Neuro-ophthalmic associations and complications of diabetes mellitus.
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Biomedical subjects
Publications and source records attributed to R M Burde.
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A 24-year-old woman had bilateral optic disk edema. A granulomatous uveitis and macular edema subsequently ensued. Histologic examination of a biopsy specimen taken from an area of marked hilar adenopathy revealed noncaseating epithelioid cell tubercles. No other associated systemic findings were noted, and after a course of topical and systemic corticosteroid therapy, the ocular manifestations disappeared.
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Eleven diabetic patients were treated with unilateral topical dexamethasone for 14 to 36 months in an attempt to control their retinopathy. Cataracts developed in the treated eye of nine patients, compared with only one cataract in an untreated eye.
We cultured cytomegalovirus from lens material aspirated from the eye of a 4-year-old boy who had a severe bilateral iridocyclitis and secondary cataracts. There were neither systemic manifestations of congenital disease nor chorioretinitis.
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A midline experimental lesion separating the medial longitudinal fasciculi at and below the level of the abducens nuclei without damaging either fasciculus at the level of the nuclei has produced defects of ocular motility resembling those of clinical internuclear ophthalmoplegia. Electromyographic recordings during lateral gaze demonstrate: (1) lack of inhibition of the lateral rectus muscle in the adducting eye, (2) delayed inhibition of the medial rectus muscle in the abducting eye, and (3) occasional evidence of excitation of the medial rectus muscle of the abducting eye probably associated with pupillary constriction. The presumed physiologic mechanisms involved in conjugate gaze movements are discussed in the light of the experimental findings.
The diagnosis of dysthyoid ophthalmopathy is based on clinical observation of characteristic ophthalmic abnormalities. Proper diagnosis and initiation of treatment should not be delayed because a patient is found to be euthyroid. Although visual problems in dysthyroid ophthalmopathy are uncommon this disorder can result in permanent severe visual loss if optic neuropathy is not detected early and managed properly. Oral corticosteroid therapy and surgical decompression both seem to have a place in the treatment of dysthyroid ophthalmopathy with optic neuropathy.
Two cases of central retinal artery occlusion of prolonged duration (greater than 6 hours) were treated with retrobulbar anesthesia, anterior chamber paracentesis, and high-dose carbon dioxide and oxygen inhalation. Both cases recovered excellent vision and illustrate that visual recovery after relatively prolonged central retinal artery occlusion is possible.
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Previous studies have shown that momentary contact between a methylmethacrylate intraocular lens and the corneal endothelial cells results in extensive cell damage. This contact damage is reduced by coating the pseudophake with various solutions prior to contact with the endothelium.
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Seven patients with asymmetrical open-angle glaucoma had relative afferent pupillary defects. This defect may have occurred during any stage of glaucoma, but the presence of this sign may be indicative of the earliest onset of optic nerve damage in patients with ocular hypertension. Although the presence of an afferent pupillary defect should suggest the consideration of a neurologic lesion, glaucomatous damage may be the sole explanation for this phenomenon.
The present study tested the assertion that there exists exclusively in persons with senile cataracts a serum factor capable of precipitating with gamma crystallin extract from bovine lens. The results of this work do not support this assertion without the imposition of rigid specifications regarding test solution concentrations and observation time. Among the 84 subjects tested, 2 individuals had posterior subcapsular cataracts. The precipitates resulting from incubation with serum from these individuals were similar to those resulting from incubations with serum from senile cataract patients. The present study did not confirm the existence of exclusive serum factors capable of precipitating with gamma crystallin extract in patients with senile cataracts.
Visual acuity, color vision, pupillary reaction, induced Pulfrich phenomenon, kinetic fields, static fields, afterimage testing, and ophthalmoscopic evaluation were studied in nine patients with a history of retrobulbar neuritis. The most consistently reliable test for determining the presence of an old optic nerve defect in these patients was meridional 0 to 180 degrees static perimetry. There was a uniform decrease in brightness discrimination to either side of the foveal peak.