.
- Author
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McCabe CM, Mieler WF, and Postel EA
- Subjects
- Adult, Calcinosis diagnosis, Choroid Diseases diagnosis, Female, Fundus Oculi, Humans, Scleral Diseases diagnosis, Tomography, X-Ray Computed, Calcinosis etiology, Choroid Diseases etiology, Scleral Diseases etiology
- Published
- 1997
- Full Text
- View/download PDF
26. Retinal complications after aqueous shunt surgical procedures for glaucoma.
- Author
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Law SK, Kalenak JW, Connor TB Jr, Pulido JS, Han DP, and Mieler WF
- Subjects
- Adult, Aged, Aged, 80 and over, Drainage, Female, Humans, Male, Middle Aged, Molteno Implants adverse effects, Retrospective Studies, Risk Factors, Visual Acuity, Aqueous Humor metabolism, Glaucoma surgery, Postoperative Complications etiology, Prostheses and Implants adverse effects, Retinal Diseases etiology
- Abstract
Objectives: To assess retinal complications and to identify risk factors for retinal complications following aqueous shunt procedures., Materials and Methods: Records of 38 consecutive aqueous shunt procedures that were performed on 36 patients at the Eye Institute of the Medical College of Wisconsin, Milwaukee, from June 1993 to March 1995 (minimum follow-up, 6 months) were reviewed. The mean +/- SD follow-up was 11.4 +/- 5.2 months (median, 10.5 months)., Results: Twelve patients (32%) had the following retinal complications: 4 serous choroidal effusions (10%) that required drainage, 3 suprachoroidal hemorrhages (8%), 2 vitreous hemorrhages (5%), 1 rhegmatogenous retinal detachment (3%), 1 endophthalmitis (3%), and 1 scleral buckling extrusion (3%). Surgical procedures for retinal complications were required in 8 (67%) of these 12 patients. Visual acuity decreased 2 lines or more in 9 (75%) of these 12 patients. The median onset of a postoperative retinal complication was 12.5 days, with 10 patients (83%) experiencing complications within 35 days. Serous choroidal effusions developed in 10 other patients (26%), and these effusions resolved spontaneously. Visual acuity decreased 2 lines or more in 2 (20%) of these additional 10 patients. Patients who experienced serious retinal complications were significantly older, had a higher rate of hypertension, and postoperative ocular hypotony. Serious retinal complications were distributed evenly among patients with Krupin valves with discs and Molteno and Baerveldt devices. Experience with the Ahmed glaucoma valve implant was limited., Conclusion: Aqueous shunt procedures may be associated with significant retinal complications and subsequent visual loss.
- Published
- 1996
- Full Text
- View/download PDF
27. Management of ectopia lentis in a family with Marfan syndrome.
- Author
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Koenig SB and Mieler WF
- Subjects
- Adult, Anterior Chamber surgery, Ectopia Lentis etiology, Family Health, Humans, Lens, Crystalline surgery, Lenses, Intraocular, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Visual Acuity, Vitrectomy, Ectopia Lentis surgery, Marfan Syndrome complications
- Abstract
Objective: To determine the effectiveness of combined pars plana vitrectomy-lensectomy and open-loop anterior chamber lens implantation for the management of ectopia lentis associated with Marfan syndrome., Methods: Retrospective review of the medical records of 4 consecutive patients with Marfan syndrome who underwent combined pars plana lensectomy-vitrectomy and anterior chamber lens implantation at our institution between August 1994 and July 1995., Results: All patients demonstrated postoperative visual acuity of 20/25 or better during an average follow-up period of 6 months (range, 4-9 months). Two patients developed pseudophakic pupillary block and required YAG laser iridotomy postoperatively., Conclusions: Pars plana lensectomy-vitrectomy and anterior chamber intraocular lens implantation appears to be an excellent technique for the management of ectopia lentis associated with Marfan syndrome. A bimanual, closed-system endosurgical technique avoids many of the complications previously associated with surgery for ectopia lentis.
- Published
- 1996
- Full Text
- View/download PDF
28. Six-year follow-up of an idiopathic retinal vasoproliferative tumor.
- Author
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McCabe CM and Mieler WF
- Subjects
- Adult, Fluorescein Angiography, Follow-Up Studies, Fundus Oculi, Humans, Male, Visual Acuity, Hemangioma pathology, Neovascularization, Pathologic pathology, Retinal Diseases pathology, Retinal Vessels pathology
- Published
- 1996
- Full Text
- View/download PDF
29. Ruptured globes following radial and hexagonal keratotomy surgery.
- Author
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Vinger PF, Mieler WF, Oestreicher JH, and Easterbrook M
- Subjects
- Adult, Cornea pathology, Cornea surgery, Eye Injuries pathology, Female, Humans, Male, Postoperative Complications etiology, Refractive Surgical Procedures, Rupture, Surgical Wound Dehiscence pathology, Surgical Wound Dehiscence surgery, Visual Acuity, Wound Healing, Wounds, Nonpenetrating pathology, Corneal Injuries, Eye Injuries complications, Keratotomy, Radial, Surgical Wound Dehiscence etiology, Wounds, Nonpenetrating complications
- Abstract
Objective: To ascertain if cases of radial keratotomy wound rupture were occurring and whether the globes ruptured through the corneal incisions., Design: Cases of traumatic ruptured globe after incisional corneal refractive surgery were collected from ophthalmologists and from peer-reviewed and other ophthalmic literature., Results: Twenty-eight human eyes (eight previously unreported) are known to have ruptured through refractive corneal incisions in activities of daily living (n = 12), assault (n = 7), motor vehicle accidents (n = 5), and sports (n = 4). Two patients died of their injuries. Of the remaining 26 ruptured eyes, eight (31%) recovered 20/40 or better visual acuity. Six eyes (23%) were totally blinded, six (23%) were legally blinded, and six (23%) had best corrected visual acuity of 20/40 to 20/100 despite multiple surgical procedures., Conclusions: As radial keratotomy becomes more popular the pool of patients who may experience traumatic ruptured globe will grow. Every patient who has had radial keratotomy should be aware that the surgery has weakened the eye(s).
- Published
- 1996
- Full Text
- View/download PDF
30. Golf-related ocular injuries.
- Author
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Mieler WF, Nanda SK, Wolf MD, and Harman J
- Subjects
- Adolescent, Adult, Aged, Eye Enucleation, Eye Injuries surgery, Female, Humans, Incidence, Male, Middle Aged, Orbit surgery, Retrospective Studies, Rupture, Visual Acuity, Wounds, Nonpenetrating surgery, Eye Injuries etiology, Golf injuries, Orbit injuries, Wounds, Nonpenetrating etiology
- Abstract
Objective: To review golf-related ocular injuries, which account for 1.5% to 5.6% of all sports injuries., Methods: During 8 years (1986 to 1994), a retrospective review of sports-related trauma was performed at the Medical College of Wisconsin, Milwaukee. Eight blunt ocular injuries (four ruptured globes and four globes without rupture) caused by golf-related activities were identified. The four ruptured globes caused by golf-related trauma accounted for 1.2% of all penetrating injuries and/or ruptured globes and 11.7% of sports-related injuries., Results: A golf ball projectile was the mechanism of injury in six patients, while two patients were struck with a gold club. The four patients with ruptured globes had an initial visual acuity of light perception or worse, and three globes were subsequently enucleated, while one was prephthisic. In the four trauma cases without rupture, surgical intervention was required to achieve anatomic stability, with final visual acuities ranging from 20/25 to 20/40., Conclusions: The incidence of ocular injuries caused by golf-related trauma is low compared with that for other sports-related injuries. Although the prognosis for ruptured globes occurring in this setting remains extremely guarded, blunt trauma without rupture caused by a golf-related injury is associated with a more favorable visual and anatomic outcome.
- Published
- 1995
- Full Text
- View/download PDF
31. 2 peripheral scatter photocoagulation for neovascularization associated with pars planitis.
- Author
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Park SE, Mieler WF, and Pulido JS
- Subjects
- Adult, Child, Female, Humans, Macular Edema etiology, Male, Neovascularization, Pathologic etiology, Pilot Projects, Prognosis, Visual Acuity, Vitrectomy, Laser Coagulation, Neovascularization, Pathologic surgery, Pars Planitis complications, Vitreous Body blood supply
- Abstract
Background: Peripheral cryotherapy appears to be efficacious in the treatment of neovascularization of the vitreous base in patients with pars planitis, although it may be associated with the development of rhegmatogenous retinal detachments., Objective: To evaluate the safety and efficacy of peripheral scatter photocoagulation for treatment of neovascularization of the vitreous base when used alone or combined with pars plana vitrectomy., Methods: Six patients (10 eyes) presented with vitritis, cystoid macular edema, and neovascularization of the vitreous base, unresponsive to corticosteroid therapy. Three patients (five eyes) received scatter diode or argon photocoagulation treatment alone. The other three patients (five eyes) underwent pars plana vitrectomy coupled with argon or diode photocoagulation, placed in three rows, posterior to the area of inferior neovascularization of the vitreous base., Results: Pretreatment visual acuity ranged from 20/20 to 20/200. All patients were followed up for a minimum of 6 months. After placement of photocoagulation (with or without concurrent pars plana vitrectomy), the neovascularization regressed, inflammation was stabilized, and cystoid macular edema improved in all eyes. There were no retinal detachments or other complications of treatment. Posttreatment visual acuity ranged from 20/20 to 20/100. When final visual acuity was 20/40 or less, cataract formation was generally responsible., Conclusions: Peripheral scatter photocoagulation is efficacious and appears at least equal to peripheral cryotherapy in causing regression of neovascularization of the vitreous base in patients with pars planitis.
- Published
- 1995
- Full Text
- View/download PDF
32. High-resolution magnetic resonance imaging evaluation of blood-retinal barrier integrity following transscleral diode laser treatment.
- Author
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Arrindell EL, Wu JC, Wolf MD, Nanda S, Han DP, Wong EC, Abrams GW, Mieler WF, and Hyde JS
- Subjects
- Animals, Cell Membrane Permeability, Gadolinium DTPA, Infusions, Intravenous, Magnetic Resonance Imaging methods, Organometallic Compounds administration & dosage, Pentetic Acid administration & dosage, Pentetic Acid analogs & derivatives, Rabbits, Random Allocation, Retina pathology, Retina physiopathology, Sclera, Blood-Retinal Barrier physiology, Cryotherapy, Laser Coagulation, Retina surgery
- Abstract
Objective: To compare the effects of contact transscleral diode laser treatment and retinal cryotherapy on blood-retinal barrier integrity with the use of high-resolution magnetic resonance imaging techniques with constant infusion of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA)., Methods: Transscleral diode laser photocoagulation and retinal cryotherapy were used to treat equivalent areas of the inferior retinal periphery of pigmented rabbits. Magnetic resonance imaging time-course studies with measurement of signal enhancements due to Gd-DTPA leakage were conducted 2 and 15 days following treatment., Results: Two days following treatment, cryotherapy-treated eyes exhibited a mean (+/- SD) effective Gd-DTPA permeability coefficient of 4.6 +/- 0.8 x 10(-6) cm/s; in comparison, diode laser-treated eyes exhibited 1.6 x 1.4 x 10(-6) cm/s effective permeability. Significant decreases in the effective permeability were also noted 15 days after treatment in both groups., Conclusions: Transscleral contact probe diode laser photocoagulation induces less disruption of the blood-retinal barrier than does conventional cryotherapy. In addition, the continuous infusion method of Gd-DTPA delivery is a reliable and easily interpretable alternative to the commonly used bolus injection approach.
- Published
- 1995
- Full Text
- View/download PDF
33. Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion.
- Author
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Koenig SB, Mieler WF, Han DP, and Abrams GW
- Subjects
- Adult, Aged, Aged, 80 and over, Cataract complications, Eye Diseases complications, Female, Humans, Male, Middle Aged, Postoperative Complications, Postoperative Period, Retinal Diseases complications, Retrospective Studies, Visual Acuity, Vitreous Body, Cataract Extraction methods, Lenses, Intraocular, Ultrasonic Therapy, Vitrectomy
- Abstract
Eighteen eyes with coexisting cataract and vitreoretinal disease underwent combined phacoemulsification, pars plana vitrectomy, and posterior chamber lens implantation. Preoperative vitreoretinal disease included nonclearing vitreous hemorrhage (eight eyes), vitreous hemorrhage and tractional retinal detachment (three eyes), tractional retinal detachment (one eye), epiretinal membranes (three eyes), peripheral uveitis (two eyes), and a retained intraocular metallic foreign body (one eye). Postoperative visual acuity improved in each case; 14 eyes achieved visual acuity between 20/20 and 20/80 during an average postoperative period of 11 months (range, 3 to 39 months). Perioperative complications included an iatrogenic retinal break (one eye) and pupillary block glaucoma (one eye). Four eyes required YAG laser capsulotomy postoperatively. Phacoemulsification did not interfere with corneal clarity, allowed water-tight wound closure during vitrectomy, and preserved the capsular bag, allowing endocapsular fixation of the posterior chamber lens. Combining phacoemulsification, posterior chamber lens implantation, and pars plana vitrectomy allows rapid visual rehabilitation and functional unaided vision in these eyes.
- Published
- 1992
- Full Text
- View/download PDF
34. Sclerochoroidal calcification.
- Author
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Schachat AP, Robertson DM, Mieler WF, Schwartz D, Augsburger JJ, Schatz H, and Gass JD
- Subjects
- Aged, Aged, 80 and over, Calcinosis diagnostic imaging, Calcinosis metabolism, Calcium blood, Choroid Diseases diagnostic imaging, Choroid Diseases metabolism, Diagnosis, Differential, Female, Fluorescein Angiography, Fundus Oculi, Humans, Male, Scleral Diseases diagnostic imaging, Scleral Diseases metabolism, Ultrasonography, Visual Acuity, Calcinosis diagnosis, Choroid Diseases diagnosis, Scleral Diseases diagnosis
- Abstract
We studied 19 patients with sclerochoroidal calcification. The findings were bilateral in 16 patients and unilateral in the remaining three patients. The lesions, which were usually multifocal, had two characteristic appearances, plaque-like and tumorlike. Eleven patients had relatively flat, irregularly shaped, plaque-like, yellow-white lesions located between the arcades and the equator. Eight patients had more elevated tumorlike lesions, ranging up to 6 mm in height. All showed patterns on echography consistent with calcification. The calcification was often documented in both the choroid and sclera; sometimes it appeared only in the choroid, but never only in the sclera. Calcium metabolism appeared to be normal in all but two of the nine patients in whom it was investigated. Idiopathic sclerochoroidal calcification has a characteristic echographic and ophthalmoscopic appearance and may be more common than has been realized.
- Published
- 1992
35. A technique for facilitated visualization and dissection of the vitreous base, pars plana, and pars plicata.
- Author
-
Murray TG, Boldt HC, Lewis H, Abrams GW, Mieler WF, and Han DP
- Subjects
- Eye Diseases surgery, Humans, Retinal Diseases surgery, Vitreous Body surgery, Vitrectomy methods
- Abstract
We describe a technique to facilitate visualization of the vitreous base, pars plana, and pars plicata during vitreous surgery. This technique takes advantage of an externally applied fiberoptic light source coupled with scleral depression to enable direct viewing of the ciliary processes and anterior vitreous base. No special instrumentation or alteration in pars plana vitrectomy techniques is required. We have used this technique to enhance anterior dissection during vitrectomy surgery in the aphakic and pseudophakic eye associated with proliferative vitreoretinopathy, diabetic retinopathy, epithelial down-growth syndromes, and postvitrectomy fibrin formation.
- Published
- 1991
- Full Text
- View/download PDF
36. Echographic diagnosis of anterior hyaloidal fibrovascular proliferation.
- Author
-
Han DP, Lewandowski M, and Mieler WF
- Subjects
- Adult, Aged, Diabetic Retinopathy surgery, Eye diagnostic imaging, Female, Humans, Light Coagulation, Male, Retinal Detachment diagnostic imaging, Ultrasonography, Vitrectomy adverse effects, Eye blood supply, Intraoperative Complications diagnostic imaging, Neovascularization, Pathologic diagnosis, Vitreous Body diagnostic imaging
- Abstract
High-resolution contact B-scan echographic imaging of the ciliary body and peripheral retina was performed on five eyes with anterior hyaloidal fibrovascular proliferation and media opacity by means of a wide (58 degrees) scanning arc. This technique determined the circumferential and anteroposterior extent of peripheral traction retinal detachment associated with anterior hyaloidal fibrovascular proliferation, which correlated highly with findings at subsequent vitrectomy. Final visual acuity of 20/400 or better was achieved in the two eyes (50%) with more limited peripheral traction detachment. In the presence of media opacity, anterior echographic imaging may allow early detection of traction retinal detachment associated with anterior hyaloidal fibrovascular proliferation and may be useful in characterizing the severity of this condition.
- Published
- 1991
- Full Text
- View/download PDF
37. Ocular injuries caused by elastic cords.
- Author
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Nichols CJ, Boldt HC, Mieler WF, Han DP, and Olsen K
- Subjects
- Adult, Child, Eye Injuries, Penetrating etiology, Eye Protective Devices, Humans, Hyphema etiology, Lens Subluxation etiology, Male, Middle Aged, Retinal Detachment etiology, Retrospective Studies, Sclera injuries, Visual Acuity, Vitreous Hemorrhage etiology, Wounds, Nonpenetrating etiology, Eye Injuries etiology
- Abstract
Five patients with ocular trauma due to elastic cords with attached metal or plastic hooks were evaluated over a 13-month period. Injuries included hyphema, angle recession, lens subluxation, choroidal rupture, vitreous hemorrhage, retinal detachment, and scleral rupture. Two patients suffered penetrating ocular injuries, and three patients had final visual acuities of 20/200 or less. This series emphasizes the potential severity of ocular injury due to these commonly used devices and reiterates a modification in design that might decrease the likelihood of accidental trauma from elastic cords.
- Published
- 1991
- Full Text
- View/download PDF
38. Penetrating ocular injury from contaminated eating utensils.
- Author
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Feist RM, Lim JI, Joondeph BC, Pflugfelder SC, Mieler WF, Ticho BH, and Resnick K
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Bacteria drug effects, Bacteria isolation & purification, Child, Endophthalmitis drug therapy, Equipment Contamination, Eye Infections, Bacterial drug therapy, Eye Injuries, Penetrating etiology, Eye Injuries, Penetrating surgery, Female, Humans, Infant, Male, Middle Aged, Visual Acuity, Vitreous Body drug effects, Vitreous Body microbiology, Cooking and Eating Utensils, Endophthalmitis etiology, Eye Infections, Bacterial etiology, Eye Injuries, Penetrating complications
- Abstract
Although the rate of infectious endophthalmitis following penetrating ocular injury is generally less than 10%, certain settings may carry a greater risk of infection. One such setting is penetrating injury resulting from eating utensils contaminated with oral flora. We reviewed six of these injuries. Culture-positive bacterial endophthalmitis developed in four of the six eyes; only one of the eyes retained reading visual acuity (greater than 20/50) and two eyes lost light perception. The potential for infection and limited visual outcome in this series warrants aggressive prophylaxis and treatment. The unexpected isolation of Haemophilus influenzae in two of the four infections suggests that broad-spectrum antibiotic treatment should be considered in all such injuries since less common organisms may be encountered.
- Published
- 1991
- Full Text
- View/download PDF
39. A two-stage technique for intraoperative fluid-gas exchange following pars plana vitrectomy.
- Author
-
Williams DF, Peters MA, Abrams GW, Han DP, and Mieler WF
- Subjects
- Body Fluids metabolism, Eye metabolism, Gases metabolism, Humans, In Vitro Techniques, Intraoperative Care, Vitrectomy methods
- Abstract
We describe herein a two-stage technique of intraoperative fluid-gas exchange following pars plana vitrectomy. The first stage is a complete fluid-air exchange using an air pump and intraocular linear suction. The air pump then maintains the intraocular pressure at the desired level during adjunctive procedures, such as laser endophotocoagulation. The second stage is an air-gas mixture exchange in which the desired gas, premixed in air to the desired final intraocular concentration, is manually flushed through the eye. This technique allows the attainment of an accurate concentration of intraocular gas if the air-gas mixture exchange is complete. In vitro and in vivo experiments in aphakic human eyes demonstrated that an effectively complete air-gas mixture exchange occurs with a 25-mL flush volume. This result compares favorably with the theoretical prediction derived from a "pharmacokinetic approximation" equation.
- Published
- 1990
- Full Text
- View/download PDF
40. Management of traumatic hemorrhagic retinal detachment with pars plana vitrectomy.
- Author
-
Han DP, Mieler WF, Schwartz DM, and Abrams GW
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Drainage, Eye Foreign Bodies surgery, Female, Follow-Up Studies, Fundus Oculi, Humans, Male, Middle Aged, Prognosis, Retinal Detachment diagnosis, Retinal Detachment etiology, Retinal Hemorrhage diagnosis, Retinal Hemorrhage etiology, Ultrasonography, Eye Injuries, Penetrating complications, Retinal Detachment surgery, Retinal Hemorrhage surgery, Vitrectomy
- Abstract
Traumatic hemorrhagic retinal detachment may prevent successful visual rehabilitation of eyes with severe posterior segment injury. We managed 19 consecutive cases of traumatic hemorrhagic retinal detachment with pars plana vitrectomy, scleral buckling, and fluid-gas exchange, with or without internal drainage of subretinal hemorrhage. We based our approach on the amount of subretinal hemorrhage present and the location of associated retinal breaks. Internal drainage of subretinal hemorrhage was performed in 16 eyes to allow adequate retinopexy to hemorrhagically elevated retinal breaks (9 eyes), to remove massive subretinal hemorrhage (4 eyes), and to allow intraoperative reattachment when the retina exhibited bullous retinal detachment (3 eyes). Overall, with a minimum of 6 months of follow-up, anatomic reattachment was achieved in 13 (68%) of 19 eyes, and functional success (visual acuity 5/200 or better) was achieved in 6 (32%) of 19 eyes. Anatomic failure resulted from proliferative vitreoretinopathy (4 eyes) and globe atrophy (2 eyes). Drainage of subretinal blood appeared to be beneficial for hemorrhagically elevated retinal tears to allow adequate retinopexy and may help to accomplish long-term anatomic attachment in eyes with massive subretinal hemorrhage or bullous retinal detachment.
- Published
- 1990
- Full Text
- View/download PDF
41. Relaxing retinotomies and retinectomies. Surgical results and predictors of visual outcome.
- Author
-
Han DP, Lewis MT, Kuhn EM, Abrams GW, Mieler WF, Williams GA, and Aaberg TM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Intraocular Pressure, Male, Middle Aged, Prognosis, Reoperation, Retinal Detachment surgery, Scleral Buckling, Visual Acuity, Vitrectomy, Retina surgery, Retinal Diseases surgery
- Abstract
Functional and anatomic success after relaxing retinotomy may be limited by recurrent retinal detachment or severe hypotony. Fifty-four consecutive eyes undergoing relaxing retinotomy for proliferative vitreoretinopathy (42 eyes) and trauma (12 eyes) were analyzed to determine whether perioperative factors, including size and location of the retinotomy, influenced visual or anatomic outcome. After 6 months' minimum follow-up, anatomic success (retina attached posterior to buckle and an intraocular pressure of 3 mm Hg or more) was achieved in 35 eyes (64%). Functional success (visual acuity of 5/200 or better) was achieved in 14 eyes (26%). Factors predicting functional success by stepwise logistic regression analysis included a preoperative visual acuity of hand motions or better and location of the retinotomy in the superior four clock hours of the fundus. Causes of anatomic failure included proliferative vitreoretinopathy (11 eyes) and severe hypotony or phthisis (8 eyes). Superior location of the retinotomy and visual acuity of hand motions or better favorably influenced visual outcome after relaxing retinotomy.
- Published
- 1990
- Full Text
- View/download PDF
42. Combined phacoemulsification and pars plana vitrectomy.
- Author
-
Koenig SB, Han DP, Mieler WF, Abrams GW, Jaffe GJ, and Burton TC
- Subjects
- Adult, Aged, Cataract complications, Eye Diseases complications, Female, Follow-Up Studies, Humans, Lenses, Intraocular, Male, Middle Aged, Retinal Diseases complications, Retrospective Studies, Visual Acuity, Vitreous Body, Cataract Extraction methods, Vitrectomy methods
- Abstract
Combined phacoemulsification and pars plana vitrectomy were performed in eight eyes with cataract and vitreoretinal disease. Six eyes had tractional retinal detachment and/or nonclearing vitreous hemorrhage, one eye had a retained metallic intraocular foreign body, and one eye had a traumatic retinal detachment. In six eyes, a posterior chamber lens implant was placed in the capsular bag. Postoperative visual acuity improved in each case and ranged between 20/15 and 6/200. There were no perioperative complications, and the posterior chamber lens implant appeared well tolerated during an average follow-up interval of 8 months (range, 3 to 30 months). This technique allows endocapsular fixation of a posterior chamber lens and provides rapid visual rehabilitation with a single operation.
- Published
- 1990
- Full Text
- View/download PDF
43. Laser photocoagulation in the acute retinal necrosis syndrome.
- Author
-
Han DP, Lewis H, Williams GA, Mieler WF, Abrams GW, and Aaberg TM
- Subjects
- Acute Disease, Female, Fluorescein Angiography, Humans, Inflammation surgery, Iritis pathology, Male, Middle Aged, Necrosis, Retina pathology, Retinal Vessels, Syndrome, Vitreous Body surgery, Iritis surgery, Laser Therapy, Light Coagulation, Retinal Detachment surgery, Retinal Diseases surgery
- Abstract
Acute retinal necrosis (ARN) is a syndrome of fulminant necrotizing vaso-occlusive retinitis associated with a high incidence of retinal detachment due to retinal breaks and vitreous traction. We performed argon or krypton laser photo-coagulation to demarcate areas of active retinitis as prophylaxis against retinal detachment in five patients with ARN. Patients were concomitantly treated with antiviral agents, systemic steroids, and antiplatelet therapy. One patient required multiple additional treatments as retinal necrosis progressed. The retinas remained attached in all five patients over a mean follow-up period of 15 months. By creating a chorioretinal adhesion in areas of potential retinal break formation, laser photocoagulation may be an effective prophylaxis against retinal detachment in ARN.
- Published
- 1987
- Full Text
- View/download PDF
44. Ab interno sclerostomy with a high-powered argon endolaser. Clinicopathologic correlation.
- Author
-
Jaffe GJ, Mieler WF, Radius RL, Kincaid MC, Massaro BM, and Abrams GW
- Subjects
- Adult, Argon, Conjunctiva pathology, Cornea pathology, Female, Humans, Sclera pathology, Anterior Chamber pathology, Laser Therapy methods, Sclerostomy methods
- Abstract
A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic probe was used to create an ab interno sclerostomy in a patient undergoing enucleation for a blind painful eye. Despite the presence of diffuse rubeosis, 360 degrees peripheral anterior synechiae, and superior conjunctival scarring, it was possible to create a full-thickness defect from the anterior chamber angle to the subconjunctival space without operative complications. Six laser applications were required using 8 W of power per pulse and 0.1-second pulse duration. The eye was enucleated immediately after the laser procedure, prepared for light microscopy, and sectioned serially. Histologic analysis demonstrated a patent fistula approximately 300 microns in diameter with sharp wound margins. Tissue damage was localized to within 150 microns of the sclerostomy. The overlying conjunctiva was intact.
- Published
- 1989
- Full Text
- View/download PDF
45. Illuminated retinal picks for vitreous surgery.
- Author
-
Williams GA, Abrams GW, and Mieler WF
- Subjects
- Disposable Equipment, Equipment Design, Humans, Lighting, Retinal Diseases surgery, Vitrectomy instrumentation
- Abstract
We developed a new illuminated disposable retinal pick system for use in vitreoretinal surgery. These instruments facilitate bimanual dissection of proliferative tissue while allowing ocular endoillumination. We have found these instruments to be helpful in the management of complicated retinal detachment due to proliferative diabetic retinopathy or proliferative vitreoretinopathy.
- Published
- 1989
- Full Text
- View/download PDF
46. Photoablation of ocular melanoma with a high-powered argon endolaser.
- Author
-
Jaffe GJ, Mieler WF, Burke JM, and Williams GA
- Subjects
- Animals, Disease Models, Animal, Light Coagulation, Melanoma, Experimental pathology, Rabbits, Uveal Neoplasms pathology, Choroid, Laser Therapy adverse effects, Melanoma, Experimental surgery, Uveal Neoplasms surgery
- Abstract
We studied the use of a 15-W argon blue-green laser in the treatment of choroidal melanoma in a rabbit model. Greene melanoma cells were used to produce 2- to 4-mm thick tumors posteriorly in the suprachoroidal space in pigmented rabbits. Endophotocoagulation delivered through a 600-micron fiberoptic probe was performed to ablate the tumor tissue and a surrounding margin of normal tissue. A vitreous cutter was used simultaneously to remove liberated necrotic debris. The effect of the laser on tumor and normal ocular tissue was evaluated by light microscopy and the extent of the proliferative response by tritiated thymidine radioautography. Application of 100 to 400 pulses of laser energy using treatment parameters of 12 to 14 W of power and 0.1-s pulses resulted in complete ablation of melanoma tissue, overlying retina, and choroid. There was no substantial intraoperative or postoperative hemorrhage. Material liberated during the laser treatment was found to be nonviable. The effect of the laser on tissue appeared localized to within approximately 1.25 mm of the margin of the central lesion. The high-energy argon laser seems to offer a means of effectively ablating melanoma tissue via an internal resection approach.
- Published
- 1989
- Full Text
- View/download PDF
47. Ferromagnetic hyperthermia and iodine 125 brachytherapy in the treatment of choroidal melanoma in a rabbit model.
- Author
-
Mieler WF, Jaffe GJ, and Steeves RA
- Subjects
- Animals, Choroid Neoplasms pathology, Combined Modality Therapy, Disease Models, Animal, Ferric Compounds, Hyperthermia, Induced instrumentation, Iodine Radioisotopes therapeutic use, Magnetics, Melanoma pathology, Rabbits, Brachytherapy methods, Choroid Neoplasms therapy, Hyperthermia, Induced methods, Melanoma therapy
- Abstract
Hyperthermia has been combined with conventional radiation methods to achieve enhanced tumor destruction. We combined iodine 125 seeds with ferromagnetic thermoseeds in a single plaque to simultaneously deliver radiation and heat in a rabbit model of choroidal melanoma. Initially, six ferromagnetic thermoseeds were placed in parallel on a 14-mm episcleral plaque. The plaques were placed on normal rabbit eyes and on eyes containing transvitreally implanted choroidal melanoma. The heating response was assessed in both normal and tumor-containing eyes. Rigid copper-constantan and flexible Baily thermocouples were used to monitor temperature responses. The animals were subjected to an electromagnetic field of 100 kHz, with power of 1100 to 1500 W. The thermoseeds autoregulated at 48.2 degrees C. Scleral temperatures stabilized at 45.8 degrees C +/- 0.4 degrees C (SD), while temperatures at the base of the tumor stabilized at 43.6 degrees C +/- 0.1 degrees C. Ferromagnetic thermoseeds were then combined with iodine 125 seeds. Similar temperature responses were recorded, and autoradiographic findings confirmed a uniform radiation distribution. Varying the amount or type of ferromagnetic material in the thermoseeds allows the delivery of heat at virtually any temperature. Ferromagnetic hyperthermia may provide a more simplified approach over currently available methods of heat delivery.
- Published
- 1989
- Full Text
- View/download PDF
48. Echographic verification of radioactive plaque position in the treatment of melanomas.
- Author
-
Williams DF, Mieler WF, Lewandowski M, and Greenberg M
- Subjects
- Humans, Brachytherapy instrumentation, Choroid Neoplasms radiotherapy, Melanoma radiotherapy, Ultrasonography
- Abstract
Visualization of the position of an episcleral plaque in relation to the underlying choroidal melanoma during the early radiation treatment period reconfirms accurate plaque location and may help assure optimal treatment. We used high-resolution B-scan echography to confirm the position of the episcleral plaque in 16 consecutive cases of choroidal melanoma. The technique is most useful for well-defined tumors as small as 3 mm in height whose anterior border does not extend beyond the ora serrata.
- Published
- 1988
- Full Text
- View/download PDF
49. Vitrectomy for traumatic retinal incarceration.
- Author
-
Han DP, Mieler WF, Abrams GW, and Williams GA
- Subjects
- Adolescent, Adult, Child, Eye Injuries complications, Female, Humans, Male, Middle Aged, Retinal Detachment etiology, Eye Injuries surgery, Retina injuries, Retinal Detachment surgery, Vitrectomy
- Abstract
Traumatic retinal incarceration into a scleral wound may prevent successful surgical rehabilitation of eyes with severe posterior segment injury. We managed 15 consecutive eyes with traumatic retinal incarceration and associated retinal detachment with vitrectomy techniques. We based our approach on the anteroposterior location of the incarceration site and the amount of retina incarcerated into the wound. Despite successful anatomic reattachment in six of seven eyes with retinal incarceration posterior to the vortex vein ampullae, only two of seven eyes achieved visual acuity of 5/200 or better. In eyes with more peripheral retinal incarceration, anatomic reattachment was achieved in five of eight eyes and visual acuity of 5/200 or better was achieved in four eyes. Overall, a visual acuity of 5/200 or better was achieved in six (40%) of 15 eyes with a minimum follow-up of six months.
- Published
- 1988
- Full Text
- View/download PDF
50. Vitreous amyloidosis. Case report.
- Author
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Mieler WF, Williams DF, and Levin M
- Subjects
- Amyloidosis complications, Eye Diseases complications, Eye Diseases pathology, Female, Fundus Oculi, Humans, Microscopy, Electron, Middle Aged, Vision Disorders etiology, Amyloidosis pathology, Vitreous Body ultrastructure
- Published
- 1988
- Full Text
- View/download PDF
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