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Biomedical subjects

E M Graham

Publications and source records attributed to E M Graham.

At least 73 records · Page 4Linked to original sources
PubMed1995

Thrombophilic factors in ischaemic and non-ischaemic idiopathic retinal vasculitis.

Two common causes of visual loss in idiopathic retinal vasculitis (RV) are retinal ischaemia and cystoid macular oedema. This study investigated whether thrombophilic factors are more prevalent in patients with ischaemic RV than non-ischaemic RV. Twenty patients with RV (10 ischaemic, 10 non-ischaemic) were prospectively recruited before starting systemic immunosuppression. Twenty-one different haemostatic parameters were tested. Seventeen patients had at least one haemostatic abnormality. Three patients had low Protein S, one had low Protein C. Three patients had positive anticardiolipin antibody titres, 1 had poor fibrinolytic activity, 3 had raised fibrinogen levels. Ten patients had raised lipoprotein (a) levels. Fibrinogen levels were higher in the smokers (p = 0.02). Although all von Willebrand's factor levels were within the normal range, they were higher in the ischaemic group (p = 0.008), in which smoking was more prevalent. This study has shown a high prevalence of thrombophilic abnormalities in RV patients, and implicates smoking in the aetiology of ischaemic RV.

Adult↗
PubMed1995

Severe idiopathic posterior scleritis in children.

Posterior scleritis is an uncommon condition that usually occurs in adults and the diagnosis is often missed. It is even more rare in children. We report five cases of the disease in children. The patients presented with severe pain in an inflamed eye and usually had orbital signs with lid swelling and limitation of extraocular movements; four of the five had optic disc swelling and two had exudative retinal detachments. The diagnosis was confirmed on B-scan ultrasonography and CT scanning and no child had clinical or laboratory evidence of associated systemic disease. The disease took a protracted course and all the children required long-term systemic immunosuppression (15-27 months), which was well tolerated. All children retained good vision and were either off treatment or on a small dose of immunosuppression at last follow-up. This condition, although rare, should be recognised in children as part of the differential diagnosis of acute orbital inflammation.

Adolescent↗
PubMed1995

Visual prognosis of AIDS patients with cytomegalovirus retinitis.

A prospective study of visual acuity (VA) was performed in a cohort of 147 AIDS patients with cytomegalovirus retinitis (CMVR). Patients were treated according to standard regimes, and corrected VA was recorded at regular intervals from presentation until death. Follow-up was 6 weeks to 5 years (mean 30 weeks). Fifty patients (34%) had bilateral CMVR at initial presentation; at death 81 patients (55%) had bilateral disease. Thirty-one eyes initially uninfected developed CMVR during follow-up. Of 228 infected eyes, VA at presentation was 6/12 or better in 182 eyes (80%) and 6/60 or better in 215 eyes (94%) At death, VA was 6/12 or better in 112 eyes (49%) and 6/60 or better in 171 eyes (75%). VA in the better eye at death was 6/12 or better in 113 of 147 patients (77%), 6/24 or better in 135 patients (92%) and worse than 6/60 in only 7 patients (5%). Treatment of AIDS-related CMVR minimises loss of vision and may protect previously uninfected eyes, prolonging visual independence.

AIDS-Related Opportunistic Infections↗
PubMed1995

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↗
PubMed1995

Sarcoidosis.

Explore the source record for details and available documents.

Eye Diseases↗
PubMed1994

The efficacy of systemic corticosteroids in sight-threatening retinal vasculitis.

This study was undertaken to assess the efficacy of a standard regime of high-dose systemic oral corticosteroids in the management of retinal vasculitis. The study was performed because the single most common reason for referral to our specialist clinic is the apparent failure of patients to respond to a course of systemic steroids, which in most cases appeared to be due to an inadequate initial dose. A retrospective study of 29 patients (30 treatment episodes) with sight-threatening retinal vasculitis managed initially with high-dose systemic steroids was evaluated 1 year after treatment. Patients included in the study all started treatment with > or = 1 mg/kg prednisolone and remained on a high steroid dose (> or = 40 mg prednisolone) for at least 5 weeks. No patient was on any other immunosuppressive agent at the start of the study. Therapeutic success for this regime, as judged by improvement in visual acuity, was 60%, improving to 77% with addition of other immunosuppressive agents. Eight patients required additional immunosuppressives. Although documented side-effects of steroids were common (50% of cases managed on steroids alone), in only 5 patients were they therapeutically important. Twelve of the 22 patients managed on high-dose steroids alone were off treatment at 12 months. There was no correlation at any stage between visual acuity, activity index or relapses and the final visual outcome at 12 months. Seven cases had a poor visual outcome and the causes for this included relapse in the twelfth month of follow-up, persistent cystoid macular oedema and lens opacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Azathioprine↗
PubMed1994

Soluble intercellular adhesion molecule-1 (sICAM-1) as a marker of disease relapse in idiopathic uveoretinitis.

This study reports the results of a point prevalence study of markers of endothelial dysfunction in the serum of patients with idiopathic uveoretinitis. sICAM-1, soluble endothelial leucocyte adhesion molecule (sELAM), anti-endothelial cell antibodies (AECA) and von Willebrand factor (vWF) levels were measured in 32 patients with isolated idiopathic uveoretinitis and seven with uveitis in association with systemic disease, using commercial and in-house ELISAs. Raised levels of AECA were found in 31% of patients with isolated uveitis, vWF in 28%, sELAM in 15.6% and sICAM-1 in 31%. Further analysis revealed that raised sICAM-1 levels were closely associated with recent relapse of disease (P = 0.00003). Patients with accompanying systemic disease were found to have a similar prevalence of these serum abnormalities to those with isolated ocular disease. In conclusion, vascular endothelial dysfunction may contribute to pathogenesis in uveoretinitis, and in particular sICAM-1 may prove a marker of disease relapse in this condition.

Adolescent↗
PubMed1993

Macular ischaemia in posterior uveitis.

The commonest cause of visual morbidity in patients with posterior uveitis is cystoid macular oedema, which usually responds to immunosuppressive treatment. However, a small group of patients do not have a satisfactory visual outcome despite apparently adequate therapy. In a retrospective study of 345 angiograms of 135 patients with active non-occlusive retinal vasculitis 12 patients were identified by independent masked review as showing macular ischaemia on their fluorescein angiograms. Four patients had Behçet's disease, 4 sarcoidosis, and 4 idiopathic retinal vasculitis. Follow-up of these patients for an average of 36 months (range 6-120 months) showed that visual acuity failed to improve in 4 patients and dropped by an average of three lines Snellen in the other 8. We suggest that a poor visual outcome in some patients with posterior uveitis may be predicted by the presence of macular ischaemia on fluorescein angiography and that immunosuppressive therapy should be prescribed with caution in these patients.

Adult↗
PubMed1993

Anterior visual system involvement in non-Hodgkin's lymphoma.

Non-Hodgkin's lymphoma may have ocular involvement but optic nerve and chiasmal disease is unusual. Determining the cause of the neuropathy in this group of patients presents major difficulties despite modern neuroimaging and immunocytochemistry. Two patients with NHL are presented; one had an anterior chiasmal syndrome and the other bilateral optic nerve involvement. The first patient was thought to have lymphomatous infiltration and the second a concomitant infection (progressive multifocal leucoencephalopathy). Toxic effects of therapy were considered but finally rejected. The importance of modern neuroimaging and the role of optic nerve biopsy are discussed.

Adult↗
PubMed1993

Ocular and neurological Behçet's disease without orogenital ulceration?

A 28 year old West Indian patient is described who had a relapsing and remitting steroid-sensitive illness for 3 years. The clinical features included uveitis and widespread CNS involvement. The patient was treated as though he had neurosarcoidosis. Post mortem examination revealed histological changes compatible with a diagnosis of Behçet's disease, but at no time did he suffer from oral or genital ulceration or arthritis. The authors suggest a new term to encompass such an entity: the "Behçet's MINUS" syndrome (multifocal intermittent neurological and uveitic syndrome).

Adult↗
PubMed1992

Late onset Leber's optic neuropathy: a case confused with ischaemic optic neuropathy.

A case is reported of a 63-year-old man with progressive central visual loss in one eye followed 11 months later by involvement of the fellow eye. A diagnosis of chronic ischaemic optic neuropathy was considered. However, despite a negative family history, the absence of electrocardiographic abnormalities, and minimal fundus changes a diagnosis of Leber's optic neuropathy was made on the basis of magnetic resonance imaging findings and the mitochondrial DNA mutation at base pair 11778.

DNA, Mitochondrial↗