Search PubMed⌕ Search

Biomedical subjects

C P Wilkinson

Publications and source records attributed to C P Wilkinson.

At least 19 recordsLinked to original sources
PubMed2000

Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration.

PURPOSE: To assess the quality of information in the literature regarding the benefits of prophylactic treatment of asymptomatic retinal tears and lattice degeneration. CLINICAL RELEVANCE: Asymptomatic retinal breaks occur in approximately 7% of patients over age 40, and lattice degeneration is present in approximately 8% of the general population. Because retinal breaks cause retinal detachment and lattice degeneration is associated with approximately 30% of retinal detachments, prophylactic treatment of these lesions has sometimes been recommended. LITERATURE REVIEWED: A panel of vitreoretinal experts performed a literature review of all publications regarding prevention of retinal detachment that have been published in English. These articles were then used to prepare recommendations for patient care in an American Academy of Ophthalmology Preferred Practice Pattern (PPP). Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation. RESULTS: Most recommendations were rated as A (most important to patient care). Only a single publication was graded as I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of level I and level II studies in the literature, level III (consensus of expert opinion) was the basis for most recommendations in the PPP. CONCLUSIONS: The current literature regarding prevention of retinal detachment does not provide sufficient information to support strongly prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.

Adult↗
PubMed1999

Retinal breaks.

Explore the source record for details and available documents.

Humans↗
PubMed1999

Evidence-based medicine regarding the prevention of retinal detachment.

PURPOSE: To assess the quality of information in the literature regarding the prevention of retinal detachment in an effort to establish appropriate practice guidelines. METHODS: A panel of vitreoretinal experts performed a literature review of all publications in the English language for articles about prevention of retinal detachment. These article were then used to prepare recommendations for patient care in an American Academy of Ophthalmology "Preferred Practice Pattern" (PPP). Each recommendation was rated according to its importance in the care process and the strength of evidence supporting the given recommendation. RESULTS: Most recommendations were given a rating of "A" (most important to patient care). Only a single publication was graded as Level I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as Level II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of Level I and Level II studies in the literature, Level III (consensus of expert opinion) was the basis for most recommendations in the PPP. CONCLUSION: The current literature regarding prevention of retinal detachment does not provide sufficient information to strongly support prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.

Clinical Trials as Topic↗
PubMed1995

Phakic retinal detachments in the elderly.

PURPOSE: To discover if clinical nontraumatic phakic retinal detachments in the elderly possess characteristics that distinguish them from similar cases in younger persons. METHODS: A retrospective study of 100 consecutive cases in patients aged 70 years and older was performed. Recorded data included patient age and sex, type and location of retinal break, extent of detachment, and associated vitreoretinal pathology. RESULTS: Approximately 90% of retinal breaks were horseshoe tears, and the majority were located in the superior temporal quadrant. Horseshoe tears confined to the posterior margin of the vitreous base were responsible for retinal detachments in 30% of cases, and an additional 36% of breaks were located anterior to the equator. CONCLUSION: The incidence of this type of anterior break is higher than that previously described for phakic retinal detachments, although previous studies have not discussed break types as a function of old age. Anterior horseshoe tears, which cause many phakic retinal detachments in the elderly, may not be caused by acute posterior vitreous detachment, but rather to persistent chronic traction on the vitreous base after posterior vitreous detachment.

Aged↗
PubMed1993

The diagnosis of diabetic retinopathy. Ophthalmoscopy versus fundus photography.

PURPOSE: To compare fundus photography with ophthalmoscopy in the detection of diabetic retinopathy. METHODS: Ophthalmoscopy and fundus photographs with a nonmydriatic camera, both performed through dilated pupils, were compared to diagnose retinopathy in a cohort of 410 Oklahoma Indians with noninsulin-dependent diabetes mellitus. A total of 795 eyes were examined using both methods. The mean age of participants was 60.3 years, with a mean duration of diabetes of 17.3 years. RESULTS: An overall agreement of 86.3% with a kappa statistic kappa of 0.74 was found between ophthalmoscopy and fundus photography with a nonmydriatic camera. For the diagnosis of proliferative diabetic retinopathy, kappa = 0.84 with an agreement of 98.1%. With a total of 61 cases of proliferative retinopathy diagnosed by either method in our study, ophthalmoscopy alone detected 88.5% and fundus photography, 78.7%. When compared on a lesion-by-lesion basis, agreement between the two diagnostic methods was highest for nonproliferative retinopathy, as well as fibrous proliferation. CONCLUSION: The fundus photography with a nonmydriatic camera, performed with mydriasis, is comparable to ophthalmoscopy for the detection of retinopathy. It may prove to be a suitable, cost-effective method for routine screening in diabetes clinics, provided ophthalmologic referral is ensured for those with a diagnosis of any form of retinopathy, questionable retinopathy, nondiabetic retinopathy, those with poor quality photographs, as well as those with acute changes in visual acuity.

Diabetes Mellitus, Type 2↗
PubMed1992

Diabetic retinopathy in Oklahoma Indians with NIDDM. Incidence and risk factors.

OBJECTIVE: To determine the incidence rates and risk factors for development of diabetic retinopathy in Oklahoma Indians. RESEARCH DESIGN AND METHODS: Cohort follow-up study with baseline examination between 1972 and 1980 and follow-up examination between 1987 and 1991. Mean +/- SD follow-up time was 12.8 +/- 1.7 yr. Eleven Indian Health Service facilities (clinics and hospitals) in Oklahoma participated in the study. Study participants were a quasirandom sample of 1012 American Indians (379 men, 633 women) in Oklahoma with NIDDM, 927 of whom received a detailed eye examination at baseline. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. The average quantum of Indian blood was 92% (77% full blood). At follow-up, 515 (55.6%) were alive, 408 (44.0%) were deceased, and 4 (0.4%) could not be traced. Of the living participants, 380 (73.8%) underwent an ophthalmoscopic examination. RESULTS: The incidence of retinopathy among the participants who were free of disease at baseline and who survived the follow-up interval was 72.3%. By multivariate analysis, significant independent predictors of retinopathy recorded at baseline were FPG level, therapeutic regimen, systolic blood pressure, and duration of diabetes. FPG levels > or = 11.1 mM (200 mg/dl) increased the risk of retinopathy 1.7 times that for levels < 7.8 mM (140 mg/dl). Insulin use was associated with a 20% greater incidence. Hypertension was a particularly significant risk factor for those with lower FPG levels. CONCLUSIONS: Given that NIDDM is reaching epidemic proportions in Oklahoma Indians and that most may be afflicted with retinopathy, frequent ophthalmological examinations are clearly indicated for this high-risk population. The role of intervention, namely glycemic and hypertensive control, deserves further study.

Blood Glucose↗
PubMed1991

Corneal ulcer and adverse reaction rates in premarket contact lens studies.

We analyzed clinical data on 22,739 contact lens wearers who were studied and whose lenses were approved under 48 manufacturer-sponsored studies for the Food and Drug Administration between 1980 and 1988. The incidence of corneal ulcers was low in the cosmetic (nontherapeutic) daily-wear soft and rigid gas-permeable lens wearers (1/1,923 and 1/1,471 patient-years, respectively). Corneal ulcers and severe adverse reactions occurred two to four times more frequently in extended-wear cosmetic soft and rigid gas-permeable lens wearers than in cosmetic daily-wear lens wearers. Aphakic extended-wear soft lens users were nine times more likely to develop a corneal ulcer when compared to the soft daily-wear cosmetic group. Corneal abrasions and keratitis accounted for 81 of 159 severe adverse reactions, whereas corneal ulcers accounted for 28 of 159 adverse reactions. The data indicate that overnight extended wear of contact lenses is associated with a greater risk of serious, sight-threatening complications than daily wear.

Aphakia↗
PubMed1991

Cilioretinal artery occlusion in young adults with central retinal vein occlusion.

Ten patients, all younger than 50 years of age, had a temporal cilioretinal artery occlusion associated with a nonischemic central retinal vein occlusion. On fluorescein angiography, the cilioretinal artery eventually filled in all but one eye. The cilioretinal artery showed pulsations on fluorescein angiography in five eyes. The central retinal vein occlusion eventually resolved and the fundus assumed a normal appearance in all nine of the followed cases. Eight of nine eyes that underwent follow-up examination had final visual acuity of 20/30 or better. The occlusion of the central retinal vein produces an elevation of intraluminal capillary pressure because the central retinal artery continues to pump blood into the retina. Because the perfusion pressure of the cilioretinal artery is lower than the central retinal artery, it becomes relatively occluded. The prognosis for these patients is generally good unless the entire parafoveal capillary net is affected by the cilioretinal artery that is occluded.

Adult↗
PubMed1991

Enlargement of circumscribed choroidal hemangiomas.

The authors describe five patients with circumscribed choroidal hemangiomas. Fundus photography, fluorescein angiography, and ultrasound examinations showed progressive enlargement of these hemangiomas. In all cases, the extent of lesion enlargement was slight: the mean change in tumor size was 1.6 mm x 1.5 mm in basal diameters by 0.9 mm in thickness during a median interval of 52 months (range 33 to 100 months) between initial tumor diagnosis and detection of lesion enlargement. This series of cases demonstrates that circumscribed choroidal hemangiomas can enlarge slightly during long intervals between observations.

Adolescent↗
PubMed1990

Bilateral diffuse uveal melanocytic proliferation in patients with occult carcinoma.

The development of multiple, round or oval, subtle, red patches at the level of the pigment epithelium in the posterior ocular fundus and their striking early hyperfluorescence angiographically are characteristic features of the bilateral diffuse uveal melanocytic proliferation syndrome. They may be accompanied by severe visual loss and may antedate the appearance of multiple melanocytic tumors, retinal detachment, and cataract in these patients with occult systemic carcinomas. These hyperfluorescent patches are caused by focal damage to the pigment epithelium overlying an intact choriocapillaris and diffuse benign nonpigmented uveal melanocytic infiltration of the outer choroid. We suggest that outer retinal damage may not be primarily caused by melanocytic proliferation, but rather by toxic and immune factors generated by interaction between a systemic carcinoma and congenital melanocytosis of the uveal tract. We report the longest survivor of this disorder to date (102 months).

Aged↗
PubMed1990

Goldmann-Favre maculopathy.

A healthy 17-year-old girl presented with typical symptoms and physical features of Goldmann-Favre vitreoretinal degeneration. She had reduced visual acuity in both eyes and night blindness. Her parents were first cousins. Striking fundus features included typical maculopathy with a radiating stellate pattern surrounded by tiny vacuole-like pockets of retinoschisis throughout the posterior pole within the temporal vascular arcades. The fundus features were quite typical and permitted a firm diagnosis when combined with the other features of night blindness, gender, and electroretinogram (ERG) abnormalities.

Adolescent↗
PubMed1989

Visual acuity after the repair of pseudophakic retinal detachments involving the macula.

Postoperative visual acuities were retrospectively evaluated in a series of 100 pseudophakic eyes in which rhegmatogenous retinal detachments involved the macula and in which reattachment surgery was anatomically successful. Preoperative visual acuity and duration of macular detachment were related to visual outcome. Eyes in which extracapsular surgery had been followed by posterior chamber lens implantation had significantly better postoperative visual acuities than cases in which older iris-fixation intraocular lenses (IOLS) were placed after intracapsular procedures. Retinal detachments associated with posterior chamber IOLs have a relatively favorable anatomical and visual prognosis.

Adult↗
PubMed1989

Pseudophakic retinal detachments. The relationships between retinal tears and the time following cataract surgery at which they occur.

The types and locations of retinal tears associated with 268 pseudophakic retinal detachments were studied as a function of the time at which they occurred following cataract surgery. Retinal detachments occurring more than two years following cataract extraction were significantly more likely to have their most posterior retinal break located at the posterior margin of the vitreous base than at or behind the equator. This distribution of tears was not observed in detachments occurring within six months of cataract surgery, with equatorial tears being significantly more common in early onset detachments than in those occurring after two years. The anterior tears which cause most retinal detachments long after cataract extraction are due to persistent chronic traction upon the vitreous base rather than to acute posterior vitreous detachment.

Aged↗
PubMed1988

Clinicopathologic correlation of pigmented epiretinal membranes.

We performed clinicopathologic correlation on ten surgically removed pigmented epiretinal membranes causing macular pucker. All cases occurred in eyes with existing retinal holes or tears, including eight cases of macular pucker after previous retinal detachment. These cases probably represented a limited form of proliferative vitreoretinopathy. All membranes contained pigment epithelial cells with polarity, basement membrane, and melanosomes. Cytoplasmic melanin granules accounted for the clinical feature of pigmentation in these eyes.

Astrocytes↗
PubMed1988

Angiographic cystoid macular edema after posterior chamber lens implantation.

We performed a prospective study evaluating the incidence of angiographic cystoid macular edema (CME) following extracapsular cataract extraction and posterior chamber intraocular lens implantation. Of the 162 eyes in the study, 141 were randomized into either a primary capsulotomy or a capsule intact group. The remaining eyes were not randomized due to intraoperative surgical complications, but they were included in the follow-up studies. Six weeks after surgery, angiographic CME was documented in 24% of the capsulotomy group and in 16% of the capsule intact group. The differences were not statistically significant. Including nonrandomized cases reduced the overall incidence of angiographic CME and the difference between the two groups. Angiographic CME was usually not extensive, and it was associated with a visual acuity less than 20/40 in 2.5% of eyes six weeks postoperatively. A subgroup of 120 eyes was followed up for approximately six months, when angiographic CME was present in 4% of the capsulotomy and capsule intact groups.

Aged↗