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Credentials

Education ?

Medical School Score
Rosalind Franklin University (1982)
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Awards & Distinctions ?

Awards  
Patients' Choice Award (2008)
Appointments
University of California, San Francisco School of Medicine
Associate Clinical Professor
Associations
American Board of Urology
American College of Surgeons
American Urological Association

Affiliations ?

Dr. Schiff is affiliated with 8 hospitals.

Hospital Affiliations

Score

Rankings

  • Saint Agnes Medical Center
    Urology
    1303 E Herndon Ave, Fresno, CA 93720
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    Top 25%
  • Community Regional Medical Center
    Urology
    2823 Fresno St, Fresno, CA 93721
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    Top 50%
  • Adventist Health/Selma Community Hospital
    1141 Rose Ave, Selma, CA 93662
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  • Children's Hospital Central California
    9300 Valley Childrens Pl, Madera, CA 93636
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  • Clovis Community Medical Center
    Urology
    2755 Herndon Ave, Clovis, CA 93611
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  • Fresno Community Hospital
  • Fresno Community Hospital and Med Center
  • Clovis Community Hospital
  • Publications & Research

    Dr. Schiff has contributed to 30 publications.
    Title Simultaneous Appearance of Multiple Evanescent White Dot Syndrome and Multifocal Choroiditis Indicate a Common Causal Relationship.
    Date January 2010
    Journal Ocular Immunology and Inflammation
    Excerpt

    To report simultaneous occurrence of multiple evanescent white dot syndrome (MEWDS) and multifocal choroiditis (MFC) in the same eye of a 33-year-old Caucasian woman.

    Title Diabetic Vitrectomy: the Influence of Lens Status Upon Surgical Outcomes.
    Date August 2008
    Journal Current Opinion in Ophthalmology
    Excerpt

    PURPOSE OF REVIEW: Management of the lens in diabetic eyes undergoing vitrectomy has long been a source of controversy. Initially, the lens was removed during diabetic vitrectomy because of intraoperative changes. It was noted, however, that anterior segment neovascular complications were greater in aphakic eyes after diabetic vitrectomy, and subsequently the vitreoretinal surgeon attempted to spare the lens. Lens management in this regard continues to attract discussion. This report reviews recent trends in the management of the native lens in the diabetic eye undergoing vitrectomy. RECENT FINDINGS: The rate of cataract formation after diabetic vitrectomy is high in eyes left phakic. The rates of anterior segment neovascularization and retinal detachment after diabetic vitrectomy are similar in phakic and nonphakic eyes. The rate of subsequent reoperation after diabetic vitrectomy may be greater in eyes left phakic. SUMMARY: Although the management of the lens in an eye undergoing diabetic vitrectomy should be individualized, cataract extraction performed either before or in combination with vitrectomy may reduce the rate of subsequent reoperation. The vitreoretinal surgeon may consider rendering an eye nonphakic before or during diabetic vitrectomy to optimize outcomes.

    Title Safety and Efficacy Assessment of Chimeric Ribozyme to Proliferating Cell Nuclear Antigen to Prevent Recurrence of Proliferative Vitreoretinopathy.
    Date October 2007
    Journal Archives of Ophthalmology
    Excerpt

    OBJECTIVE: To determine the safety and efficacy of VIT100 (Immusol, Inc, San Diego, California), a ribozyme to proliferating cell nuclear antigen, in preventing recurrent proliferative vitreoretinopathy (PVR) in patients with established PVR who undergo vitrectomy for retinal reattachment repair. METHODS: A multicenter, double-masked, placebo-controlled, randomized clinical trial. One hundred seventy-five eyes from 175 patients with grade C or worse PVR were randomly assigned to receive high-dose VIT100, low-dose VIT100, or placebo by intravitreal injection at the conclusion of retinal reattachment surgery. MAIN OUTCOME MEASURES: The primary efficacy end point was recurrent retinal detachment secondary to PVR. The secondary end point was recurrent retinal detachment due to any cause. RESULTS: One hundred fifty-four patients completed the study. Forty-one patients (27%) developed recurrent retinal detachment due to PVR by 24 weeks, including 18 patients (33%) in the group receiving 0.75 mg, 13 patients (24%) in the group receiving 0.15 mg, and 10 patients (22%) in the placebo group. There was no statistically significant difference in patients reaching this end point by 24 weeks (P = .37). Ancillary statistical analyses are reported. CONCLUSIONS: VIT100 was not effective in preventing PVR recurrence in patients with established grade C or worse PVR. APPLICATION TO CLINICAL PRACTICE: To our knowledge, this is the most recent, meticulously designed clinical trial in PVR.

    Title Optic Pit Maculopathy After Laser-assisted in Situ Keratomileusis.
    Date July 2007
    Journal Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
    Excerpt

    CASE REPORT: Optic disc pit is an embryological malformation of the optic nerve that occurs in less than one in 10,000 people. It is 10%-15% bilateral, and 25% to 70% of patients develop a neurosensory macular detachment within the 2nd to 4th decade. COMMENTS: We report a case of unilateral optic disc pit maculopathy 2 months after laser-assisted in situ keratomileusis (LASIK) revision.

    Title Ocular Hypotony: a Review.
    Date May 2007
    Journal Comprehensive Ophthalmology Update
    Excerpt

    The etiology, diagnosis, sequelae, and management of ocular hypotony are discussed in this review. Hypotony from decreased production of aqueous is often due to inflammation, medications, or proliferative vitreoretinopathy. Hypotony from aqueous loss may be external, such as following surgery or trauma, or internal, as in cyclodialysis cleft or retinal detachment. Treatment of hypotony is most effective if the underlying cause can be addressed, either surgically or medically. Marked improvement in vision may be achieved if hypotony is reversed.

    Title Diabetic Vitrectomy: Influence of Lens Status Upon Anatomic and Visual Outcomes.
    Date March 2007
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: To determine the effect of lens status upon the anatomic and visual results in primary diabetic vitrectomy. DESIGN: Retrospective, comparative, consecutive case series. PARTICIPANTS: One hundred two eyes of 85 patients with proliferative diabetic retinopathy and its complications that underwent primary vitrectomy. METHODS: The eyes that remained phakic after vitrectomy were compared with the eyes that were either aphakic or pseudophakic (nonphakic) postoperatively. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications, vitreoretinal reoperation rate, and ultimate anatomic and visual success with at least 6 months' follow-up. RESULTS: Preoperatively, 72 eyes were phakic, and 30 were aphakic (n = 1) or pseudophakic (n = 29). During vitrectomy, 1 eye underwent lensectomy and 12 eyes underwent phacoemulsification with lens implantation. Postoperatively, 59 eyes were phakic and 43 eyes were nonphakic. The vitreoretinal reoperation rate was significantly higher (P = 0.04) for the phakic group (28.8%) than for the nonphakic group (11.6%). Rubeosis iridis developed in 3 phakic eyes and no nonphakic eyes (P = 0.26). Intraoperative complications were similar in the phakic and nonphakic groups (P = 0.40). Postoperative complications such as rhegmatogenous retinal detachment (P = 0.39), nonclearing vitreous hemorrhage (P = 0.07), and anterior chamber complications (P = 0.60) were also similar. Visual acuity improved by at least 0.2 logarithm of the minimum angle of resolution units in 76.2% of the phakic eyes and 86.0% of the nonphakic eyes (P = 0.22). CONCLUSIONS: Eyes that were phakic after primary diabetic vitrectomy had a significantly higher subsequent vitreoretinal reoperation rate when compared with nonphakic eyes, suggesting that diabetic eyes are less likely to require additional vitreoretinal surgery if they are rendered nonphakic before or during vitrectomy.

    Title Remote Image Based Retinopathy of Prematurity Diagnosis: a Receiver Operating Characteristic Analysis of Accuracy.
    Date November 2006
    Journal The British Journal of Ophthalmology
    Excerpt

    BACKGROUND/AIMS: Telemedicine offers potential to improve the accessibility and quality of diagnosis of retinopathy of prematurity (ROP). The aim of this study was to measure accuracy of remote image based ROP diagnosis by three readers using receiver operating characteristic (ROC) analysis. METHODS: 64 hospitalised infants who met ROP examination criteria underwent two consecutive bedside procedures: dilated examination by an experienced paediatric ophthalmologist and digital retinal imaging with a commercially available wide angle camera. 410 images from 163 eyes were reviewed independently by three trained ophthalmologist readers, who classified each eye into one of four categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Sensitivity and specificity for detection of mild or worse ROP, type 2 prethreshold or worse ROP, and ROP requiring treatment were determined, compared to a reference standard of dilated ophthalmoscopy. ROC curves were generated by calculating values for each reader at three diagnostic cut-off levels: mild or worse ROP (that is, reader was asked whether image sets represented mild or worse ROP), type 2 prethreshold or worse ROP (that is, reader was asked whether image sets represented type 2 prethreshold or worse ROP), and ROP requiring treatment. RESULTS: Areas under ROC curves ranged from 0.747-0.896 for detection of mild or worse ROP, 0.905-0.946 for detection of type 2 prethreshold or worse ROP, and 0.941-0.968 for detection of ROP requiring treatment. CONCLUSIONS: Remote interpretation is highly accurate among multiple readers for the detection of ROP requiring treatment, but less so for detection of mild or worse ROP.

    Title Measurement of the Actual Dose of Triamcinolone Acetonide Delivered by Common Techniques of Intravitreal Injection.
    Date October 2006
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To measure the actual dose of triamcinolone acetonide (TA) delivered during intravitreal injection performed by several common techniques. DESIGN: Experimental study. METHODS: A 0.1-ml, 40-mg vial of TA (Kenalog-40; Bristol-Myers-Squibb, Peapack, New Jersey, USA) was prepared according to one of four protocols and the mass determined after drying overnight on waxed paper. In group 1, a 0.1-ml aliquot of TA was dispensed with a 30-gauge needle after shaking the vial 10 or 30 times. Group 2 used a 27-gauge needle. In group 3, the supernatant was removed from the crystals. Group 4 passed the suspension through a 0.2-microm micropore filter and rinsed the crystals with saline. RESULTS: There was no statistically significant difference between 30- or 27-gauge needles (P = 0.83, t test) or between shaking the vial 10 or 30 times before withdrawing the drug (P = 0.99). A statistically significant difference (t test, P = 0.001) was found between TA delivered from the initial 60% of each syringe (mean +/- SD, 2.7 +/- 1.0 mg) to that drawn from the last 40% of each syringe (7.8 +/- 3.6 mg). Group 3 had a mean weight of 32.1 +/- 7.0 mg and group 4, 10.6 +/- 2.1 mg. CONCLUSIONS: Efforts to achieve a 4.0-mg dose of TA, regardless of method used, are variable and inconsistent. Injecting through a small-gauge needle appears to concentrate the remaining suspension. Techniques to concentrate TA or remove aqueous preservatives by filtering effectively increase the concentration, but these results are variable.

    Title Optical Coherence Tomography in Asteroid Hyalosis.
    Date August 2006
    Journal Retina (philadelphia, Pa.)
    Excerpt

    PURPOSE: To demonstrate the clinical utility of optical coherence tomography (OCT) in diagnosing macular structural abnormalities in patients with asteroid hyalosis. METHODS: Case series. RESULTS: Seven eyes of seven patients underwent OCT due to inadequate funduscopic visualization secondary to asteroid hyalosis. Fluorescein angiography and B-scan ultrasonography were conducted for two patients but failed to provide diagnostic clarity. OCT provided definitive anatomical diagnoses that included macular epiretinal membrane, macular hole, traction retinal detachment, cystoid macular edema, and drusen. On the basis of OCT-assisted diagnoses, three patients elected to undergo surgical intervention. CONCLUSION: OCT can be critical to diagnose macular conditions when retinal visualization is limited by asteroid hyalosis.

    Title Upregulation of Rage and Its Ligands in Proliferative Retinal Disease.
    Date July 2006
    Journal Experimental Eye Research
    Excerpt

    We sought to study the presence of the receptor for advanced glycation endproducts (RAGE) and its ligands, advanced glycation endproducts (AGEs), S100/calgranulins and amphoterin (high mobility group box 1 protein; HMGB1), in the vitreous cavity and epiretinal membranes (ERMs) of eyes of patients with proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR). Undiluted vitreous specimens were collected from 30 eyes of 30 patients undergoing pars plana vitrectomy for repair of retinal detachment (RD) secondary to PDR (n = 15) or PVR (n = 15). The vitreous samples obtained from 10 eyes undergoing macular hole repair were used as controls. Epiretinal membranes were obtained from eight eyes with PDR and from 10 eyes with PVR. The levels of AGEs in the vitreous were measured using ELISA. The vitreous levels of soluble RAGE (sRAGE), S100/calgranulins and amphoterin were measured using Western blot analyses. The localization of RAGE and its ligands in ERMs was determined with immunohistochemistry. The vitreous levels of sRAGE were significantly increased in both PDR and PVR (p < or = 0.05) compared to control vitreous. In both PDR and PVR, the vitreous levels of AGEs (p < or = 0.01), S100/calgranulins (p < or = 0.05), and amphoterin (p < or = 0.01) were also elevated compared to control eyes. Expression of RAGE was detected in six of eight ERMs from eyes with PDR and eight of 10 ERMs from eyes with PVR. Many cells expressing RAGE also expressed vimentin, suggesting a glial cell origin. Ligands for RAGE were also detected in ERMs, with AGEs detected in five eyes with PDR and eight eyes with PVR. Similarly, S100 and amphoterin ERM expression was observed in six eyes with PDR; these ligands were also expressed in ERMs from eyes with PVR (8 and 7 cases, respectively). We conclude that RAGE and its ligands are increased in the vitreous cavity of eyes with PDR and PVR and are present in ERMs of eyes with these proliferative retinal disorders. These findings suggest a role for the proinflammatory RAGE axis in the pathogenesis of proliferative retinal diseases.

    Title Accuracy and Reliability of Remote Retinopathy of Prematurity Diagnosis.
    Date March 2006
    Journal Archives of Ophthalmology
    Excerpt

    OBJECTIVE: To determine the accuracy and reliability of retinopathy of prematurity (ROP) diagnosis using remote review of digital images by 3 masked ophthalmologist readers. METHODS: An atlas was compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera. All the images were independently reviewed by 3 readers, and the diagnosis in each eye was classified into 1 of 4 ordinal categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist. RESULTS: Sensitivities/specificities of the diagnosis of any ROP were 0.845/0.910 for the first reader, 0.816/0.955 for the second reader, and 0.864/0.493 for the third reader. Sensitivities/specificities of the diagnosis of ROP requiring treatment were 0.850/0.960 for the first reader, 0.850/0.973 for the second reader, and 0.900/0.953 for the third reader. When ROP was classified into ordinal categories, the overall weighted kappa for interreader reliability was 0.743. Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers. CONCLUSION: The accuracy, interreader reliability, and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial.

    Title Intravitreal Triamcinolone Treatment for Macular Edema Associated with Central Retinal Vein Occlusion and Hemiretinal Vein Occlusion.
    Date November 2005
    Journal Retina (philadelphia, Pa.)
    Excerpt

    PURPOSE: To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). METHODS: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n = 21) and HRVO (n = 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre- and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. RESULTS: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n = 23] 635 vs. 352 mum, respectively; P < 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, -3-7) over the course of the study period. Ten eyes gained > or =2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P = 0.24). None of the eyes of diabetic patients (n = 6) or patients with ischemic CRVO (n = 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P = 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P = 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n = 16] 20/133 vs. 20/67, respectively; P < 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P = 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. CONCLUSIONS: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.

    Title Intravitreal Triamcinolone Injection for Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion.
    Date November 2005
    Journal Retina (philadelphia, Pa.)
    Excerpt

    PURPOSE: To evaluate the efficacy of intravitreal triamcinolone injection in eyes with macular edema due to branch retinal vein occlusion (BRVO) over a 2-year period. METHODS: The authors performed a retrospective chart review of 13 eyes of 13 patients (mean age 68 years) who underwent intravitreal injections with 4 mg triamcinolone acetonide for macular edema due to BRVO. Six eyes received a single injection. Repeated injections were performed in one eye twice, four eyes three times, and two eyes four times. Mean follow-up was 13 months (range, 4 to 24). The time between the onset of symptoms and the injection averaged 7.4 months (range, 2 to 24). RESULTS: Mean postinjection central foveal thickness decreased to 56% of preinjection values (529 mum versus 295 mum, P < 0 .001). Final visual acuity improved in seven eyes (range 2 to 6 Snellen lines), remained the same in four eyes (range 0 to 1 Snellen lines), and worsened in two eyes (range -1 to -4 Snellen lines) compared to baseline. The retinal thickness decreased in all cases; vision improved in most cases. As the number of injections increased cataractous changes increased. Visual acuity improvement was significantly correlated with patient age (P = 0.026). Eight patients developed steroid induced ocular hypertension controlled by topical medication. Cataract extraction was judged to aggravate macular edema in three of the five eyes undergoing surgery, based upon optical coherence tomography or fluorescein angiography. Median best postinjection visual acuity (20/50) was significantly better than that of baseline (20/100) (P = 0.028) as well as last follow-up (20/70) (P = 0.003). CONCLUSIONS: Intravitreal triamcinolone should be further evaluated as a treatment option for macular edema associated with BRVO.

    Title Influence of Relaxing Retinotomy on Surgical Outcomes in Proliferative Vitreoretinopathy.
    Date October 2005
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: This study sought to determine the influence of relaxing retinotomy (RR) incisions upon surgical outcomes in the repair of recurrent retinal detachment (RD) attributable to proliferative vitreoretinopathy (PVR). DESIGN: Retrospective, consecutive, nonrandomized, single-center series. METHODS: Eighty-one eyes with recurrent RD attributable to PVR were retrospectively reviewed. Exclusion criteria were giant retinal tear, uveitis, trauma, proliferative diabetic retinopathy, and age under 18 years. A total of 52 eyes underwent RR at the time of surgery (64.2%); 29 eyes were repaired without this technique. Perfluorocarbon gas (n = 34) or silicone oil (n = 47) was used as postoperative tamponade. Statistical analyses were performed using the Fisher exact test. RESULTS: Eyes that received RR had significantly higher rates of anterior PVR (P = .009). Eyes receiving silicone oil for postoperative tamponade had worse baseline characteristics compared with those receiving gas. The use of RR in eyes receiving gas tamponade had no marked influence on the initial anatomic outcomes, with recurrent retinal detachment occurring in five of 14 eyes that received an RR and seven of 20 eyes that did not receive an RR (P = .62). Eyes in which silicone oil was used as a postoperative tamponade had a significantly lower rate of recurrent RD requiring additional surgery when RR was employed (one of 38 eyes) when compared with eyes that did not receive an RR (three of nine eyes, P = .02). Ultimately, surgical reattachment was attained in all eyes except one. Eyes that received gas tamponade without RR had significantly better median vision (P = .008). CONCLUSIONS: Surgical management of PVR often results in ultimate retinal reattachment. An RR incision does not appear to influence initial anatomic repair when gas tamponade is used after vitrectomy surgery for PVR. However, RR may increase the initial surgical success rate in eyes receiving silicone oil tamponade for PVR. In eyes undergoing RR for the treatment of severe PVR, the use of silicone oil may increase the initial rate of reattachment compared with the use of gas tamponade.

    Title Cataract Progression After Intravitreal Triamcinolone Injection.
    Date July 2005
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To assess cataract progression after intravitreal triamcinolone injection. DESIGN: Retrospective, interventional, case-control study. METHODS: Forty-two phakic eyes of 37 patients were injected one, two, or three times with intravitreal triamcinolone for various indications. Noninjected phakic fellow eyes served as the control. The mean follow-up time for single injection was 12 months, for multiple injections was 14 months, and for control group was 13 months. Lens status, best-corrected visual acuity, and refractive errors were recorded at baseline and at each follow-up examination. RESULTS: At the last follow-up, changes in posterior subcapsular cataract and refractive error from baseline were significantly different between single triamcinolone-injected eyes and the control group [0.7 +/- 0.2 (mean +/- SEM [arbitrary unit] vs 0.2 +/- 0.1, P = .02; and -0.5 +/- 0.1 diopter vs -0.2 +/- 0.1 diopter, P = .01, respectively). For multiple-injected eyes and control eyes, change from baseline in corticonuclear cataract (1.1 +/- 0.2 vs 0.2 +/- 0.1), posterior subcapsular cataract (1.1 +/- 0.2) and refractive error (-1.8 +/- 0.4 diopters) were significantly different (P < .001, P < .001, and P < .001, respectively). Visual acuity did not change after single injection (P = .83) and in control group (P = .19) but decreased after multiple injections (P = .006). Eleven study eyes and two control group eyes underwent cataract extraction during study period. Corticonuclear and posterior subcapsular cataract progression significantly correlated with follow-up time (P = .003 and P = .02, respectively) and number of injections (P = .01 and P = .04, respectively). CONCLUSIONS: Single intravitreal triamcinolone injection induces posterior subcapsular cataract development, whereas multiple injections result in all-layer cataract progression.

    Title Removal of the Intruding Miragel's Scleral Buckle by Pars Plana Ultrasonic Fragmentation.
    Date February 2005
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To introduce a surgical approach for removing intruded scleral buckle resulting from Miragel's implant. DESIGN: Interventional case report. METHODS: After cutting and releasing scleral band externally, a pars plana Fragmatome was used to break up and aspirate pieces of the Miragel's implant that had grown into the eye, filling the vitreous cavity. RESULTS: The intruding Miragel's buckle was shaved to the plane of the retina without any complication. The retina was completely attached. CONCLUSION: Use of ultrasonic fragmentation by a pars plana approach was effective in removing the intavitreally expanded buckling element without harming the retina.

    Title Levofloxacin Versus Ciprofloxacin in the Treatment of Chronic Bacterial Prostatitis: a Randomized Double-blind Multicenter Study.
    Date October 2003
    Journal Urology
    Excerpt

    OBJECTIVES: To compare the safety and efficacy of levofloxacin with that of ciprofloxacin for the treatment of chronic bacterial prostatitis. METHODS: In a multicenter, double-blind, active-control trial, 377 men with a history of chronic bacterial prostatitis, current clinical signs and symptoms, and laboratory evidence of prostatitis were randomized to treatment with levofloxacin 500 mg once daily or ciprofloxacin 500 mg twice daily for 28 days. The primary endpoint was microbiologic efficacy in the microbiologically assessable population. The Meares-Stamey "four-glass" procedure was used to obtain prostatic secretions and urine for culture. RESULTS: A total of 377 subjects received the study drug. The clinical success rates, including cured plus improved patients, were similar (75% for levofloxacin and 72.8% for ciprofloxacin; 95% confidence interval for the difference in the success rates: -13.27 to 8.87), as were the microbiologic eradication rates (75% for levofloxacin and 76.8% for ciprofloxacin; 95% confidence interval for the difference -8.98 to 12.58). Enterococcus faecalis and Escherichia coli were the most common isolates. The 6-month relapse rates were similar for both regimens. Both levofloxacin and ciprofloxacin were well tolerated, with similar rates of adverse events. CONCLUSIONS: Levofloxacin 500 mg once daily for 28 days is as effective as ciprofloxacin 500 mg twice daily for 28 days for the treatment of chronic bacterial prostatitis. Isolation of a high proportion of gram-positive organisms, as well as gram-negative pathogens, underscores the necessity of choosing an antimicrobial agent with broad-spectrum activity.

    Title Pars Plana Vitrectomy for Persistent, Visually Significant Vitreous Opacities.
    Date January 2001
    Journal Retina (philadelphia, Pa.)
    Excerpt

    PURPOSE: To evaluate the role of vitrectomy in patients with persistent, visually disabling vitreous opacities. METHODS: Six consecutive eyes of five men (age 58-66 years) with pseudophakia or aphakia and vitreous opacities resulting in visual symptoms for more than 1 year that underwent vitrectomy were retrospectively reviewed. Postoperative questionnaires regarding functional performance and quality-of-life issues were completed by the participants to assess subjective patient satisfaction. RESULTS: Postoperative Snellen visual acuity was improved or equal to preoperative acuity in all cases (8-44 month follow-up) and there were no surgical complications. All patients expressed high satisfaction with overall visual function. Analysis of the National Eye Institute Visual Function Questionnaire-39 indicated that general vision, near activities, distance activities, mental health, role difficulties, and peripheral vision were significantly improved (P < 0.05) following surgical intervention. CONCLUSIONS: Vitrectomy may be indicated in a select group of patients with visually disabling vitreous floaters, although objective assessment of visual dysfunction from vitreous floaters requires further evaluation.

    Title Soluble Cellular Adhesion Molecules in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy.
    Date January 2000
    Journal Current Eye Research
    Excerpt

    PURPOSE. To measure vitreous levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cellular adhesion molecule-1 (sVCAM-1) in the eyes of patients with retinal detachment (RD) due to proliferative diabetic retinopathy (PDR) or proliferative vitreoretinopathy (PVR) and to determine whether the levels of these mediators correlated with clinical parameters of disease. METHODS. Undiluted vitreous specimens were collected from 50 eyes of 48 patients undergoing vitrectomy for traction RD due to PDR (21 specimens) and recurrent RD due to PVR (19 specimens). Control vitreous specimens were obtained from patients undergoing macular hole repair (10 specimens). The levels of sICAM-1 and sVCAM-1 were measured in each sample by specific enzyme-linked immunoadsorbent assays. RESULTS. Vitreous levels of sICAM-1 were significantly increased in vitreous specimens from both PVR (median +/- SD; 12.0 +/- 76.3 ng/ml; P < 0.01) and PDR (8.4 +/- 24.0 ng/ml; P < 0.01) when compared to vitreous from eyes with macular holes (0. 3 +/- 4.2 ng/ml). Vitreous levels of sVCAM-1 were significantly increased in both PVR (36.5 +/- 255.2 ng/ml; P < 0.001) and PDR (26. 2 +/- 93.5 ng/ml; P < 0.01) when compared to control vitreous (17.7 +/- 7.8 ng/ml). The vitreous levels of sICAM-1 were higher in cases of PDR which developed recurrent proliferative disease (P < 0.01) and recurrent RD (P = 0.01), whereas the levels of sICAM-1 in PVR and sVCAM-1 in PDR and PVR did not significantly correlate with these clinical parameters. CONCLUSIONS. Soluble forms of ICAM-1 and VCAM-1 are increased in the vitreous cavity of patients with RD due to PDR or PVR, reflecting the inflammatory nature of these conditions and suggesting a possible role for these mediators in the pathogenesis of proliferative retinal disease. The vitreous levels of these sCAMs at the time of surgery may serve as a marker of inflammation, but their specific levels do not predict the likelihood of recurrent proliferation or surgical anatomic success in most cases of PVR and PDR.

    Title Neovascular Complications Associated with Rubeosis Iridis and Peripheral Retinal Detachment After Retinal Detachment Surgery.
    Date September 1998
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To report clinical features and surgical management of neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery in nondiabetic patients. METHODS: Seven consecutive eyes of seven nondiabetic patients who developed neovascular complications associated with rubeosis iridis and peripheral retinal detachment after scleral buckling and vitrectomy procedures were retrospectively reviewed. None of the eyes had clinical evidence of anterior segment ischemia or retinal vascular disease, but each eye developed rubeosis iridis and neovascular complications. RESULTS: Of the seven eyes with rubeosis iridis and peripheral retinal detachment, six developed recurrent or progressive vitreous hemorrhage, and three developed progressive neovascular glaucoma. Four eyes underwent a revision procedure to repair the peripheral retinal detachment, and anterior proliferative vitreoretinopathy was found in each of these cases. Rubeosis iridis regressed in all three eyes in which surgery resulted in complete reattachment of the retina. In one eye with persistent peripheral retinal detachment and in the three remaining eyes that did not undergo revision surgery, rubeosis iridis persisted and was associated with long-term neovascular complications. Final corrected visual acuity was 20/70 to 20/400 in three eyes with total retinal reattachment and no light perception to hand motions in four eyes with persistent peripheral retinal detachment and rubeosis iridis. CONCLUSION: Visually significant neovascular complications may occur in eyes that develop rubeosis iridis associated with peripheral retinal detachment after retinal detachment surgery in nondiabetic patients. Successful repair of the peripheral retinal detachment may induce regression of rubeosis iridis, reduce associated complications, and improve the long-term prognosis of these eyes.

    Title Rifabutin-associated Uveitis in an Immunosuppressed Pediatric Patient Without Acquired Immunodeficiency Syndrome.
    Date June 1998
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To describe a case of bilateral, symptomatic rifabutin-associated uveitis with hypopyon and vitreal opacities in an immunosuppressed pediatric patient without acquired immunodeficiency syndrome (AIDS). METHOD: Case report. An 8-year-old boy presented with bilateral uveitis 24 months after a bilateral lung transplant. RESULTS: Our patient, whose medications included rifabutin, clarithromycin, and immunosuppressive agents, responded to discontinuation of the rifabutin and initiation of intensive topical corticosteroid therapy with complete resolution of the uveitis. CONCLUSION: Rifabutin-associated uveitis may occur in a non-AIDS pediatric patient.

    Title Circumpapillary Chorioretinopathy in Multiple Evanescent White-dot Syndrome.
    Date May 1997
    Journal Retina (philadelphia, Pa.)
    Title The Collagen Shield As a Collagenase Inhibitor and Clinical Indicator of Collagenase Activity on the Ocular Surface.
    Date May 1992
    Journal The Clao Journal : Official Publication of the Contact Lens Association of Ophthalmologists, Inc
    Excerpt

    Collagen shields applied to the corneas of patients with bacterial keratitis degrade rapidly, often within a few hours. Once treatment brings the infection under control, subsequently applied collagen shields degrade more slowly. In vitro models were established to evaluate the significance of these observations. Twenty-four and 72-hour collagen shields were incubated with collagenase from Clostridium histolyticum. The in vitro rate of digestion of the shields was directly proportional to the concentration of collagenase, with the rate of digestion of the 24-hour shields being greater than that of the 72-hour shields. Therefore, the rate of collagen shield degradation may be a clinically useful index of collagenase activity on the ocular surface. Ultrastructural studies of collagen shields from patients with acute bacterial keratitis revealed irregular degradation of shield matrix with no evidence of adherence of microorganisms or inflammatory cells. Co-incubation of deepithelialized rabbit corneas and collagen shields resulted in inhibition of the digestion of the rabbit corneas when the weight:weight ratio of collagen shield:rabbit cornea was increased to greater than or equal to 2:1. Collagen shields may inhibit corneal collagen degradation in infectious ulceration and melting disorders by effectively competing for collagenase on the ocular surface.

    Title Prospective Study of Metabolic Abnormalities in Patient with Continent Kock Pouch Urinary Diversion.
    Date March 1989
    Journal Urology
    Excerpt

    Metabolic alterations as a result of bowel being employed in the urinary tract are well documented. To investigate this phenomenon in the continent ileal reservoir urinary diversion, 106 patients who had undergone Kock pouch surgery were followed in a prospective study at the University of Southern California between 1985 and 1987. Serum chemistries and urine osmolality determinations were performed approximately every three months for a year. Mean patient values for each time period were then compiled and compared with the norms and with the preoperative values. The mean serum electrolyte values were found to be within normal limits during all follow-up periods. Fourteen patients were identified, however, as having values falling intermittently outside of the normal range. These patients were investigated and found to be abnormal during episodes of acute renal failure usually secondary to dehydration or obstruction at which time they usually became acidotic and occasionally hyperchloremic. These problems disappeared when the renal failure was corrected. This study corroborated our previously reported findings that hyperchloremic acidosis or other metabolic alterations requiring replacement therapy do not routinely occur in this population.

    Title Inflatable Penile Prostheses in Patients Undergoing Cystoprostatectomy with Urethrectomy.
    Date January 1989
    Journal The Journal of Urology
    Excerpt

    When urethrectomy is indicated in the male patient in combination with cystoprostatectomy for diffuse transitional cell carcinoma, an additional challenge to reconstruction and sexual rehabilitation will be encountered. Inflatable penile prostheses were implanted in 19 patients who had undergone cystoprostatectomy with prophylactic urethrectomy. Of the patients 13 underwent cystoprostatectomy with en bloc urethrectomy and delayed placement of an inflatable penile prosthesis. The remaining 6 patients required urethrectomy and simultaneous implantation of an inflatable penile prosthesis 6 to 12 weeks after radical cystectomy. All 19 patients healed appropriately and had an adequate functioning prosthesis. However, results in patients in whom the glandular urethra could be preserved safely were far superior to those in patients requiring total urethrectomy. This was so because of easier and improved cylinder placement with better support to the glans, increased glandular sensation and a more acceptable penile appearance. The inflatable penile prosthesis can be used successfully in the cystourethrectomy patient with gratifying results, especially when the glandular urethra remains intact.

    Title The Potency-sparing Radical Cystectomy: Does It Compromise the Completeness of the Cancer Resection?
    Date January 1989
    Journal The Journal of Urology
    Excerpt

    Anatomical radical cystectomies with en bloc pelvic lymph node dissections were performed post mortem on 10 male cadavers. The traditional technique of radical cystectomy was used on 1 side and the potency-sparing technique was used on the opposite side. The tissue responsible for the differences in the surgical margins with the 2 procedures was examined by routine surgical pathological techniques to determine if it contained lymph nodes. Lymph nodes were identified in the bundle of tissue left in the pelvis with the nerve-sparing radical cystectomy in 6 of the 10 dissections (60 per cent). Because these lymph nodes may represent the potential first site of metastatic disease leaving the bladder, the reader is cautioned about adopting the nerve-sparing radical cystectomy as part of the management of invasive bladder cancer until the long-term sequelae of the procedure are known.

    Title Treatment of Unusual Kock Pouch Urinary Calculi with Extracorporeal Shock Wave Lithotripsy.
    Date April 1988
    Journal The Journal of Urology
    Excerpt

    Since the establishment of extracorporeal shock wave lithotripsy for the treatment of upper urinary tract calculi, further potential applications have been explored. We report the successful use of extracorporeal shock wave lithotripsy for the treatment of obstructive calculi on staples within the afferent nipple of a Kock pouch ureteroileal urinary diversion.

    Title Fire! Disaster in the Dental Office.
    Date July 1983
    Journal Florida Dental Journal
    Title Stress Breaker Design for a Mandibular Maxillofacial Prosthesis.
    Date July 1980
    Journal Florida Dental Journal
    Title Nanophthalmos and Acquired Retinoschisis.
    Date
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To report three cases of nanophthalmos associated with acquired (senile) retinoschisis. DESIGN: Observational case series. METHODS: Complete ophthalmologic evaluation (including funduscopy with scleral indentation, total axial length measurement with A-scan, optical coherence tomography [Stratus 3 OCT; Carl Zeiss Meditec Inc, Dublin, California, USA], and fundus photography) of three consecutive patients presenting with nanophthalmos and acquired retinoschisis. RESULTS: Three patients with nanophthalmos presented with bilateral acquired retinoschisis. One patient underwent a course of systemic steroids to treat concurrent and bilateral uveal effusion with macular edema. In this patient, one eye responded to this course of therapy without recurrence, while the fellow eye required vortex vein decompression with scleral windows, with subsequent, successful resolution. The average follow-up period was 40 months (range, eight to 95 months). Retinoschisis cavities remained stationary in each case. CONCLUSIONS: Bilateral acquired retinoschisis may occur in patients with nanophthalmos, suggesting that there may be correlation in the mechanisms underlying these ocular disorders.

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