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Biomedical subjects

C S Migdal

Publications and source records attributed to C S Migdal.

7 recordsLinked to original sources

Retinal detachment in AIDS-related cytomegalovirus retinitis.

Patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus retinitis (CMVR) are surviving longer due to the use of virostatic medicines and improved treatment of opportunistic infections. As a result, retinal detachment is likely to become an increasingly common cause of visual morbidity in these patients. The incidence and outcome of retinal detachment complicating CMVR was studied at two London AIDS centres. Patients with CMVR were identified prospectively and underwent standard treatment. Retinal detachments were diagnosed during regular follow-up. If retinal reattachment surgery was performed, a standard procedure of vitrectomy and silicone oil internal tamponade was employed. Of 147 patients with CMVR, 41 (28%) developed retinal detachments (47 eyes). Forty-three detachments were rhegmatogenous and 4 were exudative. Fifteen eyes of 9 patients with rhegmatogenous detachments underwent retinal reattachment surgery. Of these, visual acuity remained stable or improved in 12 eyes (80%) in the immediate post-operative period. At the last clinic visit, 8 eyes (53%) maintained a visual acuity of 6/60 or better. The visual results of surgery are good in selected patients, bearing in mind the progressive nature of the underlying disease and poor life expectancy.

AIDS-Related Opportunistic Infections

The primary treatment trial: changes in the visual field analysis by computer-assisted perimetry.

Computer-assisted perimetry was performed 6-monthly on patients entered into the Primary Treatment Trial using the 30-2 program. Those patients with a minimum of five visual fields had pointwise linear regression analysis (Progressor) carried out. Two consecutive slopes significant at the 0.05 level were taken as evidence for change, either improvement or worsening. Forty-eight patients in the surgery group, 40 in the medical group and 20 in the laser group were suitable for analysis. A comparison of the eyes showing 'improvement' or 'worsening' in the surgery and medicine groups showed no difference between them. This lack occurred despite a significant difference in intraocular pressure between the two groups. The reasons for this lack of difference are discussed.

Diagnosis, Computer-Assisted

The influence of prior therapy on the success of trabeculectomy.

The role of early surgery in the management of primary open angle glaucoma is under debate. To determine whether previous medical therapy influences the outcome of subsequent trabeculectomy, we retrospectively reviewed the results of surgery in two groups of patients. The first group underwent primary trabeculectomy, having had an average of 2 weeks of preoperative medical therapy, and this group was compared with a group of patients who had received at least 1 year of topical glaucoma therapy before undergoing trabeculectomy (the multiple-treatment group). The two groups were similar in terms of a number of variables, including race, age, sex, presenting intraocular pressures, and presenting visual fields, and they differed only in the known duration of their disease. The success rate of trabeculectomy was significantly higher in the primary trabeculectomy group as compared with that in the multiple-treatment group (P less than .001). We discuss the possible reasons for this difference and its implications for the future management of primary open angle glaucoma.

Aged

Acute blinding sinusitis.

Sinusitis may produce blindness, and deterioration in visual acuity is a strong indication for urgent admission and possible surgery.

Adolescent

Radiation retinopathy following treatment of posterior nasal space carcinoma.

Posterior nasal space carcinoma has a high mortality and most patients are treated with radiotherapy. Radiation retinopathy was encountered in 7 out of 10 survivors included in this study. Five of the affected patients lost vision as a result of the retinopathy. One patient required laser photocoagulation and responded well to this treatment. There was a variation in the severity of the retinopathy among the patients studied despite the fact that all patients received a similar dose of radiotherapy. We suspect that previously unrecognised factors in the planning of radiotherapy fields may explain this difference.

Adult

The management of eyelid neoplasms.

The results of 377 patients treated for eyelid neoplasms are reported. A definitive histological diagnosis is essential before commencing treatment. Basal cell carcinomata were the commonest lesions encountered in this series. The various indications for radiotherapy, surgery and cryotherapy are discussed and their respective advantages and disadvantages considered. The aim of treatment is a cure of the primary condition and a satisfactory cosmetic result with the minimum of complications. In this Unit surgery is reserved for a simple excision biopsy or diathermy excision and Wolfe graft as radiotherapy appears to offer the best form of treatment in most cases.

Basal Cell Carcinoma