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Biomedical subjects

T C Burton

Publications and source records attributed to T C Burton.

At least 19 recordsLinked to original sources
PubMed1992

Progression of nonproliferative diabetic retinopathy and visual outcome after extracapsular cataract extraction and intraocular lens implantation.

Twenty-one patients with symmetric nonproliferative retinopathy who underwent extracapsular cataract extraction and intraocular lens implantation were followed up postoperatively for an average (+/- standard deviation) of 18 +/- 7 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity, and factors predictive of progression of retinopathy and final visual acuity. Progression of retinopathy, defined as the development of clinically significant macular edema, an increase in intraretinal hemorrhages or hard exudate, or the development of proliferative diabetic retinopathy, was assessed in both eyes of 19 patients; in two remaining patients, dense preoperative cataract in the fellow eye precluded comparison of retinopathy progression in the operated-on eye to progression in the fellow eye. Overall, retinopathy progressed in 14 of 19 operated-on eyes (74%). Cataract extraction was highly associated with asymmetric progression of nonproliferative retinopathy; it progressed only in the operated-on eye in seven of 19 patients (37%), but in no patients did progression occur in the fellow eye alone (P = .0078). Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men (P = .005). Visual acuity improved in 19 of 21 operated-on eyes (86%); however, only 11 eyes (52%) achieved a visual acuity of 20/50 or better and only six eyes (14%) achieved a visual acuity of 20/25 or better. In only five eyes was the final visual acuity in the operated-on eye more than two lines better than the final visual acuity in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Aspirin effects on the development of cataracts in patients with diabetes mellitus. Early treatment diabetic retinopathy study report 16.

The Early Treatment Diabetic Retinopathy Study, a randomized clinical trial supported by the National Eye Institute, was designed to assess the effect of photocoagulation and aspirin in 3711 patients with mild to severe nonproliferative or early proliferative diabetic retinopathy. Although the primary goal of the study was to evaluate the effect of photocoagulation and aspirin on diabetic retinopathy, the study also provided an opportunity to evaluate the effects of aspirin on the development of cataract. No evidence showed that aspirin use reduced the risk of development of cataract requiring extraction (4.1% vs 4.3% in patients assigned to aspirin or placebo treatment, respectively; Mantel-Cox P = .77; relative risk, 1.05; 99% confidence interval, 0.73 to 1.51). Aspirin use also did not reduce the risk of less extensive but visually significant lens opacities developing (29.6% vs 28.3%; Mantel-Cox P = .76; relative risk, 0.99; 99% confidence interval, 0.85 to 1.15). Early Treatment Diabetic Retinopathy Study results do not support the hypothesis that aspirin (at a dose of 650 mg/d) reduces the risk of cataract development in this diabetic population.

Adult↗
PubMed1992

Outcome and cost analysis of scheduled versus emergency scleral buckling surgery.

BACKGROUND: Retinal detachments are usually considered to be a surgical emergency. However, there are additional risks and costs for unnecessary emergency surgeries. The purpose of this study is to evaluate whether the conventional wisdom for treating all retinal detachments as emergencies needs to be re-examined. METHODS: Forty-eight patients who had an emergency scleral buckle and 89 patients who had a scheduled procedure were randomly selected from 884 consecutive patients who had a primary scleral buckling procedure during a 4 1/2-year period. The medical records of each patient were used to obtain detailed information related to prognosis. The visual acuity measurements of each patient, taken 6 months after the procedure, were obtained from the records of the ophthalmologist following the patient. Linear regression analysis was used to compare the final visual outcome for patients who had emergency surgery with patients who had scheduled surgery after taking into account patient factors related to prognosis. RESULTS: Patients selected for emergency surgery had better visual prognoses than scheduled patients but had the same risk of systemic complications and the same extent of detachment if the macula was not involved. None of the 18 patients with an attached macula experienced macular involvement while awaiting scheduled surgery. There were no differences between emergency and scheduled patients in ocular or systemic complications, rate of reattachment, rate of decreased visual acuity after surgery, visual outcome adjusted for prognosis, or, since 1985, length of hospital stay. A greater cost was incurred for the patients having emergency surgery due to difference in pay scales for support personnel. CONCLUSIONS: Because the study is not large and the patients were not randomized to treatment, the results are not definitive. However, they suggest that emergency surgery is unnecessary for many patients with a detached retina.

Appointments and Schedules↗
PubMed1979

Changing concepts of failures after retinal detachment surgery.

One thousand eighty-eight consecutive operations for retinal detachment were analyzed to determine the influence of current methods of examination and treatment on failures following surgery. The majority of failures were produced by preretinal membranes formation (33%) and massive preretinal retraction (27%). Other causes of failure included undetected retinal breaks (13%), inadequate scleral buckel (10%), new retinal breaks (8%), inadequate chorioretinal reaction (7%), and iatrogenic retinal breaks (2%). Primary operations yielded an initial cure rate of 76%. Successful reoperations raised the final cure rate to 89%. Reoperations were associated more frequently with preretinal membrane formation and chance of recognition and management of preretinal membrane formation. Except for new retinal tears and massive preretinal retraction, surgical failures can be avoided by improved utilization of current examination and operative techniques.

Humans↗
PubMed1979

Intraocular pressure in retinal detachment.

Relative hypotony in the affected eye was present in 40% of patients with uncomplicated unilateral retinal detachments. The average pressure asymmetry was only 1.3 mm Hg, but in one out of every four patients the difference was 3 mm Hg or more. In a control group, such a difference occured in only one out of every twenty patients. Relative hypotony persisted for longer than six months after scleral buckling operation, occuring even in patients that did not exhibit hypotony preoperatively.

Humans↗
PubMed1979

Direct and indirect laser photocoagulation of central serous choroidopathy.

A 3 1/2-year prospective randomized clinical trial showed a definite superiority of direct argon laser photocoagulation to the fluorescein leaking site compared to indirect treatment away from the leak in patients with central serous choroidopathy. One patient in each treatment group developed a subretinal neovascular membrane after photocoagulation to the fluorescein leak. Moderate prolongation of the neurosensory detachment did not adversely influence the final visual acuity in the indirect treatment group. Although direct laser photocoagulation reduces the duration of central serous choroidopathy, there is a risk of producing subretinal neovascularization. The principles of risk vs benefit should be explained to all patients and treatment should be advised only for compelling reasons.

Adolescent↗
PubMed1978

The incidence of macular pucker after retinal detachment surgery.

In a study of 63 cases of macular pucker among 857 patients who underwent retinal detachment repair, we isolated several statistically significant risk factors: preoperative vision of less than 6/15 (20/50); preoperative presence of rolled edges, starfolds, or equatorial ridges; re-operations; choroidal hemorrhage; and age past 30 years. We were unable to confirm the risk associated with vitreous loss, vitreous hemorrhage, and degeneration. Results suggested that macular pucker after detachment surgery is produced by a membrane similar in origin to those causing other forms of periretinal proliferation.

Adult↗
PubMed1978

A predictive model for visual recovery following retinal detachment surgery.

By multiple regression analysis we have identified 26 out of 200 observations which significantly affect the visual acuity following retinal detachment surgery. In addition, we have developed a highly significant mathematical model, which is able to predict in rather broad ranges of visual acuity to approximately 67% accuracy. There is still a large percentage of patients for whom we cannot account for the variability in final vision, a problem requiring future investigation. Potentially important factors which were not analyzed in this study include duration of macular detachment, afferent pupil defect, drainage of subretinal fluid, extent of the scleral-buckling procedure, and postoperative follow-up longer than six months. While most of the variables are fixed and cannot be alterd, such as age, senile cataract, and refractive error, improved knowledge of influential factors may allow us to manipulate some of them and provide mechanisms for improving results in recovery or maintenance of macular function after retinal detachment surgery.

Adult↗
PubMed1977

Glaucoma and retinal detachment.

In a survey of 817 patients undergoing primary operations for retinal detachment, glaucoma was present in 9.5%. Ocular hypertension (intraocular pressure [IOP] greater than 21 mm Hg) was present in an additional 6.5%. Primary open-angle glaucoma; the type of glaucoma most frequently encountered, occurred in 4% of the patients. Aphakic eyes and eyes with peripheral anterior synechiae had high prevalences of glaucoma. A high percentage of eyes with posttraumatic angle recessions had either glaucoma or elevated IOPs. Miotics used in the treatment of glaucoma could not be definitely implicated as a cause of retinal detachment. The rate of successful retinal reattachment was the same, whether or not glaucoma was present. However, a good visual result occurred less frequently in patients with glaucoma.

Eye Injuries↗
PubMed1977

False-positive results with the radioactive phosphorus test.

A chorioretinal granuloma that contained acid-fast bacilli and a choriodal nevus that consisted of benign nevus cells yielded false-positive radioactive phosphorus tests. The beta emission exceeded that of the control areas by more than 100% in each case. The granuloma had infiltrated the sclera, permitting inflammatory tissue to be in closer proximity to the counting probe than was the normal choroid. The reason for the increased metabolic activity of the nevus cells remains unexplained.

Adult↗
PubMed1977

Axial length changes after retinal detachment surgery.

A-scan echography was an accurate method for detecting changes in the depth of the anterior chamber, lens thickness, and length of the vitreous cavity after retinal detachment surgery in 30 eyes. Approximately 60% of the eyes had significant alterations in axial lengths exceeding+/-0.36 mm in aphakic eyes and +/-0.54 mm in phakic eyes. However, the operation of scleral bucklingg with large segments of hard silicone rubber implants or explants supported by an encircling band failed to result in a significant predictable shift of axial change in phakic or aphakic eyes. A-scan echography showed significant shallowing of the anterior chamber, and scleral buckling significantly increases lens thickness for at least six weeks. This induced a minor myopic refractive change that may explain some of the difference in postoperative refracitons between phakic and aphakic eyes.

Astigmatism↗
PubMed1977

The retinal manifestations of Rocky Mountain spotted fever.

The prominent ophthalmoscopic features in a 9-year-old white girl with Rocky Mountain spotted fever consisted of papilledema, cotton-wool spots, and dilated, tortuous retinal veins. Fluorescein angigography showed focal areas of capillary nonperfusion with blocked retinal and choroidal fluorescence at the cotton-wool spots. We observed perivascular staining adjacent to the infarcted areas. In addition to hyperfluorescence of the optic disks, late phase photographs demonstrated prolonged retention of intravascular fluorescein indicating obstruction to venous outflow.

Child↗
PubMed1977

Fractures of the orbital floor.

The charts of 324 patients treated for 363 orbital floor fractures between 1965 and 1973 were reviewed retrospectively. Of these, 38 (11 percent) were isolated floor fractures, 27 (8 percent) were rim and floor fractures, 168 (46 percent) were trimalar fractures and 130 (35 percent) were associated with complex facial fractures. On initial examination, 31 percent of the patients were found to have diplopia and 4 percent enophthalmos. Orbital prolapse was suspected in 31 percent of the patients. Thirty-seven percent of the patients had demonstrable ocular injury at the time of initial examination. Treatment was surgical in 336 of the fractures and non-surgical in 29. Of the surgical patients 140 had no support placed, 120 had antral support only, 51 had both antral support and orbital implant, and 20 had an orbital implant only. Postoperatively the incidence of diplopia was 8 percent in all patients, and 7 percent had enophthalmos. A smaller group followed for more than five months, were found to have diplopia in 17 percent and enophthalmos in 11 percent. Of the 29 patients treated non-surgically, none had persistent diplopia.

Diplopia↗
PubMed1976

Oribital floor fractures: a retrospective study.

A retrospective series of 365 orbital floor fractures was studied and many variables were analyzed. Some type of ocular or orbital adnexal damage was present in 32% of the patients. After a repair procedure there was a low incidence of decreased visual acuity, and there were no implant extrusions. Late enophthalmost and diplopia were found to be related to the type of orbital floor damage. The comminuted floor fractures and fractures associated with prolapse of orbital tissue into the maxillary antrum were more prone to demonstrate these late sequelae. Despite various surgical procedures there was a 19% incidence of late diplopia and an 11% incidence of late enophthalmos.

Adolescent↗
PubMed1976

"Twin peaks" papilledema: the appearance of papilledema with optic tract atrophy.

A woman with a right middle fossa meningioma causing right optic tract atrophy and papilledema had distinctive funduscopic changes. The ipsilateral eye showed temporal disc pallor and nasal edema. The contralateral disc showed edema of the upper and lower poles which was separated by a horizontal band of optic atrophy. The fluorescein angiographic changes clearly illustrate this pattern. Apart from its theoretical interest this appearance of papilledema and atrophy provides definite localizing information.

Adult↗
PubMedDate not supplied

Fluorescein angiography of the fundus: a schematic approach to interpretation.

Fluorescein angiographic patterns reveal a wide variety of anatomical, pathological and physiological information which, correctly interpreted, contributes to the differential diagnosis of fundus diseases and to the evaluation of appropriate therapeutic approaches. A schema for interpretation of the fluorescein angiogram is presented, following a logical progression from the initial determination of abnormal hypofluorescence of hyperfluorescence to the evaluation of the specific locations and features of the patterns, and their relationships to various disorders.

Choroid Neoplasms↗
PubMedDate not supplied

Posterior choroidal involvement in Letterer-Siwe disease.

A five-year-old child with Letterer-Siwe disease in remission was found to have decreased vision in on eye produced by a choroidal mass and secondary retinal detachment with cystic degeneration. Echography confirmed a vascularized disciform-like mass with possible involvement of the optic nerve. Florescein angiography showed a well vascularized, intensely staining lesion, with optic disc edema, destruction of the retinal pigment epithelium and cystoid macular edema.

Adolescent↗