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Mezad-Koursh D, Klein A, Rosenblatt A, Roth S, Neudorfer M, Loewenstein A, Iglicki M, Zur D. Response to: Comment on: "Peripapillary hyperreflective ovoid mass-like structures-a novel entity as frequent cause of pseudopapilloedema in children". Eye (Lond) 2022; 36:2068. [PMID: 35066578 PMCID: PMC9499942 DOI: 10.1038/s41433-021-01908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Daphna Mezad-Koursh
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ainat Klein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Rosenblatt
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Roth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meira Neudorfer
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matias Iglicki
- Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Leshno A, Barak A, Barzelay A, Zloto O, Neudorfer M. Diagnosis of Peripheral Retinoschisis Using Ultrasound Biomicroscopy. Ophthalmic Surg Lasers Imaging Retina 2020; 50:e196-e202. [PMID: 31415704 DOI: 10.3928/23258160-20190806-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/17/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Retinal imaging can help differentiate retinoschisis (RS) from retinal detachment (RD). This study describes new sonographic features of RS using ultrasound biomicroscopy (UBM) and evaluates their diagnostic value. PATIENTS AND METHODS Medical records of subjects diagnosed with RS and RD who underwent imaging prior to intervention were reviewed. Images were evaluated for detachment shape ultrasound (US) B-mode, as well as presence of intraretinal pillars, retinal layers split, and intraretinal cysts on UBM. RESULTS Of 48 eyes from 48 patients in the study, 25 were diagnosed as RS and 23 as RD. "Retinal layers split" was the most common UBM finding in the RS group (72%), followed by intraretinal pillars (64%) and intraretinal cysts (36%). No RD case exhibited these findings (P < .001). CONCLUSIONS UBM might assist in difficult cases to differentiate between RS and RD by detection of the unique sonographic features of RS described herein. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e196-e202.].
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Mezad-Koursh D, Rosenblatt A, Cohen S, Neudorfer M, Keynan I, Stolovitch C, Zur D. Accuracy of the Ultrasound Biomicroscopy Bag/Balloon Technique in Locating Horizontal Extraocular Muscle Insertions Before and After Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2020; 57:12-20. [PMID: 31972035 DOI: 10.3928/01913913-20191115-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/22/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the accuracy of high frequency ultrasound biomicroscopy using the bag/balloon technique to locate recti muscle insertions before and after strabismus surgery. METHODS This was a prospective masked study. The distance from the limbus to horizontal recti muscle insertions was measured by caliper intraoperatively and ultrasound biomicroscopy preoperatively and during follow-up. Accuracy was defined as the difference between ultrasound biomicroscopy and caliper measurements. RESULTS Thirty-nine muscles (19 medial rectus and 20 lateral rectus) of 22 patients were included. The mean age of the patients was 34.7 ± 15.5 years (range: 18 to 78 years). Follow-up measurements were available for 25 muscles: 12 muscles were recessed and 13 were resected/advanced. Twelve of the included muscles underwent prior surgery. There was a strong correlation between preoperative mean ultrasound biomicroscopy and caliper measurements (P < .001, rp = 0.872) without significant difference between the accuracy of identification of medial rectus and lateral rectus muscles (P = .116 and .377, respectively). On average, postoperative ultrasound biomicroscopy measurements of recessed muscles were 1.15 mm greater than caliper measurements at the end of surgery (P = .003), whereas the mean difference in the resected muscles was not statistically significant (-0.07 mm, P > .999). Overall, in 16 of 25 muscles (64%), the differences between the postoperative measurements and the end of surgery measurements were less than 1 mm. There was no correlation between the accuracy and the time of ultrasound biomicroscopy after surgery (P = .516). CONCLUSIONS The ultrasound biomicroscopy bag/balloon technique is an accurate and reliable method of locating recti muscle insertions before and after strabismus surgery. Ultrasound biomicroscopy may assist strabismologists in planning repeated operations. [J Pediatr Ophthalmol Strabismus. 2020;57(1):12-20.].
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Keren S, Leibovitch I, Ben Cnaan R, Neudorfer M, Fogel O, Greenman Y, Shulman S, Zur D, Habot‐Wilner Z. Aminobisphosphonate-associated orbital and ocular inflammatory disease. Acta Ophthalmol 2019; 97:e792-e799. [PMID: 30816018 DOI: 10.1111/aos.14063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/31/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Aminobisphosphonates may cause orbital/ocular inflammation. Awareness of the clinical presentation and disease course is crucial. The purpose of this study was to analyse demographics, clinical presentation, disease course and treatment of aminobisphosphonate-associated orbital/ocular inflammation in a large series of patients. METHODS A retrospective study of patients with aminobisphosphonate-associated orbital/ocular inflammation and a literature review to differentiate disease presentation and course between various aminobisphosphonates. RESULTS Eight patients from our institution (6 women and 2 men, median age 62 years) were included. The used drugs were zoledronate, alendronate and risedronate. The most common clinical presentation was conjunctival hyperaemia/chemosis. Scleritis was the most common manifestation, followed by diffuse orbital inflammation and anterior uveitis. Ultrasound aided in diagnosis in all our patients. The aminobisphosphonate was halted in all patients, and some patients had anti-inflammatory treatment. Literature review included 68 patients (83 eyes), of them the most abundant drugs causing orbital/ocular inflammation were pamidronate (38 eyes) and zoledronate (35 eyes). Overall, among 76 patients, all drugs induced orbital disease, while uveitis was induced mostly by zoledronate and pamidronate, less by alendronate and not found among risedronate users. Time interval from drug administration to symptoms was hours to 28 days. Resolution was achieved in all patients, after 1-60 days from disease presentation, and the longer resolution period was found among alendronate users. CONCLUSION Orbital/ocular inflammation was mostly caused by intravenous aminobisphosphonates. Uveitis was not induced by risedronate. The putative aminobisphosphonate should be halted at the onset of orbital/ocular involvement and prognosis is favourable.
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Affiliation(s)
- Shay Keren
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Igal Leibovitch
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Ran Ben Cnaan
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Meira Neudorfer
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Ortal Fogel
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Shiri Shulman
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Dinah Zur
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Zohar Habot‐Wilner
- Division of Ophthalmology Tel‐Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
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Neudorfer M, Fuhrer A, Zur D, Barak A. Reply: The role of posterior vitreous detachment on the efficacy of anti–vascular endothelial growth factor intravitreal injection for treatment of neovascular age-related macular degeneration. Indian J Ophthalmol 2019; 67:1784. [PMID: 31546570 PMCID: PMC6786158 DOI: 10.4103/ijo.ijo_1097_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Neudorfer M, Fuhrer AE, Zur D, Barak A. The role of posterior vitreous detachment on the efficacy of anti-vascular endothelial growth factor intravitreal injection for treatment of neovascular age-related macular degeneration. Indian J Ophthalmol 2018; 66:1802-1807. [PMID: 30451182 PMCID: PMC6256908 DOI: 10.4103/ijo.ijo_373_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: A prospective cohort study investigating the effect of posterior vitreous detachment (PVD) on the efficacy of intravitreal bevacizumab for exudative age-related macular degeneration (AMD), in view of evidence that the vitreoretinal interface impacts the severity of the disease. Methods: Treatment-naïve AMD eyes with (+) complete PVD and without (−) PVD on ultrasonography received three monthly and then pro re nata bevacizumab injections. Best-corrected visual acuity (BCVA) on Snellen charts and optical coherence tomography (OCT) findings were recorded for 12 months. Secondary analysis included PVD definition and group allocation according to OCT baseline scan. Results: Forty-one eyes of 34 patients met the inclusion criteria. At 12 months, median BCVA improved by 0.12 logMAR in the PVD+ group [interquartile range (IQR) −0.52, 0.03, P = 0.140] and remained the same in the PVD− group (IQR −0.12, 0.15, P = 0.643). Median central retinal thickness improved by 43.5 μm and 43 μm in the PVD+ (IQR −143, 3, P = 0.016) and PVD− group (IQR −90, −14, P = 0.008), respectively. All parameters were similar in the two groups at final follow up (P > 0.05). The secondary analysis included 32 eyes of 26 patients and showed no significant differences between the groups at the 12 months endpoint (P > 0.05). Conclusion: Our findings show no significant impact of PVD as assessed by ultrasound or by OCT on visual and anatomical outcomes in exudative AMD treated with bevacizumab.
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Affiliation(s)
- Meira Neudorfer
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Audelia Eshel Fuhrer
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Adiel Barak
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
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Zur D, Frenkel S, Leshno A, Iglicki M, Ben-Artzi Cohen N, Khoury A, Martínez Cartier M, Barak A, Moroz I, Loewenstein A, Neudorfer M, Vishnevskia-Dai V. Subretinal Fluid Optical Density and Spectral-Domain Optical Coherence Tomography Characteristics for the Diagnosis of Circumscribed Choroidal Hemangioma. Ophthalmologica 2018; 241:195-201. [DOI: 10.1159/000492948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/15/2018] [Indexed: 11/19/2022]
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Merimsky O, Inbar M, Groswasser-Reider I, Neudorfer M, Chaitchik S. Sphenoid and Cavernous Sinuses Involvement as First Site of Metastasis from a Fallopian Tube Carcinoma. Case Report. Tumori 2018; 79:444-6. [PMID: 8171748 DOI: 10.1177/030089169307900615] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The occurrence of central nervous system metastases in ovarian cancer patients ranges from 0.88 to 4.5 %. Centra nervous system involvement in a fallopian tube carcinoma is extremely rare. A 77-year-old woman with an invasive tubal carcinoma was admitted because of ophthalmoplegia, sparing the lateral rectus muscle of the left eye, a decreased left corneal reflex and hypoesthesia along the distribution of the ophthalmic and maxillary branches of the left trigeminal nerve. CT scan showed a space occupying lesion in the left sphenoid sinus invading the left cavernous sinus and the submucosa of the left lateral wall of the nasopharynx, proven histologically to be a metastasis from her primary cancer. Attention should be paid to the possibility of distant and unusual metastases associated with tubal cancer in order to treat the patients promptly.
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Affiliation(s)
- O Merimsky
- Department of Oncology, Tel Aviv Sourasky Medical Center, Israel
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Blum Meirovitch S, Leibovitch I, Kesler A, Varssano D, Rosenblatt A, Neudorfer M. Retina and Nerve Fiber Layer Thickness in Eyes with Thyroid-Associated Ophthalmopathy. Isr Med Assoc J 2017; 19:277-281. [PMID: 28513113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Thyroid-associated ophthalmopathy (TAO) is an inflammatory disease that affects the thyroid gland and the eye orbit. Of patients with TAO, 3%-5% have severe sight-threatening disease due to optic neuropathy Optical coherence tomography (OCT), the non-invasive imaging technology that yields high-resolution cross-sectional images of the retina, provides qualitative and quantitative data on the retina. OBJECTIVES To apply this technique to quantitatively assess retinal nerve fiber layer (RNFL) and macular ring thicknesses in healthy subjects and in patients with TAO to determine their relationship to the severity of the orbital disease. METHODS All patients in the ophthalmology clinic who were diagnosed with TAO and underwent OCT imaging as part of their ocular examination comprised the study group, and healthy patients who volunteered to undergo OCT examination served as controls. Results of the complete ophthalmologic examination and OCT findings were collected from medical files, including the thickness of the RNFL and the macula. RESULTS The study comprised 21 patients and 41 healthy controls. TAO patients exhibited RNFL thickening and inner macula thinning compared to healthy subjects. Mean RNFL thickness was correlated with the severity of the orbital disease. CONCLUSIONS The OCT findings suggest that the retina is involved in TAO, probably as early as the subclinical stage. This highlights the ability of OCT to identify retinal changes earlier and far more accurately than is detected today, enabling earlier diagnosis and more timely treatment to prevent severe visual sequelae.
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Affiliation(s)
- Sharon Blum Meirovitch
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igal Leibovitch
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Kesler
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Varssano
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Rosenblatt
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meira Neudorfer
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zur D, Neudorfer M, Shulman S, Rosenblatt A, Habot-Wilner Z. High-resolution ultrasound biomicroscopy as an adjunctive diagnostic tool for anterior scleral inflammatory disease. Acta Ophthalmol 2016; 94:e384-9. [PMID: 26892270 DOI: 10.1111/aos.12995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/24/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To study high-resolution ultrasound biomicroscopy (UBM) findings in anterior scleral inflammatory disease and evaluate the efficacy of high-resolution UBM as an adjunctive diagnostic tool. METHODS A cross-sectional study. The medical records of 30 patients (33 eyes) with episcleritis or anterior scleritis were reviewed for clinical features and high-resolution UBM findings. Ultrasound biomicroscopy (UBM) examination was performed using 50 MHz Aviso S (Quantel Medical, Clermont-Ferrand, France). RESULTS Seventeen eyes had episcleritis [nodular (12), simple (five)], and 16 eyes had anterior scleritis [nodular (14), diffuse (two)] as classified by UBM. The use of high-resolution UBM allowed high-resolution imaging of the sclera and episclera and showed characteristic patterns of episcleritis and anterior scleritis. The clinical classification matched UBM findings in 25 (76%) eyes. In the other eight eyes (24%), UBM analysis led to a change in the final classification: four eyes with suspected episcleritis were classified with scleritis, and four eyes with suspected scleritis were classified with episcleritis. Eleven patients (36.7%) had an associated systemic disease. CONCLUSION High-resolution UBM enabled visualization of distinct imaging findings of episcleritis and anterior scleritis, indicating its usefulness in the classification of challenging cases of anterior scleral inflammatory disease.
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Affiliation(s)
- Dinah Zur
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Meira Neudorfer
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shiri Shulman
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Amir Rosenblatt
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Mintz HR, Waisbourd M, Kessner R, Stolovitch C, Dotan G, Neudorfer M. Macular Thickness Following Strabismus Surgery as Determined by Optical Coherence Tomography. J Pediatr Ophthalmol Strabismus 2016; 53:11-5. [PMID: 26835996 DOI: 10.3928/01913913-20160113-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/28/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate macular changes following strabismus surgery by using optical coherence tomography (OCT). METHODS The authors prospectively evaluated 60 eyes of 30 patients undergoing unilateral extraocular muscle surgery. OCT measurements employing the fast macular thickness mapping protocol were performed 1 day prior to surgery and 1 day postoperatively. Postoperative macular changes in the study eye that was operated on (n = 30) were compared with the fellow control eye (n = 30, controls). RESULTS There was an increase in mean ± standard deviation central foveal thickness (CFT) in the operated eyes, from 201.63 ± 18.36 µm at baseline to 206.03 ± 22.73 µm postoperatively (P = .024). Preoperative and postoperative perifoveal outer temporal quadrant thicknesses were 220.10 ± 16.23 and 225.80 ± 14.78 µm, respectively (P = .009). There were no differences between preoperative and postoperative retinal thickness measurements for all measured areas in the control eyes. Eyes that underwent surgery involving the rectus muscles showed a trend toward a greater CFT increase compared with eyes that had oblique muscle surgery (P = .070). CONCLUSIONS The authors found subclinical increases in the foveal and perifoveal macular thicknesses following extraocular muscle surgery. These findings could be attributed to change in the mechanical forces caused by the new position of the extraocular muscles and transmitted via the sclera or, alternatively, to postoperative inflammation and alterations in the blood-retinal barrier. The clinical implications of these findings remain to be clarified.
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Koenigstein D, Neudorfer M, Goldenberg D, Habot-Wilner Z. CHOROIDAL EFFUSION AS AN OCULAR MANIFESTATION OF IMMUNOGLOBULIN G4-RELATED DISEASE. Retin Cases Brief Rep 2016; 10:197-200. [PMID: 26484804 DOI: 10.1097/icb.0000000000000223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To report a unique ocular manifestation of immunoglobulin G4-related disease (IgG4-RD) as choroidal effusion. METHODS Case report. RESULTS An 81-year-old man presented with clinical manifestations of choroidal effusion, confirmed by fluorescein angiography, ophthalmic ultrasound (posterior segment), high-frequency ultrasound biomicroscopy, Heidelberg Spectralis spectral domain optical coherence tomography, and enhanced depth imaging spectral domain optical coherence tomography. Systemic multi-organ findings included chronic pancreatitis, irregularity of the intrahepatic bile ducts, lymphadenopathy, aortitis, fibrotic changes of the lungs, hypophysitis, and sialadenitis. Extensive workup revealed elevated IgG4 serum levels, and lymph nodes biopsy showed reactive pattern with polyclonal IgG4 positive plasma cells. These findings were compatible with IgG4-related disease. Treatment with oral corticosteroids resulted in complete resolution of the choroidal effusion. CONCLUSION Choroidal effusion may be an ocular manifestation of IgG4-related disease. Oral corticosteroids is an effective treatment. Ophthalmologists should be aware of this possible finding.
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Affiliation(s)
- Dvir Koenigstein
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Leshno A, Barak A, Loewenstein A, Weinberg A, Neudorfer M. Optical Density of Subretinal Fluid in Retinal Detachment. Invest Ophthalmol Vis Sci 2015; 56:5432-8. [PMID: 26284548 DOI: 10.1167/iovs.15-16952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the changes over time in optical density (OD) characteristics of subretinal fluid (SRF) in rhegmatogenous retinal detachment (RRD) and their clinical relevance. METHODS The study included patients with first-onset RRD and no history of intraocular illness who underwent optical coherence tomography (OCT) and whose OCT scans showed sufficient SRF for sampling (08/2013-09/2014). The highest quality B-scan (as graded by the OCT image acquisition software) containing SRF was analyzed. Optical density measurements were obtained using ImageJ. Optical density ratios (ODRs) were calculated as SRF OD divided by vitreous OD. Time from onset of RRD was determined by first signs of visual loss as described in the patient's anamnesis. Patients were divided into three groups by RRD duration: acute (≤1 week), subacute (between 1 week and 1 month), and chronic (>1 month). RESULTS Thirty-five eyes (34 patients) met the inclusion criteria. The ODR measurement was significantly associated with RRD duration. The ODR had a significant (P < 0.0001) association with the 3-month postoperative visual acuity (VA). Vitreous OD did not differ significantly between the three groups. CONCLUSIONS The increase over time in the ODR of the SRF in RRD might reflect a change in SRF composition and state of the retina. This, together with a significant association between preoperative ODR values and postoperative VA suggest its potential as a biological prognostic marker.
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Kornhauser T, Schwartz R, Goldstein M, Neudorfer M, Loewenstein A, Barak A. Bevacizumab treatment of macular edema in CRVO and BRVO: long-term follow-up. (BERVOLT study: Bevacizumab for RVO long-term follow-up). Graefes Arch Clin Exp Ophthalmol 2015; 254:835-44. [DOI: 10.1007/s00417-015-3130-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/05/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022] Open
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Neudorfer M, Kessner R, Goldenberg D, Lavie A, Kessler A. Retrobulbar blood flow changes in eyes with diabetic retinopathy: a 10-year follow-up study. Clin Ophthalmol 2014; 8:2325-32. [PMID: 25473257 PMCID: PMC4247149 DOI: 10.2147/opth.s71158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We sought to assess long-term changes in the flow parameters of retrobulbar vessels in diabetic patients. Methods The retrobulbar circulation of 138 eyes was evaluated between 1994 and 1995 and 36 eyes were reevaluated between 2004 and 2008 (study group). They were divided into four groups: eyes of diabetic patients without diabetic retinopathy (DR), eyes with nonproliferative DR, eyes with proliferative DR, and eyes of nondiabetic patients (controls). Color Doppler imaging was used to assess the flow velocities in the major retrobulbar vessels. The resistive index (RI) was calculated and compared among the groups and between the two time periods. Results RI values of the central retinal artery and posterior ciliary artery had increased in the two non-DR groups and in the nonproliferative DR group, with a surprising decrease measured in eyes with proliferative DR (P= nonsignificant [NS]). Combining the nonproliferative DR and proliferative DR groups resulted in a milder increase of the RI of the posterior ciliary artery (P= NS) and the central retinal artery (P=0.02) in the DR group compared to the other groups. Conclusion Our results demonstrate that an increase of the resistance in the retrobulbar vessels, as a part of DR, can lessen over time and may even be reversed.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Kessner
- Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Goldenberg
- Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ada Kessler
- Radiology Ultrasound Unit, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Varssano D, Waisbourd M, Minkev L, Sela T, Neudorfer M, Binder PS. Visual acuity outcomes in eyes with flat corneas after PRK. J Refract Surg 2013; 29:384-9. [PMID: 23739830 DOI: 10.3928/1081597x-20130515-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/05/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the impact of corneal curvatures less than 35 diopters (D) after photorefractive keratectomy (PRK) on visual acuity outcomes. METHODS Visual acuity outcomes of 5,410 eyes that underwent PRK from January 2006 to November 2010 were retrospectively analyzed for the impact of postoperative corneal curvatures on visual outcomes. All procedures were performed on a single platform (Allegretto 200Hz excimer laser; Alcon Laboratories, Inc., Irvine, CA). Main outcome measures were postoperative corrected distance visual acuity (CDVA) and loss of CDVA. RESULTS Corneas with a measured or a calculated postoperative flat meridian less than 35 D and those with a measured postoperative steep meridian less than 35 D had worse postoperative CDVA than corneas with meridians of either 35 D or more (P ≤ .021). However, the preoperative CDVA was worse in the flatter curvatures in all comparisons performed (P ≤ .024). Consequently, the measured or calculated meridian curvature had no effect on CDVA loss (P ≥ .074). CONCLUSION Postoperative corneal keratometry values (flat and steep meridians) less than 35 D did not have a predictive effect on the risk of losing visual acuity following myopic PRK performed on the Allegretto 200Hz excimer laser.
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Affiliation(s)
- David Varssano
- Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
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17
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Neudorfer M, Ben-Haim MS, Leibovitch I, Kesler A. The efficacy of optic nerve ultrasonography for differentiating papilloedema from pseudopapilloedema in eyes with swollen optic discs. Acta Ophthalmol 2013; 91:376-80. [PMID: 21951833 DOI: 10.1111/j.1755-3768.2011.02253.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the diagnostic yield of optic nerve ultrasonography (US) in distinguishing between papilloedema (swollen discs owing to raised intracranial pressure) and pseudopapilloedema. METHODS We prospectively evaluated all patients with bilateral optic disc swelling who underwent a complete neuro-ophthalmological examination. Suitable patients were referred for neuroimaging (computerized tomography or magnetic resonance imaging) and lumbar puncture. They underwent optic nerve US (A-mode and B-mode), and the findings were compared with the final clinical assessment. Sensitivity, specificity and predictive values for US distinction between true papilloedema and pseudopapilloedema were calculated and compared with those of the other imaging tests. RESULTS Forty-four patients were enrolled. Ultrasonography detected papilloedema with a high degree of sensitivity (85%) when the normal optic nerve width (ONW) was set at ≤3.3 mm, and with an even higher degree of sensitivity (95%) when the normal ONW was set at ≤3.0 mm. Ultrasonography had a high negative predictive value for detecting papilloedema: 83% when the normal ONW was set at ≤3.3 mm and 93% when it was set at ≤3.0 mm. There was a significant correlation between the US findings and the final diagnosis (p < 0.001) when the upper limit of the normal ONW was set at 3.0 mm. CONCLUSIONS Ultrasonography findings of the ONW correlated well with the final diagnosis of papilloedema or pseudopapilloedema, especially when the upper limit of the normal ONW was set at 3.0 mm. Ultrasonography could be a useful non-invasive technique for differentiating papilloedema from other causes for swollen discs, such as pseudopapilloedema.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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18
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Spierer O, Neudorfer M, Leibovitch I, Stolovitch C, Kessler A. Colour Doppler ultrasound imaging findings in paediatric periocular and orbital haemangiomas. Acta Ophthalmol 2012; 90:727-32. [PMID: 21457487 DOI: 10.1111/j.1755-3768.2011.02155.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the combined grey-scale ultrasonography (US) and colour Doppler imaging (CDI) as the first and primary imaging modalities in diagnosing paediatric orbital haemangiomas. METHODS The charts of 20 consecutive children with a periorbital mass echographically diagnosed as a haemangioma between January 2004 and June 2009 in the Tel-Aviv Sourasky Medical Center were reviewed. Data on demographic details, clinical findings, US and CDI characteristics, treatment and outcome were retrieved. RESULTS Twelve (60%) haemangiomas were located on the upper eyelid, five in the lower eyelid (25%) and three in the medial cantus (15%). The tumour resolved completely in 10 children (50%) and in 10 children (50%) partial resolution was documented. Seven (35%) patients underwent treatment (intralesional or oral steroids or propranolol). Grey-scale US depicted a solid-tissue mass with low internal echogenicity. Mean haemangioma volume was 1.33 cm(3) . Colour Doppler imaging demonstrated intralesional flow with a mean peak systolic velocity of 15.2 cm per second and a mean resistance index of 0.51. All US and CDI examinations were carried out on alert children and no sedation or general anaesthesia was needed. During mean follow-up time of 23 months, no child required any additional imaging or diagnostic procedures to confirm the diagnosis. CONCLUSION Combined US and CDI are suggested as the first imaging modalities in cases with a suspected diagnosis of periocular and orbital capillary haemangioma.
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Affiliation(s)
- Oriel Spierer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Shulman S, Goldenberg D, Habot-Wilner Z, Goldstein M, Neudorfer M. Optical coherence tomography characteristics of eyes with acute anterior uveitis. Isr Med Assoc J 2012; 14:543-546. [PMID: 23101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Acute, as opposed to chronic, anterior uveitis is rarely associated with macular or optic nerve edema. Nevertheless, mild changes may not be visible on examination. OBJECTIVE To implement non-invasive ocular coherence tomography (OCT) for obtaining quantitative and qualitative data in the assessment of changes in macular morphology and peripapillary retinal nerve fiber layers in eyes with acute anterior uveitis. METHODS This retrospective case-control study was conducted in patients with unilateral acute anterior uveitis lasting for up to one month. Patients with evidence of other ocular disease or who had undergone intraocular surgery were excluded. We reviewed the charts of 14 consecutive patients who were diagnosed with acute unilateral anterior uveitis between 2007 and 2008 at the Tel Aviv Medical Center. Data on demographic details, ophthalmic examination, macular thickness and peripapillary retinal nerve fiber layer (RNFL) thickness (as demonstrated by OCT) were retrieved. Retinal and RNFL thickness was compared between the healthy fellow eye (control) and the uveitic eye in the central and four perifoveal quadrant regions, and RNFL thickness was compared in the mean and four quadrant values by Student's t-test. RESULTS We evaluated 28 eyes of7 males and 7 females (mean age 37.7 years, range 20-65). The diagnoses were: idiopathic in five patients, ankylosing spondylitis in five, Crohn's disease in one patient and reactive arthritis in one. Nine patients were HLA-B27 positive. The retina and the peripapillary NFL in each area were thicker in the uveitic eyes compared to the controls. The difference was statistically significant. There was no correlation between the differences in OCT values and patients' demographic characteristics. CONCLUSIONS OCT demonstrated that eyes with acute anterior uveitis had thicker maculae and thicker peripapillary RNFL than controls. This finding suggests that even milder anterior uveitis may be associated with some degree of posterior segment manifestations.
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Affiliation(s)
- Shiri Shulman
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Neudorfer M, Goldshtein I, Shamai-Lubovitz O, Chodick G, Dadon Y, Shalev V. Ocular Adverse Effects of Systemic Treatment With Isotretinoin. ACTA ACUST UNITED AC 2012; 148:803-8. [DOI: 10.1001/archdermatol.2012.352] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
PURPOSE We investigated the optical density characteristics of 3subretinal spaces in neovascular age-related macular degeneration (AMD), diabetic retinopathy (DR), rhegmatogenous retinal detachment (RRD), central serous retinopathy (CSR), retinoschisis (RS), and pseudophakic cystoids macular edema (PCME). METHODS Patients in whom subretinal fluid (SRF) was detected by optical coherence tomography (OCT), and whose earliest OCT scans showed sufficient SRF for sampling that did not include tissue edges, were chosen for study. The highest quality B-scan containing SRF (as graded by the OCT image acquisition software) was analyzed. Optical density measurements were obtained using ImageJ, an open code Java-based image processing software. RESULTS The diagnoses of the 71 patients who met the inclusion criteria were AMD in 17, DR in 7, RRD in 18, CSR in 17, RS in 8, and PCME in 4. Optical density ratios (ODRs) were calculated as SRF OD divided by vitreous OD. ODRs were significantly higher in patients with AMD, DR, CSR, and PCME than in those with RRD and RS. No significant difference in vitreous reflectivity was detected between the former and latter patients. CONCLUSIONS The finding that disease states produce significant changes in optical density ratios calls for further investigation of the possible usefulness of the parameter in differentiating between disease states, determining the outcome of various retinal diseases, and designing therapies aimed at treating the disease by correcting the abnormal density.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
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22
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Meshi A, Neudorfer M, Fireman E. Contribution of T cell subset analysis in induced sputum in diagnosing ocular sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29:34-40. [PMID: 23311121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to establish a correlation between the diagnosis of ocular sarcoidosis and the presence of an elevated CD4/CD8 ratio in the induced sputum(IS) of patients with uveitis and no other systemic symptoms. METHODS This retrospective chart review study included all newly diagnosed uveitis patients treated between 1998-2006. IS examinations and determination of angiotensin-converting enzyme (ACE) levels were carried out. A CD4/CD8 ratio > 2.5 and an ACE level > 145 Cd/ml/min were considered abnormal. The etiology of uveitis was retrieved from the medical records. RESULTS Twenty males and 26 females (mean age 47 +/- 16.1 years) were enrolled. The CD4/CD8 ratio was elevated in 26 (56.5%) patients, and five (10.9%) were diagnosed as having sarcoidosis by the end of follow-up. The sensitivity and specificity of the T lymphocytes CD4/CD8 ratio in diagnosing sarcoidosis were 100% and 48.8%, respectively. CD4/CD8 ratios were not significantly different between the sarcoid and non-sarcoid groups (p > 0.05), but the former tended to have higher levels (p = 0.0991). The mean ACE level of the sarcoid patients was significantly higher than that of the non-sarcoid patients (p < 0.001). CONCLUSION CD4/CD8 lymphocytes ratios obtained by IS were sensitive in uveitis patients with concomitant sarcoidosis, suggesting that analysis of T cells subsets in IS may rule out an etiology of sarcoidosis in newly diagnosed uveitis patients.
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Affiliation(s)
- Amit Meshi
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
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Abstract
Purpose To describe the spectral-domain optical coherence tomography (SD-OCT) findings in a case of Coats' disease, with emphasis on the intraretinal exudates. Methods Case report of a 4.5-year-old girl who presented with total exudative retinal detachment and organized exudates in a stellate configuration. SD-OCT was performed before and after treatment, which included surgical drainage of subretinal fluid and indirect laser application during the surgery. Results At presentation, the SD-OCT showed an elevation of the foveal contour, with thickening of the retina, many exudates and a large quantity of subretinal fluid. Two months after the surgical treatment, SD-OCT revealed a significant reduction in the amount of subretinal fluids, but with persistence of the exudates. Conclusion SD-OCT can be used as an important tool in order to describe the changes in each layer of the retina in Coats' disease. Considering the histopathological findings in Coats' disease, it is reasonable to assume that the exudates accumulate in the outer plexiform layer.
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Affiliation(s)
- Rivka Kessner
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
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Balash Y, Gurevich T, Neudorfer M, Naftaliev E, Shabtai H, Rosenberg A, Ezra A, Korczyn A, Giladi N, Kesler A. 2.115 PERIPAPILLARY RETINAL NERVE FIBER LAYER THICKNESS IN PATIENTS WITH PARKINSON'S DISEASE AND MULTIPLE SYSTEM ATROPHY. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Klein A, Barak A, Habot-Wilner Z, Goldenberg D, Neudorfer M. The appearance of congenital hypertrophy of retinal pigment epithelium by high-resolution optical coherence tomography. Retina 2011; 31:1740-1. [PMID: 21817965 DOI: 10.1097/iae.0b013e31821f2d8b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ainat Klein
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Kesler A, Vakhapova V, Korczyn AD, Naftaliev E, Neudorfer M. Retinal thickness in patients with mild cognitive impairment and Alzheimer's disease. Clin Neurol Neurosurg 2011; 113:523-6. [PMID: 21454010 DOI: 10.1016/j.clineuro.2011.02.014] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 12/24/2010] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) may represent a transition to early Alzheimer's disease (AD). The retinal nerve fiber layer (RNFL) is composed of axons originating in retinal ganglion cells that eventually form the optic nerves. Previous studies have shown that degenerative changes occur in optic nerve fibers and manifested as thinning of RNFL in patients with AD. The objective of this study was to assess the relationship between MCI, AD and loss of RNFL. PATIENTS AND METHODS In this study, patients fulfilling diagnostic criteria for MCI (n=24), AD (n=30) and cognitively normal age-matched controls (n=24) have undergone neuro-ophthalmologic and optical coherence tomography (OCT) examinations to measure RNFL thickness. RESULTS There was a significant decrease in RNFL thickness in both study groups (AD and MCI) compared to the control group, particularly in the inferior quadrants of the optic nerve head, while the superior quadrants were significantly thinner only in AD. Although AD patients may have more severe changes than MCI cases, the differences were statistically nonsignificant. Furthermore among AD patients, there was no relation to the severity of the dementia. CONCLUSIONS Our data confirm the retinal involvement in AD, as reflected by loss of axons in the optic nerves.
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Affiliation(s)
- Anat Kesler
- Neuro-ophthalmology Unit, Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Weizman Str. 6, Tel Aviv, Israel.
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Neudorfer M, Waisbourd M, Anteby I, Liran A, Goldenberg D, Barak A, Kessler A. Color flow mapping: a non-invasive tool for characterizing and differentiating between uveal melanomas and choroidal metastases. Oncol Rep 2011; 25:91-96. [PMID: 21109962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The objective of this study was to characterize and differentiate vascular patterns of choroidal melanomas and choroidal metastases by color flow mapping (CFM). We conducted a retrospective chart study on CFM findings in 18 patients with choroidal melanomas and 10 patients with choroidal metastases. We evaluated the possibilities of applying CFM to identify hypo- versus hyper-vascularity within the tumor, a central 'dominant vessel', and Doppler signals in the tumor's center and/or periphery. CFM demonstrated hypervascular patterns in 33% melanomas and 100% metastases (p<0.0001). CFM identified a central dominant vessel in 94% melanomas and 0/10 metastases (p<0.0001). Vascularity occupied the center of 11/18 melanomas and 0/10 metastases (p<0.0001), the periphery of 2/18 melanomas and 9/10 metastases (p<0.0001), and equally occupied the tumor's center and periphery of 5/18 melanomas and 1/10 metastases (p<0.0001). Based on our findings, we conclude that CFM was capable of non-invasively demonstrating different and distinct vascular patterns in malignant choroidal melanomas and choroidal metastases.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Barkana Y, Burgansky-Eliash Z, Gerber Y, Melamed S, Neudorfer M, Avni I, Bartov E, Morad Y. Inter-device variability of the Stratus optical coherence tomography. Am J Ophthalmol 2009; 147:260-6. [PMID: 18835473 DOI: 10.1016/j.ajo.2008.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 08/09/2008] [Accepted: 08/11/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess inter-device measurement variability with the Stratus optical coherence tomography (OCT). DESIGN Evaluation of diagnostic test technology. METHODS Eight eyes of eight healthy subjects were examined with four different Stratus machines in four medical centers during a period of five hours using fast retinal nerve fiber layer (RNFL) and fast macula protocols. Inter-device measurement variability and signal strength was assessed with standard deviation, coefficient of variance, and intraclass correlation coefficient (ICC). Spearman correlation coefficient was calculated between signal strength and thickness measurements. RESULTS Statistically significant differences were not found for all macular parameters and all but one RNFL parameter. Mean signal strengths obtained with the four Stratus machines were significantly different; the newer the machine, the stronger signal strength it produced. Some RNFL parameters were moderately and statistically significantly correlated with signal strength. CONCLUSIONS We did not observe statistically significant differences in any macular and all but one RNFL parameter between the four Stratus OCT machines. Signal strength was significantly different between the machines, and significantly correlated with some RNFL parameters. Inter-machine variability in RNFL measurements may have clinical significance. Signal strength should be included in the assessment of measurements obtained on different machines and in serial examinations with a single Stratus machine during patient follow-up.
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Affiliation(s)
- Yaniv Barkana
- Department of Ophthalmology, Assaf Harofe Medical Center, Zerifin, Israel.
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Barak A, Neudorfer M, Heilweil G, Merimsky O, Lowenstein A, Inbar M, Yaal-Hahoshen N. Decreased prevalence of asymptomatic choroidal metastasis in disseminated breast and lung cancer: argument against screening. Br J Ophthalmol 2006; 91:74-5. [PMID: 16943227 PMCID: PMC1857549 DOI: 10.1136/bjo.2006.099416] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the frequency of visually asymptomatic choroidal metastases in patients with disseminated breast and lung carcinomas in order to establish optimal patient management policies. METHODS All patients with confirmed metastatic disease treated in our institution between January 2002 and December 2003 were invited to undergo a funduscopic examination and a B-scan ultrasound evaluation. RESULTS Of the 169 study participants, 77 had breast cancer (64 with metastases in one organ and 13 with multiple-organ involvement) and 92 had lung cancer (85 with metastases in one organ and 7 with multiple-organ involvement). No patient with metastatic breast cancer and two patients with metastatic lung disease (each with multiple-organ involvement) were found to have choroidal metastases. The choroidal metastases were detected by both the funduscopic and ultrasound examinations. CONCLUSIONS The 2.17% incidence of choroidal metastasis in disseminated lung cancer and the 0% incidence in disseminated breast cancer speaks against the practicality of screening for early detection of choroidal metastasis among these patients, even though it would lead to early implementation of appropriate, often vision saving, therapeutic management. Its low incidence probably testifies to progress achieved by enhanced systemic oncological treatment policies that have been introduced into routine patient management over the past few years.
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Affiliation(s)
- A Barak
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel.
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Dodiuk-Gad RP, de Morentin HM, Schafer J, Harel A, Neudorfer M, Misonzhnik F, Gitstein G, Rozenman D, Tur E, Brenner S. Minocycline-induced cutaneous hyperpigmentation: confocal laser scanning microscope analysis. J Eur Acad Dermatol Venereol 2006; 20:435-9. [PMID: 16643143 DOI: 10.1111/j.1468-3083.2006.01436.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Minocycline has a characteristic yellow-green fluorescent emission. This fluorescence has been previously demonstrated only in type 1 minocycline-induced skin hyperpigmentation. OBJECTIVE To investigate whether the fluorescence can be detected in other types of minocycline-induced cutaneous hyperpigmentation, and to study the possible mechanisms. METHODS Biopsies of pigmented and nonpigmented skin from 3 patients with different types of skin hyperpigmentation induced by minocycline were analysed by light microscopy and Confocal Laser Scanning Microscope (CLSM). RESULTS A yellow-green fluorescence was observed in the hyperpigmented skin of two patients with type 2, and one patient with type 4 minocycline-induced cutaneous hyperpigmentation. No fluorescence was detected in the non-pigmented skin. CONCLUSION Minocycline can possibly serve as a fluorescent probe in the diagnosis of all types of minocycline-induced cutaneous hyperpigmentation.
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Affiliation(s)
- R P Dodiuk-Gad
- Department of Dermatology, Ha'emek Medical Center, Afula, Israel
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Zayit-Soudry S, Neudorfer M, Barak A, Loewenstein A, Bash E, Siegman-Igra Y. Endogenous Phialemonium curvatum endophthalmitis. Am J Ophthalmol 2005; 140:755-7. [PMID: 16226540 DOI: 10.1016/j.ajo.2005.04.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 04/18/2005] [Accepted: 04/18/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To report a case of bilateral endogenous Phialemonium curvatum endophthalmitis, secondary to intrapenile injections for erectile dysfunction. DESIGN Observational case report. METHODS A 71-year-old man with P. curvatum endocarditis and bilateral decreased vision was diagnosed as having bilateral endogenous endophthalmitis. P. curvatum was identified in cultures that were performed on samples of the vitreous. Treatment consisted of bilateral vitrectomy and intraocular and systemic antifungals. RESULTS Despite resolution of the systemic infection, the patient's postoperative visual acuity remained limited to hand movement, and the ophthalmic clinical picture remained unchanged. CONCLUSIONS P. curvatum is a pathogen that can be readily isolated from the vitreous. The authors are unaware of previous reported cases of ocular infection that was caused by P. curvatum.
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Affiliation(s)
- Shiri Zayit-Soudry
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Abstract
BACKGROUND The concomitant occurrence of both intraocular and periocular lymphomas is extremely rare. Periocular involvement by lymphoproliferative disease ranges from benign lymphoid hyperplasia to malignant lymphoma. Intraocular lymphomas usually appear in conjunction with primary central nervous system lymphoma. CASE REPORTS We describe clinical characteristics, standardized A- and B-scan ultrasonography, colour Doppler, computerized tomographic and magnetic resonance imaging, and immunohistological findings in three cases of concurrent choroidal and periocular involvement of lymphoma. DISCUSSION The clinical presentation of diffuse choroidal tumours may be variable, making diagnosis of intraocular lymphoma troublesome on clinical grounds alone. The high accuracy of colour Doppler imaging is known to be effective in differentiating the benign from the malignant and adds valuable information in the differential diagnosis of a low reflective lesion. We suggest the use of auxiliary examinations such as ultrasonography and colour Doppler imaging to help in the differential diagnosis of choroidal and orbital tumours.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel.
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Neudorfer M, Leibovitch I, Stolovitch C, Dray JP, Hermush V, Nagar H, Kessler A. Intraorbital and periorbital tumors in children--value of ultrasound and color Doppler imaging in the differential diagnosis. Am J Ophthalmol 2004; 137:1065-72. [PMID: 15183791 DOI: 10.1016/j.ajo.2004.01.050] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the role of ultrasonography (US) and color Doppler imaging (CDI) in the diagnosis of orbital tumors in children. DESIGN Retrospective nonrandomized interventional case series. METHODS This study included 42 children with intraorbital and periorbital tumors who were evaluated in our clinic. All children underwent a complete clinical evaluation as well as orbital US and CDI. The children then underwent operation or were followed up, based on the clinical diagnosis and the findings on the imaging modalities. RESULTS The mean age of the patients at diagnosis was 22.5 months (range 2 weeks-14 years old). Eighteen patients (12 female and 6 male) were diagnosed with hemangioma based on the findings in US and CDI; 16 patients (9 female and 7 male) were diagnosed with dermoid, 5 patients (4 female and 1 male) with lymphangioma, 2 patients with rhabdomyosarcoma, and 1 patient with a subperiostal abscess. Twenty-two patients underwent operation, and the diagnosis was confirmed on pathology. Twenty patients did not undergo operation and continued to be followed up in the clinic (mean follow-up period 38.2 months). The disease course in all patients who did not undergo operation was consistent with the working diagnosis. CONCLUSION Both US and CDI are useful modalities in the diagnosis of intraorbital and periorbital tumors in the pediatric age group.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel.
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Obermair A, Cheuk R, Horwood K, Neudorfer M, Janda M, Giannis G, Nicklin JL, Perrin LC, Crandon AJ. Anemia before and during concurrent chemoradiotherapy in patients with cervical carcinoma: Effect on progression-free survival. Int J Gynecol Cancer 2004; 13:633-9. [PMID: 14675347 DOI: 10.1046/j.1525-1438.2003.13395.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To determine the impact of anemia before and during chemoradiation in patients with cervical cancer, we collected data on hemoglobin (Hb) levels before and during treatment from 60 unselected patients with cervical carcinoma. All patients had FIGO stage IB to IVA disease and were treated with concurrent chemoradiation for the aim of cure. Patients with an Hb value below or equal to the lower 25th quartile were considered anemic. Progression-free survival (PFS) was evaluated by univariate and multivariate analyses. After a median follow-up of 26.3 months, 20 patients developed disease progression. The lowest Hb during chemoradiation (nadir Hb), the stage of disease, and parametrial involvement were correlated significantly with PFS. On multivariate analysis, the nadir Hb (relative risk [RR] 0.29) and tumor stage (RR 3.4) remained the only prognostically relevant factors predicting PFS. At 60 months the PFS was 39.1% for anemic patients and 48.0% for nonanemic patients (P < 0.0002). In patients undergoing chemoradiation for cervical carcinoma, a low nadir Hb is highly predictive of shortened PFS, whereas the Hb before treatment is prognostically not significant.
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Affiliation(s)
- A Obermair
- Queensland Center for Gynaecological Cancer, Royal Women's Hospital, Queensland University of Technology, School of Public Health, Brisbane, Australia.
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Neudorfer M, Sadetzki S, Anisimova S, Geyer O. Nonpenetrating deep sclerectomy with the use of adjunctive mitomycin C. Ophthalmic Surg Lasers Imaging 2004; 35:6-12. [PMID: 14750756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND OBJECTIVE To determine whether adjunctive use of mitomycin C (MMC) would increase the success rate of primary nonpenetrating deep sclerectomy with collagen implant. PATIENTS AND METHODS Twenty-six patients (26 eyes) with primary open-angle glaucoma uncontrolled with maximally tolerated medical therapy were randomly assigned to undergo nonpenetrating deep sclerectomy and collagen implant, either with (13 eyes) or without (13 eyes) 0.3 mg/mL of adjunctive MMC for 3 minutes. Intraocular pressure (IOP), number of glaucoma medications, and visual acuity were assessed before and 12 and 24 months after surgery. RESULTS The mean age of the study patients was similar in both groups (MMC = 68.1 +/- 8 years, control = 65.8 +/- 6.8 years). At the 12- and 24-month follow-up visits, the mean IOP with or without medications was lower in the MMC group than in the control group (15.6 +/- 3.5 vs 17.2 +/- 3.9 mm Hg at 12 months and 15.8 +/- 5.6 vs 17.8 +/- 2.8 mm Hg at 24 months, respectively). The IOP with or without medications significantly decreased after surgery in both groups (P < .05). Twelve months after surgery, the IOP decreased by 48% in the MMC group and by 35% in the control group. At the end of follow-up (24 months), the IOP decreased by 48% in the MMC group and by 32% in the control group (P = .01). The mean number of glaucoma medications decreased after surgery, there was no significant difference in complications (hyphema and suprachoroidal hemorrhage), and visual acuity was unchanged throughout the study in both groups. CONCLUSION The use of MMC in nonpenetrating deep sclerectomy with collagen implant is safe and improves surgical results.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Neudorfer M, Sadetzki S, Anisimova S, Geyer O. Nonpenetrating Deep Sclerectomy With the Use of Adjunctive Mitomycin C. Ophthalmic Surg Lasers Imaging Retina 2004. [DOI: 10.3928/1542-8877-20040101-03] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Obermair A, Cheuk R, Horwood K, Neudorfer M, Janda M, Giannis G, Nicklin JL, Perrin LC, Crandon AJ. Anemia before and during concurrent chemoradiotherapy in patients with cervical carcinoma: Effect on progression-free survival. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200309000-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To determine the impact of anemia before and during chemoradiation in patients with cervical cancer, we collected data on hemoglobin (Hb) levels before and during treatment from 60 unselected patients with cervical carcinoma. All patients had FIGO stage IB to IVA disease and were treated with concurrent chemoradiation for the aim of cure. Patients with an Hb value below or equal to the lower 25th quartile were considered anemic. Progression-free survival (PFS) was evaluated by univariate and multivariate analyses. After a median follow-up of 26.3 months, 20 patients developed disease progression. The lowest Hb during chemoradiation (nadir Hb), the stage of disease, and parametrial involvement were correlated significantly with PFS. On multivariate analysis, the nadir Hb (relative risk [RR] 0.29) and tumor stage (RR 3.4) remained the only prognostically relevant factors predicting PFS. At 60 months the PFS was 39.1% for anemic patients and 48.0% for nonanemic patients (P < 0.0002). In patients undergoing chemoradiation for cervical carcinoma, a low nadir Hb is highly predictive of shortened PFS, whereas the Hb before treatment is prognostically not significant.
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Fireman E, Greif J, Onn A, Neudorfer M, Loewenstein A. Unsuspected sarcoidosis diagnosed by induced sputum in a case of isolated uveitis. Sarcoidosis Vasc Diffuse Lung Dis 2002; 19:95-6. [PMID: 12102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Abstract
OBJECTIVE To evaluate the value of the induced sputum technique in diagnosing sarcoidosis as the cause of uveitis. DESIGN Comparative case series. PARTICIPANTS Seventeen patients with uveitis. Two control groups were used. The first included 10 patients with sarcoid without uveitis; the second included 5 healthy volunteers. TESTING Sputum was induced by a 20-minute inhalation of 3.5% saline using an ultrasonic nebulizer. Samples were studied by differential counts of 200 cells on cytopreps stained by Giemsa. T lymphocyte subset analyses were done by fluorescence-activated cell sorter using the monoclonal antibodies CD4 (T helper cells) and CD8 (T suppressor-cytotoxic cells). Angiotensin-converting enzyme (ACE) serum levels were obtained. MAIN OUTCOME MEASURES A CD4/CD8 ratio >2.5 and an ACE level >145 microl/ml/minute were considered to be abnormal. RESULTS The difference in the CD4/CD8 ratios in the induced sputum examination between the group of patients with an elevated ACE level and the group of patients with an ACE level within normal limits was statistically significant (P = 0.0001). CONCLUSIONS The induced sputum examination showed increased CD4/CD8 ratios in patients with uveitis who also had elevated ACE levels, suggesting the presence of sarcoidosis.
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Affiliation(s)
- Meira Neudorfer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Abstract
An 84-year-old woman with unstable angina pectoris was treated with subcutaneous enoxaparine (Clexane) for several days before presenting with severe pain and decreased vision in her left eye. The intraocular pressure was 70 mmHg, and fundus examination showed a pigmented choroidal lesion and associated choroidal and retinal detachment. Ultrasonography was consistent with choroidal hemorrhage, and she was diagnosed as having acute glaucoma secondary to massive subchoroidal hemorrhage. Medical control of the intraocular pressure resulted in a significant clinical improvement. Intraocular hemorrhage and angle-closure glaucoma are rare and previously unreported complications in patients treated with low molecular weight heparin. It is important to be aware of this ocular complication as these drugs are so often used.
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Affiliation(s)
- M Neudorfer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Hod Y, Zalish M, Neudorfer M, Peer J, Geyer O. Case report: sudden painful blindness. Complication of anticoagulant and antiplatelet therapy in patients with disciform macular degeneration. Can Fam Physician 2001; 47:1252-3. [PMID: 11421054 PMCID: PMC2018510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- Y Hod
- Department of Ophthalmology, Carmel Medical Center, 7 Michal St, Haifa, Israel
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Leibovitch I, Goldstein M, Neudorfer M, Loewenstein A. Transient phacodonesis after circling buckle procedure for rhegmatogenous retinal detachment. Eye (Lond) 2001; 15:350-1. [PMID: 11450744 DOI: 10.1038/eye.2001.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Geyer O, Schmidt KG, Pianka P, Neudorfer M, Lazar M. Clonidine provides an allergy-free alternative in glaucoma patients with proven allergy to apraclonidine. Graefes Arch Clin Exp Ophthalmol 2000; 238:149-52. [PMID: 10766284 DOI: 10.1007/pl00007883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study was to determine allergic responses to clonidine hydrochloride 0.25% in glaucoma patients with proven allergic reaction to apraclonidine 0.5%. METHODS Fifteen consecutive glaucoma patients with allergic reaction to apraclonidine were prospectively challenged with clonidine hydrochloride 0.25% and evaluated for recurrence of allergic reactions and efficacy of treatment. Intraocular pressure (IOP), conjunctival hyperemia, blood pressure and resting pulse rate were determined at baseline and after 1, 3, 6 and 12 months. RESULTS None of the patients developed ocular allergic reaction during 12 months on clonidine therapy. Blood pressure and pulse rate did not change significantly with clonidine treatment. Clonidine caused a significant reduction of IOP from baseline. In one patient, topical clonidine caused fatigue, dizziness and dry mouth. CONCLUSION Clonidine did not cause allergic reaction in patients with proven allergy to apraclonidine, indicating that there is no cross-reactivity with apraclonidine. Due to the small series, however, we cannot assume that allergy will not occur with clonidine 0.25% given time and a larger number of patients.
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Affiliation(s)
- O Geyer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Abstract
PURPOSE To assess circulatory properties of eyes with progressive stages of diabetic retinopathy. METHODS The intraocular pressure, pulse amplitude (PA) and pulsatile ocular blood flow (POBF) were measured with a pneumatonometer (OBF Labs UK Ltd). The eyes were grouped: (a) normal control, n = 26, (b) diabetes with no observable diabetic retinopathy (NDR), n = 18, (c) mild to moderate non-proliferative diabetic retinopathy (NPDR), n = 20, and (d) very severe pre-proliferative and proliferative diabetic retinopathy (PPDR/PDR), n = 12. RESULTS The PA and POBF values were lower than normal values in the earliest stage (NDR). The POBF increased but was still below normal levels at the NPDR stage, and then increased to an above normal level in the PPDR/PDR stage of diabetic retinopathy. The PA was at normal levels in these later two stages. CONCLUSION An initial decrease in pulsatile ocular blood flow is present with the onset of diabetes where no diabetic retinopathy has yet occurred. Subsequently, the pulsatile ocular blood flow increases with the severity of the retinopathy.
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Affiliation(s)
- O Geyer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Israel
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Michaeli-Cohen A, Neudorfer M, Loewenstein A, Lazar M, Geyer O. Case report: visual loss caused by facial steroids. Can Fam Physician 1998; 44:2462-3. [PMID: 9839064 PMCID: PMC2277977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- A Michaeli-Cohen
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Geyer O, Neudorfer M, Rothkoff L, Michaeli-Cohen A, Lazar M. Iris retraction syndrome associated with nonrhegmatogenous retinal detachment. Acta Ophthalmol Scand 1998; 76:617-9. [PMID: 9826052 DOI: 10.1034/j.1600-0420.1998.760522.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To present the first documentation of iris retraction syndrome in eyes with nonrhegmatogenous retinal detachment. PATIENTS AND METHODS One patient with age-related macular degeneration and another with panuveitis developed exudative retinal detachment with iris retraction configuration. Ultrasound biomicroscopy was performed to investigate the anatomic relationship of structures in the anterior segment of the eye. RESULTS Ultrasound biomicroscopy demonstrated a severe backward bowing of the peripheral iris with irido-ciliary body and irido-zonular contact as well as broad iris lens touch. The iris retraction syndrome resolved after pupil dilation and disruption of the pupillary adhesions in both cases. The retinal detachment resolved several months later, without surgery. CONCLUSION Iris retraction syndrome appears not to be exclusive to rhegmatogenous retinal detachment but can present in eyes with exudative - nonrhegmatogenous retinal detachment. Thus, when the configuration of the iris shows bowing in patients with retinal detachment, iris retraction syndrome should be considered and prompt pupil dilation should be carried out.
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Affiliation(s)
- O Geyer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Centre and the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Geyer O, Michaeli-Cohen A, Silver DM, Versano D, Neudorfer M, Dzhanov R, Lazar M. Reproducibility of topographic measures of the glaucomatous optic nerve head. Br J Ophthalmol 1998; 82:14-7. [PMID: 9536873 PMCID: PMC1722358 DOI: 10.1136/bjo.82.1.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS/BACKGROUND Laser scanning tomography provides an assessment of three dimensional optic disc topography. For the clinical purpose of follow up of glaucoma patients, the repeatability of the various measured variables is essential. In the present study, the reproducibility of morphometric variables calculated by the topographic scanning system, TopSS (Laser Diagnostic Technology, San Diego, CA) was investigated. METHODS Two independent measurements (30 minutes apart) each consisting of three complete images of the optic disc were performed on 16 eyes of 16 glaucoma patients using a TopSS. The instrument calculates 14 morphometric variables for the characterisation of the optic disc. RESULTS From the two tailed paired tests, all variables were seen to have good reproducibility. However, correlation and regression analyses showed that only the three variables, volume below, half depth area, and average cup depth, are acceptably reproducible. CONCLUSION The TopSS provides three variables which describe the physiological shape of the optic disc that have high reproducibility. These three variables might be useful for following the progression of optic disc changes in glaucoma patients.
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Affiliation(s)
- O Geyer
- Department of Ophthalmology, Sourasky Medical Center, Tel-Aviv University, Israel
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Neudorfer M, Kessler A, Firsteter E, Lazar M, Geyer O. Effect of oral nifedipine on ocular blood flow in patients with low tension glaucoma. Am J Ophthalmol 1997. [DOI: 10.1016/s0002-9394(14)71155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Geyer O, Michaeli-Cohen A, Silver DM, Neudorfer M, Lazar M. The mechanism of intraocular pressure rise during cyclocryotherapy. Invest Ophthalmol Vis Sci 1997; 38:1012-7. [PMID: 9112997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Intraocular pressure (IOP) spikes that occur during cyclocryotherapy for advanced glaucoma may further injure the already damaged glaucomatous optic nerve and be responsible for visual impairment that may occur after this treatment. The authors investigated the mechanism of pressure rise to see whether it can be avoided and thus prevent further optic nerve injury. The authors postulated that intraocular ice forms during the cryo procedure and causes the pressure changes. METHODS Intraocular pressure was monitored using a pneumatonometer during 15 cryocycles of four patients with advanced glaucoma and 21 cryocycles of five normal rabbits. A simple thermal model was developed to analyze the relation between volume expansion and pressure rise in the eye. The physical effect of freezing rabbit eye structures was investigated in vitro. RESULTS The largest pressure spikes observed during the cryocycles in this work were increases of 32 mm Hg for humans and 25 mm Hg for rabbits. The mean value of the IOP immediately before and after the cryo freezing stage was 53 +/- 1 and 68 +/- 2 mm Hg, respectively, for humans and 22 +/- 1 and 32 +/- 1 mm Hg for rabbits. The parameters of the thermal model were determined from the observed IOP spikes. Calculated thaw times were consistent with measured times for return to precryo IOPs. In vitro cryoapplication (rabbit eye) showed the formation of an ice ball internal to the eye. CONCLUSIONS Volumetric increase of the intraocular content related to the formation of an ice ball in the eye, is the mechanism of pressure spikes during cyclocryotherapy. Because this complication is unavoidable, other cyclodestuctive methods may be more prudent, particularly in patients with advanced glaucoma.
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Affiliation(s)
- O Geyer
- Department of Ophthalmology, Sourasky Medical Center, Tel-Aviv University, Israel
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Geyer O, Neudorfer M, Kessler A, Firsteter E, Lazar M, Almog Y. Effect of oral nifedipine on ocular blood flow in patients with low tension glaucoma. Br J Ophthalmol 1996; 80:1060-2. [PMID: 9059270 PMCID: PMC505703 DOI: 10.1136/bjo.80.12.1060] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM To investigate the effect of oral nifedipine on ocular blood flow in patients with low tension glaucoma (LTG). METHODS In this prospective study we examined the effects of 3 weeks of treatment with oral nifedipine 30 mg/day in 11 patients with LTG, by using colour Doppler ultrasound imaging to measure haemodynamic variables in the central retinal (CRA), short posterior ciliary (SPCA), and ophthalmic (OA) arteries. Intraocular pressure (IOP) and blood pressures were also evaluated. RESULTS Nifedipine failed to alter IOP nor did it change peak systolic velocity, end diastolic velocity,or the resistance index in any of the three ocular vessels studied (p > 0.05). However systolic and diastolic systemic arterial blood pressure measurements varied significantly after nifedipine treatment compared with baseline (p < 0.05). CONCLUSION Our study failed to demonstrate a significant effect of nifedipine on retrobulbar circulation of patients with LTG.
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Affiliation(s)
- O Geyer
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Israel
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