Biomedical subjects
Publications and source records attributed to G M Gombos.
We describe a case of grand mal generalized tonic-clonic seizure after fluorescein angiography. The patient had a history of seizure disorders and had been controlled with proper medication before the test. We advocate the need to include diazepam and phenytoin in the list of emergency medications needed to control adverse reactions of fluorescein angiography.
We investigated by means of a controlled prospective study, the effect of low dose oral colchicine (1.2 mg/day) on proliferative vitreoretinopathy (PVR) in humans. The PVR cases studied included ones associated with proliferative diabetic retinopathy, sickle retinopathy, trauma, and by venous occlusive disease. Applying Sandler's A statistic for correlated samples, we found no statistically significant difference between the results achieved in the colchicine group and those in the control group (vitamin C, 250 mg/day orally). We conclude that safe dosages of this drug do not significantly inhibit PVR.
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The causes of blindness in 105 consecutive legally blind patients were analyzed in a large urban multidisciplinary medical center. It was found that the leading causes of blindness, in order of frequency of incidence, were glaucoma, diabetic retinopathy, senile macular degeneration, and cataract. The periodic collection of statistics on the relative frequency of the causes of blindness is strongly suggested so that possible changes and improvements in health care may be determined.
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An 11-year-old black girl with excessive tissue growth from the conjunctiva and adjacent tissue, of several years' duration, was treated with excision of the tissue and topical steroids. Histopathologic examination revealed eosinophilic and plasma cell infiltration with a few lymphocytes and polymorphonuclear cells. Proliferation of the capillary endothelium was also noted. To our best knowledge, this type of inflammatory reaction of the anterior aspects of the globe has not yet been reported.
Fifty-two cases of retinal vascular occlusions were treated with retrobulbar injection of lidocaine (Xylocaine) and acethylcholine and systemic administration of low molecular weight dextran and papaverine hydrochloride. Twenty-eight patients had arterial occlusion while 24 patients suffered from venous occlusion. Improvement in vision was observed in 13 eyes (46%) with arterial occlusion. Sixteen patients (66%) with venous occlusion showed improvement in vision. Only 9 cases (17.3%) recovered completely (3 arterial occlusion and 6 venous occlusion). Good results were achieved only if treatment was started shortly after the onset of the disease. Systemic side effects of low molecular weight dextran were observed in 6 cases, all of which were excluded from the present study. Despite the relatively good results obtained with the use of low molecular dextran combined with papaverine hydrochloride in the treatment of retinal vascular occlusions, this treatment cannot be considered a revolutionary breakthrough.
The ocular manifestations of 76 sickle cell disease patients are reported. Our findings indicate that any type of sickle cell oculopathy may appear in conjunction with any type of hemoglobinopathy and that no single ocular finding is specific to any one type of sickle cell anomaly. Sickle cell oculopathy, particularly retinopathy, is found to be a slowly progressive condition. Treatment of retinal and vitreal neovascularization with photocoagulation seems to be indicated to stop the disease process. Acute retinal vascular occlusion seems to respond favorably to the intravenous administration of low molecular weight dextran and papaverine hydrochloride. Sickle cell patients suffering from retinal detachment do not respond favorably to conventional retinal detachment surgery.
The ocular complications in 78 renal transplant patients were evaluated. Fifty-eight (74%) showed some ocular abnormality. Forty-one patients (53%) were found to have various degrees of cataracts. The duration of hemodialysis, the age of the patients, and daily dosage of prednisone did not seem to influence the development of cataracts. Correlation was found between the total dosage of prednisone and the cataract formation. Mild and moderated hypertensive fundus changes were found in 15 patients. Severe progression of diabetic retinopathy was observed in 2 diabetic patients. For the first time focal hemorrhagic necrosis of the eyelid as a result of cryptococcus septicemia was noted. Other ocular complications include one case of ocular hypertension and one case of herpetic keratitis. Although the incidence of ocular complications was high, the severity of ocular pathology seemed to be relatively mild.
A case of unilateral retinal vascular occlusion secondary to the use of oral contraceptives is presented. The vision was only slightly affected. Fundus examination revealed tortuosity of venules around the macular area and alteration of the pigment epithelium indicating low-grade retinal vein occlusion. Periodic ophthalmologic examination is suggested to women on oral contraceptives to prevent serious thromboembolic complications.
A 58-year-old woman with painful ophthalmoplegia of the left eye associated with thrombosis of the left superior ophthalmic vein and normal angiography is presented. Symptoms cleared on systemic prednisone therapy within 72 hours. The clinical picture associated with the venographic findings and response to steroids are characteristic of the Tolosa-Hunt syndrome.
A study of 402 patients was undertaken in a diabetic clinic at a county hospital. Diabetes was more common in females. Diabetic retinopathy varied directly with the duration of diabetes. Retinopathy occurred earlier with late onset diabetes as compared with diabetes occurring in younger patients. The incidence of raised intraocular pressure was 13.1%. Raised intraocular pressure did not seem to protect the eye against diabetic retinopathy. Good control of diabetes did not seem to affect the nature of established retinopathy. The incidence of retinopathy was higher if hypertension was present.
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