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Biomedical subjects

R J Marsh

Publications and source records attributed to R J Marsh.

At least 37 records · Page 2Linked to original sources
PubMed1987

Ophthalmic zoster: mucous plaque keratitis.

Data taken from 1221 patients attending the Zoster Clinic of Moorfields Eye Hospital over the past 15 years were used to characterise the clinical appearance and behaviour of zoster mucous plaque keratitis (MPK). The typical greyish branching plaques are usually accompanied by a limbitis, stromal keratitis, or decrease in corneal sensation and are commonly associated with cataract, raised intraocular pressure, or corneal ulceration. MPK may begin at any time within two years of onset of the rash, but when it appears after three months there are more complications. Usually MPK settles within one month if appropriate treatment with topical steroids and acetylcysteine drops is given, but surgical intervention is sometimes required to control glaucoma or neuroparalytic keratitis or to remove cataracts. The results of surgery are surprisingly good.

Adult↗
PubMed1987

Retinal arterial macroaneurysms: a retrospective study of 40 patients.

We studied 40 patients with a total of 44 retinal arterial macroaneurysms. All patients were followed up for at least six months. Macroaneurysms (MAs) have variable clinical presentations and are still frequently misdiagnosed before fluorescein angiography. Haemorrhagic MAs were most frequently misdiagnosed (75%), and had a sudden onset with a relatively poor visual outcome. Patients with these MAs had higher systolic blood pressures and significantly fewer associated retinal vein occlusions (p less than 0.05) than other types of MA. Exudative MAs caused a gradual onset of symptoms, were frequently associated with retinal vein occlusions, and were the most frequent indication for laser treatment. Only one of 10 quiescent MAs subsequently developed significant exudation or haemorrhage. We confirm the association of MAs with retinal and systemic vascular disease. In addition we found that MA patients had a significantly higher blood packed cell volume (haematocrit) than controls (p less than 0.05). Laser treatment significantly shortened the duration of MA patency (p = 0.006).

Aged↗
PubMed1987

Ophthalmic findings in a group of ambulatory patients infected by human immunodeficiency virus (HIV): a prospective study.

Twenty-eight patients with either the acquired immune deficiency syndrome (AIDS) or persistent generalised lymphadenopathy (PGL) were studied prospectively as outpatients for up to one year. Six patients had fundal cotton wool spots at some stage of their follow-up and all six suffered opportunistic infections associated with AIDS. We suggest that ocular abnormalities may be prognostic for opportunistic infection in AIDS and discuss the wide range of ophthalmic complications consequent to HIV infection.

AIDS-Related Complex↗
PubMed1987

Mycobacterium chelonei infection of a corneal graft.

We present a case of Mycobacterium chelonei infection in a corneal graft. The chronic ulceration and stromal infiltration followed a well defined course and eventually responded to topical amikacin, though a further graft was required. Previous cases of keratitis due to the M. fortuitum complex are reviewed.

Amikacin↗
PubMed1986

Development of an immunofluorescence test for the serodiagnosis of herpes zoster ophthalmicus.

An indirect immunofluorescence test has been developed and evaluated for the serodiagnosis of herpes zoster ophthalmicus (HZO) by the detection of antivaricella zoster virus (VZV) antibody. The results show that, in patients with HZO, anti-VZV IgG antibody titre usually rises rapidly after onset. One hundred and seven of the 134 sera (80%) from patients with a clinical diagnosis of HZO had an anti-VZV IgG titre of greater than or equal to 256, and IgM antibody at a level of 1 in 8 was present in six of them. In comparison only two of the 216 sera (1%) from patients with a clinical diagnosis of ocular infections other than those caused by VZV had such IgG titres. It was concluded that, on the basis of results of a single sample of serum, it is possible to make a provisional diagnosis of HZO with a high degree of confidence.

Antibodies, Viral↗
PubMed1986

The ophthalmological features of AIDS and AIDS related disorders.

The ocular findings in 38 patients infected by the Human T Cell Lymphotropic Virus Type III (HTLV III) are reviewed. Twenty patients were suffering from the Acquired Immunodeficiency Syndrome (AIDS) and 18 from the HTLV III related disease Persistent Generalised Lymphadenopathy (PGL). Cotton wool spots were found in the retinae of 8 patients at some stage of their disease and the prognostic significance of these is discussed. Cytomegalovirus (CMV) Retinitis was an ocular complication in eight of the patients with AIDS. The therapeutic effects of a new anti-viral drug, di-hydroxy propoxymethyl guanine (DHPG), are discussed.

AIDS-Related Complex↗
PubMed1984

Bacterial contamination of intraocular lens surgery.

One hundred sterile intraocular lenses were placed on the external eye of 50 patients during cataract surgery. Half of the specimens were cultured for bacteria, the other half were examined under the light microscope after fixing and staining. A bacterial contamination rate of 26% was recorded. This is significantly higher than that found in conjunctival swabs (6%) or irrigation specimens (8%) taken at the same time, and higher than that recorded in a group of control lenses (15.2%) exposed to operating theatre air alone. We propose that intraocular lenses contaminated with viable bacteria may be implanted into the eye and thereby account for some cases of postoperative uveitis in the pseudophakic eye.

Anti-Bacterial Agents↗
PubMed1983

Alpha thalassaemia and the macular vasculature in homozygous sickle cell disease.

The interaction of homozygous alpha thalassaemia 2 with homozygous sickle cell (SS) disease results in a generally milder haematological picture with less intravascular sickling, less haemolysis, and higher haemoglobin levels. Clinically, patients are generally more mildly affected, though not all vaso-occlusive complications are reduced. Thus there is a possibility that the advantages gained by inhibition of sickling have been offset by the rheological disadvantages of the higher haemoglobin level. The capillary bed in the perimacular region of the posterior pole has been used to examine the degree of vaso-occlusion in age and sex matched controls with SS disease with and without homozygous alpha thalassaemia 2. The results demonstrated significantly less capillary abnormalities in the perimacular region of patients with alpha thalassaemia, though the size of the foveal avascular zone and the grading of perimacular capillary drop-out did not differ between the 2 genotypes. These results are compatible with a mild inhibitory effect of alpha thalassaemia on vaso-occlusion of the macular vasculature in SS disease.

Adolescent↗
PubMed1982

Treatment of lipid keratopathy with the argon laser.

Twenty-two patients with lipid keratopathy were treated with argon laser photocoagulation to the feeder vessels. Two were grafted just over a week after treatment and the corneal discs examined histologically. The remainder of the patients were followed up for a least a year. In 6 cases the visual acuity improved, in 3 deteriorated, and in 10 did not change. The density and extent of the lipid deposition were diminished in 50% of cases. The commonest complications were bleeding into the lipid keratopathy and iris damage. The only serious problem was a disciform type of lipid keratopathy that flared up after treatment. Suggestions are made on improvements in the technique of laser application.

Adult↗
PubMed1982

Macular vasculature, visual acuity, and irreversibly sickled cells in homozygous sickle cell disease.

Observations of visual acuity and the conjunctival, macular, and perimacular vascularity have been assessed in patients with homozygous sickle cell (SS) disease. There were 17 matched pairs, each consisting of one patient with a high count (greater than or equal to 15%) and one with a low count (less than or equal to 5%) of irreversibly sickled cells (ISCs). The macular vascular bed was assessed by measurements of the foveal avascular zone (FAZ), perimacular avascular zones, and counts of perimacular vascular abnormalities (perimacular counts). Small foveal avascular zones and high perimacular counts were commoner in younger than older patients and there was a significant inverse correlation between size of the FAZ and the perimacular count. These observations were compatible with the hypothesis that perimacular vessel anomalies represent the early vaso-occlusive phase which progresses to ischaemia and the formation and enlargement of avascular areas. Visual acuity was assessed by Snellen's test type and by measuring contrast sensitivity. There was no obvious relationship between acuity measured by the 2 methods and no relationship between acuity and observations of macular vascularity. High ISC counts were significantly related to abnormalities of the conjunctival vasculature, but no relationship was noted with abnormalities of the macular vasculature or with visual acuity.

Adult↗
PubMed1982

Lasering of lipid keratopathy.

A series of 41 patients with varying types and degrees of lipid keratopathy was examined and then treated with the Argon laser. This was done primarily in an attempt to prevent extension of lipid keratopathy, but secondarily to see if any clearing of lipid would occur. The results were encouraging and although the visual acuity was not improved in the majority of patients, the symptoms were alleviated in a significant number. Iris atrophy was very common after treatment, although the incidence was lowered by the use of the Abraham contact lens. Two cases of severe corneal thinning were encountered 6 months after laser application, but both responded well to corneal grafting.

Cornea↗
PubMed1981

Herpes zoster ophthalmicus: a medical review.

Patients with herpes zoster undergo extensive screening to detect underlying malignant disease which is compromising their immunity. In a retrospective survey of 1000 patients with herpes zoster ophthalmicus 12 patients had malignant disease which was known on presentation. No new cases were detected or discovered on follow-up. Three patients developed a disseminated rash, but none of these had an underlying malignant disease.

Adolescent↗
PubMed1981

Experience with extracapsular extraction and binkhorst 2-loop intraocular lenses: preliminary communication.

Extracapsular cataract extraction and implantation of a Binkhorst 2-loop intraocular lens were performed on 50 patients. The majority of the patients achieved a corrected postoperative acuity of 6/9. Operative, immediate postoperative and late postoperative complications are discussed. The commonest postoperative complication was the formation of a dense capsular membrane which required capsulotomy in 9 patients. Suggestions are put forward for improving the result of this rewarding operation.

Aged↗