Peter R. Egbert, MD

All Publications

• Histologic Artifacts of Autolytic Muller Cell Foot Process Swelling in Postmortem Examination of Infant Eyes Potential Pitfall in the Evaluation of Traumatic Retinal Hemorrhages JAMA OPHTHALMOLOGY Plowey, E. D., Egbert, P. R. 2015; 133 (6): 706-709

  Abstract

  Retinal hemorrhages are an important sequela of fatal head trauma. The accurate pathologic diagnosis of retinal hemorrhages has critical implications for determination of the manner of death.We describe an autolytic postmortem histologic artifact of eosinophilic Müller cell foot process swelling that mimics a nerve fiber layer hemorrhage. From April 24, 2012, through November 11, 2014, we conducted postmortem examination of the eyes of 23 infants and children who were referred to our institution for possible nonaccidental head trauma. A focal artifact of Müller cell foot process swelling was identified in most patients (16 of 23) up to 4 years of age. Three infants, all of whom were younger than 3 months, demonstrated diffusely swollen Müller cell foot processes with intensely eosinophilic cytoplasm that mimicked erythrocytes of nerve fiber layer hemorrhages. The difference in the mean age between patients with diffuse eosinophilic artifacts (1.7 months) and patients with only a multifocal, focal, or absent artifact (13.3 months) was 11.6 months (95% CI, 6.5-16.7 months). Glycophorin C immunohistochemical analysis was useful to differentiate this artifact from nerve fiber layer hemorrhage.Our case review demonstrates an artifact of eosinophilic Müller cell foot processes swelling in postmortem examination of young infant eyes, a potential pitfall in the diagnosis of retinal hemorrhages. Our findings have important implications for the diagnosis of retinal hemorrhages in potential cases of nonaccidental head injury.

  View details for DOI 10.1001/jamaophthalmol.2015.0493

  View details for PubMedID 25837496

• Human histopathology of PASCAL laser burns. Eye (London, England) Paulus, Y. M., Kaur, K., Egbert, P. R., Blumenkranz, M. S., Moshfeghi, D. M. 2013

  View details for DOI 10.1038/eye.2013.100

  View details for PubMedID 23722723

• Enucleated eyes after failed intra-arterial infusion of chemotherapy for unilateral retinoblastoma: histopathologic evaluation of vitreous seeding. Clinical ophthalmology (Auckland, N.Z.) Kim, J., Do, H., Egbert, P. 2011; 5: 1655-1658

  Abstract

  Selective intra-arterial chemotherapy (IAC) has been adopted by many ocular oncology centers to treat advanced intraocular retinoblastoma. In this report, we describe two patients with unilateral intraocular retinoblastoma and persistent vitreous seeding, who were treated with IAC after failed systemic chemotherapy. Despite multiple sessions and increasing dosage of drug delivery, vitreous seeding in these cases failed to respond to IAC, and ultimately both eyes were enucleated for tumor control. Based on the histopathologic findings in these two cases, IAC appears to have limitations in treating persistent vitreous seeding in eyes which have failed systemic chemotherapy. Possible causes for failure of IAC to treat persistent vitreous seeding include poor vitreous penetration, inactive state of tumor seeds within the avascular vitreous cavity, and chemotherapeutic drug resistance.

  View details for DOI 10.2147/OPTH.S24318

  View details for PubMedID 22174572

  View details for PubMedCentralID PMC3236709

• Onchocerciasis: a potential risk factor for glaucoma BRITISH JOURNAL OF OPHTHALMOLOGY Egbert, P. R., Jacobson, D. W., Fiadoyor, S., Dadzie, P., Ellingson, K. D. 2005; 89 (7): 796-798

  Abstract

  Onchocerciasis is a microfilarial disease that causes ocular disease and blindness. Previous evidence of an association between onchocerciasis and glaucoma has been mixed. This study aims to further investigate the association between onchocerciasis and glaucoma.All subjects were patients at the Bishop John Ackon Christian Eye Centre in Ghana, west Africa, undergoing either trabeculectomy for advanced glaucoma or extracapsular extraction for cataracts, who also had a skin snip biopsy for onchocerciasis. A cross sectional case-control study was performed to assess the difference in onchocerciasis prevalence between the two study groups.The prevalence of onchocerciasis was 10.6% in those with glaucoma compared with 2.6% in those with cataracts (OR, 4.45 (95% CI 1.48 to 13.43)). The mean age in the glaucoma group was significantly younger than in the cataract group (59 and 65, respectively). The groups were not significantly different with respect to sex or region of residence. In models adjusted for age, region, and sex, subjects with glaucoma had over three times the odds of testing positive for onchocerciasis (OR, 3.50 (95% CI 1.10 to 11.18)).This study has shown a positive association between subclinical onchocerciasis and glaucoma. This finding emphasises the importance of eradication of onchocerciasis from west Africa.

  View details for DOI 10.1136/bjo.2004.061895

  View details for PubMedID 15965151

• Glaucoma in West Africa: a neglected problem BRITISH JOURNAL OF OPHTHALMOLOGY Egbert, P. R. 2002; 86 (2): 131-132

  Abstract

  Glaucoma in sub-Saharan Africa is a devastating disease which has not been fully addressed by the global ophthalmology community. The key issue is the lack of a satisfactory treatment.

  View details for PubMedID 11815333

• A PROSPECTIVE TRIAL OF INTRAOPERATIVE FLUOROURACIL DURING TRABECULECTOMY IN A BLACK-POPULATION AMERICAN JOURNAL OF OPHTHALMOLOGY Egbert, P. R., Williams, A. S., Singh, K., Dadzie, P., Egbert, T. B. 1993; 116 (5): 612-616

  Abstract

  In a study population of black Africans with advanced glaucoma in Ghana we conducted a prospective study of intraoperative 5-fluorouracil alone. Eyes undergoing trabeculectomy were randomly selected either to receive or not receive a single intraoperative application of 5-fluorouracil (50 mg/ml for five minutes). Fifty-five eyes had a mean follow-up of 282 days (minimum, 92 days). Twenty of 24 eyes (83%) in the 5-fluorouracil group vs 12 of 31 eyes (39%) in the control group had postoperative intraocular pressure of 20 mm Hg or less with or without medical therapy (P = .01). Eleven of 24 eyes (46%) in the 5-fluorouracil group and five of 31 eyes (16%) in the control group had intraocular pressure of 15 mm Hg or less (P = .02). Without medical therapy, 17 of 24 eyes (71%) in the 5-fluorouracil group and ten of 31 eyes (32%) in the control group had intraocular pressure of 20 mm Hg or less (P = .02). The overall complications were similar in the two groups. In this population, intraoperative 5-fluorouracil markedly improved the ability of trabeculectomy to lower intraocular pressure. We recommend that intraoperative 5-fluorouracil be considered in glaucoma surgery with poor prognosis as an alternative to postoperative subconjunctival injections when multiple injections are not feasible.

  View details for PubMedID 8238222

• RESULTS OF EXTRACAPSULAR CATARACT-SURGERY AND INTRAOCULAR-LENS IMPLANTATION IN GHANA ARCHIVES OF OPHTHALMOLOGY Egbert, P. R., Buchanan, M. 1991; 109 (12): 1764-1768

  Abstract

  Neither outpatient surgery nor intraocular lenses have been widely used in developing countries. We performed extracapsular cataract extraction with posterior chamber intraocular lens implantation in a simple outpatient clinic in Ghana, West Africa. Forty-nine (64%) of 77 eligible patients with follow-up times of 12 to 29 months after surgery underwent an eye examination and an interview related to activities of daily life. Preoperative visual acuity was counting fingers or worse in all but one patient. Visual acuity improved in 44 patients (90%) after surgery. Twenty-six patients (53%) had a corrected visual acuity of 20/40 or better, 11 (22%) had a corrected visual acuity of 20/50 to 20/100, and 12 (25%) had a corrected visual acuity of 20/200 or worse. Subjectively, 94% of patients believed that their vision improved after surgery. No major late complications occurred following the immediate postoperative period. In addition, our population experienced no complications attributable to the outpatient format of this surgery. Every patient, all of whom lived within a 32-km radius of the clinic, reliably returned for postoperative appointments. Our results demonstrate that outpatient surgery may be a safe and practical alternative to routine hospitalization for eye surgery in developing countries.

  View details for PubMedID 1841592

• Retinal Glioneuronal Hamartoma in Neurofibromatosis Type 1 ARCHIVES OF OPHTHALMOLOGY Lad, E. M., Karamchandani, J. R., Alcorn, D. M., Moshfeghi, D. M., Egbert, P. R. 2012; 130 (10): 1335-1337

  View details for Web of Science ID 000309543500017

  View details for PubMedID 23044954

• Histopathologic correlation of Aspergillus endophthalmitis following uncomplicated cataract surgery. Clinical ophthalmology (Auckland, N.Z.) Haddock, L. J., Flynn, H. W., Dubovy, S. R., Khurana, R. N., Egbert, P. R. 2012; 6: 1573-1577

  Abstract

  A clinicopathologic correlation between two patients with acute-onset Aspergillus endophthalmitis undergoing enucleation is reported. These two patients presented with pain, redness, and decreased vision following uncomplicated cataract surgery. In both patients, vitreous aspiration and intravitreal injections were the initial treatment followed later by pars plana vitrectomy for clinical worsening. Despite repeated surgical and medical interventions, the clinical course of both patients was prolonged, unsuccessful, and resulted in enucleation for a blind painful eye. Histologic examination of the enucleated specimens showed that, in spite of prolonged local and systemic therapy, there was persistent diffuse infiltration of the anterior chamber and ciliary body by a filamentous mold.

  View details for DOI 10.2147/OPTH.S35386

  View details for PubMedID 23055681

  View details for PubMedCentralID PMC3460706

• Comparison of One-Day Versus One-Hour Application of Topical Gatifloxacin in Eliminating Conjunctival Bacterial Flora 111th Annual Meeting of the American-Academy-of-Ophthalmology Moss, J. M., Nguyen, D., Liu, Y. I., Singh, K., Montague, A., Egbert, P. R., de Kaspar, H. M., Ta, C. N. ELSEVIER SCIENCE INC. 2008: 2013?16

  Abstract

  To compare efficacies of 1-day, 1-hour, and combined 1-day/1-hour preoperative topical gatifloxacin in eliminating conjunctival bacterial flora.Prospective, comparative case series.Sixty patients (120 eyes) scheduled to undergo anterior segment intraocular surgery at Stanford University Medical Center.Cultures were collected from the palpebral conjunctival sac at baseline and after 1 day (4 doses), 1 hour (3 doses), and 1 day/1 hour (7 doses) of gatifloxacin use.Incidence of positive bacterial samples collected pre- and post-antibiotic treatment and number of colony forming units (CFUs).SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures significantly decreased from 67% growth at baseline to 28% (P<0.0001) after 1 day and from 60% at baseline to 37% (P = 0.018) after 1 hour of gatifloxacin use. Reductions of 44% growth at baseline to 12% (P = 0.0001) after 1 day and 32% at baseline to 13% (P = 0.029) after 1 hour of gatifloxacin use were observed on blood agar. Surgical eyes that received both 1-day and 1-hour preoperative gatifloxacin had reductions from 67% growth at baseline to 18% posttreatment (P<0.0001) and 45% at baseline to 7% posttreatment (P<0.0001) on SeptiChek and blood agar media, respectively. In addition to a lower frequency of positive cultures, a significantly lower CFU count was found after 1-day (P = 0.004) and 1-hour (P = 0.049) gatifloxacin use compared with pretreatment levels. Combined 1-day/1-hour doses of gatifloxacin were associated with a greater reduction in CFUs (P = 0.001) when compared with 1-hour treatment alone.Both 1-hour and 1-day topical gatifloxacin use are effective in reducing the frequency of conjunctival bacterial growth and the overall bacterial load as measured by CFUs, relative to baseline. Although a 1-hour pretreatment is associated with a reduction in bacterial growth, the combination of 1-day and 1-hour preoperative gatifloxacin dosing results in an even lower overall bacterial load, suggesting that the latter might be the preferred preoperative regimen for eyes undergoing anterior segment surgery.

  View details for DOI 10.1016/j.ophtha.2008.06.024

  View details for PubMedID 18708260

• Long-term Comparison of Primary Trabeculectomy With 5-Fluorouracil Versus Mitomycin C in West Africa JOURNAL OF GLAUCOMA Kim, H. Y., Egbert, P. R., Singh, K. 2008; 17 (7): 578-583

  Abstract

  To compare the long-term efficacy and safety of intraoperative 5-fluorouracil (5-FU) versus mitomycin-C (MMC) used adjunctively with primary trabeculectomy in a Black West African population.Retrospective comparative study supplemented with cross-sectional follow-up data.Review of 68 eyes of 68 Black West African subjects that underwent primary trabeculectomy with the use of intraoperative 5-FU or MMC between January 1, 1988 and January 1, 2002 and had at least 3 years postoperative follow-up. Postoperative outcome measures included intraocular pressure (IOP) control, number of glaucoma medications, visual acuity, and complications.Thirty-eight of sixty-eight eyes received 5-FU and 30 received MMC. Mean postoperative follow-up was 7.5 and 6.5 years in the 5-FU and MMC groups, respectively (P=0.17). A higher proportion of eyes in the MMC group achieved "qualified" (with or without medical therapy) success with varying IOP targets relative to the 5-FU group, but the differences were not statistically significant. "Complete" (without medical therapy) postoperative success was greater in the MMC group with a significantly higher proportion achieving an IOP <21 mm Hg (P=0.02). MMC use was also associated with a lower likelihood of receiving IOP-lowering medications postoperatively (P=0.01). Baseline demographic characteristics, preoperative and postoperative IOP, visual acuity, and complications did not differ significantly between the 2 groups.Intraoperative MMC use is associated with a lower likelihood of requiring postoperative medications and a greater likelihood of achieving IOP lowering without medications relative to the use of 5-FU in a Black West African population.

  View details for PubMedID 18854737

• Prospective comparison of topical moxifloxacin in eliminating conjunctival bacterial flora following a one-day or one-hour application Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Ta, C. N., Chan, I., Dhatt, H. S., Paterno, J., Fisher, E., Singh, K., Montague, A., Egbert, P. R., Cockerham, G., de Kaspar, H. M. MARY ANN LIEBERT INC. 2008: 427?31

  Abstract

  The aim of this study was to compare the efficacy of a 1-hour(h) versus 1-day application of topical moxifloxacin in eliminating conjunctival bacterial flora.In this prospective, nonrandomized, controlled trial, the surgical eyes of 60 patients scheduled for intraocular surgery received topical moxifloxacin four times a day, starting 1 day prior to surgery and three additional applications at 5-minute intervals 1 h before surgery. The nonsurgical eye of each patient only received three applications of the same antibiotic at 5-minute intervals 1 h before surgery. Conjunctival cultures were obtained at baseline and after antibiotic application.Prior to antibiotic application, 80% of surgical eyes and 70% of nonsurgical eyes had positive cultures. Following the 1-day application, significantly fewer eyes (40%) had positive cultures (P < 0.0001), with a further reduction to 32% with three additional doses 1 h prior to surgery. In the nonsurgical eye, the decrease in the percentage of positive cultures, from 55% to 53% following the three applications 1 h prior to surgery, was not significant (P > 0.9999). The 1-day application was associated with significantly fewer positive cultures, compared to the 1-h group (P = 0.0267).The one-day application of moxifloxacin resulted in significantly fewer positive conjunctival cultures, compared with a 1-h application.

  View details for DOI 10.1089/jop.2008.0018

  View details for PubMedID 18665815

• Orbital giant cell angiofibroma recurring as a solitary fibrous tumor Fall Meeting of the American-Society-of-Ophthalmic-Plastic-and-Reconstructive-Surgeons Zoumalan, C. I., Egbert, P. R., Warwar, R. E., McCulley, T. J. LIPPINCOTT WILLIAMS & WILKINS. 2008: 325?27

  Abstract

  Giant cell angiofibroma has recently been hypothesized to be a clinicopathologic variant of solitary fibrous tumor. The authors report a case of an orbital giant cell angiofibroma that recurred as a solitary fibrous tumor 4 years later. The report strongly supports the hypothesis that giant cell angiofibroma and solitary fibrous tumor are related.

  View details for DOI 10.1097/IOP.0b013e31817dd6f5

  View details for PubMedID 18645449

• ThinPrep (R) vitreous-based diagnosis of choroidal malignant melanoma OCULAR IMMUNOLOGY AND INFLAMMATION Chan, A., Egbert, P. R., Moshfeghi, D. M. 2008; 16 (4): 135-137

  Abstract

  To report an alternative method for the diagnosis of atypical choroidal malignant melanoma-ThinPrep sampling of the vitreous cavity through 25-gauge vitrectomy.Case report.A 79-year-old gentleman presented with a progressive decline in visual acuity in his left eye. A clinical diagnosis of large choroidal malignant melanoma was made. Given the history of trauma and the possibility of enucleation, the patient wished to have histopathological confirmation. The patient underwent 25-gauge vitrectomy. However, he developed a choroidal hemorrhage during the procedure and the surgeon elected not to perform transretinal biopsy. Instead a sample of the vitreous was evaluated by ThinPrep analysis, and a diagnosis of choroidal malignant melanoma was made.Cytological evaluation of vitreous substance with ThinPrep may provide an alterative method for a diagnosis in select cases in which FNA is not possible or desirable. This technique is straightforward and minimizes the risk of retinal detachment or hemorrhage.

  View details for DOI 10.1080/09273940802140796

  View details for PubMedID 18716946

• Endogenous Scedosporium apiospermum endophthalmitis ARCHIVES OF OPHTHALMOLOGY Jain, A. T., Egbert, P., McCulley, T. J., Blumenkranz, M. S., Moshfeghi, D. M. 2007; 125 (9): 1286-1289

  View details for Web of Science ID 000249342100023

  View details for PubMedID 17846376

• Prospective randomized comparison of 2 different methods of 5% povidone-iodine applications for anterior segment intraocular surgery. Archives of ophthalmology Miño de Kaspar, H., Chang, R. T., Singh, K., Egbert, P. R., Blumenkranz, M. S., Ta, C. N. 2005; 123 (2): 161-165

  Abstract

  To determine the efficacy of reducing conjunctival bacteria flora with 2 different regimens of 5% povidone-iodine application: 2 drops on the conjunctiva cul-de-sac vs a 10-mL conjunctival irrigation of the fornices.In this prospective controlled trial, 200 eyes undergoing anterior segment intraocular surgery were randomized to control and study groups. All patients from both groups received topical ofloxacin and a povidone-iodine scrub of the periorbital area before the surgical procedure. The eyes in the control group received 2 drops of povidone-iodine on the conjunctiva preoperatively, whereas eyes in the study group had irrigation of the fornices with 10 mL of povidone-iodine. Conjunctival cultures were obtained at 4 separate time points before and after surgery.Twenty (26%) of 78 eyes in the study group had positive conjunctival cultures immediately prior to surgery compared with 40 (43%) of 94 eyes in the control group (P = .02). At the conclusion of the surgery, 14 (18%) of 78 eyes and 30 (32%) of 94 eyes had positive cultures in the study and control groups, respectively (P = .05).Irrigation of the fornices with 5% povidone-iodine was associated with significantly fewer positive conjunctival cultures at the time of surgery compared with the application of 2 drops on the conjunctiva.

  View details for PubMedID 15710810

• Prospective Randomized comparison of 2 different methods of 5% povidone-lodine applications for anterior segment, Intraocular surgery 106th Annual Meeting of the American-Academy-of-Ophthalmology de Kaspar, H. M., Chang, R. T., Singh, K., Egbert, P. R., Blumenkranz, M. S., Ta, C. N. AMER MEDICAL ASSOC. 2005: 161?65

  Abstract

  To determine the efficacy of reducing conjunctival bacteria flora with 2 different regimens of 5% povidone-iodine application: 2 drops on the conjunctiva cul-de-sac vs a 10-mL conjunctival irrigation of the fornices.In this prospective controlled trial, 200 eyes undergoing anterior segment intraocular surgery were randomized to control and study groups. All patients from both groups received topical ofloxacin and a povidone-iodine scrub of the periorbital area before the surgical procedure. The eyes in the control group received 2 drops of povidone-iodine on the conjunctiva preoperatively, whereas eyes in the study group had irrigation of the fornices with 10 mL of povidone-iodine. Conjunctival cultures were obtained at 4 separate time points before and after surgery.Twenty (26%) of 78 eyes in the study group had positive conjunctival cultures immediately prior to surgery compared with 40 (43%) of 94 eyes in the control group (P = .02). At the conclusion of the surgery, 14 (18%) of 78 eyes and 30 (32%) of 94 eyes had positive cultures in the study and control groups, respectively (P = .05).Irrigation of the fornices with 5% povidone-iodine was associated with significantly fewer positive conjunctival cultures at the time of surgery compared with the application of 2 drops on the conjunctiva.

  View details for Web of Science ID 000226755000002

• Three-day application of topical ofloxacin reduces the contamination rate of microsurgical knives in cataract surgery - A prospective randomized study Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology de Kaspar, H. M., Chang, R. T., Shriver, E. M., Singh, K., Egbert, P. R., Blumenkranz, M. S., Ta, C. N. ELSEVIER SCIENCE INC. 2004: 1352?55

  Abstract

  To determine the rate of contamination of microsurgical knives during cataract surgery and the benefit of a 3-day versus a 1-hour preoperative application of topical ofloxacin in reducing the contamination rate.Prospective, randomized controlled trial.Seventy-eight eyes of 75 patients were randomly assigned to control (39 eyes) or study groups (39 eyes).All patients from both groups received 0.3% topical ofloxacin 1 hour before surgery, 5% povidone-iodine (PVI) scrub of the periorbital area, and 2 drops of PVI onto the ocular surface preoperatively. The patients in the study group also received ofloxacin 4 times a day for 3 days before surgery.Microsurgical knives were placed in blood culture broth media immediately after the incision had been made. The number of positive cultures and types of bacteria isolated were determined.Ten of 39 knives (26%) in the control group were found to be positive for bacterial growth compared with only 2 of 39 (5%) in the study group (P = 0.028).The initial paracentesis incision frequently results in contamination of the microsurgical knife and may serve as a mechanism for introducing bacteria from the ocular surface into the anterior chamber. The application of topical ofloxacin for 3 days before surgery significantly reduces the contamination rate of the microsurgical knives, compared with a preoperative application of ofloxacin given 1 hour before surgery.

  View details for PubMedID 15234136

• The challenge of determining aqueous contamination rate in anterior segment intraocular surgery AMERICAN JOURNAL OF OPHTHALMOLOGY Ta, C. N., Egbert, P. R., Singh, K., Blumenkranz, M. S., de Kaspar, H. M. 2004; 137 (4): 662-667

  Abstract

  To determine aqueous contamination rate in anterior segment intraocular surgery using two different techniques of obtaining aqueous fluid and to assess whether a 3-day application of topical 0.3% ofloxacin reduces this contamination rate compared with a 1-hour application.Randomized clinical trial.One hundred and thirty-three eyes of 130 patients undergoing anterior segment intraocular surgery were randomized to either control (64 eyes received topical ofloxacin 1 hour before surgery) or study groups (69 eyes received topical ofloxacin four times a day for 3 days before surgery in addition to 1 hour preoperatively). Eyes in both groups received a periorbital iodine scrub and two drops of topical 5% iodine. Aqueous fluid was obtained at the beginning and conclusion of surgery using a cannula passed through a paracentesis or a needle passed through clear cornea. The aqueous, cannula, and needles were inoculated in blood culture media broth and bacterial growth was identified.Overall, eight of 89 aqueous samples (9%) obtained using a cannula at the beginning of surgery were culture-positive. Similarly, six of 41 aqueous samples (15%) obtained through a needle through clear cornea at the beginning of surgery showed contamination. At the conclusion of surgery, nine of 112 samples (8%) showed positive cultures. There was no difference in the aqueous contamination rates between the control and study groups.Despite the use of a needle to obtain aqueous fluid at the beginning of surgery before creating a paracentesis, the aqueous contamination rate remained higher than that found at the conclusion of surgery. A 3-day application of topical ofloxacin before surgery did not reduce the anterior chamber aqueous contamination rate relative to a 1-hour application.

  View details for DOI 10.1016/j.ajo.2003.11.057

  View details for PubMedID 15059705

• Antibiotic resistance patterns of ocular bacterial flora - A prospective study of patients undergoing anterior segment surgery Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Ta, C. N., Chang, R. T., Singh, K., Egbert, P. R., Shriver, E. M., Blumenkranz, M. S., de Kaspar, H. M. ELSEVIER SCIENCE INC. 2003: 1946?51

  Abstract

  To determine the antibiotic susceptibility patterns of conjunctival bacterial flora isolated preoperatively from patients undergoing anterior segment surgery.Prospective observational study.One hundred fifty-six eyes from 139 patients scheduled for anterior segment surgery were enrolled over a 6-month period from August 2001 to February 2002.Conjunctival cultures were obtained on the day of surgery before povidone-iodine or antibiotic application.Bacterial isolates were identified and tested for antibiotic susceptibility using the Kirby-Bauer disc-diffusion technique.Among the 156 eyes studied, 36 were from patients who had undergone either bilateral surgery or more than one surgery in the same eye. Only the first eyes of the 120 patients that underwent initial ocular surgery were included in our analysis. Of these 120 eyes, 21 (18%) showed no bacterial growth. Of the 143 bacterial strains isolated from the remaining 99 eyes, 112 (78%) were coagulase-negative staphylococci (CNS). Among the CNS, greater than 90% were susceptible to cefotaxime, levofloxacin, imipenem, meropenem, vancomycin, and each of the aminoglycosides except neomycin. Between 70% and 90% of the CNS were susceptible to cefazolin, neomycin, ciprofloxacin, ofloxacin, norfloxacin, and chloramphenicol. Less than 70% of the isolated CNS were sensitive to the penicillin analogues, ceftazidime, erythromycin, and tetracycline.Preoperative conjunctival isolates of CNS seem to be most sensitive to vancomycin, the aminoglycosides (except neomycin), and levofloxacin.

  View details for DOI 10.1016/S0161-6420(03)00735-8

  View details for PubMedID 14522770

• Risk factors for antibiotic-resistant conjunctival bacterial flora in patients undergoing intraocular surgery 100th Annual Meeting of the Deutsche-Ophthalmologische-Gesellschaft de Kaspar, H. M., Shriver, E. M., Nguyen, E. V., Egbert, P. R., Singh, K., Blumenkranz, M. S., Ta, C. N. SPRINGER. 2003: 730?33

  Abstract

  The purpose of this study was to determine if patients with certain risk factors are more likely to harbor conjunctival bacterial flora resistant to multiple antibiotics.In this prospective study, detailed medical history and slit-lamp examination were performed on all patients prior to intraocular surgery. Patients with local risk factors were defined as those with chronic blepharitis, conjunctivitis or discharge. Those with systemic risk factors were patients with diabetes, autoimmune, immunodeficient or skin disorders, asthma and those taking immunosuppressant medications. Conjunctival cultures were obtained prior to preoperative antibiotics and povidone-iodine. Bacteria isolated were identified and antibiotic susceptibility was determined. Bacteria resistant to five or more antibiotics were defined as multi-resistant (MR).Among the 207 patients enrolled in the study, 73 patients had local risk factors. Of these patients, 32 patients (44%) carried MR organisms, compared to 32 of the 134 patients (24%) without local risk factors (P=0.0049). Thirty-two of 71 patients (45%) with systemic risk factors harbored MR organisms, compared to 32 of 136 patients (24%) without systemic risk factors (P=0.0025). Seventeen of 93 patients (18%) who had neither local nor systemic risk factors had MR organisms on their conjunctiva. In contrast, 17 of the 30 patients (57%) with both local and systemic risk factors (57%) carried MR bacteria (P=0.0001).Patients with local and/or systemic risk factors are more likely to harbor MR organisms. This may be one mechanism for the reported increased risk of postoperative endophthalmitis in this group of patients.

  View details for DOI 10.1007/s00417-003-0742-5

  View details for PubMedID 12928904

• Ten-fold reduction of conjunctival bacterial contamination rate using a combined 3-day application of topical ofloxacin and iodine irrigation in patients undergoing anterior segment intraocular surgery Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology de Kaspar, H. M., Singh, G., Egbert, P. R., Haw, W. W., Nguyen, E. V., Singh, K., Blumenkranz, M. S., Ta, C. N. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2003: U344?U344

  View details for Web of Science ID 000184606801409

• Prospective randomized comparison of 3-day versus 1-hour preoperative ofloxacin prophylaxis for cataract surgery 105th Annual Meeting of the American-Academy-of-Ophthalmology Ta, C. N., Egbert, P. R., Singh, K., Shriver, E. M., Blumenkranz, M. S., de Kaspar, H. M. ELSEVIER SCIENCE INC. 2002: 2036?40

  Abstract

  To determine the efficacy of reducing conjunctival bacterial flora with topical ofloxacin when given for 3 days compared with 1 hour before surgery.Prospective, randomized, controlled trial.Ninety-two eyes from 89 patients were randomized to a control group (48 eyes) or study group (44 eyes).All patients from both groups received topical ofloxacin 0.3% 1 hour before surgery and a 5% povidone iodine scrub of the periorbital area before surgery. The patients in the study group received additional ofloxacin four times daily for 3 days before surgery.Conjunctival cultures were obtained at five separate time points and were inoculated in solid and liquid culture media. The presence of bacteria was determined, quantified, and identified.Forty-two percent of eyes in the control group had positive conjunctival culture immediately before surgery, compared with 19% of eyes in the study group (P < 0.05). Immediately after surgery, 34% and 14% of eyes had positive cultures in the control and study groups, respectively (P < 0.05). Quantitatively, fewer bacteria were isolated from eyes in the study group compared with those in the control group for culture samples that were obtained both before povidone iodine scrub and at the conclusion of surgery (P

  View details for PubMedID 12414411

• Bacterial contamination of paracentesis blades used in cataract surgery Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Chang, R. T., Ta, C. N., Egbert, P. R., Singh, K., Haw, W. W., Shriver, E. M., Espinosa, L., Williams, D. Y., Blumenkranz, M. S., de Kaspar, H. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2002: U73?U73

  View details for Web of Science ID 000184606600340

• Multiresistant Staphylococcus epidermidis on the conjunctiva prior to intraocular surgery Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Shriver, E. M., Ta, C. N., Egbert, P. R., Singh, K., Chang, R. T., Blumenkranz, M. S., de Kaspar, H. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2002: U860?U860

  View details for Web of Science ID 000184606700226

• Antibiotic susceptibility pattern of coagulase-negative staphylococci in patients undergoing Intraocular surgery Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Ta, C. N., de Kaspar, H. M., Chang, R. T., Shriver, E. M., Egbert, P. R., Singh, K., Blumenkranz, M. S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2002: U1275?U1275

  View details for Web of Science ID 000184606701594

• Antibiotic susceptibility pattern of coagulase-negative staphylococci in patients undergoing intraocular surgery. Ta, C. N., de Kaspar, H., Egbert, P., Singh, K., Blumenkranz, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2001: S254?S254

  View details for Web of Science ID 000168392101365

• Immediate bacterial contamination of the aqueous humor in intraocular surgery. Braun, M., de Kaspar, H., Ta, C. N., Egbert, P., Singh, K., Blumenkranz, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2001: S256?S256

  View details for Web of Science ID 000168392101374

• Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma ARCHIVES OF OPHTHALMOLOGY Egbert, P. R., Fiadoyor, S., Budenz, D. L., Dadzie, P., Byrd, S. 2001; 119 (3): 345-350

  Abstract

  To evaluate the feasibility of diode laser transscleral cyclophotocoagulation (TSCPC) as a primary surgical treatment for primary open-angle glaucoma and to compare 2 laser energy settings used for treatment.In a prospective clinical trial in Cape Coast and Accra, Ghana, 1 eye of each of 92 patients with primary open-angle glaucoma was treated by diode laser TSCPC as a primary surgical treatment. Eyes were randomly assigned to receive treatment by 20 applications of either 1.5 W applied for 1.5 seconds or 1.25 W applied for 2.5 seconds.Seventy-nine (86%) of 92 patients completed 3 months of follow-up; follow-up was 13.2 +/- 6.0 months (mean +/- SD). Intraocular pressure decreased in 53 (67%) of the 79 eyes. The drop in intraocular pressure was 20% or more in 37 eyes (47%) and final intraocular pressure was 22 mm Hg or less in 38 eyes (48%). An atonic pupil was a previously unreported complication that arose in 27 (28%) of 92 eyes. There were no serious complications of hypotony, phthisis bulbi, or sympathetic ophthalmia. Visual acuity decreased in 18 (23%) of 79 eyes treated by TSCPC and in 10 (23%) of 47 fellow eyes treated only with glaucoma medications. There was no difference in outcomes between the 2 laser energy settings.Diode laser TSCPC is a practical, rapid, well-tolerated procedure that may provide a modest and variable lowering of intraocular pressure. The treatment, used with conservative energy levels applied to the eye, seems to have few serious complications, although a previously unrecognized complication of atonic pupil needs further evaluation. A moderate variation in laser energy settings does not influence the results of treatment.

  View details for PubMedID 11231767

• Granulomatous local cell reaction to intravitreal silicone ARCHIVES OF OPHTHALMOLOGY Shaikh, S., Egbert, P. R., Goldblum, R. S., Wieland, M. R. 2000; 118 (8): 1133-1134

  View details for PubMedID 10922215

• Risk of hypotony after primary trabeculectomy with antifibrotic agents in a black West African population JOURNAL OF GLAUCOMA Singh, K., Byrd, S., Egbert, P. R., Budenz, D. 1998; 7 (2): 82-85

  Abstract

  To evaluate the risk of hypotony and hypotony maculopathy following trabeculectomy with 5-fluorouracil (5-FU) and mitomycin C (MMC) in a black West African population.One hundred and one eyes of black Ghanaian patients with advanced primary open-angle glaucoma received intraoperative antifibrotic therapy with trabeculectomy as part of two randomized clinical trials. Overall, 57 patients received 5-FU (50.0 mg/ml for 5 minutes) and 44 received MMC (0.5 mg/ml for 3.5 minutes). All cases were performed by one of five surgeons at a single outpatient surgery center.Two of 101 eyes had a final intraocular pressure (IOP) of less than 5 mm Hg and were thus classified as having hypotony. No patient in either group was noted to develop hypotony-related maculopathy. Overall mean pre- and postoperative IOPs were 30.1 and 15.9 mm Hg, respectively. The patients receiving intraoperative MMC had a lower mean postoperative IOP (14.7 mm Hg) than those receiving 5-FU (first study, 17.1 mm Hg; second study, 16.7 mm Hg; p = 0.05). Mean overall follow-up was 17.7 months and did not differ significantly between the MMC and combined 5-FU groups.Hypotony following trabeculectomy supplemented with antifibrotic agents is a rare complication in this population. No eyes in either clinical trial developed hypotony maculopathy, suggesting that the prevalence of this condition is substantially lower in black West Africans than in whites.

  View details for PubMedID 9559492

• Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C AMERICAN JOURNAL OF OPHTHALMOLOGY Singh, K., Egbert, P. R., Byrd, S., Budenz, D. L., Williams, A. S., Decker, J. H., Dadzie, P. 1997; 123 (1): 48-53

  Abstract

  To compare the effectiveness of intraoperative 5-fluorouracil (5-FU) and mitomycin C used adjunctively with trabeculectomy in a black West African population.Eighty-five consecutive eyes of 85 black patients undergoing primary trabeculectomy for open-angle glaucoma were prospectively randomly assigned to receive either 5-FU (50 mg/ml for 5 minutes) or mitomycin C (0.5 mg/ml for 3 1/2 minutes) intraoperatively by soaked sponge.Of the 81 eyes with at least a 3-month postoperative follow-up, 41 of 44 (93.2%) in the mitomycin C group and 27 of 37 (73.0%) in the 5-FU group had a final intraocular pressure of less than 21 mm Hg (P = .01). Twenty-eight of 44 eyes (63.6%) in the mitomycin C group and 18 of 37 (51.4%) in the 5-FU group had a final intraocular pressure of less than 15 mm Hg (P = .26). Mean postoperative intraocular pressure was 13.7 mm Hg in the mitomycin C group and 16.3 mm Hg in the 5-FU group (P = .05). There were no differences between the two groups in mean age, preoperative intraocular pressure, postoperative visual acuity, and complications. Mean follow-up was 10.0 +/- 4.41 months (range, 4 to 19 months).The adjunctive use of mitomycin C with trabeculectomy is equally safe and more efficacious compared to 5-FU in this West African population. Use of mitomycin C in this study was not associated with a statistically significantly greater proportion of patients achieving low intraocular pressure (less than 15 mm Hg) compared to 5-FU.

  View details for PubMedID 9186096

• Risk of hypotony following antimetabolite trabeculectomy in a black West African Singh, K., Egbert, P. R., Budenz, D., Dadzie, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 1996: 1161?61

  View details for Web of Science ID A1996TX39701159

• HISTOLOGIC-STUDY OF HEALING AFTER AB INTERNO LASER SCLEROSTOMY AMERICAN JOURNAL OF OPHTHALMOLOGY Shahinian, L., Egbert, P. R., Williams, A. S. 1992; 114 (2): 216-219

  Abstract

  We examined the histologic characteristics of healing after ab interno laser sclerostomy in a human eye. A KTP 532 green laser coupled to a 300-microns quartz fiberoptic probe was used to create an ab interno sclerostomy in a terminally ill patient with pigmentary glaucoma. The intraocular pressure increased five days postoperatively and did not respond to medical treatment. The patient died six weeks postoperatively of metastatic lung cancer. Histopathologic analysis showed a patent 150-microns scleral lumen from the anterior chamber to the episclera, surrounded by a 300-microns zone of acellular thermal damage. There was no healing of the lumen. The subconjunctival end of the lumen was capped with a thick episcleral scar, which caused the failure of the operation.

  View details for PubMedID 1642299

• INTRAOCULAR INVOLVEMENT WITH SUBRETINAL PIGMENT-EPITHELIUM INFILTRATES BY MYCOSIS-FUNGOIDES BRITISH JOURNAL OF OPHTHALMOLOGY Erny, B. C., Egbert, P. R., PEAT, I. M., Shorrock, K., Rosenthal, A. R. 1992; 76 (6): U384-U387

  View details for Web of Science ID A1992HX13100022

• EYELID TUMORS CURRENT OPINION IN OPHTHALMOLOGY Aguilar, G. L., Egbert, P. 1992; 3 (3): 333-340

  View details for Web of Science ID A1992HZ59900006

• INTRAOCULAR INVOLVEMENT WITH SUBRETINAL PIGMENT-EPITHELIUM INFILTRATES BY MYCOSIS-FUNGOIDES BRITISH JOURNAL OF OPHTHALMOLOGY Erny, B. C., Egbert, P. R., PEAT, I. M., Shorrock, K., Rosenthal, A. R. 1991; 75 (11): 698-701

  Abstract

  We report a case of intraocular mycosis fungoides in a 48-year-old man. The patient presented with decreased visual acuity, white subretinal lesions, and vitritis. Post-mortem histopathology revealed malignant T cell infiltrates consistent with mycosis fungoides in the retina, vitreous, and between the retinal pigment epithelium (RPE) and Bruch's membrane Focal atrophy of the RPE, along with the sub-RPE infiltrates, correlated with the clinically visible fundus lesions.

  View details for PubMedID 1751471

• TREATMENT OF REFRACTORY ORBITAL PSEUDOTUMORS WITH PULSED CHEMOTHERAPY OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY PARIS, G. L., WALTUCH, G. F., Egbert, P. R. 1990; 6 (2): 96-101

  Abstract

  Five patients with orbital pseudotumor refractive to initial therapy are discussed. Three had a destructive granulomatous process associated with a sclerosing component. Two exhibited a predominantly lymphocytic infiltration. Chemotherapy with Prednisone (100 mg/day) and either Cytoxan (100 mg/day) or Chlorambucil (10 mg/day) in 5-day pulses is described. All patients responded clinically to this treatment without unfavorable side effects.

  View details for PubMedID 2285671

• AGGRESSIVE MANAGEMENT OF 2ND PRIMARY TUMORS IN SURVIVORS OF HEREDITARY RETINOBLASTOMA INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Smith, L. M., Donaldson, S. S., Egbert, P. R., Link, M. P., Bagshaw, M. A. 1989; 17 (3): 499-505

  Abstract

  Survivors of hereditary retinoblastoma are at increased risk for the development of second primary tumors, most commonly osteosarcoma. Recent molecular genetic data demonstrate that a pleiotrophic effect of the retinoblastoma gene may be responsible for the development of these sarcomas. This report describes the incidence of second nonocular malignancies among 53 infants seen at Stanford University Medical Center who have been followed a median of 11.7 years. Of these, 42 initially had bilateral disease and eleven had unilateral disease. Of 53 infants, 50 received irradiation either as part of the initial therapy or as treatment for recurrent disease. The actuarial survival for the entire group is 67% at 30 year follow-up with a median survival of 79% at 11.7 years. Eight patients developed eleven second primary tumors. All occurred in the group having hereditary retinoblastoma. Eight were within the previously irradiated field and three were at distant sites. The second tumors included seven osteosarcomas, one angiosarcoma, one rhabdomyosarcoma, one malignant fibrous histiocytoma, and one unclassifiable round blue cell tumor. The actuarial incidence of the development of a second primary malignancy was 6% at 10 years, 19% at 20 years, and 38% at 30 years. The latent period from treatment of retinoblastoma to the diagnosis of malignancy ranged from 5.2 years to 36.2 years (median 16 years). An aggressive approach with combined modality therapy including radical resection, re-irradiation and/or chemotherapy was used to treat these second primary tumors in five of eight patients. In four of the five, there was no evidence of disease at 22-72 months following treatment. In the three patients who did not receive aggressive combined treatment, there were no survivors. These data confirm the previously reported risk of developing a second primary tumor among survivors with hereditary retinoblastoma. Careful long-term follow-up for this genetically susceptible group is essential for early detection and implementation of curative therapy.

  View details for PubMedID 2777644

• INTERNAL SUTURE OCCLUSION OF THE MOLTENO GLAUCOMA IMPLANT FOR THE PREVENTION OF POSTOPERATIVE HYPOTONY OPHTHALMIC SURGERY AND LASERS Egbert, P. R., Lieberman, M. F. 1989; 20 (1): 53-56

  Abstract

  The Molteno glaucoma drainage implant procedure is useful for managing refractory glaucoma, but a significant concern has been the avoidance of postoperative hypotony due to temporary excessive filtration. We have developed a method of temporarily closing the translimbal tube with an internally-placed occluding suture (4-0 or 5-0 chromic). Seven to 12 days later this suture was removed, without surgery, in an outpatient setting. We have used this method on 30 patients. The advantages are that postoperative hypotony is reduced, and the Molteno drainage implant can be inserted in a single operation.

  View details for PubMedID 2648233

• OPHTHALMIC DISEASE IN WESTERN-SAMOA AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY Egbert, P. R. 1986; 14 (2): 167-170

  Abstract

  Since the last report on eye disease in Western Samoa in 1959 by Dr. Elliott, the population has increased from 97,000 to 158,000. The country now has a full-time ophthalmologist but could benefit from a larger eye care service. The distribution of disease is very similar to that found in 1959, with pterygium, cataract and injuries comprising the most frequent eye problems. Acute angle-closure glaucoma is much more common than open-angle glaucoma and is associated with a plateau iris configuration.

  View details for Web of Science ID A1986E724100011

  View details for PubMedID 3801207

• RADIOTHERAPY OF LYMPHOID DISEASES OF THE ORBIT INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS AUSTINSEYMOUR, M. M., Donaldson, S. S., Egbert, P. R., McDougall, I. R., KRISS, J. P. 1985; 11 (2): 371-379

  Abstract

  Thirty-two patients with orbital pseudotumor (18), reactive lymphoid hyperplasia (2), atypical lymphoid infiltrate (4) or malignant lymphoma (8) were treated in the Division of Radiation Therapy at Stanford University between January 1973 and May 1983. Of the 20 patients with pseudotumor or reactive lymphoid hyperplasia, 10 had unilateral lesions and 10 had bilateral lesions. Biopsy samples were obtained in 15 patients; in five patients with bilateral disease the diagnosis was made on the basis of computed tomography (CT) and clinical findings. The majority of patients were referred because of disease refractory to treatment with corticosteroids. The patients were given a mean dose of 2360 rad using complex, individualized megavoltage techniques including lens shielding. Radiotherapy was well tolerated with no significant acute or late complications. Fifteen patients had complete resolution of symptoms after treatment; five had continued symptoms. Of the 12 patients with malignant lymphoma or atypical lymphoid infiltrate, four had systemic lymphoma with orbital involvement and eight had orbital involvement only. The diagnosis was made by biopsy in all patients and immunophenotyping was done in six cases, of which 5 were monoclonal. Patients were evaluated with a chest radiograph, lymphogram or abdominal CT, bone marrow biopsy and orbital CT. A mean dose of 3625 rad was delivered to the orbit only. Most of the patients received complex megavoltage treatment using bolus. All patients in this group had a complete response and local control. There were no relapses in those with localized disease. Two patients developed cataracts. Carefully planned orbital radiotherapy provides local control without symptomatic sequelae for orbital masses ranging from pseudotumor to malignant lymphoma.

  View details for Web of Science ID A1985ACJ5900020

  View details for PubMedID 3918966

• THE HISTOPATHOLOGY OF FAMILIAL EXUDATIVE VITREORETINOPATHY - A REPORT OF 2 CASES ARCHIVES OF OPHTHALMOLOGY Boldrey, E. E., Egbert, P., Gass, J. D., Friberg, T. 1985; 103 (2): 238-241

  Abstract

  Two eyes were enucleated for angle-closure associated with familial exudative vitreoretinopathy. Characteristic features included total retinal detachment, peripheral retinal vascular proliferation, and a fibrovascular preretinal membrane. Angle-closure glaucoma developed in one case when sudden massive subretinal hemorrhage, associated with abnormal intraretinal vessels, produced anterior displacement of the lens-iris diaphragm; in the second case, angle-closure was associated with the development of rubeosis iridis. Intraretinal inflammatory cells and exudates were also seen in the enucleated eyes.

  View details for Web of Science ID A1985ABV4800027

  View details for PubMedID 3977696

• ALPHA-INTERFERON ADMINISTRATION IN CYTOMEGALOVIRUS RETINITIS ANTIMICROBIAL AGENTS AND CHEMOTHERAPY Chou, S., Dylewski, J. S., Gaynon, M. W., Egbert, P. R., Merigan, T. C. 1984; 25 (1): 25-28

  Abstract

  Four patients, including three with the acquired immunodeficiency syndrome (AIDS), were treated with high-dose, buffy coat-derived alpha-interferon for progressive cytomegalovirus retinitis. Two of these patients had decreased viruria during therapy and the other two had increased viruria. There was evidence of progression of disease despite therapy in all patients, although the retinitis eventually became quiescent in the patient without AIDS. The severe immunosuppression encountered in AIDS patients complicates the management of cytomegalovirus and other opportunistic infections.

  View details for Web of Science ID A1984RY30400007

  View details for PubMedID 6322678

  View details for PubMedCentralID PMC185427

• LYMPHOCYTIC INFILTRATES OF THE CONJUNCTIVA AND ORBIT - IMMUNOHISTOCHEMICAL STAINING OF 16 CASES AMERICAN JOURNAL OF CLINICAL PATHOLOGY Turner, R. R., Egbert, P., Warnke, R. A. 1984; 81 (4): 447-452

  Abstract

  The authors have performed frozen section immunologic stains on 16 cases of ocular lymphocytic infiltrates and correlated the results with clinical and histologic findings. Their cases included inflammatory pseudotumor (3), reactive lymphoid hyperplasia (3), atypical lymphocytic infiltrate (9), and small cleaved cell lymphoma (1). Seven of the nine cases with an atypical lymphocytic infiltrate expressed one immunoglobulin light chain, while only one of six considered reactive on histologic evaluation had immunologic results suggestive of a neoplastic B cell proliferation. The case of follicular small cleaved cell lymphoma expressed B lineage antigens but did not express immunoglobulin; this patient died of disseminated lymphoma two years after conjunctival involvement. Percentages and subset ratios of T lymphocytes were quantitated and showed similar results in reactive and neoplastic lesions. There is no apparent difference in clinical presentation or follow-up information between patients with reactive lesions and those having an atypical lymphocytic infiltrate with monotypic immunoglobulin.

  View details for Web of Science ID A1984SL52500006

  View details for PubMedID 6608261

• LEBERS CONGENITAL AMAUROSIS AS A MANIFESTATION OF INFANTILE CEROID LIPOFUSCINOSIS (HALTIA-SANTAVUORI TYPE) NEURO-OPHTHALMOLOGY Herrick, M. K., Forno, L. S., Egbert, P. R., Urich, H. 1984; 4 (3): 151-163

  View details for Web of Science ID A1984TJ33000003

• OCULAR ALBUMIN FLUOROPHOTOMETRIC QUANTITATION OF ENDOTOXIN-INDUCED VASCULAR-PERMEABILITY INFECTION AND IMMUNITY Cousins, S. W., ROSENBAUM, J. T., GUSS, R. B., Egbert, P. R. 1982; 36 (2): 730-736

  Abstract

  Bacterial endotoxin (lipopolysaccharide; LPS) is known to alter systemic vascular permeability, but this effect is difficult to monitor and quantitate in vivo. The ocular vessels of the rabbit are particularly sensitive to LPS. Using a slit lamp equipped with a fluorophotometer, we have adapted a method to quantitate endotoxin-induced ocular vascular permeability by measuring the accumulation of fluorescein isothiocyanate-conjugated albumin into the anterior chamber of the eye. After intravenous administration of Salmonella typhimurim LPS, the anterior chamber fluorescence and blood fluorescence were measured at intervals of 15 min and 1 h, respectively, over 4 h. In controls, maximal fluorescence in the anterior chamber was 3.1 +/- 0.8% of blood fluorescence. Doses of LPS as low as 0.25 mug/kg produced an ocular/serum fluorescence ratio of 17.6 +/- 4.9. A dose of 2.5 mug of LPS per kg tended to produce a higher ratio (68.0 +/- 7.1) than a larger dose of 50 mug/kg (30.5 +/- 16.6). Permeability changes began within 30 min after LPS, and the rate of dye accumulation varied over time, with maximal leakage usually occurring 90 min after LPS, but occasionally occurring much later. Repeated doses produced tolerance. By conjugating albumin to rhodamine and utilizing a second filter with the slit lamp to measure accumulation of this dye, we demonstrated the persistence of marked permeability during a period when intraocular fluorescein isothiocyanate and albumin levels were relatively constant. This methodology indicates that extremely low doses of LPS induce ocular permeability changes and that neither the time course nor the dose response of this effect is linear. Ocular fluorophotometry is a sensitive, noninvasive technique to study the dynamics and pharmacology of LPS-induced permeability changes.

  View details for Web of Science ID A1982NN05400045

  View details for PubMedID 6806194

  View details for PubMedCentralID PMC351291

• NOSEMATOSIS OF THE CORNEA - CASE-REPORT, INCLUDING ELECTRON-MICROSCOPIC STUDIES ARCHIVES OF OPHTHALMOLOGY Pinnolis, M., Egbert, P. R., Font, R. L., WINTER, F. C. 1981; 99 (6): 1044-1047

  Abstract

  A 26-year-old woman underwent enucleation of a blind, painful eye because of a perforated corneal ulcer. Histopathologic examination of the eye disclosed an acute, necrotizing keratitis surrounding myriad small (2.5 to 3 x 4.5 to 5 micrometer), oval, faintly visible structures. Under polarized light, they were partially birefringent and stained intensely positive with the acid-fast technique. The organisms were located mainly within the cytoplasm of histiocytes in the deep corneal lamellae. They were interpreted as a protozoa of the genus Nosema. The diagnosis was confirmed by electron microscopic studies. The distinguishing features between Nosema species and Encephalitozoon are discussed. To our knowledge, this is the second documented case of corneal nosematosis.

  View details for Web of Science ID A1981LT58300011

  View details for PubMedID 6786272

• HARD +/-E - WARBURGS SYNDROME - REPLY ARCHIVES OF NEUROLOGY CHAN, C. C., Egbert, P. R., Herrick, M. K., Urich, H. 1981; 38 (1): 66-66

  View details for Web of Science ID A1981KZ85100022

• CYTOMEGALO-VIRUS RETINITIS IN IMMUNOSUPPRESSED HOSTS .1. NATURAL-HISTORY AND EFFECTS OF TREATMENT WITH ADENINE-ARABINOSIDE ANNALS OF INTERNAL MEDICINE Pollard, R. B., Egbert, P. R., Gallagher, J. G., Merigan, T. C. 1980; 93 (5): 655-664

  Abstract

  Cytomegalovirus (CMV) retinitis presents with typical ophthalmologic appearance in patients with underlying immunosuppressive conditions. Fourteen patients with this disorder were diagnosed by culture of cytomegalovirus from urine or throat specimens, elevated complement fixation titers to cytomegalovirus, and characteristic funduscopic appearance. Ten of 11 had decreased CMV-specific cell-mediated immune responses. Three of seven who received no specific therapy improved after decreasing dosages of immunosuppressive drugs. Seven patients with progressive disease despite minimal immunosuppressive therapy were treated with adenine arabinoside at doses from 1 to 20 mg/kg of body weight per day. Daily dosages of 20 mg/kg . d in five patients were associated with decreased inflammatory activity and improvement of retinal lesions and quantitative decreases in urinary virus excretion. Adenine arabinoside administration was associated with significant gastrointestinal, hematologic, and neurologic side effects. Adenine arabinoside may have some beneficial effect on selected patients with progressive CMV retinitis.

  View details for Web of Science ID A1980KQ78400001

  View details for PubMedID 6259979

• ENDOTOXIN-INDUCED UVEITIS IN RATS AS A MODEL FOR HUMAN-DISEASE NATURE ROSENBAUM, J. T., McDevitt, H. O., GUSS, R. B., Egbert, P. R. 1980; 286 (5773): 611-613

  View details for Web of Science ID A1980KC62900042

  View details for PubMedID 7402339

• OCULO-CEREBRAL MALFORMATIONS - REAPPRAISAL OF WALKER LISSENCEPHALY ARCHIVES OF NEUROLOGY CHAN, C. C., Egbert, P. R., Herrick, M. K., Urich, H. 1980; 37 (2): 104-108

  Abstract

  We describe an infant with multiple ocular and cerebral malformations. The eye lesions included microphthalmia, detachment and dysplasia of the retina, hypoplasia of the optic nerve, persistence of the primary vitreous, cataracts, obliteration of the anterior chamber, and vascularization of the cornea. In the brain, the salient features were microencephaly, agyria of an unusual type, cerebellar hypoplasia and dysplasia, persistent corpus pontobulbare, obliteration of the subarachnoid space, and a midline arachnoid cyst in the posterior fossa. We suggest that these lesions were the end result of a fetal infection that operated during a protracted period starting not later than the fourth month of intrauterine life.

  View details for Web of Science ID A1980JE73900012

  View details for PubMedID 6766714

• CYTOMEGALO-VIRUS RETINITIS IN IMMUNOSUPPRESSED HOSTS .2. OCULAR MANIFESTATIONS ANNALS OF INTERNAL MEDICINE Egbert, P. R., Pollard, R. B., Gallagher, J. G., Merigan, T. C. 1980; 93 (5): 664-670

  Abstract

  We observed the course of cytomegalovirus (CMV) retinitis in 21 eyes of 14 immunosuppressed patients. In two patients, other organisms, specifically Toxoplasma and Candida, also appeared to be causing retinal disease simultaneously. Post-mortem examination was done on 10 eyes from seven patients. At initial presentation, the retinitis was often asymptomatic and diagnosed during routine examination. The ophthalmoscopic picture was characteristic of cytomegalovirus; the early lesion was a small opaque, white granular area of retinal necrosis that spread in a centrifugal, brush-fire-like manner over 1 to 8 months. Vessel sheating and hemorrhages appeared as the disease progressed. In two patients new foci of retinitis developed remote from the original lesion. Four weeks to 4 months (average, 10 weeks) elapsed from the most extensive disease to total resolution. Resolution of active disease left a subtle retinal scar, and final visual acuity was reduced in one half the eyes. Repeated ophthalmoscopic examinations can aid in early diagnosis of CMV retinitis and in ascertaining which persons are most at risk for visual loss.

  View details for Web of Science ID A1980KQ78400002

  View details for PubMedID 6259980

• POSTERIOR OCULAR ABNORMALITIES AFTER IRRADIATION FOR RETINOBLASTOMA - A HISTOPATHOLOGICAL STUDY BRITISH JOURNAL OF OPHTHALMOLOGY Egbert, P. R., Fajardo, L. F., Donaldson, S. S., MOAZED, K. 1980; 64 (9): 660-665

  Abstract

  Radiation-induced ocular lesions in the posterior eye and orbit were investigated in 33 surgical specimens of patients with retinoblastoma. The eyes were obtained from children 7 months to 6 years of age. Seventeen eyes were irradiated; 16 eyes had not received irradiation and served as controls. The majority of the irradiated eyes were treated with 6000 rads of external beam radiation. They were removed at a mean of 23 months after radiotherapy. All specimens were examined simultaneously by 2 observers without knowledge of treatment and analysed for the presence or absence of 15 lesions. The most consistent lesions in the irradiated eyes were abnormalities of the retinal vessels (11 of 17 eyes) and striking changes in the ciliary arteries (13 of 17 eyes). The retinal vessels showed thickening of the wall, often caused by deposition of fibrillary material, sometimes with fibrin deposits. The most consistent lesion was myointimal proliferation with narrowing of the ciliary arteries. Lesions of the central retinal artery were less common but occurred only in irradiated patients.

  View details for Web of Science ID A1980KL85500004

  View details for PubMedID 7426587

  View details for PubMedCentralID PMC1043788

• CANDIDA ENDOPHTHALMITIS AFTER INTRAVENOUS DRUG-ABUSE ARCHIVES OF OPHTHALMOLOGY Aguilar, G. L., BLUMENKRANTZ, M. S., Egbert, P. R., McCulley, J. P. 1979; 97 (1): 96-100

  Abstract

  Patients with endogenous Candida endophthalmitis associated with intravenous (IV) drug abuse may manifest ocular and systemic signs different from those seen in other forms of endogenous Candida endophthalmitis. There may be a sparcity of evidence of systemic candidiasis, including negative serology and normal physical examination results. Anterior uveitis and extensive vitreous involvement are common and do not necessarily have associated typical retinal lesions, which are more commonly seen in the compromised host. This may occur either because of the more transitory nature of choroidal or retinal lesions or because these patients often seek treatment at later stages. Even with a typical clinical picture, it is difficult to get culture confirmation of the diagnosis. Material obtained by vitrectomy must be concentrated before inoculation of media because of the known difficulty of culturing Candida from the vitreous cavity.

  View details for Web of Science ID A1979GF44700008

  View details for PubMedID 310294

• REGRESSION OF IRIS NEOVASCULARIZATION FOLLOWING PAN-RETINAL PHOTO-COAGULATION ARCHIVES OF OPHTHALMOLOGY Murphy, R. P., Egbert, P. R. 1979; 97 (4): 700-702

  Abstract

  A 57-year-old woman with proliferative diabetic retinopathy in both eyes also had iris surface neovascularization with early angle neovascularization in her right eye, which regressed completely following treatment with panretinal photocoagulation. Histopathologic examination confirmed the complete absence of abnormal vessels on the iris surface or in the iridocorneal angle of the right eye; an avascular fibrous membrane persisted on a segment of the posterior iris pigment epithelium near the pupil. There was advanced rubeosis in the untreated left eye.

  View details for Web of Science ID A1979GR34100013

  View details for PubMedID 426685

• USE OF PLATELET-FIBRINOGEN-THROMBIN MIXTURE TO SEAL EXPERIMENTAL PENETRATING CORNEAL WOUNDS ALBRECHT VON GRAEFES ARCHIV FUR KLINISCHE UND EXPERIMENTELLE OPHTHALMOLOGIE Rosenthal, A. R., Egbert, P. R., HARBURY, C., Hopkins, J. L., Rubenstein, E. 1978; 207 (2): 111-115

  Abstract

  A platelet-fibrinogen-thrombin mixture utilizing autologous platelets was studied for its potential to seal perforating corneal wounds. In rabbits, the mixture demonstrated sufficient adhesive properties to permit 75% of penetrating keratoplasties to remain in place without the use of sutures. All 12 grafts held initially; after 48 h three grafts extruded. In control eyes only two out of 12 (16%) of the corneal grafts remained in place. The material is simple to prepare and apply and is not toxic to the cornea. It does not cause inflammation or lid irritation. Intraocular complications observed with its use were transient anterior synechiae and retrocorneal membrane formation.

  View details for Web of Science ID A1978FJ82400006

  View details for PubMedID 308778

• OPTIC-NERVE HEAD INVOLVEMENT WITH CYTOMEGALOVIRUS IN AN ADULT WITH LYMPHOMA ARCHIVES OF OPHTHALMOLOGY Marmor, M. F., Egbert, P. R., Egbert, B. M., Marmor, J. B. 1978; 96 (7): 1252-1254

  Abstract

  An optic nerve swelling that was thought clinically to represent a lymphomatous infiltrate of the nerve head developed in a 51-year-old man with histiocytic lymphoma. Histologic examination of the eyes showed the presence of cytomegalovirus (CMV) in the nerve head, but no lymphoma cells. Tru lymphomatous invasion of the nerve head in systemic lymphoma is probably very rare. This case points out an unusual manifestation of adult CMV infection, and a new concern in patients with compromised immune systems.

  View details for Web of Science ID A1978FG91100015

  View details for PubMedID 208496

• MULTIPLE OCULAR ANOMALIES ASSOCIATED WITH MATERNAL LSD INGESTION ARCHIVES OF OPHTHALMOLOGY CHAN, C. C., Fishman, M., Egbert, P. R. 1978; 96 (2): 282-284

  Abstract

  Severe ocular malformations, including microphthalmos, intraocular cartilage, cataract, persistent hyperplastic primary vitreous, and retinal dysplasia, occurred in a premature baby girl. The mother had ingested LSD during the first trimester of pregnancy. To our knowledge, this is the third case reported of ocular teratogenesis associated with maternal LSD ingestion. Further cases must be documented to establish an actual cause and effect relationship between the drug and the induced malformations.

  View details for Web of Science ID A1978EL58200009

  View details for PubMedID 415706

• VISUAL RESULTS AND OCULAR COMPLICATIONS FOLLOWING RADIOTHERAPY FOR RETINOBLASTOMA ARCHIVES OF OPHTHALMOLOGY Egbert, P. R., Donaldson, S. S., MOAZED, K., Rosenthal, A. R. 1978; 96 (10): 1826-1830

  Abstract

  Between 1956 and 1974, 28 children with retinoblastoma have been irradiated with the linear accelerator at the Stanford University Medical Center. Twenty-seven children (96%) have been cured of their tumor, with follow-up ranging from 2 1/2 to 21 years. In these survivors, 50 eyes were affected. Twelve were treated by primary enucleation and 38 were irradiated. Sixteen of the 38 irradiated eyes (42%) were ultimately enucleated for recurrent tumor, neovascular glaucoma, or inability to observe the tumor through opaque media. Thus, 22 (58%) irradiated eyes were saved. Of these, five eyes had visual acuity of 20/40 or better, five had 20/50 to 20/100, nine had 20/200 to hand motion, and three had light perception or no light perception. Radiation therapy can sterilize the tumor and maintain useful vision in many children with retinoblastoma.

  View details for Web of Science ID A1978FS98000008

  View details for PubMedID 697618

• SIMPLE CONJUNCTIVAL BIOPSY AMERICAN JOURNAL OF OPHTHALMOLOGY Egbert, P. R., Lauber, S., Maurice, D. M. 1977; 84 (6): 798-801

  Abstract

  Biopsy of conjunctival goblet cells may be carried out by pressing a piece of Millipore filter on the conjunctival surface. This can then be stained with PAS and hematoxylin and observed under the microscope after the filter has been cleared with oil. Either spots of mucous corresponding to the openings of the goblet cells are seen, or the filter adheres to the surface and pulls off one or more layers of epithelial cells and goblet cells. The procedure can be carried out on the unanesthetized eye and does not cause discomfort.

  View details for Web of Science ID A1977ED82500006

  View details for PubMedID 596392

• USE OF A PLATELET FIBRINOGEN THROMBIN MIXTURE AS A CORNEAL ADHESIVE - EXPERIMENTS WITH SUTURELESS LAMELLAR KERATOPLASTY IN RABBIT INVESTIGATIVE OPHTHALMOLOGY Rosenthal, A. R., HARBURY, C., Egbert, P. R., Rubenstein, E. 1975; 14 (11): 872-875

  Abstract

  A platelet-fibrinogen-thrombin mixture utilizing autologous platelets was studied for its potential as a corneal adhesive. In the rabbit it demonstrated sufficient adhesive properties to allow 50 per cent of lamellar keratoplasties (autotransplants) to remain in place without the use of sutures. The mixture retains significant adhesive properties for four to six days. It is simple to prepare and apply. It also appears nonantigenic and nontoxic to the cornea; it does not incite inflammation, nor interfere with corneal clarity or the regrowth of corneal epithelium.

  View details for Web of Science ID A1975AW07700010

  View details for PubMedID 1102485