Bernard Doft - Academia.edu (original) (raw)

Papers by Bernard Doft

Research paper thumbnail of Macular disease for the practicing ophthalmologist

Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology, 1980

Research paper thumbnail of An Investigation of the Hospital Charges Related to the Treatment of Endophthalmitis in the Endophthalmitis Vitrectomy Study

Ophthalmology, 1997

The purpose of the study is to assess the hospital charges associated with the treatment of endop... more The purpose of the study is to assess the hospital charges associated with the treatment of endophthalmitis using a sample of patients from the Endophthalmitis Vitrectomy Study (EVS). The Endophthalmitis Vitrectomy Study was a multicenter, randomized clinical trial with a two-by-two factorial design to compare immediate pars plana vitrectomy to tap-biopsy and to compare the use of systemic antibiotics (intravenous) to no intravenous antibiotics in the management of postoperative endophthalmitis. Hospital charge data were collected retrospectively from 129 patients from the 4 clinical centers participating in this ancillary study. This represents 31% of the total Endophthalmitis Vitrectomy Study population. An analysis of variance was used to compare hospital charges across center and treatment. A charge-effectiveness analysis compared measures the effectiveness across treatment groups. The annual savings of hospital charges in the United States was estimated for a range of annual incidence rates of endophthalmitis. The use of intravenous antibiotics significantly increased hospital charges. Patients undergoing vitrectomy had significantly higher hospital charges than did patients undergoing tap-biopsy. The most charge-effective treatment for patients presenting with light perception only vision was immediate vitrectomy, whereas the most charge-effective treatment for patients presenting with better vision was tap-biopsy. Factors other than treatment independently associated with hospital charges were female sex, history of diabetes, symptom of red eye, and baseline vision of light perception only. Assuming the results of the Endophthalmitis Vitrectomy Study were used as a guide for the treatment of endophthalmitis, the estimated annual nationwide reduction of hospital charges would be between 7.6millionand7.6 million and 7.6millionand40.0 million.

Research paper thumbnail of Sudden loss of vision: Purtscher retinopathy in multiple myeloma

Canadian Medical Association Journal, 2009

Research paper thumbnail of Treatment of Postcataract Extraction Endophthalmitis

Archives of Ophthalmology, 2008

N THE LATE 1980S, THE VALUE OF PARS PLANA VItrectomy (VIT) in the initial management of postcatar... more N THE LATE 1980S, THE VALUE OF PARS PLANA VItrectomy (VIT) in the initial management of postcataract extraction-related endophthalmitis was unclear. Immediate VIT offered several theoretical advantages, but limited data from human case series had not shown that VIT conferred an advantage. In those reports, VIT had been reserved for eyes with the worst clinical manifestation. Because of severe selection bias in the reports, the role of pars plana VIT in the management of patients with endophthalmitis after cataract surgery remained uncertain.

Research paper thumbnail of The Endophthalmitis Vitrectomy Study-Reply

Archives of Ophthalmology, 1996

In Reply. —We thank Drs Haimann, Weiss, and Miller for their interest in the reasons for specific... more In Reply. —We thank Drs Haimann, Weiss, and Miller for their interest in the reasons for specific antibiotic choices in the Endophthalmitis Vitrectomy Study (EVS). Several considerations are important in choosing antimicrobial agents for endophthalmitis. To select the drugs for intravitreal administration, one must weigh the toxicity of the drug in the eye, the ability to achieve bactericidal levels, the antibacterial spectrum, and the drug's half-life. However, for systemically administered antibiotics, one must also consider the systemic toxicity of the drug and the degree to which it penetrates into the vitreous cavity. Even when the antibacterial spectrum is excellent, if a drug administered systemically does not penetrate the vitreous cavity it will be of little benefit in treating endophthalmitis. There is currently broad consensus that the intravitreal drugs of choice in the initial treatment of postsurgical endophthalmitis should be amikacin and vancomycin. Amikacin provides a broad spectrum extending to gram-negative

Research paper thumbnail of Acknowledgement of Referees We would like to thank the following people, who have contributed their time and talents to the peer review of outlines and manuscripts published from January 2003 through December 2003

Richard L Abbott, San Francisco, CA G. Adamus, Portland, OR Daniel M. Albert, Madison, WI Rando L... more Richard L Abbott, San Francisco, CA G. Adamus, Portland, OR Daniel M. Albert, Madison, WI Rando L. Allikmets, New York, NY Anthony C. Arnold, Los Angeles, CA Dimitri T. Azar, Boston, MA Scott Brodie, New York, NY Louvenia Carter-Dawson, Houston, TX M. Caversaccio, Bern, Switzerland Devron Char, San Francisco, CA CT Chen, Taipei, Taiwan Eunyoung Cho, Boston, MA Brent Clark, Minneapolis, MN J. Colin, Brest, France Anne Coleman, Los Angeles, CA Sandra Cramers, Boston, MA John Danias, New York, NY Bernard Doft, Pittsburgh, PA Larry Donoso, Philadelphia, PA Harminder S. Dua, Nottingham,UK Ralph C. Eagle, Philadelphia, PA Fred Ederer, Rockville, MD David Epstein, Durham, NC Daniel Finkelstein, Baltimore, MD Gerald Fishman, Chicago, IL Ronald S. Fishman, Leonardtown, MD Josef Flammer, Basel, Switzerland H.C. Fledelius, Copenhagen, Denmark C. Stephen Foster, Boston, MA Joseph Frucht-Pery, Jerusalem, Israel Mark C. Gillies, Sydney, Australia

Research paper thumbnail of Retinal Detachment and Culture-Proven Bacterial Endophthalmitis in the EVS

Archives of Ophthalmology, 2002

1. Arch Ophthalmol. 2002 Feb;120(2):230-1. Retinal detachment and culture-proven bacterial endoph... more 1. Arch Ophthalmol. 2002 Feb;120(2):230-1. Retinal detachment and culture-proven bacterial endophthalmitis in the EVS. Enzenauer RW, Biderman M. Comment on: Arch Ophthalmol. 2000 Dec;118(12):1661-5. Arch Ophthalmol. 1995 Dec;113(12):1479-96. ...

Research paper thumbnail of Acknowledgment of a Seminal Publication. Author's reply

Archives of Ophthalmology, 2008

Research paper thumbnail of Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the Endophthalmitis Vitrectomy Study

Archives of Ophthalmology, Sep 1, 1997

To analyze the data for cultures and Gram stains prospectively collected by protocol in the Endop... more To analyze the data for cultures and Gram stains prospectively collected by protocol in the Endophthalmitis Vitrectomy Study. Cultures of aqueous, undiluted vitreous, and (for patients who underwent vitrectomy) vitrectomy cassette fluid obtained from 420 patients were prepared on chocolate agar, in thioglycolate broth, and on Sabouraud dextrose agar; Gram stains of the aqueous and undiluted vitreous were made. Criteria were devised to distinguish true pathogens (confirmed positive cultures) from contaminants. Private and university-based retina-vitreous practices and corresponding microbiology laboratories. Compared with the aqueous, undiluted vitreous produced a higher percentage of confirmed positive cultures and higher colony counts on chocolate agar and was more frequently the only source of a positive culture from the eye. Nevertheless, the aqueous and vitrectomy cassette fluid were the only source of a positive culture from the eye in 4.2% and 8.9% of eyes, respectively. The overall yields of chocolate agar and thioglycolate broth were similar. A positive Gram stain from the aqueous or undiluted vitreous was highly predictive of a positive culture from the eye, but a negative Gram stain had little predictive value for the culture result. The overall rate of laboratory-confirmed infection was not statistically significantly higher in the vitrectomy group than in the tap or biopsy group. The vitreous was a richer source of positive cultures and high colony counts than was the aqueous, either because it is more supportive of bacterial growth or because a somewhat larger inoculum of the vitreous than of aqueous could be obtained. The result of Gram stain should not determine the choice of antibiotic drugs in the treatment of endophthalmitis. Vitrectomy, with culture of the vitrectomy cassette fluid, did not produce significantly more positive cultures than tap or biopsy material, and the procedure should not be performed to improve the microbiological yield.

Research paper thumbnail of The Endophthalmitis Vitrectomy Study. Relationship between clinical presentation and microbiologic spectrum

Ophthalmology, Feb 1, 1997

The authors determine if specific features of the clinical presentation of acute postoperative en... more The authors determine if specific features of the clinical presentation of acute postoperative endophthalmitis correlated with the microbiologic culture results. A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation were evaluated as part of a randomized clinical trial. Results of cultures performed on aqueous and vitreous specimens obtained at presentation were categorized as follows: gram-positive coagulase-negative micrococci, "other" gram-positive, gram-negative, and equivocal/no growth. Eleven features of the initial clinical presentation were associated with significant differences in the microbiologic spectrum (P < 0.05). Baseline factors correlating with higher rates of both gram-negative and other gram-positive isolates were: corneal infiltrate, cataract wound abnormalities, afferent pupillary defect, loss of red reflex, initial light perception-only vision, and symptom onset within 2 days of surgery. Gram-negative organisms did not grow in any eyes in which a retinal vessel could be visualized, and 61.9% of these eyes had equivocal or no growth. Diabetes mellitus was associated with a higher yield of gram-positive, coagulase-negative micrococci. Eye pain was not a discriminator for culture results. The presenting characteristics of acute endophthalmitis after cataract surgery may be helpful in predicting the most likely culture results. Such predictions do not appear sufficiently strong to guide the initial empiric choice of intravitreal antibiotics.

Research paper thumbnail of Retinal toxicity of amphotericin B in vitrectomised versus non-vitrectomised eyes

The British Journal of Ophthalmology, Sep 1, 1986

The retinal toxicity of intravitreally administered amphotericin B was compared in nonvitrectomis... more The retinal toxicity of intravitreally administered amphotericin B was compared in nonvitrectomised versus vitrectomised rabbit eyes. Doses of 5 and 10 [tg in both groups resulted in transient vitritis but had no effect on electroretinograms. Histopathological examination four weeks after injection showed vitreous cells and minimal areas of retinal necrosis in both groups at 5 or 10 ,tg doses. At these doses vitrectomy did not modify the retinotoxic effects of intravitreally administered amphotericin B. At higher doses marked toxicity was found in both vitrectomised and non-vitrectomised groups.

Research paper thumbnail of Diabetes and postcataract extraction endophthalmitis

Current Opinion in Ophthalmology, Jun 1, 2002

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

Research paper thumbnail of Immunocytochemical demonstration of prealbumin in the vitreous in heredofamilial amyloidosis

American journal of ophthalmology, 1984

Vitreous material obtained at pars plana vitrectomy from a patient with heredofamilial amyloidosi... more Vitreous material obtained at pars plana vitrectomy from a patient with heredofamilial amyloidosis with vitreous involvement and control vitreous from a patient without amyloidosis were subjected to immunocytochemical studies. P component (AP), a minor constituent of all amyloid deposits, was found in trace amounts in the familial amyloid vitreous, but other amyloid proteins, which occur in secondary amyloidosis or in primary amyloidosis, were not found. The major amyloid protein in the vitreous in heredofamilial amyloidosis (but not control vitreous) was found to be prealbumin.

Research paper thumbnail of Diabetes and the EVS: a different interpretation of the results

Archives of ophthalmology, 2002

Research paper thumbnail of Cryptococcal Endophthalmitis and Meningitis Associated With Acute Psychosis and Exudative Retinal Detachment

American Journal of Ophthalmology, 1987

Research paper thumbnail of An Experimental Model to Assess Factors Associated with Scleral Buckle Infection

Retina, 1983

A reproducible rabbit model to assess factors associated with scleral buckle infection was develo... more A reproducible rabbit model to assess factors associated with scleral buckle infection was developed. Buckle exoplant material incubated with staphylococcus was sutured to rabbit sclera, covered with conjunctiva, then removed after 24 hours. Colony counts from removed exoplant material were used to define experimentally the degree of infection. Experimental modifications of the model were used to determine how differences in perioperative treatment may affect infection. Soaking sponge exoplant in antibiotic or subconjunctival injection of antibiotic had a marked beneficial effect, while prophylactic topical antibiotic drops, or systemically administered antibiotics had a less marked effect. Silicone sponge exoplant material showed a greater tendency towards bacterial contamination than did solid silicone.

Research paper thumbnail of Pars Planitis in Identical Twins

Retina, 1983

ABSTRACT colon; Pars planitis occurred in two individuals who were related as identical twins, bu... more ABSTRACT colon; Pars planitis occurred in two individuals who were related as identical twins, but the disease was not present in other siblings of the same family. The familial occurrence of pars planitis has been reported only rarely. This is the first report of its presence in genetically identical individuals. (C) The Ophthalmic Communications Society, Inc.

Research paper thumbnail of Nummular Thioridazine Retinopathy

Retina, 1984

While thioridazine retinopathy has been well described, the features of nummular thioridazine ret... more While thioridazine retinopathy has been well described, the features of nummular thioridazine retinopathy, a unique clinical subset, have been documented in only five previously published cases. This report describes the clinical features in an additional three cases. Nummular areas of retinal pigment epithelial atrophy separated by relatively intact pigment epithelium are found in the midretinal periphery, with sparing of central vision. This entity can occur with doses of thioridazine previously considered safe.

Research paper thumbnail of Retinopathy Risk Factor Regression After Laser Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

Ophthalmology, 1984

Fifty eyes of patients with proliferative diabetic retinopathy were followed at frequent interval... more Fifty eyes of patients with proliferative diabetic retinopathy were followed at frequent intervals to determine the rapidity and stability of retinopathy risk factor regression after argon laser pametinal photocoagulation. Retinopathy risk factors regress rapidly after laser photocoagulation. The incidence of eyes at high risk for severe visual loss (eyes with 3 or more retinopathy risk factors) decreased from 100% prior to treatment to 28% three weeks after treatment. The early response to treatment was a good prognostic indicator of longer term results. Seventy-two percent of eyes which improved from a high-to a low-risk category by three weeks continued to remain at low risk at six months. Sixty-four percent of eyes which failed to improve to a low-risk category by three weeks continued to remain at high risk at six months. The early response to laser panretinal ablation may be used to predict longer-term results.

Research paper thumbnail of Single versus Multiple Treatment Sessions of Argon Laser Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

Ophthalmology, 1982

A prospective, randomized study was performed to demonstrate whether there was a difference in th... more A prospective, randomized study was performed to demonstrate whether there was a difference in the beneficial or adverse effects of argon laser photocoagulation for proliferative diabetic retinopathy depending on whether treatment was administered in a single session as compared with multiple sessions spaced over time. Results show no major differences between groups in the effect of treatment on visual acuity, visual field scores, or retinopathy risk factors. Exudative retinal detachment, choroidal detachment, and angle closure occurred more commonly in single session treatment group eyes, but these effects were transient, and no long-term difference between treatment groups was found.

Research paper thumbnail of Macular disease for the practicing ophthalmologist

Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology, 1980

Research paper thumbnail of An Investigation of the Hospital Charges Related to the Treatment of Endophthalmitis in the Endophthalmitis Vitrectomy Study

Ophthalmology, 1997

The purpose of the study is to assess the hospital charges associated with the treatment of endop... more The purpose of the study is to assess the hospital charges associated with the treatment of endophthalmitis using a sample of patients from the Endophthalmitis Vitrectomy Study (EVS). The Endophthalmitis Vitrectomy Study was a multicenter, randomized clinical trial with a two-by-two factorial design to compare immediate pars plana vitrectomy to tap-biopsy and to compare the use of systemic antibiotics (intravenous) to no intravenous antibiotics in the management of postoperative endophthalmitis. Hospital charge data were collected retrospectively from 129 patients from the 4 clinical centers participating in this ancillary study. This represents 31% of the total Endophthalmitis Vitrectomy Study population. An analysis of variance was used to compare hospital charges across center and treatment. A charge-effectiveness analysis compared measures the effectiveness across treatment groups. The annual savings of hospital charges in the United States was estimated for a range of annual incidence rates of endophthalmitis. The use of intravenous antibiotics significantly increased hospital charges. Patients undergoing vitrectomy had significantly higher hospital charges than did patients undergoing tap-biopsy. The most charge-effective treatment for patients presenting with light perception only vision was immediate vitrectomy, whereas the most charge-effective treatment for patients presenting with better vision was tap-biopsy. Factors other than treatment independently associated with hospital charges were female sex, history of diabetes, symptom of red eye, and baseline vision of light perception only. Assuming the results of the Endophthalmitis Vitrectomy Study were used as a guide for the treatment of endophthalmitis, the estimated annual nationwide reduction of hospital charges would be between 7.6millionand7.6 million and 7.6millionand40.0 million.

Research paper thumbnail of Sudden loss of vision: Purtscher retinopathy in multiple myeloma

Canadian Medical Association Journal, 2009

Research paper thumbnail of Treatment of Postcataract Extraction Endophthalmitis

Archives of Ophthalmology, 2008

N THE LATE 1980S, THE VALUE OF PARS PLANA VItrectomy (VIT) in the initial management of postcatar... more N THE LATE 1980S, THE VALUE OF PARS PLANA VItrectomy (VIT) in the initial management of postcataract extraction-related endophthalmitis was unclear. Immediate VIT offered several theoretical advantages, but limited data from human case series had not shown that VIT conferred an advantage. In those reports, VIT had been reserved for eyes with the worst clinical manifestation. Because of severe selection bias in the reports, the role of pars plana VIT in the management of patients with endophthalmitis after cataract surgery remained uncertain.

Research paper thumbnail of The Endophthalmitis Vitrectomy Study-Reply

Archives of Ophthalmology, 1996

In Reply. —We thank Drs Haimann, Weiss, and Miller for their interest in the reasons for specific... more In Reply. —We thank Drs Haimann, Weiss, and Miller for their interest in the reasons for specific antibiotic choices in the Endophthalmitis Vitrectomy Study (EVS). Several considerations are important in choosing antimicrobial agents for endophthalmitis. To select the drugs for intravitreal administration, one must weigh the toxicity of the drug in the eye, the ability to achieve bactericidal levels, the antibacterial spectrum, and the drug's half-life. However, for systemically administered antibiotics, one must also consider the systemic toxicity of the drug and the degree to which it penetrates into the vitreous cavity. Even when the antibacterial spectrum is excellent, if a drug administered systemically does not penetrate the vitreous cavity it will be of little benefit in treating endophthalmitis. There is currently broad consensus that the intravitreal drugs of choice in the initial treatment of postsurgical endophthalmitis should be amikacin and vancomycin. Amikacin provides a broad spectrum extending to gram-negative

Research paper thumbnail of Acknowledgement of Referees We would like to thank the following people, who have contributed their time and talents to the peer review of outlines and manuscripts published from January 2003 through December 2003

Richard L Abbott, San Francisco, CA G. Adamus, Portland, OR Daniel M. Albert, Madison, WI Rando L... more Richard L Abbott, San Francisco, CA G. Adamus, Portland, OR Daniel M. Albert, Madison, WI Rando L. Allikmets, New York, NY Anthony C. Arnold, Los Angeles, CA Dimitri T. Azar, Boston, MA Scott Brodie, New York, NY Louvenia Carter-Dawson, Houston, TX M. Caversaccio, Bern, Switzerland Devron Char, San Francisco, CA CT Chen, Taipei, Taiwan Eunyoung Cho, Boston, MA Brent Clark, Minneapolis, MN J. Colin, Brest, France Anne Coleman, Los Angeles, CA Sandra Cramers, Boston, MA John Danias, New York, NY Bernard Doft, Pittsburgh, PA Larry Donoso, Philadelphia, PA Harminder S. Dua, Nottingham,UK Ralph C. Eagle, Philadelphia, PA Fred Ederer, Rockville, MD David Epstein, Durham, NC Daniel Finkelstein, Baltimore, MD Gerald Fishman, Chicago, IL Ronald S. Fishman, Leonardtown, MD Josef Flammer, Basel, Switzerland H.C. Fledelius, Copenhagen, Denmark C. Stephen Foster, Boston, MA Joseph Frucht-Pery, Jerusalem, Israel Mark C. Gillies, Sydney, Australia

Research paper thumbnail of Retinal Detachment and Culture-Proven Bacterial Endophthalmitis in the EVS

Archives of Ophthalmology, 2002

1. Arch Ophthalmol. 2002 Feb;120(2):230-1. Retinal detachment and culture-proven bacterial endoph... more 1. Arch Ophthalmol. 2002 Feb;120(2):230-1. Retinal detachment and culture-proven bacterial endophthalmitis in the EVS. Enzenauer RW, Biderman M. Comment on: Arch Ophthalmol. 2000 Dec;118(12):1661-5. Arch Ophthalmol. 1995 Dec;113(12):1479-96. ...

Research paper thumbnail of Acknowledgment of a Seminal Publication. Author's reply

Archives of Ophthalmology, 2008

Research paper thumbnail of Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the Endophthalmitis Vitrectomy Study

Archives of Ophthalmology, Sep 1, 1997

To analyze the data for cultures and Gram stains prospectively collected by protocol in the Endop... more To analyze the data for cultures and Gram stains prospectively collected by protocol in the Endophthalmitis Vitrectomy Study. Cultures of aqueous, undiluted vitreous, and (for patients who underwent vitrectomy) vitrectomy cassette fluid obtained from 420 patients were prepared on chocolate agar, in thioglycolate broth, and on Sabouraud dextrose agar; Gram stains of the aqueous and undiluted vitreous were made. Criteria were devised to distinguish true pathogens (confirmed positive cultures) from contaminants. Private and university-based retina-vitreous practices and corresponding microbiology laboratories. Compared with the aqueous, undiluted vitreous produced a higher percentage of confirmed positive cultures and higher colony counts on chocolate agar and was more frequently the only source of a positive culture from the eye. Nevertheless, the aqueous and vitrectomy cassette fluid were the only source of a positive culture from the eye in 4.2% and 8.9% of eyes, respectively. The overall yields of chocolate agar and thioglycolate broth were similar. A positive Gram stain from the aqueous or undiluted vitreous was highly predictive of a positive culture from the eye, but a negative Gram stain had little predictive value for the culture result. The overall rate of laboratory-confirmed infection was not statistically significantly higher in the vitrectomy group than in the tap or biopsy group. The vitreous was a richer source of positive cultures and high colony counts than was the aqueous, either because it is more supportive of bacterial growth or because a somewhat larger inoculum of the vitreous than of aqueous could be obtained. The result of Gram stain should not determine the choice of antibiotic drugs in the treatment of endophthalmitis. Vitrectomy, with culture of the vitrectomy cassette fluid, did not produce significantly more positive cultures than tap or biopsy material, and the procedure should not be performed to improve the microbiological yield.

Research paper thumbnail of The Endophthalmitis Vitrectomy Study. Relationship between clinical presentation and microbiologic spectrum

Ophthalmology, Feb 1, 1997

The authors determine if specific features of the clinical presentation of acute postoperative en... more The authors determine if specific features of the clinical presentation of acute postoperative endophthalmitis correlated with the microbiologic culture results. A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation were evaluated as part of a randomized clinical trial. Results of cultures performed on aqueous and vitreous specimens obtained at presentation were categorized as follows: gram-positive coagulase-negative micrococci, "other" gram-positive, gram-negative, and equivocal/no growth. Eleven features of the initial clinical presentation were associated with significant differences in the microbiologic spectrum (P < 0.05). Baseline factors correlating with higher rates of both gram-negative and other gram-positive isolates were: corneal infiltrate, cataract wound abnormalities, afferent pupillary defect, loss of red reflex, initial light perception-only vision, and symptom onset within 2 days of surgery. Gram-negative organisms did not grow in any eyes in which a retinal vessel could be visualized, and 61.9% of these eyes had equivocal or no growth. Diabetes mellitus was associated with a higher yield of gram-positive, coagulase-negative micrococci. Eye pain was not a discriminator for culture results. The presenting characteristics of acute endophthalmitis after cataract surgery may be helpful in predicting the most likely culture results. Such predictions do not appear sufficiently strong to guide the initial empiric choice of intravitreal antibiotics.

Research paper thumbnail of Retinal toxicity of amphotericin B in vitrectomised versus non-vitrectomised eyes

The British Journal of Ophthalmology, Sep 1, 1986

The retinal toxicity of intravitreally administered amphotericin B was compared in nonvitrectomis... more The retinal toxicity of intravitreally administered amphotericin B was compared in nonvitrectomised versus vitrectomised rabbit eyes. Doses of 5 and 10 [tg in both groups resulted in transient vitritis but had no effect on electroretinograms. Histopathological examination four weeks after injection showed vitreous cells and minimal areas of retinal necrosis in both groups at 5 or 10 ,tg doses. At these doses vitrectomy did not modify the retinotoxic effects of intravitreally administered amphotericin B. At higher doses marked toxicity was found in both vitrectomised and non-vitrectomised groups.

Research paper thumbnail of Diabetes and postcataract extraction endophthalmitis

Current Opinion in Ophthalmology, Jun 1, 2002

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

Research paper thumbnail of Immunocytochemical demonstration of prealbumin in the vitreous in heredofamilial amyloidosis

American journal of ophthalmology, 1984

Vitreous material obtained at pars plana vitrectomy from a patient with heredofamilial amyloidosi... more Vitreous material obtained at pars plana vitrectomy from a patient with heredofamilial amyloidosis with vitreous involvement and control vitreous from a patient without amyloidosis were subjected to immunocytochemical studies. P component (AP), a minor constituent of all amyloid deposits, was found in trace amounts in the familial amyloid vitreous, but other amyloid proteins, which occur in secondary amyloidosis or in primary amyloidosis, were not found. The major amyloid protein in the vitreous in heredofamilial amyloidosis (but not control vitreous) was found to be prealbumin.

Research paper thumbnail of Diabetes and the EVS: a different interpretation of the results

Archives of ophthalmology, 2002

Research paper thumbnail of Cryptococcal Endophthalmitis and Meningitis Associated With Acute Psychosis and Exudative Retinal Detachment

American Journal of Ophthalmology, 1987

Research paper thumbnail of An Experimental Model to Assess Factors Associated with Scleral Buckle Infection

Retina, 1983

A reproducible rabbit model to assess factors associated with scleral buckle infection was develo... more A reproducible rabbit model to assess factors associated with scleral buckle infection was developed. Buckle exoplant material incubated with staphylococcus was sutured to rabbit sclera, covered with conjunctiva, then removed after 24 hours. Colony counts from removed exoplant material were used to define experimentally the degree of infection. Experimental modifications of the model were used to determine how differences in perioperative treatment may affect infection. Soaking sponge exoplant in antibiotic or subconjunctival injection of antibiotic had a marked beneficial effect, while prophylactic topical antibiotic drops, or systemically administered antibiotics had a less marked effect. Silicone sponge exoplant material showed a greater tendency towards bacterial contamination than did solid silicone.

Research paper thumbnail of Pars Planitis in Identical Twins

Retina, 1983

ABSTRACT colon; Pars planitis occurred in two individuals who were related as identical twins, bu... more ABSTRACT colon; Pars planitis occurred in two individuals who were related as identical twins, but the disease was not present in other siblings of the same family. The familial occurrence of pars planitis has been reported only rarely. This is the first report of its presence in genetically identical individuals. (C) The Ophthalmic Communications Society, Inc.

Research paper thumbnail of Nummular Thioridazine Retinopathy

Retina, 1984

While thioridazine retinopathy has been well described, the features of nummular thioridazine ret... more While thioridazine retinopathy has been well described, the features of nummular thioridazine retinopathy, a unique clinical subset, have been documented in only five previously published cases. This report describes the clinical features in an additional three cases. Nummular areas of retinal pigment epithelial atrophy separated by relatively intact pigment epithelium are found in the midretinal periphery, with sparing of central vision. This entity can occur with doses of thioridazine previously considered safe.

Research paper thumbnail of Retinopathy Risk Factor Regression After Laser Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

Ophthalmology, 1984

Fifty eyes of patients with proliferative diabetic retinopathy were followed at frequent interval... more Fifty eyes of patients with proliferative diabetic retinopathy were followed at frequent intervals to determine the rapidity and stability of retinopathy risk factor regression after argon laser pametinal photocoagulation. Retinopathy risk factors regress rapidly after laser photocoagulation. The incidence of eyes at high risk for severe visual loss (eyes with 3 or more retinopathy risk factors) decreased from 100% prior to treatment to 28% three weeks after treatment. The early response to treatment was a good prognostic indicator of longer term results. Seventy-two percent of eyes which improved from a high-to a low-risk category by three weeks continued to remain at low risk at six months. Sixty-four percent of eyes which failed to improve to a low-risk category by three weeks continued to remain at high risk at six months. The early response to laser panretinal ablation may be used to predict longer-term results.

Research paper thumbnail of Single versus Multiple Treatment Sessions of Argon Laser Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

Ophthalmology, 1982

A prospective, randomized study was performed to demonstrate whether there was a difference in th... more A prospective, randomized study was performed to demonstrate whether there was a difference in the beneficial or adverse effects of argon laser photocoagulation for proliferative diabetic retinopathy depending on whether treatment was administered in a single session as compared with multiple sessions spaced over time. Results show no major differences between groups in the effect of treatment on visual acuity, visual field scores, or retinopathy risk factors. Exudative retinal detachment, choroidal detachment, and angle closure occurred more commonly in single session treatment group eyes, but these effects were transient, and no long-term difference between treatment groups was found.