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Biomedical subjects

R P Murphy

Publications and source records attributed to R P Murphy.

At least 55 records · Page 3Linked to original sources
PubMed1991

Ocular manifestations of onchocerciasis in a rain forest area of west Africa.

The epidemiology and natural history of onchocerciasis and its ocular complications in rain forest areas are poorly understood. The present study was conducted on a rubber plantation in a hyperendemic area in the rain forest of Liberia, West Africa, where 800 persons were examined. The prevalence of infection was 84% overall 29% had intraocular microfilariae, and 2.4% were blind in one or both eyes. Onchocerciasis was the cause of all binocular blindness and one-third of all visual impairment. Over half of the visual impairment caused by onchocerciasis was due to posterior segment diseases. Chorioretinal changes were present in 75% of people, and included intraretinal pigment clumping in 52% and retinal pigment epithelium atrophy in 32%. Atrophy of the retinal pigment epithelium was associated with increasing age and severity of infection. Intraretinal pigment was strongly associated with anterior uveitis. There was a strong correlation between uveitis and the inflammatory chorioretinal sequelae: retinitis, intraretinal pigment, subretinal fibrosis, and optic neuropathy. These findings indicate that considerable visual impairment associated with rain forest onchocerciasis is common and is due largely to chorioretinal disease.

Adolescent↗
PubMed1990

The relationship of puberty to diabetic retinopathy.

The presence of background and preproliferative retinopathy in 70 patients with type I diabetes was correlated with their pubertal development. Pubertal status was assessed by pediatricians using the sexual maturity ratings of Tanner. In young diabetics with comparable disease duration (5 to 10 years), postpubertal children had a greater prevalence of retinopathy than those who were not sexually mature. After adjusting for duration of diabetes and sex, the relative odds of having retinopathy in the postpubescent group relative to the prepubescent or pubescent groups was 4.8 (95% confidence interval: 1.5 to 15.3). This study suggests that minimal retinopathy in children is not rare and that postpubescent children have a greater prevalence of diabetic retinopathy than do prepubescent children with similar diabetes duration.

Adolescent↗
PubMed1990

Longitudinal study of lesions of the posterior segment in onchocerciasis.

Onchocerciasis is a major cause of blindness, and much of the blindness due to onchocerciasis is caused by chorioretinitis. Little is known about the progression of lesions in the posterior segment in either untreated or treated disease. The authors studied the progression of onchocercal chorioretinitis in 57 patients from 1 to 3 years. Changes were documented from detailed ocular examinations, fundus photographs, and fluorescein angiograms, and included live intraretinal microfilariae, intraretinal hemorrhages, cotton-wool opacities, intraretinal pigment, white and shiny intraretinal deposits, retinal pigment epithelial window defects, and atrophy. Depigmentation at the edge of chorioretinal scarring progressed at a rate of up to 200 microns per year. Ivermectin or mebendazole treatment did not appear to alter the progress of depigmentation at the edge of chorioretinal scars. These observations suggest that onchocercal chorioretinitis is associated with early changes in the retina and retinal pigment epithelium, and that disease in the posterior segment may progress rapidly.

Animals↗
PubMed1990

Choroidal neovascularization after laser photocoagulation for diabetic macular edema.

Choroidal neovascular membranes (CNVMs) developed in eight patients after photocoagulation for clinically significant diabetic macular edema (DME). The CNVMs developed in areas where Bruch's membrane was ruptured and were diagnosed 2 weeks to 5 months after treatment. Only six patients had symptoms. The CNVMs were treated in four patients; final visual acuity was poor in all eight patients. This serious complication that follows laser treatment for DME may be related to the use of repeated small-size, short-duration laser or intense laser burns, or both.

Aged↗
PubMed1990

Prospective study of the impact of hypertension upon kidney function in diabetes mellitus.

Longitudinal data were obtained on 131 diabetic subjects enrolled in a study designed to evaluate the impact of persistent elevation of the blood pressure (BP) upon progression of renal damage in diabetes mellitus. For both insulin-dependent and non-insulin-dependent diabetes, serum creatinine exhibited a more rapid rise in those individuals whose BP remained elevated above 140 mm Hg despite therapy. Since no significant difference in age, duration of diabetes, diabetic control, or renal function at entry in the study could be identified as possible explanations for these differences, the findings support the conclusion that persistent elevation of the BP adds significantly to the risk of renal damage in both insulin-dependent and non-insulin-dependent diabetes, with more rapid decline occurring in non-insulin-dependent diabetes. Hypertensive subjects exhibited higher levels of plasma angiotensin II during the follow-up period.

Age Factors↗
PubMed1989

The use of fundus photographs and fluorescein angiograms in the identification and treatment of choroidal neovascularization in the Macular Photocoagulation Study. The Macular Photocoagulation Study Group.

The Macular Photocoagulation Study (MPS) Fundus Photograph Reading Center has developed a standard set of methods for assessing color photographs and fluorescein angiograms on study patients. For pretreatment angiograms, these methods are used to determine the location and extent of the choroidal neovascularization. For posttreatment color fundus photographs, these methods are used to assess the extent and intensity of treatment. Although these methods were developed to judge eligibility and treatment of patients enrolled in the MPS, they provide an excellent way for all treating ophthalmologists to evaluate their patients' angiograms and to assess immediately the intensity and extent of laser photocoagulation. The technique requires a microfilm reader or slide projection device to determine the completeness of treatment. The authors superimpose independent drawings made from pre- and posttreatment photographs. The techniques described can be applied readily in clinical practice. Since persistent neovascularization is highly correlated with incomplete and/or inadequate photocoagulation treatment, clinicians may adopt these Reading Center techniques to minimize the frequency of persistent neovascularization and, possibly, to reduce the frequency of visual loss in treated eyes.

Choroid↗
PubMed1988

Transient severe visual loss after panretinal photocoagulation.

Seven diabetic patients experienced severe but transient visual loss after panretinal photocoagulation for proliferative diabetic retinopathy. In all patients, visual acuity decreased shortly after treatment to levels ranging from 5/200 to no light perception. In five of the patients, no observable ocular disease or surgical complications could explain the degree of visual loss. The other two patients developed exudative macular detachments, although it was not clear that this change accounted for their severe visual loss. Vision improved in all patients over a period ranging from nine days to nine months. In five patients, visual acuity returned to within two Snellen lines of the pretreatment level.

Adult↗
PubMed1988

Laser treatment for choroidal neovascularization outside randomized clinical trials.

This study was undertaken to determine whether the treatment benefit reported in randomized trials for patients with extrafoveal choroidal neovascular membranes (NVMs) secondary to age-related macular degeneration (AMD) or the ocular histoplasmosis syndrome (OHS) can be duplicated in other clinical settings. The visual results and recurrence rates in treated extrafoveal NVMs of 70 patients with AMD and 21 patients with OHS were similar to those reported by the Macular Photocoagulation Study Group, in which all treated patients received argon blue-green laser photocoagulation after the administration of retrobulbar anesthesia. In this study, 78% (71/90) of the patients were treated with krypton laser and only 35% (32/90) had retrobulbar anesthesia. These results suggest, but do not prove, that the wavelength of the laser used or the administration of retrobulbar anesthesia may not be critical variables in determining the success of treatment in patients with extra-foveal NVMs.

Argon↗
PubMed1988

The evolution of argon laser photocoagulation scars in patients with the ocular histoplasmosis syndrome.

In 34 patients (35 eyes) with successfully treated histoplasmic choroidal neovascular membranes with a mean follow-up of 10.1 years, neither the neovascular membrane size nor the distance to the center of the foveal avascular zone (FAZ) affected final visual acuity. For a subgroup of 18 patients who had a two-year follow-up visit, the average chorioretinal scar expanded in area 50.1% per year for the first two years and 4.6% per year thereafter. This corresponded to a migration rate toward the FAZ of 152 micron/y for the first two years and 22 micron/y thereafter. After ten years, the average scar was 3.23 times larger than the initial treatment area and 480 micron closer to the FAZ than the initial treatment edge. Of the eight patients whose scars expanded to involve the center of the FAZ, six had final visual acuities either equal to or better than the initial visual acuities.

Adult↗
PubMed1988

Natural course of poorly defined choroidal neovascularization associated with macular degeneration.

We obtained follow-up data on 84 eyes with age-related macular degeneration and poorly defined angiographic leakage presumed to represent choroidal neovascularization. A poorly defined neovascular membrane was presumed to be present when subsensory retinal fluid was present in association with choroidal leakage on fluorescein angiography and in which the extent of leakage was not well defined. Among the 84 eyes, the average initial visual acuity was 20/80. In 75 (89%) of 84 eyes, the leakage involved the foveal center at initial presentation. At follow-up (average, 28 months; range, six to 53 months), the average visual acuity was 20/250; the final acuity declined at least three but less than six lines in 18 eyes (21%) and six or more lines in 35 eyes (42%). There was a statistically significant difference in the percentage of eyes that developed moderate or severe visual loss among eyes that progressed to disciform scarring compared with eyes that continued to manifest poorly defined leakage without evidence of scarring. Given that most severe visual loss associated with macular degeneration can be attributed to consequences of neovascular membranes and that many membranes associated with age-related macular degeneration are poorly defined, our study results support the possibility that poorly defined neovascular membranes represent a major cause of severe visual loss among the elderly in the United States.

Aged↗
PubMed1988

Subperiosteal osteoid osteoma of the distal phalanx of the thumb.

Osteoid osteomas have been subgrouped into subperiosteal, cancellous, and cortical. The occurrence of subperiosteal osteoid osteoma of the hand is rare. The location in the distal phalanx of the thumb has not been described. The case reported illustrates the unusual presentation and radiographic features of subperiosteal osteoid osteoma.

Adult↗
PubMed1988

Anterior segment ischaemia following laser photocoagulation in a patient with systemic lupus erythematosus.

The authors report the occurrence of occlusive retinal arterial disease and retinal neovascularisation in a 44-year-old woman with systemic lupus erythematosus (SLE). Two days after uncomplicated panretinal photocoagulation the patient developed an acute anterior segment ischaemic syndrome. To our knowledge this complication has not been reported in any other patient following laser photocoagulation or in association with SLE.

Adult↗
PubMed1988

Retinal pigment epithelial tears. Patterns and prognosis.

Increasing experience with the diagnosis of retinal pigment epithelial (RPE) tears has led to expanded recognition and understanding of this clinical entity. The authors report 18 RPE tears followed for an average of 28 months; 16 were associated with age-related macular degeneration and 2 with presumed ocular histoplasmosis syndrome. Retinal pigment epithelial dehiscences fell into four categories: nine spontaneous tears associated with choroidal neovascularization, one tear associated with an RPE detachment without choroidal neovascularization, four iatrogenic tears occurring at krypton treatment of choroidal neovascularization, and four iatrogenic tears developing weeks to months after laser treatment of choroidal neovascularization. Eight patients had a final visual acuity of 20/100 or better, four were 20/200, and six were 20/400 or worse. Photocoagulation, particularly with the use of krypton red laser, may be modified on the basis of possible RPE tear formation. Heightened awareness of the possibility of inducing pigment epithelial rips should improve diagnosis and management of these cases.

Adult↗
PubMed1987

Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital.

Herpes simplex encephalitis may be underdiagnosed in Britain. We report eight patients treated at one hospital over three years. Fever, impaired consciousness or focal neurological signs were seen in all patients at presentation but herpes simplex encephalitis was rarely considered as the initial diagnosis. The electroencephalogram was the only initial investigation that was abnormal in each case and was the most useful test in establishing a clinical diagnosis. The diagnosis was confirmed by laboratory methods in each case. Following acyclovir treatment five patients were able to resume normal activities, one patient has moderate disability and two patients died. Three patients showed clinical evidence of relapse but two improved after further treatment with acyclovir. Herpes simplex encephalitis is a treatable condition and should be considered in all patients presenting with fever and neurological signs. The electroencephalogram is usually abnormal and the changes may be characteristic of the condition.

Acyclovir↗
PubMed1986

Parafoveal telangiectasis and diabetic retinopathy.

Five patients with mild nonproliferative diabetic retinopathy had visual loss associated with parafoveal telangiectasis. Minimal macular edema with characteristic parafoveal plaques of subretinal pigment epithelial hyperplasia was seen in all patients. Fluorescein angiography revealed the presence of ectatic, dilated, leaking perifoveal capillaries. The occurrence of parafoveal telangiectasis in patients with diabetic retinopathy has, to our knowledge, not been previously described. One previous clinicopathologic report described the histologic appearance of parafoveal telangiectasis in a nondiabetic patient to be similar to that seen in diabetic patients. The association of parafoveal telangiectasis and diabetic retinopathy raises interesting speculations into the pathogenesis of the entity of parafoveal telangiectasis. In addition, the importance of obtaining fluorescein angiography prior to therapy of diabetic macular edema is emphasized.

Aged↗