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Biomedical subjects

J G Clarkson

Publications and source records attributed to J G Clarkson.

At least 37 records · Page 2Linked to original sources

Acute multifocal hemorrhagic retinal vasculitis.

The authors present a series of seven patients with acute visual loss associated with mild anterior uveitis, multifocal retinal vasculitis, retinal capillary nonperfusion, retinal hemorrhage, disc swelling, and vitreitis. Oral prednisone was of some benefit in these patients and oral acyclovir was generally ineffective. Neovascular complications including retinal, disc, choroidal, and iris new vessels were common, requiring photocoagulation in five patients. Horseshoe tears developed in two patients in zones of uninvolved retina but retinal detachment did not occur. The etiology remains unknown, although it may represent either a localized ocular form of Behçet's disease or other systemic syndrome, infection with a herpes group virus other than zoster varicella virus, or a manifestation of an undefined infectious agent.

Acute Disease↗

Microbial endophthalmitis resulting from ocular trauma.

Twenty-seven cases of culture-positive endophthalmitis that developed after ocular trauma were reviewed. The intraocular culture specimens showed a virulent microbiologic spectrum with Bacillus sp as the most common isolate (8 eyes). The visual prognosis was poor, with only 22% of patients retaining 20/400 or better vision. This level of vision was achieved in 2 of 22 (9%) bacterial cases and in four of five (80%) fungal cases. Retinal detachment (5 cases) or retinal breaks (2 cases) at the time of the initial injury had a uniformly poor visual prognosis. Postoperative retinal detachment not associated with phthisis bulbi occurred in five eyes, three of which had successful retinal reattachment surgery. Delayed onset retinal detachment after successful initial management of traumatic endophthalmitis had a greater frequency of successful retinal reattachment surgery.

Adolescent↗

Treatment of the acute retinal necrosis syndrome with intravenous acyclovir.

We treated 13 eyes of 12 patients with the acute retinal necrosis syndrome (ARN) with intravenous acyclovir (1500 mg/M2/day) for an average of 10.9 days. All patients were also treated with oral aspirin or Coumadin. in an attempt to prevent thrombotic complications and nine of twelve patients were treated with oral prednisone after intravenous acyclovir had been initiated. Regression of retinal lesions was first seen on average 3.9 days after initiation of therapy and required 32.5 days on average for completion. No eye developed new retinal lesions or progressive optic nerve involvement 48 hours or more after initiation of therapy, although progression within the first 48 hours was occasionally seen. Treatment did not ameliorate vitritis or prevent retinal detachment, which occurred in 11 of 13 eyes, an average of 59 days after the initiation of therapy. There were no evident ocular or systemic complications of therapy. Our data suggest the need for a prospective randomized clinical trial to evaluate the efficacy of intravenous or oral acyclovir in the treatment of the acute retinal necrosis syndrome.

Acute Disease↗

Retinal detachment following the acute retinal necrosis syndrome.

Twenty-six patients with the acute retinal necrosis involving 32 eyes have been followed at the Bascom Palmer Eye Institute. Sixteen eyes developed retinal detachment and surgical repair was attempted in thirteen. Ten eyes were successfully reattached. Vitreous surgery was necessary in ten eyes and was performed in eight of the ten successful eyes. The clinical characteristics of the retinal detachments as well as the surgical procedures and results are presented.

Acute Disease↗

Centrifugal cytology of ocular fluids.

Centrifugal cytology is a new technique for the preparation of ocular fluids for cytologic examination. It differs from conventional cytocentrifuge techniques, since fixation is carried out simultaneously with centrifugation. It avoids air-drying artifacts and can be applied to small (50 microL) or large (200 mL or more) sample volumes and dilute cell suspensions, such as might be obtained by anterior chamber paracentesis, vitreous aspiration, or vitrectomy. The resultant preparation is a permanent, stained, well-preserved, flattened, homogeneous cell dispersion suitable for detailed cytologic evaluation.

Adult↗

Atypical serpiginous choroiditis.

Patients with serpiginous choroiditis may demonstrate atypical features. In this series 14 (56%) of 53 patients demonstrated either active choroidal neovascularization (13%) or disciform macular scarring (13%). Despite a slight excess of male subjects, five of seven patients with active choroidal neovascularization were female. Three had bilateral disciform disease. All patients with this complication had visual acuity of 6/60 or less. None were able to be successfully treated by photocoagulation. One patient had secondary branch venous obstruction peripherally, associated with retinal neovascularization. Patients with serpiginous choroiditis are at risk of losing central vision from either an acute active lesion in the macula or choroidal neovascularization occurring at the margin of an inactive chorioretinal scar. Serial examination at regular intervals is recommended to rule out the development of possibly treatable choroidal neovascularization in patients with serpiginous choroiditis.

Choroid↗

The acute retinal necrosis syndrome. Part 1: Clinical manifestations.

The acute retinal necrosis syndrome is characterized by necrotizing retinitis, vitritis, and retinal vasculitis occurring in otherwise healthy patients. Experience with 11 cases and the review of 30 additional cases in the literature are presented. In this series, 50% of the affected eyes developed retinal detachments, and 64% had a final visual acuity of less than 20/200. The natural history, diagnosis, postulated etiology, and suggestions for management will be discussed.

Acute Disease↗

Endogenous Aspergillus endophthalmitis in drug abusers.

One of two cases of endogenous Aspergillus endophthalmitis in abusers of intravenously administered drugs was treated successfully by subtotal pars plana vitrectomy; amphotericin B administered by intravitreal, periocular, and systemic routes; and flucytosine administered systemically. Aspergillus sp should be considered a possible pathogenic organism in drug abusers with endogenous endophthalmitis. An aggressive diagnostic and therapeutic approach may result in preservation of useful vision.

Adult↗

Vitrectomy in Terson's syndrome.

Five patients with nonclearing vitreous hemorrhage associated with subarachnoid or subdural hemorrhages (Terson's syndrome) underwent pars plana vitrectomy. All six eyes of the five patients had postoperatively improved visual acuity and visual function. We recommend treating this rare syndrome with vitrectomy after careful preoperative ophthalmologic examination and a minimum observation period of six months to one year.

Adult↗

A histopathologic review of 168 cases of preretinal membrane.

In 168 eyes with preretinal membranes studied histopathologically, five major distinct types of membranes were categorized: 61 glial, 28 fibrous, 22 cortical vitreous, 16 retinal pigment epithelium, 15 fibroinflammatory, 24 combinations, and one endothelial and melanomatous membrane each. The overall prevalence of preretinal membranes was 5.5% in 2,000 cases studied. Selected cases examined by electron microscopy were supportive of the origin of the cells in the preretinal membranes in the glial, fibrous, and retinal pigment epithelial types. Glial preretinal membranes occurred as the result of defects in the internal limiting membrane, such as retinal pits or holes, and from the optic nerve head in association with posterior vitreous detachment. Fibrous preretinal membranes were associated with proliferative retinopathy and long-standing retinal detachment. Studies of the cellular origin of these membranes were inconclusive. The cortical vitreous type of preretinal membrane was hypocellular and occurred in the absence of associated ocular abnormalities. Pigment epithelial preretinal membranes occurred in eyes with rhegmatogenous retinal detachment.

Adult↗

Angioid streaks.

Angioid streaks are often associated with a systemic condition, most frequently pseudoxanthoma elasticum, Paget's disease of the bone, or one of the sickle hemoglobinopathies. The clinical manifestations of angioid streaks and those three systemic conditions are reviewed. A diagnostic survey is suggested for patients discovered to have angioid streaks with no known systemic disease. The results of such a survey in 50 patients are presented. In addition, separate studies of patients with Paget's disease of the bone (50 patients) and of the sickle hemoglobinopathies (100 patients) are described, and the characteristics of patients with angioid streaks as well as the incidence of streaks in these conditions is reviewed. The histopathologic and fluorescein angiographic characteristics of angioid streaks, as well as the possible benefit of photocoagulation for complications of angioid streaks is discussed.

Age Factors↗

Multifocal pigment epithelial detachments by reticulum cell sarcoma. A characteristic funduscopic picture.

Patients with systemic reticulum cell sarcoma often develop evidence of ocular involvement months or several years prior to the onset of neurologic symptoms. This neoplasm appears to have proclivity of arising multicentrically within the subpigment epithelial space, as well as in the vitreous. When this occurs it may produce a peculiar ophthalmoscopic picture of multiple large, solid detachments of the pigment epithelium that is rarely duplicated by any other disease. Three patients illustrating this disease are presented.

Aged↗