摘要:

The detection and treatment of choroidal melanoma early in its natural course is critical to providing the patient with the best prognosis. Patients with small choroidal melanoma (< 4 mm thickness) develop metastasis in 16% of cases at 5 years follow up, whereas those with medium choroidal melanoma (4–8 mm thickness) and large choroidal melanoma (> 8 mm thickness) develop metastasis in 32 and 53%, respectively. The difficulty with early detection of choroidal melanoma relates to its clinical similarity to benign choroidal nevus. Factors that differentiate small choroidal melanoma from choroidal nevus can be remembered using the mnemonic TFSOM, indicating To Find Small Ocular Melanoma. The letters in this mnemonic represent T (Thickness >2 mm), F (subretinal Fluid), S (Symptoms), O (Orange pigment), and M (Margin touching optic disc). Choroidal melanocytic tumors that display 0 factors have 3% chance for growth at 5 years and most likely represent choroidal nevi. Tumors that display one factor have a 38% chance for growth and those with two or more factors show growth in over 50% of cases at 5 years. Most of those tumors with two or more risk factors probably represent small choroidal melanoma and early treatment is generally indicated. Therefore, ophthalmologists should be aware of the important factors that identify small choroidal melanoma so that early treatment and better life prognosis can be achieved for their patients.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Retinal arteriolar emboli can be found in approximately 1% of adults more than 40 years of age. The frequency of retinal emboli increases with age and are more common in men than in women. Bilateral retinal emboli are rare, although multiple emboli in a single eye may be seen in up to one third of cases. Retinal emboli are associated with the presence of carotid artery plaque and stenosis, hypertension, cigarette smoking, and, possibly, diabetes. There are few prospective studies regarding the risk of stroke associated with retinal emboli. Available data suggest that retinal emboli in otherwise asymptomatic people are associated with a higher risk of stroke and stroke mortality, independent of conventional risk factors. Therefore, these patients are likely to benefit from a careful cardiovascular evaluation for risk stratification. Whether carotid ultrasound and other vascular imaging studies should be performed routinely for all patients with asymptomatic retinal emboli remains uncertain.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This paper reports the results of an exploratory analysis among patients in the Endophthalmitis Vitrectomy Study to determine if there was a different response to treatment in diabetes and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients. Patients in this multicenter clinical trial were followed for 9 months after random assignment to either vitrectomy or tap/biopsy. Outcome measures included visual acuity assessed in standardized fashion. Fifty-eight of 420 study patients were diabetic. Diabetics presented with slightly worse vision and ocular media. Only 39% of diabetics compared with 55% of nondiabetics achieved 20/40 final vision. Both diabetic and nondiabetic patients who presented with vision of only light perception (LP) had better visual results with immediate vitrectomy. For those who presented with better than LP vision, diabetics achieved 20/40 more often with vitrectomy (57%) than with tap/biopsy (40%), but non diabetics did equally well with vitrectomy or tap/biopsy. In the diabetic group, small numbers did not allow adequate statistical power to test treatment difference. A new clinical trial is needed to determine if in fact there is a difference in response to treatment among diabetic and nondiabetic patients who present with better than LP vision.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recent innovations in macular imaging and surgery have provided important new information concerning the pathogenesis and treatment of idiopathic macular hole. New imaging data suggest that localized perifoveal vitreous detachment (an early stage of age-related posterior vitreous detachment) is the primary pathogenic event in idiopathic macular hole formation. Detachment of the posterior hyaloid from the pericentral retina exerts anterior traction on the foveola and localizes into the foveola the dynamic vitreous traction associated with ocular rotations. Optical coherence tomography has clarified the pathoanatomy of early macular hole stages, beginning with a foveal pseudocyst (stage 1A) and typically followed by disruption of the outer retina (stage 1B) before progressing to a full-thickness dehiscence (stage 2). The treatment of macular hole continues to evolve as modifications to the standard surgical procedure are proposed and evaluated. These innovations include the use of cytokine adjuvants, peeling of the internal limiting membrane, vital staining of the internal limiting membrane with indocyanine green dye, and variations in the length of postoperative face-down positioning.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Branch retinal vein occlusion (BRVO) is second only to diabetic retinopathy as a cause of retinal vascular disease. Vision loss from BRVO may be associated with multiple causes, including macular edema, macular ischemia, foveal hemorrhage, vitreous hemorrhage, epiretinal membrane, and retinal detachment. The few published studies that report outcomes of pars plana vitrectomy for complications of BRVO consist only of case reports and small case series, limitations of which include small sample sizes and lack of comparison groups. Given the variable outcomes among patients with untreated BRVO, comparison groups are necessary for accurate evaluation of the efficacy of pars plana vitrectomy for BRVO.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recent trends have indicated that the home and recreational environment have become the most common settings for bungee cord-related ocular trauma. Bungee cords are commonly used to secure items to automobile rooftops and to bicycle racks. The annual incidence of reported ocular injuries secondary to bungee cords has steadily climbed in recent years, and the frequency of bungee cord-related injuries is likely to continue to grow with the ever increasing popularity of sports such as skiing, bicycling, and windsurfing. The elastic recoil of a bungee cord can generate tremendous force, capable of producing severe blunt and penetrating ocular trauma. Though wearing safety glasses while handling bungee cords would likely eliminate a majority of bungee cord injuries, the public has yet to show that they are willing to wear eye protection during recreational activities that pose a risk of ocular trauma. In addition to educating consumers regarding proper safety techniques, bungee cord manufacturers should consider making alterations in the design of bungee cords to significantly reduce the potential for ocular injuries.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the United States and other western nations. Limited treatment is available, and there are no established means of prevention. The detection of modifiable risk factors is important to suggest preventive behaviors that can reduce disease occurrence or prevent the progression to the late stages of AMD. Results of recent studies suggest that the etiology and pathogenesis of AMD are a complex interaction of genetic and external factors. Although a number of factors seem promising, only age and cigarette smoking are confirmed as increasing AMD risk. Other factors that most likely play a significant role in AMD are nutritional factors,eg,antioxidants, and hypertension or other underlying atherosclerotic disease processes. The results of the Age-Related Eye Disease Study suggest a moderate beneficial effect of antioxidant, vitamin, and zinc supplementation in reducing progression to severe AMD.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID