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Biomedical subjects

H R McDonald

Publications and source records attributed to H R McDonald.

At least 19 recordsLinked to original sources
PubMed1998

Crystalline retinopathy associated with chronic retinal detachment.

OBJECTIVE: To describe the presence of crystalline opacities located at the level of the inner retina in patients with chronic retinal detachment. METHODS: We reviewed the clinical records, fundus photographs, and fluorescein angiograms of patients with superficial retinal crystals in the presence of a chronic retinal detachment. RESULTS: Eleven eyes in 11 patients with chronic retinal detachment were found to have these peculiar crystalline opacities on the inner retinal surface. In 5 patients, the crystalline opacities were noted on initial assessment prior to surgery and persisted without change in appearance or number after surgical repair. In 6 eyes, the crystals were not appreciated until after surgical repair of the retinal detachment. The crystals appeared similar in all 11 eyes, were highly refractile, and were located in the posterior pole. Eight of the eyes had retinal detachment associated with retinal dialysis and 6 of these had a history of trauma. There was a definite history of vitreous hemorrhage in 2 eyes. The crystals did not seem to be associated with any visual deficit. CONCLUSIONS: Chronic retinal detachment can be associated with crystals on the inner retinal surface. The cause and composition of these crystals are unknown. They seem to be visually inconsequential and unchanging.

Adult↗
PubMed1998

Rash, fever, and chills after intravenous fluorescein angiography.

PURPOSE: To report a previously unreported complication associated with intravenous injection of fluorescein dye. METHOD: Case report. A 75-year-old man developed a unique complication after intravenous injection of fluorescein dye for angiography. RESULTS: Two hours after receiving an intravenous injection of fluorescein for angiography, the patient developed a fever, rash, and chills. Admission to a hospital and careful systemic evaluation determined that this reaction was a noninfectious allergic response to intravenous fluorescein dye injection. CONCLUSION: A delayed allergic response to intravenous fluorescein dye injection can occur.

Aged↗
PubMed1998

Management of complications in eyes containing two intraocular lenses.

OBJECTIVE: To describe the management of complications in eyes containing two intraocular lenses (IOLs). DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Eight patients having a dislocated posterior chamber intraocular lens (PC IOL) and a secondary anterior chamber intraocular lens (AC IOL) participated. INTERVENTION: Surgical treatment of complications, including mobile dislocated PC IOLs in five eyes and retinal detachment in three eyes, was performed. MAIN OUTCOME MEASURES: Visual acuity and anatomic status were evaluated. RESULTS: Dislocated PC IOLs were removed through a pars plana incision in five eyes and a limbal incision in three eyes. Retinal detachments were repaired in three eyes. With follow-up from 7 months to 6.5 years, visual acuities ranged from 20/25 to 20/40 in five eyes and 20/60 to 20/400 in the three eyes undergoing retinal detachment repair. CONCLUSION: Eyes in which dislocation of a PC IOL occurs during or after cataract surgery may have significant complications develop. Successful surgical repair is more complex in the presence of a secondary AC IOL.

Aged↗
PubMed1998

Surfing-related ocular injuries.

PURPOSE: This report evaluates the clinical characteristics of surfing-related ocular trauma to learn the nature of such injuries and propose possible preventive measures. METHODS: The authors reviewed 11 cases of surfing-related eye injuries caused by direct trauma from the surfboard, studying their mechanism of injury, the associated ocular complications, and the anatomic and visual outcomes of surgical repair. RESULTS: Surfing-related ocular injuries occurred exclusively in young males (mean age, 24.8 years; range, 14-37 years). The mechanism of injury most frequently responsible was impact with the sharp nose of the surfboard following a fall. Serious posterior segment complications were observed in all 11 patients, with nine patients suffering ruptured globes. Despite immediate medical attention, five patients did not recover ambulatory levels of visual acuity (>5/200). CONCLUSIONS: Surfing-related ocular trauma presenting to the retinal specialist typically leaves the patient with a permanent visual disability. Important factors contributing to these high-velocity injuries include the sharply pointed nose of the surfboard and the leash keeping the surfer in close proximity to the board following a fall. A simple modification in surfboard design such as blunting the sharp nose of the surfboard, or appropriate protective guards fitted over the surfboard nose, should lessen the severity of such injuries.

Adolescent↗
PubMed1998

Outcomes of vitreoretinal surgery in patients with X-linked retinoschisis.

BACKGROUND AND OBJECTIVE: To assess the outcomes of vitreoretinal surgery in the treatment of vision-threatening posterior segment complications of X-linked retinoschisis. PATIENTS AND METHODS: The authors performed a retrospective analysis of 16 eyes from 11 patients who underwent vitreoretinal surgery. All the patients had a documented positive family history of X-linked retinoschisis, and all patients had bilateral macular disease. RESULTS: The ages of the patients ranged from 14 months to 37 years (mean age 15.1 years; median age 11.5 years), and postoperative follow-up ranged from 3 months to 10 years (mean 2.8 years; median 1 year). The indications for surgical intervention included rhegmatogenous retinal detachment (12 eyes), vitreous hemorrhage (2 eyes), progression of the schisis cavity through the fovea (2 eyes), cataract associated with a persistent hyperplastic primary vitreous-like condition (2 eyes), and exudative maculopathy (1 eye). The primary surgical intervention included pars plana vitrectomy alone (7 eyes), pars plana vitrectomy and pars plana lensectomy (4 eyes), and a scleral buckle procedure alone (5 eyes). Surgical success (defined as reattachment of the retina, removal of media opacities, or arrest of schisis progression) was achieved in 14 of 16 eyes, after an average of 1.2 procedures per eye. The major reason for reoperations was recurrent retinal detachment due to proliferative vitreoretinopathy. Two eyes were eventually enucleated due to pain associated with neovascular glaucoma resulting from recurrent retinal detachment. Of the remaining 14 eyes, visual acuity improved in 8 eyes and remained unchanged in 6 eyes. CONCLUSION: Vitreoretinal surgery is often helpful in stabilizing or improving visual function in patients with posterior segment complications from X-linked retinoschisis.

Adolescent↗
PubMed1997

Acute multifocal retinitis.

PURPOSE: To describe the clinical presentation, ophthalmoscopic and fluorescein angiographic findings, and natural history of 14 eyes in nine otherwise healthy, young-to-middle-age adults with idiopathic, acute, multifocal retinitis. METHODS: A retrospective review of the clinical and photographic records of nine patients. RESULTS: Five of the nine patients reported a flu-like illness 1 to 2 weeks before the onset of visual symptoms. Ophthalmoscopic findings included mild vitritis (11 of 14), mild optic nerve edema (seven of 14), macular star (two of 14) or localized neurosensory retinal detachment (two of 14) caused by adjacent focus of retinitis, and small branch-artery occlusion (two of 14). Fluorescein angiography showed early blocking hypofluorescence with late staining hyperfluorescence of all areas of retinitis. In patients with optic nerve edema, the disk showed late leakage. Specific tests for collagen vascular disorders, as well as systemic syphilis and toxoplasmosis titers, were negative in all patients. Five of six patients with histories of cat exposure tested negative for systemic Bartonella henselae antibodies. One patient with a history of cat exposure refused testing. Clinical courses were self-limited, with complete return of vision without treatment in all but one eye, which developed a juxtafoveal scar and localized traction retinal detachment in an area of prior retinitis. CONCLUSIONS: Idiopathic acute multifocal retinitis should be considered in any otherwise healthy, young-to-middle-age adult with acute loss of vision in the presence of multifocal retinitis, particularly when accompanied by an antecedent flu-like illness. Patients with idiopathic acute multifocal retinitis usually have favorable clinical course.

Acute Disease↗
PubMed1997

Grid laser photocoagulation for macular edema in bilateral juxtafoveal telangiectasis.

OBJECTIVE: The purpose of the study is to report the efficacy of laser photocoagulation treatment for macular edema in bilateral juxtafoveal telangiectasis (BJT). DESIGN: The study design was a retrospective, clinical study. PARTICIPANTS: The authors observed 14 patients with BJT, studying the visual acuities and retinal changes of treated and untreated eyes. MAIN OUTCOME MEASURES: Visual acuity, presence of macular edema, and associated retinal findings were measured. RESULTS: Of 28 eyes, 10 (8 patients) received 15 laser photocoagulation treatments for macular edema. Neither treated nor untreated eyes had visual improvement of two or more lines. After treatment, five eyes (50%) had increased retinal vascular distortion develop, three (30%) had new draining retinal venules, five (50%) had intraretinal fibrovascular tissues, and four (40%) had retinal and preretinal hemorrhages develop. CONCLUSIONS: Grid laser photocoagulation therapy for macular edema in patients with BJT appears to neither improve nor stabilize long-term visual acuity. In addition, treatment is associated with retinal pigment epithelial changes, increased postoperative retinal vascular distortion, postoperative vascularized retinal scars, and postoperative retinal hemorrhages. These changes, however, do not appear to cause a further loss of vision.

Aged↗
PubMed1997

Outpatient postoperative fluid-gas exchange after early failed vitrectomy surgery for macular hole.

BACKGROUND: Vitrectomy surgery with fluid-gas exchange and prone positioning has been shown to close macular holes and improve vision. In those eyes that have failed surgery, repeat vitrectomy has been advocated. As an alternative, the authors performed an outpatient postoperative fluid-gas exchange on eyes when the macular hole failed to close after vitrectomy surgery. METHODS: The authors reviewed all cases of failed vitrectomy surgery for macular holes that underwent a postoperative fluid-gas exchange. Eyes were considered to have failed initial surgery if a rim of subretinal fluid surrounded an open full-thickness macular hole. RESULTS: Twenty-three consecutive eyes underwent outpatient fluid-gas exchange 1 week to 8 weeks after vitrectomy surgery. In 17 eyes (74%), fluid-gas exchange resulted in flattening and closure of the macular hole. In all 17 eyes, visual acuity improved 2 or more lines, with 8 (35%) of the 23 eyes achieving 20/50 or better visual acuity. CONCLUSIONS: Postoperative fluid-gas exchange may achieve successful closure of macular holes and improve vision in eyes that have failed surgery for full-thickness macular holes and should be considered as a cost-effective alternative to repeat vitrectomy.

Aged↗