1/7. Providing timely and ongoing vision rehabilitation services for the diabetic patient with irreversible vision loss from diabetic retinopathy.BACKGROUND: diabetic retinopathy (DR) remains the leading contributor to severe vision loss in the united states among persons 20 to 70 years of age. Despite advances in disease management and treatment, patients with vision loss from DR continue to constitute a significant portion of patients served in vision rehabilitation service (VRS) settings. These patients present special challenges to VRS providers because of early onset, fluctuations in and the complex nature of vision loss, unique visual demands of disease management, and associated multi-system losses. case reports: After introductory epidemiologic review, a case presentation format is used to illustrate solutions a multidisciplinary VRS can offer the special visual challenges of the person with diabetes with vision loss from DR. Four patients are presented--ages 30 to 70 years--with varying degrees and types of vision loss, with different lifestyle demands and disease management needs. The cases address vocational issues, vision fluctuation, coordinating adaptive solutions to complex visual losses, and meeting diabetic needs to measure medication, insulin, and blood glucose levels, to maintain skin care, diet, exercise, transportation, family roles, and support systems. CONCLUSIONS: The unique and complex needs of people with diabetes who experience vision loss can be well addressed through timely and ongoing VRS consultations, in conjunction with medical/ocular disease management.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/7. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients.Four patients with diabetes mellitus had cataract extraction with implantation of a hydrophilic acrylic intraocular lens (IOL) (ACRL-C160, Ophthalmed). The IOLs showed progressive and generalized opacification 10 to 20 months after implantation, decreasing visual acuity. All 4 IOLs were removed. By light microscopic examination, the IOL surfaces were wrinkled and encrusted with microspheres. Electron microscopy revealed the material to be crystalline in nature. Energy dispersive x-ray spectrum analysis showed that the deposits were mainly composed of calcium and phosphate.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/7. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation.OBJECTIVE: To report clinicopathologic and ultrastructural features of two opacified single-piece hydrophilic acrylic intraocular lenses (IOLs) explanted from a diabetic patient. DESIGN: Interventional case report with clinicopathologic correlation. SETTING: A 64-year-old white female underwent phacoemulsification and implantation of a single-piece hydrophilic acrylic lens (SC60B-OUV; Medical Developmental research, Inc., Clear water, FL) in October 1998 in the left eye and in July 1999 in the right eye. The best-corrected visual acuity after surgery was 20/60 in the left eye and 20/50 in the right eye. The patient had a marked decrease in visual acuity in June 2000 as a result of a milky, white opalescence of both lenses. Intraocular lens explantation and exchange was performed in both eyes and the explanted IOLs were submitted to our center for detailed pathologic, histochemical, and ultrastructural evaluation. They were stained with alizarin red and the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. MAIN OUTCOME MEASURES: documentation of calcium deposits confirmed by histochemical stains and surface analyses. RESULTS: Opacification of the IOL was found to be the cause of decreased visual acuity. The opacification involved both the IOL optic and the haptics in the left eye and was confined to the IOL optic in the right eye. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic and haptics. CONCLUSIONS: There are two features that distinguish this case from those reported earlier. This is the first clinicopathologic report of lens opacification that has involved completely the lens optic and the haptics. Second, these two explanted IOLs document the first bilateral case. This process of intraoptic and haptic opacification represents dystrophic calcification of unknown cause. Diabetic patients appear to be more severely and more often affected by lens opacification. Long-term follow-up of diabetic patients implanted with this IOL design should be maintained by surgeons and manufacturers.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/7. Intraocular carbon dioxide laser photocautery. II. Preliminary report of clinical trials.carbon dioxide laser photocautery was used successfully intraocularly in human patients to seal fibrovascular fronds and retinal tears at the time of vitrectomy. Closure of rubeotic vessels in the iris was demonstrated histologically. The 10.6-microgram infrared radiation was delivered to the intraocular treatment site by means of 1.5-mm-diameter photocautery probe containing a 1.0-mm-diameter lumen closed at the end with an infrared transmitting window. Treatment was localized to the tissue adjacent to the window. Typical energy dosage was 0.4 W for 2 to 4 s duration. These early clinical trials were carried out under the guidelines established by the food and Drug Administration; informed consent clearly outlined the experimental nature of these studies.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/7. diabetic retinopathy in acromegaly.A study was made of diabetic retinopathy in acromegaly. 10 of 15 patients with acromegaly had diabetes mellitus, and 3 of the 10 showed diabetic retinopathy. 2 of them had a diabetic family history. 1 patient with a diabetic family history had retinopathy of state IIIa in Scott's classification, and the other 2 showed a few microaneurysms and/or punctate hemorrhages in the macula. diabetes mellitus and diabetic retinopathy in acromegaly showed no correlation with the duration of acromegaly and diabetes mellitus, age, or growth hormone level. No diabetic cataract was found in the present series. It was concluded that diabetic retinopathy due to secondary diabetes mellitus is usually slight or moderate. diabetes mellitus with severe retinopathy is probably primary diabetes due to a genetic defect, and secondary diabetes may be different in nature from the primary disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/7. Anterior ischemic optic neuropathy. VI. In juvenile diabetics.3 cases of acute optic neuropathy in juvenile diabetics are reported. The neuropathy included initially optic disc edema (ODE), usually with prominent, dilated and frequently telangiectatic vessels over the disc, and later, generally, development of optic disc-related visual field defects. On resolution of the neuropathy, the disc was normal in all eyes except for a mild pallor in one, and the visual acuity and fields recovered to normal. 2 of the patients also had early diabetic retinopathy. The nature of the optic neuropathy is discussed. We feel the available evidence indicates that the condition most likely represents a mild or subclinical anterior ischemic optic neuropathy (AION) despite the youth of the patient. It is pertinent to note that AION can vary widely not only in severity (from subclinical to severe) but also in age distribution (from juvenile to elderly), and the subject is discussed. The clinical significance of early detection of this optic neuropathy, and the dangers of confusing it with proliferative diabetic retinopathy or ODE due to other causes, are stressed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/7. Pupillary block during cataract surgery.Sudden phakic pupillary block occurred immediately upon cortical cleaving hydrodissection during cataract surgery in two patients. We believe this unique complication is related to the recent introduction of viscoelastics with properties that enhance the maintenance of the anterior chamber during capsulorhexis. We postulate that the cause of the block was a combination of O-ring capsulocortical and iridocapsular seals that tamponade hydrodissection fluid posteriorly. Additional precipitating factors were diabetes, poorly dilating pupils, and increased vitreous pressure, which may have contributed to the sudden and irreversible nature of this block. If this complication is not recognized, an aqueous misdirection syndrome may ensue, requiring pars plana vitrectomy. Immediate mechanical breakage of the pupillary and capsular block, resulting in an immediate decrease in intraocular pressure from greater than 70 mm Hg, may cause severe retinal vascular damage. These cases stress the importance of mechanical pupil dilation to prevent this serious complication of cataract surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |