Ophthalmol Clin North Am
· 2005 Mar · PMID 15763190
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This article argues the case for the creation of a new group classification of intraocular retinoblastoma. The current Reese-Ellsworth group classification has not been updated since it was published 35 years ago. The pr...This article argues the case for the creation of a new group classification of intraocular retinoblastoma. The current Reese-Ellsworth group classification has not been updated since it was published 35 years ago. The proposed classification is based on the natural history of intraocular retinoblastoma and on the risk of loss of the eye following primary therapy.
Ophthalmol Clin North Am
· 2005 Mar · PMID 15763189
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Employment of animal models in basic research has significantly advanced the understanding of fundamental processes underlying tumorigenesis in retinoblastoma, including elucidating the complex role of pRb and other rela...Employment of animal models in basic research has significantly advanced the understanding of fundamental processes underlying tumorigenesis in retinoblastoma, including elucidating the complex role of pRb and other related protein products in cell cycle regulation, apoptosis, DNA damage responses, and terminal differentiation. The evolution of therapy for retinoblastoma has also been facilitated through translational research using in vivo models, including xenograft and genetically engineered systems. In retinoblastoma, these models provide a valuable preclinical context for testing the efficacy and safety of conventional chemotherapy, radiotherapy, or novel agents on tumor growth, tissue invasion, and metastasis.
Ophthalmol Clin North Am
· 2005 Mar · PMID 15763188
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Melanocytic conjunctival tumors include a wide range of lesions that vary in their clinical and histopathologic features. Their management depends on numerous factors, including their location, focality, tumor dimensions...Melanocytic conjunctival tumors include a wide range of lesions that vary in their clinical and histopathologic features. Their management depends on numerous factors, including their location, focality, tumor dimensions (including depth), histopathologic characteristics, recurrences, growth, and the presence of metastasis.
Ophthalmol Clin North Am
· 2005 Mar · PMID 15763187
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This article discusses ocular surface squamous neoplasia, a spectrum of malignancy that includes intraepithelial dysplasia, carcinoma in situ of the conjunctiva and cornea, and invasive squamous cell carcinoma.This article discusses ocular surface squamous neoplasia, a spectrum of malignancy that includes intraepithelial dysplasia, carcinoma in situ of the conjunctiva and cornea, and invasive squamous cell carcinoma.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533752
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Significant anterior segment complications can occur following periocular or intraocular injections. These complications may be intraoperative or postoperative. They vary with different procedures and may be secondary to...Significant anterior segment complications can occur following periocular or intraocular injections. These complications may be intraoperative or postoperative. They vary with different procedures and may be secondary to the surgical procedure or related to drug toxicity. Cataract and increased intraocular pressure are the most frequent complications. Other less commonly reported complications include hypotony, hyphema, corneal decompensation, strabismus, and cosmetic complications.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533751
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The management of retinopathy of prematurity (ROP) has changed over the last 20 years. Screening and treatment protocols have been established to provide timely therapy to infants at risk. Cryotherapy, laser photoablatio...The management of retinopathy of prematurity (ROP) has changed over the last 20 years. Screening and treatment protocols have been established to provide timely therapy to infants at risk. Cryotherapy, laser photoablation, vitrectomy, and scleral buckling have proven effective but also have inherent risks of complications. The anterior segment complications related to ROP therapy are presented herein.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533750
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Vitrectomy is the most common surgical technique performed in eyes with vitreoretinal disease. The development and widespread use of vitreous substitutes has revolutionized vitreoretinal surgery and improved anatomic and...Vitrectomy is the most common surgical technique performed in eyes with vitreoretinal disease. The development and widespread use of vitreous substitutes has revolutionized vitreoretinal surgery and improved anatomic and visual results. The three most common types of vitreous substitutes available in North America include silicone oil, intraocular gas, and perfluorocarbon liquid. Each of these agents has unique properties, allowing completely different roles of the agents in vitreoretinal surgery. The physical properties, clinical indications, and potential complications of these agents are described.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533749
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Although cataract is widely described among the complications of vitrectomy, the precise relationship between vitrectomy and the development of lens opacity is not completely understood. This article presents an extensiv...Although cataract is widely described among the complications of vitrectomy, the precise relationship between vitrectomy and the development of lens opacity is not completely understood. This article presents an extensive literature review and the authors' personal experience with this complication.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533748
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This article discusses the early and late postoperative complications of scleral buckling involving the anterior segment of the eye. Emphasis is placed on the incidence, pathogenesis, clinical presentation, and treatment...This article discusses the early and late postoperative complications of scleral buckling involving the anterior segment of the eye. Emphasis is placed on the incidence, pathogenesis, clinical presentation, and treatment of each complication. Preventive measures are also discussed.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533747
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Anterior segment ischemia is a rare complication of posterior segment surgery with a broad spectrum of presentations. Most frequently, it follows a mild self-limited course. Cases that are more prominent usually result f...Anterior segment ischemia is a rare complication of posterior segment surgery with a broad spectrum of presentations. Most frequently, it follows a mild self-limited course. Cases that are more prominent usually result from a co-incidence of precipitating factors. Recognition of precipitating factors and appropriate action can avoid anterior segment ischemia. Management includes nonspecific steps, such as topical medications (ie, corticosteroids and cycloplegics) and face-mask and eye-mask oxygen delivery, as well as specific steps related to the underlying cause (eg, removal of an encircling scleral buckle).
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533746
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Recent advances in the instrumentation and surgical techniques for posterior segment surgery permit better anatomic and functional outcomes. Nevertheless, these procedures may be associated with complications involving t...Recent advances in the instrumentation and surgical techniques for posterior segment surgery permit better anatomic and functional outcomes. Nevertheless, these procedures may be associated with complications involving the anterior segment, including postoperative inflammation and hypotony. One must differentiate infectious from noninfectious inflammation to initiate appropriate therapy promptly. Hypotony is a frustrating problem because it is difficult to reverse. The exclusion of eyes with other known causes of hypotony is important before establishing the putative mechanism of tractional ciliary body detachment caused by epiciliary proliferative tissue.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533745
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Retinal surgery can induce significant refractive errors. These errors include spherical changes caused by alterations in axial length after scleral buckle placement, astigmatic changes induced by a scleral buckle or par...Retinal surgery can induce significant refractive errors. These errors include spherical changes caused by alterations in axial length after scleral buckle placement, astigmatic changes induced by a scleral buckle or pars plana vitrectomy, and focal alterations in corneal curvature that can significantly limit postoperative visual acuity. The adjunctive use of silicone oil can impose alterations directly, by the oil's interaction with the other refractive elements of the eye, and indirectly, through its effects on intraocular lens power calculations for subsequent cataract surgery.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533744
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Significant corneal compromise can occur subsequent to vitreoretinal surgery, especially in diabetic corneas. Associated factors include the operating lens systems used, irrigating solutions, preoperative lens and anteri...Significant corneal compromise can occur subsequent to vitreoretinal surgery, especially in diabetic corneas. Associated factors include the operating lens systems used, irrigating solutions, preoperative lens and anterior capsule status, and the use of adjunctive agents such as intraocular gasses or silicone oil. Corneal, conjunctival, and ocular surface complications can also occur after scleral buckling procedures, often related to buckle extrusion or infection.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533743
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Elevated intraocular pressure is a common occurrence following vitreoretinal surgery. The use of silicone oil or intravitreal gas in conjunction with pars plana vitrectomy increases the likelihood of postoperative intrao...Elevated intraocular pressure is a common occurrence following vitreoretinal surgery. The use of silicone oil or intravitreal gas in conjunction with pars plana vitrectomy increases the likelihood of postoperative intraocular pressure elevation. Fortunately, the pressure elevation is usually transient and managed medically. In certain instances, surgical intervention is warranted. Therapeutic intervention should be tailored to the individual patient based on the mechanism of pressure elevation.
Ophthalmol Clin North Am
· 2004 Dec · PMID 15533742
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Persistent diplopia following posterior segment surgery is not uncommon. There are several causes of postoperative strabismus, some of which are preventable. Knowledge of the possible causes, proper evaluation, and appro...Persistent diplopia following posterior segment surgery is not uncommon. There are several causes of postoperative strabismus, some of which are preventable. Knowledge of the possible causes, proper evaluation, and appropriate treatment can eliminate or at least reduce the morbidity from this unwelcome postoperative surprise.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337202
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Toxic optic neuropathy refers to the ingestion of a toxin or an adverse drug reaction that results in vision loss from optic nerve damage. Patients may present with bilateral sudden loss of vision in the setting of an ac...Toxic optic neuropathy refers to the ingestion of a toxin or an adverse drug reaction that results in vision loss from optic nerve damage. Patients may present with bilateral sudden loss of vision in the setting of an acute intoxication or an insidious asymmetric loss of vision from an adverse drug reaction. Toxins and drugs associated with a toxic optic neuropathy may directly harm the optic nerve; however, some drugs are associated with an ischemic optic neuropathy or optic neuritis, in which optic nerve damage is an indirect effect of the causative agent. The most important aspect of treatment is recognition and drug withdrawal. Patients need to be appropriately counseled, particularly in the setting of amiodarone-associated optic neuropathy.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337201
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This article reviews the neuroimaging modalities commonly used in neuro-ophthalmology. These modalities are illustrated with several cases in an atlas format to highlight the differences between each technique. The focus...This article reviews the neuroimaging modalities commonly used in neuro-ophthalmology. These modalities are illustrated with several cases in an atlas format to highlight the differences between each technique. The focus is a review of MRI, MR angiography, CT,CT angiography, and digital subtraction angiography.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337200
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Although direct injury to the orbit and globes can easily result in ophthalmologic disorders, it is less appreciated that distant head injury can similarly result in injury to the retrobulbar afferent visual pathways or...Although direct injury to the orbit and globes can easily result in ophthalmologic disorders, it is less appreciated that distant head injury can similarly result in injury to the retrobulbar afferent visual pathways or cranial nerves. The physician must be suspicious of latent and manifest injuries to the neuro-ophthalmologic system after head trauma and maintain an awareness of the need for timely intervention in a subset of these disorders. Even patients with injuries removed from the eyes should be checked for visual problems, and if any are detected, a careful neuro-ophthalmologic examination should be performed. In most cases, examination and judicious use of neuroimaging will help in choosing the appropriate management for injuries to the afferent and efferent visual systems.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337199
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Although paraneoplastic syndromes are not common, their recognition is important. Diagnosis of a paraneoplastic disorder can lead to the diagnosis of an underlying tumor or avoid the continued search for metastasis in a...Although paraneoplastic syndromes are not common, their recognition is important. Diagnosis of a paraneoplastic disorder can lead to the diagnosis of an underlying tumor or avoid the continued search for metastasis in a patient who has a known cancer. In addition, appropriate diagnosis leads to providing appropriate treatment and prognostic information.
Ophthalmol Clin North Am
· 2004 Sep · PMID 15337198
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Genetic disorders can cause a broad range of optic nerve pathology. Clinical symptoms and examination findings of optic nerve dysfunction may provide early clues to the presence of inherited genetic disease. For many dis...Genetic disorders can cause a broad range of optic nerve pathology. Clinical symptoms and examination findings of optic nerve dysfunction may provide early clues to the presence of inherited genetic disease. For many disorders, molecular genetic testing is available for the diagnosis of affected individuals and the identification of unaffected carriers. This article surveys a broad array of systemic genetic disorders affecting the optic nerve, reviewing their ocular manifestations, systemic findings, and clinical genetics.