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Biomedical subjects

R P Murphy

Publications and source records attributed to R P Murphy.

At least 73 records · Page 4Linked to original sources
PubMed1986

Subfoveal choroidal neovascular membranes in age-related macular degeneration. Visual prognosis in eyes with relatively good initial visual acuity.

We determined the visual prognosis of 94 eyes in 92 patients having age-related macular degeneration, a discrete choroidal neovascular membrane directly under the center of the foveal avascular zone (subfoveal), and an initial visual acuity of 20/100 or better. Of the patients who were reexamined 24 months following their initial presentation, 77% had lost at least four lines of vision and 64% had lost at least six lines. Estimation of visual loss using a conservative assessment procedure showed four-line visual loss in 65% of the patients and six-line loss in 50%. In general, the better the visual acuity at the initial examination, the more likely the patient was to have a smaller choroidal neovascular membrane. These results suggest that it may be reasonable to consider a randomized clinical trial of laser photocoagulation for this group of patients with a relatively poor visual prognosis.

Age Factors↗
PubMed1986

Treatment of onchocerciasis. The ocular effects of ivermectin and diethylcarbamazine.

The ocular changes that occur with diethylcarbamazine treatment of onchocerciasis seriously restrict its usefulness. Ivermectin, a newly developed antifilarial drug, was compared with diethylcarbamazine for treatment of onchocerciasis in a double-masked, placebo-controlled trial. Thirty men with moderate to severe infection and ocular involvement were randomly assigned to receive ivermectin as a single oral dose (200 micrograms/kg), diethylcarbamazine (administered for eight days), or placebo. Detailed ocular examinations were performed serially over a 12-month period. Diethylcarbamazine treatment caused a marked increase in living and dead microfilariae in the cornea, punctate opacities, and limbitis during the first week of therapy. Ivermectin had no such effect. However, ivermectin therapy resulted in a long-term reduction in intraocular microfilariae comparable to that seen with diethylcarbamazine. Ivermectin appears to have few ocular complications and be a better-tolerated and more effective microfilaricidal agent than diethylcarbamazine for the treatment of onchocerciasis.

Adult↗
PubMed1986

The role of fluorescein angiography in national collaborative studies.

Over the past 20 years, fluorescein angiography has demonstrated its value in the diagnosis and management of most diseases of the retinal vessels and choroidal vessels, including diabetic retinopathy, aging macular degeneration, and venous occlusive disorders. Fluorescein angiography has become so important for diagnostic purposes and for laser management that it has become a standard technique in the authors' most carefully performed clinical research studies such as randomized clinical trials. These clinical trials demand fluorescein angiography not only for diagnosis and eligibility of patients, but also to document the adequacy of laser photocoagulation. The use of fluorescein angiography has encouraged the development of newer photographic techniques and has encouraged a commendable level of expertise among photographers. Experience with fluorescein angiography in clinical trials has led to the development of general guidelines for the use of angiography for the management of patients outside the confines of a clinical trial; we emphasize the importance of recent angiography as a general guideline for all patients with macular edema or choroidal neovascularization before consideration of laser photocoagulation.

Aspirin↗
PubMed1986

Age-related macular degeneration.

Age-related macular degeneration (AMD) is a major cause of visual loss. The atrophic form is more frequent but accounts for only 20% of severe visual loss. The neovascular form accounts for 80% of severe visual loss. The Macular Photocoagulation Study demonstrated that prompt argon laser photocoagulation can significantly reduce the risk of severe visual loss for patients with neovascular membranes outside the fovea. For patients with both atrophic and neovascular forms of AMD, low vision aids may be of great benefit.

Aged↗
PubMed1986

The natural history of serous retinal pigment epithelium detachment in patients with age-related macular degeneration.

One hundred ten patients with serous detachment of the retinal pigment epithelium (RPE) were reexamined to enhance our knowledge of the natural course of this condition. All patients were greater than 50 years of age, had age-related macular degeneration, and had neither blood, lipid, nor angiographic evidence of a definite choroidal neovascular membrane (NVM) at the time of the initial examination. All patients were followed up for at least six months except for two patients who had developed a choroidal NVM within the first six months of the initial exam. Forty-five of 140 eyes (32%) developed a choroidal NVM within an average of 19.6 months (median, 12 months). This was associated with a final visual acuity of 20/200 or worse (P less than 0.0001). Ophthalmoscopic and angiographic features present at the initial visit which were associated with the development of NVM and poor final visual acuity were: sensory retinal detachment; increased size of PED; hot spot; late filling; notching; and irregular filling. At the most recent examination, 39% of the eyes had a final visual acuity of 20/20 to 20/40, while 24% of the eyes had a final visual acuity of less than or equal to 20/200.

Aged↗
PubMed1985

Comparison of ivermectin and diethylcarbamazine in the treatment of onchocerciasis.

We compared ivermectin with diethylcarbamazine for the treatment of onchocerciasis in a double-blind, placebo-controlled trial. Thirty men with moderate to heavy infection and ocular involvement were randomly assigned to receive ivermectin in a single oral dose (200 micrograms per kilogram of body weight), diethylcarbamazine daily for eight days, or placebo. Diethylcarbamazine caused a significantly more severe systemic reaction than ivermectin (P less than 0.001), whereas the reaction to ivermectin did not differ from the reaction to placebo. Diethylcarbamazine markedly increased the number of punctate opacities in the eye (P less than 0.001), as well as the number of dead and living microfilariae in the cornea over the first week of therapy. Ivermectin had no such effect. Both ivermectin and diethylcarbamazine promptly reduced skin microfilaria counts, but only in the ivermectin group did counts remain significantly lower (P less than 0.005) than in the placebo group at the end of six months of observation. Analysis of adult worms isolated from nodules obtained two months after the start of therapy showed no effect of either drug on viability. Ivermectin appears to be a better tolerated, safer, and more effective microfilaricidal agent than diethylcarbamazine for the treatment of onchocerciasis.

Adult↗
PubMed1985

Two successive outbreaks of Clostridium perfringens at a state correctional institution.

An outbreak of acute gastrointestinal illness of short duration involving 100 inmates at a correctional institution followed a similar outbreak among the same population by eight days. Clostridium perfringens was the specific etiology in both outbreaks; the vehicle was roast beef in the first outbreak, ham in the second. Direct observation of food handling practices revealed that the meats were not cooled quickly enough following cooking; not reheated adequately prior to serving, and; held at improper temperatures prior to serving.

Animals↗
PubMed1985

Fluorescein angiographic studies of mebendazole treatment for onchocerciasis.

Mebendazole was compared to placebo treatment in a prospective double-masked study of the treatment of onchocerciasis. Twenty Ghanaian men were randomly assigned to one of two groups and received either mebendazole 2 G per day for 14 days preceded by 300 mg of levamisole in 2 doses or placebo vitamin tablets for 14 days. They were then followed for 12 months. Systemic side effects during the first 2 weeks of treatment were uncommon in each group. Similarly, ocular changes associated with a microfilaricidal action were infrequent. No fluorescein angiographic changes attributable to treatment appeared during the one-year follow up although there was progression of ocular disease in some men in each group. Skin microfilarial (mf) counts fell significantly in both groups at 1 week but returned toward pretreatment levels at 3 months and fell again by 12 months. At no time was there a difference between the placebo-treated control group and the mebendazole/levamisole group in terms of mf counts, ocular changes, clinical changes, biochemical parameters, nor was there a difference in the status of adult worms or embryogenesis assessed in nodules excised at 5 months. These results suggest that, in this study at least, mebendazole/levamisole was no more effective than placebo in treating onchocerciasis. Why mebendazole, which has been previously reported to both suppress embryogenesis and lower skin mf counts, had no effect in this study is unknown.

Adult↗
PubMed1983

Comparison of flubendazole and diethylcarbamazine in treatment of onchocerciasis.

Flubendazole, an injectable benzimidazole drug, was compared with diethylcarbamazine (DEC) in a prospective double-blind study of the treatment of onchocerciasis. Nineteen Mexican men were randomly assigned to receive either flubendazole 750 mg intramuscularly once a week for 5 doses, or DEC 100 mg twice daily for 14 days, and they were then followed up for 12 months. Major systemic side-effects during the first 3 weeks were common in the DEC group but not in the flubendazole group in which there was considerable inflammation at the injection site instead. Ocular complications (limbitis, punctate keratitis, and uveitis) were also common in the DEC group, whereas in the flubendazole group they consisted only of one new punctate opacity at day 4 in one subject. One DEC patient also had several new areas of chorioretinal changes on day 2 but these had disappeared by 2 months. Skin microfilaria counts fell rapidly in the DEC group, but returned to the pretreatment levels. In contrast, skin microfilaria counts in the flubendazole group fell slowly, but by 6 and 12 months were lower than in the DEC group (at 12 months 0.2 vs 7.3 mf/mg, p less than 0.001). In addition, by 6 months none of the flubendazole subjects had intracorneal microfilariae, and only one had microfilariae in the anterior chamber, whereas the numbers of intraocular microfilariae in the DEC group had returned to pretreatment levels. The results suggest that flubendazole is safer and more effective than DEC in the treatment of onchocerciasis.

Adolescent↗
PubMed1983

Photocoagulation for choroidal neovascularization.

Nearly 90% of severe visual loss among patients with senile macular degeneration can be ascribed to the neovascular form of the disease. The Senile Macular Degeneration Study demonstrated that argon laser photocoagulation can reduce the risk of severe visual loss by more than 60% among patients with choroidal new vessel membranes 200 microns or greater from the center of the foveal avascular zone (FAZ). The Krypton Photocoagulation Study, also supported by the National Eye Institute, is evaluating whether krypton red laser photocoagulation can reduce the risk of visual loss in SMD patients with new vessels within 200 microns of the center of the FAZ.

Blindness↗