Biomedical subjects

D B Burgess

Publications and source records attributed to D B Burgess.

18 recordsLinked to original sources

PubMed1996

The surgical removal of subfoveal choroidal neovascularization. Ingrowth site as a predictor of visual outcome.

PURPOSE: The authors determine the significance of location of the ingrowth site of subfoveal choroidal neovascularization (CNV) as a preoperative indicator of postsurgical visual acuity. DESIGN: A retrospective review is given of preoperative fluorescein angiograms and color fundus photographs for 84 eyes with subfoveal CNV due to the following etiologies: presumed ocular histoplasmosis syndrome (POHS) = 67 eyes; multifocal choroiditis = 9 eyes; not identifiable. If identifiable, the ingrowth site was further classified as extrafoveal, juxtafoveal, or subfoveal. Correlations between CNV ingrowth site location and postoperative visual acuity were made. RESULTS: The ingrowth site for subfoveal CNV was identifiable preoperatively in 60 eyes (71%). Of 31 eyes with an extrafoveal ingrowth site, 18 (60%) had a final visual acuity of 20/40 or better. Of 12 eyes with a juxtafoveal ingrowth site and 18 eyes with a subfoveal ingrowth site, only 2 (7%) had a final visual acuity of 20/40 or better. If the ingrowth site was not identifiable or identifiable and subfoveal in location (N = 42), 76% of eyes had a final visual acuity of 20/200 or worse. CONCLUSION: The ingrowth site of subfoveal CNV can be identified in the majority of eyes with POHS, multifocal choroiditis, or idiopathic membranes. A significant number of subfoveal CNV will have an extrafoveal ingrowth site. Eyes with an extrafoveal ingrowth site have a favorable visual prognosis after the surgical removal of the CNV. If the ingrowth site is subfoveal or not identifiable, the visual prognosis after surgery is guarded.

Adult↗

PubMed1987

Macular disease resembling adult foveomacular vitelliform dystrophy in older adults.

Fifty-three eyes of 31 patients over age 50 with macular disease were reviewed. Clinical appearance of the macula was of two types: a yellow slightly elevated lesion (29 eyes) and a pigmented flat lesion with surrounding atrophy (24 eyes). Drusen were found in 60% of affected eyes. No familial tendencies were documented. A reduced electro-oculogram (EOG) was present in approximately 50% of all eyes tested. Fluorescein angiographic findings and differential diagnosis are described. Visual prognosis was markedly different for the two groups: 69% of eyes with yellow elevated lesions lost two or more lines of visual acuity and 48% went on to visual acuity equal to or less than 20/200, whereas 33% of eyes with pigmented flat lesions lost two or more lines of visual acuity and 8% went on to visual acuity equal to or less than 20/200.

Aged↗

PubMed1987

Neovascular glaucoma: a retrospective analysis of treatment with peripheral panretinal cryotherapy.

A retrospective analysis of thirty-one eyes in thirty patients with neovascular glaucoma (NVG) associated with proliferative diabetic retinopathy or venous occlusive disease was performed. Eyes treated with transconjunctival peripheral panretinal cryotherapy alone, or in combination with limited cyclocryotherapy had improvement or stabilization of visual acuity in 55%, reduction of intraocular pressure in 55%, and stabilization or regression of iris neovascularization in 70% of eyes at 12-14 months post-treatment. Transconjunctival peripheral panretinal cryotherapy alone, or in combination with limited cyclocryotherapy is recommended in the treatment of eyes with NVG and media opacities precluding photocoagulation therapy, or in eyes unresponsive to previous photocoagulation therapy.

Aged↗

PubMed1987

Factors related to spontaneous visual recovery in the ocular histoplasmosis syndrome.

In an effort to better describe the phenomenon of spontaneous visual recovery in the ocular histoplasmosis syndrome (OHS), 700 patient records were reviewed. Spontaneous visual recovery was defined as a two or more line improvement in Snellen acuity after a minimum of 12 months of stable visual reduction to 20/70 or less, secondary to central disciform scarring. Ten cases of spontaneous visual recovery were found. Eight patients had recovery of vision only when visual acuity was reduced to 20/80 or less in the fellow eye. One patient experienced spontaneous recovery without visual loss in the fellow eye. Another patient experienced spontaneous visual recovery 57 months after xenon photocoagulation in the study eye. This group of patients was compared to 14 similar patients who did not experience spontaneous recovery when visual acuity was reduced to less than 20/80 in the fellow eye. Compared to the nonrecovery group, patients experiencing spontaneous visual recovery in OHS were younger at the time of visual loss in the fellow eye (30 years vs. 48 years, p less than 0.01); had a shorter interval of visual loss prior to visual loss in the fellow eye (44 months vs. 150 months, p less than 0.10); had smaller diameter scars (1,711 microns vs. 3,078 microns, p less than 0.05); and had shorter distances from the foveal center to adjacent normal retina (267 microns vs. 846 microns, p less than 0.01).

Cicatrix↗

PubMed1986

Pseudophakic retinal detachments in the presence of various IOL types.

A series of 600 pseudophakic retinal detachments in 578 patients undergoing surgical repair between 1974 and 1984 was reviewed. Patients with previous retinal surgery of less than six months follow-up were excluded. The series included 395 iris-fixated (IF) lenses, 130 anterior chamber (AC) lenses, and 75 posterior chamber (PC) lenses. The overall success rate for retinal detachment was 88% but was significantly better in the PC lens group and significantly worse in the AC lens group. Forty-one percent of all cases achieved 20/40 visual acuity or better, although the AC lens group did worse (28%), while the PC lens group did significantly better (48%). Risk factors that were predictive of failure also were identified. Many of these factors occurred more frequently in the AC lens group and probably are related to the overall worse outcome in eyes with AC lens implants. The implications of these results for retinal and cataract surgeons are discussed.

Humans↗

PubMed1986

Ocular histoplasmosis syndrome.

The Macular Photocoagulation Study (MPS) is a multi-center clinical trial supported by the National Eye Institute whose purpose is to assess argon laser photocoagulation as a treatment for choroidal neovascular membranes (NVMs) that do not involve the fovea. The MPS documented that in patients with ocular histoplasmosis syndrome argon laser photocoagulation in comparison with no treatment can reduce the risk of severe visual loss from 46 to 13% in the first two years. Accordingly, patients with ocular histoplasmosis and NVMs outside the fovea are advised to undergo prompt treatment with argon laser photocoagulation.

Clinical Trials as Topic↗

PubMed1985

Treatment of recurrent juxtafoveal subretinal neovascular membranes with krypton red laser photocoagulation.

Thirty-seven eyes initially treated with argon blue-green, argon green, or krypton red laser photocoagulation demonstrated a recurrent subretinal neovascular membrane (SRNVM) at the edge of the treatment scar extending into the foveal avascular zone and were retreated with krypton red laser photocoagulation. The subretinal neovascular membrane was due to the presumed ocular histoplasmosis syndrome (POHS) in 10 eyes, aging macular choroidal degeneration (AMCD) in 22 eyes, and miscellaneous causes in five eyes. Anatomic success, defined as complete obliteration of the recurrent SRNVM, was achieved in 26 eyes (70%). When compared to pretreatment visual acuities, 23 of 37 eyes (62.2%) had stable or improved postoperative visual acuities during the follow-up period. Twenty-six eyes were retreated one time; nine eyes required two retreatments; and two eyes required three retreatments. Final visual results showed visual acuity greater than or equal to 20/40 in 7 eyes (18.9%); visual acuity greater than or equal to 20/80 in 16 eyes (43.8%); visual acuity greater than or equal to 20/100 in 19 eyes (51.4%); visual acuity greater than or equal to 20/200 in 27 eyes (73%); and visual acuity greater than or equal to 20/400 in 34 eyes (91.9%).

Adult↗

PubMed1984

Preoperative antibiotic soaking of silicone sponges. Does it make a difference?

A prospective randomized trial was carried out during the years 1974 to 1981 to determine whether preoperative antibiotic soaking of silicone sponges used in retinal detachment surgery would reduce the incidence of postoperative infection and extrusion. During this period 2972 consecutive primary scleral buckles were performed and in 921 (31%) of the cases an episcleral sponge was utilized either alone or in conjunction with a hard silicone encircling band. In alternate cases the sponge was soaked in an antibiotic solution for at least 30 minutes prior to insertion. In the remaining cases the sponge was not soaked. Overall, a statistically significant (P = 0.00018) seven-fold reduction in the rate of infection or extrusion was observed in cases where the silicone sponge was soaked preoperatively in antibiotics. An additional result of the study showed the rate of sponge removal was significantly increased by the use of multiple episcleral sponges (P = 0.00002).

Anti-Bacterial Agents↗

PubMed1984

Subfoveal and juxtafoveal subretinal neovascularization in the presumed ocular histoplasmosis syndrome. Visual prognosis.

The visual prognosis of 148 eyes in patients with an active subfoveal or juxtafoveal subretinal neovascular membrane (SRNVM) in the presumed ocular histoplasmosis syndrome (POHS) was reviewed. Average follow-up was 39 months. One hundred twenty of 148 eyes (81.1%) had a final visual acuity worse than 20/40. One hundred three of 148 eyes (69.6%) had a final visual acuity equal to or worse than 20/200. Systemic and/or periocular steroids had no effect on final visual outcome. Factors affecting final visual outcome are described and prognosis in the fellow eye is discussed.

Adolescent↗

PubMed1984

Parent report as a means of administering the prescreening developmental questionnaire: an evaluation study.

The increasing emphasis on screening the pediatric population for developmental delays requires that rapid and efficient screening tests be developed and evaluated. This study assessed the ability of three rapid screening procedures to predict full Denver Developmental Screening Test (DDST) results. Ninety children were randomly assigned to one of three prescreening groups. The first group was prescreened with the Prescreening Developmental Questionnaire (PDQ), administered in the "standard" fashion, i.e., mother reads and answers 10 questions about her child's development. The second group was prescreened using a modified means of administering the PDQ (PDQ-M); a health care professional read each PDQ question to the mother. The third group was prescreened with the Alpern-Boll Developmental Profile II, a relatively lengthy procedure utilizing parent report information. All of the children were then tested with the DDST. Each of the prescreening procedures was highly predictive of performance on the DDST. The Alpern-Boll profile, as anticipated, demonstrated greater validity than the PDQ and PDQ-M on six of seven indices of prescreening test validity, generated from a four-group referral matrix. The PDQ-M was more similar to the Alpern-Boll on four indices, while the PDQ was more similar on three. It was judged that the two PDQ procedures were equivalent in their validity characteristics. The PDQ-M appears to be an acceptable means of rapidly screening preschool children for developmental delays.

Attitude↗

PubMed1982

The developmental status of children undergoing the Kasai procedure for biliary atresia.

Children with biliary atresia who have undergone the Kasai procedure suffer prolonged illness and recurrent hospitalizations, both of which may interfere with normal growth and development. The developmental status of 20 children with this disorder is described. The mean cognitive developmental quotient of the entire group of children was within the normal range. The mean motor developmental quotient was within the borderline normal range. The developmental test results suggested an interesting pattern of development including normal cognitive and motor development until the age of 6 to 8 months, followed by a decreasing rate of development between ages 8 and 24 months with the potential for improved developmental outcome at the age of school entry. The overall developmental status of these children was better than might be expected considering the numerous high-risk medical/surgical and social/emotional stresses that these children must face. The effort required in the care of children with this disorder certainly seems warranted by their subsequent developmental outcome.

Bile Ducts↗

PubMed1975

Early photocoagulation treatment of active histoplasmic maculopathy.

Photocoagulation has proved to be an effective means of treating active presumed histoplasmic maculopathy. Xenon arc and argon laser light sources have proved equally effective when moderately intense, confluent burns are produced, and both are ineffective when mild lesions are produced. The membrane must be destroyed for the treatment to be effective; and, of course, the fovea must be preserved. In treating neovascular nets that are very close to the fovea, the argon laser offers the advantage of being capable of producing a sharper zone of delineation than the xenon arc (Fig. 6). When moderate amounts of subretinal fluid or hemoglobin overlie the neovascular membrane, it is very difficult to achieve the required degree of coagulation. Under these circumstances, it is best first to try to reduce the height of the sensory retinal detachment by means of systemic steroid treatment. If this is not successful, xenon photocoagulation has produced better coagulation effects than the argon laser. Analysis of our data indicates that resultant visual acuity can be correlated with pretreatment visual acuity (Fig. 5), with best results achieved before visual acuity deteriorates beyond the 20/40 level. The closer the edge of the neovascular membrane is to the fovea, the more risky it is to treat. However, these lesions are also those most apt to destroy central vision if left alone. It is encouraging to note that in only 3 of the 16 lesions in which the foveal edge was within 1 degree of the fovea did the visual acuity deteriorate to the 20/200 level, compared to 50 percent deterioration reported in the natural history of this disease [3].

Argon↗

PubMed1973