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Biomedical subjects

David J Browning

Publications and source records attributed to David J Browning.

26 records · Page 2Linked to original sources
PubMed2003

Retinal tear and detachment after transpupillary thermotherapy for choroidal melanoma.

PURPOSE: To report a side effect of transpupillary thermotherapy for choroidal melanoma. DESIGN: Small case series. METHODS: Review of clinical charts and photographs in a private retina practice. RESULTS: Retinal tears developed in two patients after transpupillary thermotherapy for choroidal melanoma. In one patient a secondary rhegmatogenous retinal detachment developed. CONCLUSIONS: Transpupillary thermotherapy can result in vitreous traction on the retina over the choroidal tumor, which can lead to a retinal tear and to retinal detachment. Patients should be warned about this possibility and advised to be examined should photopsias or new floaters develop after treatment.

Aged↗
PubMed2003

Acute retinal necrosis following epidural steroid injections.

PURPOSE: To report a side effect of epidural corticosteroid injections for back pain. DESIGN: Case series. METHODS: Review of clinical charts and photographs. SETTING: Private retina practice. RESULTS: Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker. CONCLUSIONS: Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist.

Acyclovir↗
PubMed2003

Potential pitfalls from variable optical coherence tomograph displays in managing diabetic macular edema.

PURPOSE: To describe potential pitfalls in the use of optical coherence tomography for management of diabetic macular edema. DESIGN: Prospective, noninterventional case series. METHODS: Review of optical coherence tomographs in 13 eyes with clinically significant diabetic macular edema from 11 consecutive patients in a private retina practice. RESULTS: Optical coherence tomography displays are based on 3.5-mm or 6-mm diameter circular grids that look very similar and have identical sector names but schematize different areas of the macula. The numeric outputs for the identically named sectors in the two displays do not differ significantly for retinal thickness but differ significantly in all sectors except the fovea for retinal volume because of the different areas represented by the sectors. CONCLUSIONS: Failure to explicitly note the scale of the optical coherence tomography display can potentially misdirect planned focal and grid laser treatment for diabetic macular edema. Failure to explicitly verify identical optical coherence tomography display scales in longitudinal studies of laser treatment for diabetic macular edema can potentially lead to errors in interpreting treatment efficacy.

Data Display↗
PubMed2003

Choroidal osteoma: observations from a community setting.

PURPOSE: To determine the characteristics of choroidal osteoma arising from a previously unreported patient population and to document new observations in this condition. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eleven consecutive patients seen from 1986 through 2002 with choroidal osteoma from one community-based retina practice. INTERVENTION: Laser ablation of subretinal neovascularization in two cases and focal laser treatment of retinal pigment epithelial leaks in one case. METHODS: Photographs, fluorescein and indocyanine green angiograms, and clinical records were analyzed. MAIN OUTCOME MEASURES: Demographic variables, visual acuity, complications of laser treatment, growth of lesions, and associated funduscopic changes. RESULTS: Choroidal osteoma from a community setting is more frequently asymptomatic (5/11 cases; 45%) than in previously reported university series, is usually initially misdiagnosed, and is not rare. Light-intensity focal laser photocoagulation for serous retinal detachment unaccompanied by subretinal neovascularization can resolve fluid (1/11 cases; 9%). Laser ablation of secondary subretinal neovascularization stimulates rapid choroidal osteoma vascular remodeling (2/11 cases; 18%) and can cause retina-osteoma venous and arterial anastomoses (1/11 cases; 9%). Spontaneous choroidal hemorrhage unaccompanied by subretinal neovascularization can occur with confinement to the osteoma borders (1/11 cases; 9%). Association of choroidal osteoma with retinitis pigmentosa is reported. CONCLUSIONS: These data on choroidal osteoma natural history and treatment help clinicians managing these lesions. In the community, a higher index of suspicion for choroidal osteoma is warranted.

Adolescent↗
PubMed2002

Hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity.

PURPOSE: To report hydroxychloroquine and chloroquine retinopathy and consider screening for drug toxicity. DESIGN: Retrospective observational case series. METHODS: Review of clinical records, visual fields, fundus photographs, and fluorescein angiography of six patients from a retina referral practice. RESULTS: All cases arose because of failure by physicians to avoid dosing above published safe levels. Five cases developed despite accepted ophthalmologic patterns of screening for toxicity. All cases developed parafoveal retinal pigment epithelial atrophic changes and paracentral scotomas to threshold visual field testing. CONCLUSIONS: New cases of hydroxychloroquine and chloroquine toxicity continue to develop in a screening environment. Increased ophthalmologic attention to dosing, awareness of location and nature of early visual field defects, and traditional attention to presence or absence of maculopathy can reduce the incidence of this avoidable condition.

Aged↗
PubMed2002

Patchy ischemic retinal whitening in acute central retinal vein occlusion.

OBJECTIVE: To describe a new fundus abnormality in nonischemic central retinal vein occlusion and its pathophysiologic basis. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eleven consecutive patients from a community-based retina referral practice who had central retinal vein occlusion (CRVO) and patchy ischemic retinal whitening (PIRW) and 225 consecutive patients from the same practice with CRVO and no PIRW. RESULTS: Patchy ischemic retinal whitening occurs in younger patients with nonischemic CRVO (P < 0.0003) and is associated with better visual outcomes than without PIRW (P = 0.0201). Patchy ischemic retinal whitening has a perivenular distribution in the macula, has no fluorescein angiographic correlate in milder cases, can occur before any retinal hemorrhages or macular edema, and resolves in 2 to 4 weeks. Cilioretinal arteriolar insufficiency is a common finding associated with PIRW (5/11 cases). The laboratory evaluation of patients with PIRW is generally normal. CONCLUSIONS: Patchy ischemic retinal whitening is a useful fundus sign of nonischemic CRVO that can precede other signs. Familiarity with this sign and its correlates will allow accurate diagnosis and counseling of affected patients.

Acute Disease↗
PubMedDate not supplied

A spreadsheet template for the analysis of optical coherence tomography in the longitudinal management of diabetic macular edema.

BACKGROUND AND OBJECTIVE: To provide a tool for analyzing optical coherence tomography data in patients with diabetic macular edema. PATIENTS AND METHODS: Retrospective series of 206 patients with diabetic macular edema involving at least one eye and receiving focal laser photocoagulation, intravitreal triamcinolone acetonide injection, or vitrectomy, membrane peeling, and intravitreal triamcinolone acetonide injection, and of untreated fellow eyes without diabetic macular edema. Main outcome measures included foveal subfield mean thickness and thickening relative to normal (microns), total macular volume and its increase relative to normal (mm3), visual acuity (Snellen decimal), and intraocular pressure (mm Hg). RESULTS: The authors demonstrate a graphical display of data based on a spreadsheet template for the longitudinal management of diabetic macular edema. Complex relationships of ocular response and interventions are concisely displayed. CONCLUSION: A graphical display of optical coherence tomography, visual acuity, and intraocular pressure data is a practical aid in the management of diabetic macular edema.

Computer Graphics↗