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Biomedical subjects

D L Knox

Publications and source records attributed to D L Knox.

At least 37 records · Page 2Linked to original sources
PubMed1984

Progressive subretinal fibrosis and uveitis.

Three patients with intraocular inflammation and unusual progressive subretinal lesions are described. This entity is characterised by a chronic vitreous inflammation in association with whitish "fibrotic'-like subretinal lesions which progressively enlarge and coalesce. The patients all developed cystoid macular oedema. The differential diagnosis of this entity is discussed. These patients appear to have a unique and previously undescribed inflammatory disorder. The macular oedema responded to corticosteroid therapy in only one patient, and no therapy appeared to alter the course of the disease. Unlike many other patients with posterior uveitis these did not respond to the retinal S-antigen.

Adolescent↗
PubMed1983

Ocular inflammatory pseudotumor associated with propranolol therapy.

A 60-year-old man presented with a unilateral mass involving the iris and ciliary body associated with iridocyclitis, which was refractive to both topical and systemic corticosteroid therapy. After a systemic work-up was negative, anterior chamber paracentesis and transcorneal biopsy were performed to rule out malignant melanoma and other tumors. The lesion proved to be an inflammatory lymphoid process, which resolved when systemic propranolol administration was withdrawn. Evidence for the possible role of propranolol in the induction of an intraocular inflammatory pseudotumor is presented.

Angina Pectoris↗
PubMed1982

Retinal arteritis, iridocyclitis, and giardiasis.

The intestinal parasite Giardia lamblia was found in the stools of three patients with retinal arteritis. Iridocyclitis was also present in two of these patients, who had not responded to treatment with systemic corticosteroids. Antiparasitic drug treatment was followed by improvement of ocular and systemic findings.

Adult↗
PubMed1982

Acute retinal necrosis syndrome.

Six patients with the acute retinal necrosis (ARN) syndrome are described. Ophthalmoscopic examination demonstrated occlusion of peripheral retinal vessels and patchy areas of peripheral retinal whitening spreading rapidly over a period of weeks to markedly decreased vision. In four patients, the disease was bilateral. Histologic examination of vitrectomy specimens from three cases and one enucleated eye revealed chronic granulomatous inflammation. Extensive medical evaluations were noncontributory, with no evidence of compromised immune systems. No patient demonstrated a response to any form of therapy. The etiology is unknown.

Acute Disease↗
PubMed1982

A clinicopathological case report of retinopathy of pancreatitis.

A 32-year-old black woman with pancreatitis developed visual loss in both eyes. On ophthalmoscopic examination she had extensive ischaemic infarcts at the posterior poles of both eyes, a clinical picture which has been reported previously in patients with pancreatitis and noted to be similar to Purtscher's retinopathy. On histopathological examination of the eyes after death there were arteriolar occlusions in both the choroid and retina and inner ischaemic infarctions with inner retinal oedema. Owing to the 23-day interval from arteriolar occlusion until death the exact nature of the original occlusion could not be determined. However, either fat emboli or activated complement C5-induced granulocyte embolus formation are possible causes.

Adult↗
PubMed1982

Migraine optic neuropathy.

Transient visual symptoms associated with migraine are a well-described feature of this disease, but permanent visual loss is seen relatively infrequently. Three patients are discussed who experienced permanent visual defects following migraine attacks. Recognition of this syndrome may allow the physician to defer doing an extensive neurological examination of an otherwise neurologically intact patient.

Adult↗
PubMed1981

Choroidal neovascularization as a late complication of ocular toxoplasmosis.

Macular detachment caused by choroidal neovascularization in eyes with previous toxoplasmic infections is one possible explanation of sudden loss of visual acuity. Three patients with quiescent chorioretinal scars, presumed to be toxoplasmic in origin, developed choroidal neovascular membranes that caused sudden loss of visual acuity. In none of the three cases was there any ophthalmoscopic evidence of intraocular inflammation. In two patients, the choroidal neovascularization was subfoveal and, therefore, not suitable for photocoagulation. However, visual acuity in each of the affected eyes was only partially impaired (6/15 [20/50] in one patient and 6/30 [20/100] in the other). In the third patient, the choroidal neovascular membrane was treated with argon-laser photocoagulation. Two months after treatment, visual acuity in that eye was 6/9 (20/30), and there was angiographic evidence that the neovascular membrane had closed.

Adolescent↗
PubMed1980

The keratopathy of Crohn's disease.

A distinctive subepithelial keratopathy developed in four adult patients with Crohn's disease (granulomatous ileocolitis). Small, bilateral, symmetrical subepithelial, and anterior proliferative infiltrates and scarring were present 2 to 3 mm inside the entire corneoscleral limbus. Vision was not affected because the lesions spared the central cornea. The mechanism is not known and the lesion should be regarded as a distinct clinical sign of Crohn's disease.

Adult↗
PubMed1979

Psoriasis and intraocular inflammation.

Presented in this series were seven men and three women. Ages when seen, ranged from 32 to 68 years (average 54). Psoriasis had begun in childhood in the women and in the late 20's and 30's in the men. Arthritis (ankylosing spondylitis) was present in only one. Their ocular inflammations began from ages 26 to 62 (average 41). The onset of the inflammation was acute iritis in four and in indolent iridocylcitis in six. All but one were bilateral and chronic. The vitreous had heavy debris in nine of the ten patients. The retina was normal in only three. Boggy congestion was present in two with cystoid edema. Patches of edema. fluorescein leaking, depigmentation of both maculae, pars plana exudate, and retinal vessel obliteration to grey-white, shaggy cords was present in at least one of the remaining five patients. Systemic corticosteroid therapy has been used in eight of the ten patients described in this report. Doses no higher than 30 mg of prednisone per day were used to initiate reversal of the inflammatory response. In case 10, knowledge of the sensitivity of the process to steroids led to the successful rapid reversal of a recalcitrant iritis with only 20 mg of prednisone as a first dose and 20 mg per day for less than three weeks. Maintenance corticosteroid therapy ranged from 40 mg of prednisone every other day in case 9, prednisone 12.5 mg one day and 5 mg the next in case 8, to 8 mg of Aristocort or methylprednisolone acetate (M-edrol) daily in cases 1 and 2. In summary, these patients are older, have an indolent onset bilateral uveitis with dense vitreous debris, retinal abnormalites, and are extremely sensitive to systemic corticosteroids. Many of these patients had undergone the series of clinical evaluations known as a "uveitis survey." Many different systemic abnormalities were found and merited treatment which rarely made a difference in their ocular disease, though two improved after infected teeth were treated. Assuming that these ocular diseases were related to psoriasis, one can then challenge the value of anything found by a "uveitis survey." The author uses information gained from such studies to insure that the patient is in the best possible heatlh and then makes clinical correlations such as presented in this paper. The rarity of this combination of ocular inflammations in patients with psoriasis makes it risky to propose that this is a significant association. Arguments that this is a disease entity began with the clinical similarities: older age, indolent onset, vitreous and retinal involvement, and the extreme sensitivity to systemic corticosteroids. None of these patients had psoriatic arthritis and only one had ankylosing spondylitis. The best explanation for the fact that this disorder has not been emphasized in the past would be an attitude of ophthalmologists and physicians that the eye and skin disease were coincident.

Adolescent↗
PubMed1978

Hypoplasia of the optic nerve.

Premorbid ophthalmoscopic and histopathologic findings were correlated in a case of bilateral optic nerve hypoplasia in a 9-month-old infant with bilateral hydranencephaly. The double-ring sign was due to an extension of retina and retinal pigment epithelium (RPE) over the outer portion of the lamina cribrosa. The outer ring was the junction between sclera and lamina cribrosa, and the inner ring was the termination of the RPE. The center of the inner ring was the hypoplastic nerve head, which appeared whitish because of fibroglial tissue surrounding the central retinal vessels where they entered the optic nerve head. We speculate that an in utero vascular insult, after the third month of development, led to cystic cavitation of the anterior cerebral hemispheres, with subsequent retrograde degeneration of developing retinal ganglion cells.

Abnormalities, Multiple↗
PubMed1977

Cytomegalovirus retinitis in adults. A manifestation of disseminated viral infection.

Retinitis caused by cytomegalovirus (CMV) infection is unusual in adults. Sixteen of the 17 cases reported have occurred in immunologically compromised patients, most frequently renal transplant recipients. CMV retinitis is associated with a distinctive ophthalmoscopic appearance and, in the majority of cases, was the first clinical manifestation of systemic viral infection. Severe and permanent visual deficits are characteristic. Since retinitis is a reliable sign of disseminated disease and ophthalmoscopic examination a rapid method of establishing its presence, recognition of this manifestation should allow earlier diagnosis of serious CMV infection.

Adult↗
PubMed1977

Follow-up study in eyes with choroidal neovascularization caused by presumed ocular histoplasmosis.

Sixty-four eyes of 60 patients with ocular histoplasmosis, and choroidal neovascularization documented by fluorescein angiography, and not treated with photocoagulation, were followed for an average of 29 months. The primary determinant of visual outcome was the proximity of the neovascular membrane to the fovea. Sixty-four percent of eyes with membranes 0.25 disk diameter or greater from the fovea had a final visual acuity of 6/12 (20/40) or better, and 71% of such eyes maintained or improved initial visual acuity. All eyes with subfoveal neovascularization had a poor visual result. Other factors related to visual prognosis included initial visual acuity, size of the neovascular membrane, size of sensory retinal detachment, and presence of hemorrhage.

Adolescent↗
PubMed1976

The tilted disk syndrome.

We noted occasional diagnostic confusion with papilledema and chiasmal compression when its true congential nature was not recognized in 12 patients with a benign ocular syndrome. Retinoscopy, fluorescein angiography, ocular ultrasonography, and histopathology suggested that associated visual field defects were related to a localized staphylomatous ectasia of the posterior globe.

Adolescent↗