Tubular rotavirus structures in human stool.
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Feces↗
Biomedical subjects
A D Steele
Publications and source records attributed to A D Steele.
Report of a repositioned posteriorly dislocated intraocular lens via pars plicata sclerotomy.
A patient had an apparently uncomplicated extracapsular cataract extraction with insertion of a posterior chamber intraocular lens (IOL). Posterior dislocation of the implant was noted postoperatively. The IOL was successfully repositioned via a pars plicata sclerotomy and the haptic was sutured to the sclera. We believe this procedure is relatively atraumatic and is preferable to removal and replacement of a partially dislocated implant.
Aged↗
The success and survival of repeat corneal grafts.
The results of 99 second grafts in individual eyes are reported. The five-year survival of these grafts was 49%. Allograft rejection was responsible for the majority of failures, but recurrence of host disease and endothelial decompensation were also important. Glaucoma was an important complication in 38% of eyes. Only 12 eyes in the series had no significant complication and 18 eyes achieved a corrected visual acuity of 6/12 or better.
Adolescent↗
Microbial keratitis after penetrating keratoplasty.
Thirty cases of microbial keratitis after penetrating keratoplasty were reviewed to examine the associated risk factors, the spectrum of pathogens and the prognosis for graft survival and visual outcome. The indications for keratoplasty in this group differed markedly from those for all corneal grafts performed with a much higher incidence of previous microbial keratitis and of herpes simplex keratitis. A positive culture was obtained in 93% of cases and in contrast to microbial keratitis overall, Gram positive organisms predominated particularly streptococcus pneumoniae and staphylococcus aureus. Risk factors identified were loose or broken sutures, graft decompensation and a poor ocular surface environment. There was a poor prognosis for graft survival with only 23% of cases retaining a clear graft. Overall 53% of cases were regrafted.
Adult↗
The success of penetrating keratoplasty for keratoconus.
We report the results, over a 20 year period up to 1989, of 201 penetrating keratoplasties in 198 eyes of 158 patients. The five year graft survival was 97%. A corrected visual acuity of 6/12 or better was attained by 91%. The mean spherical equivalent refraction on removal of sutures was -2.68 Ds and the mean cylindrical correction was -5.56 Ds. The cumulative time to dispensing final refractive correction was 38 months for 90% of patients. Rejection episodes occurred in 20% of grafts and were associated with loosening of sutures and bilateral grafts. Atopic patients (28%) were not at greater risk from rejection. Graft refractive surgery was undertaken in 18% and, of these, 55% achieved 6/12 vision or better with an refractive correction which could be dispensed and tolerated within 6 months.
Adolescent↗
Intraocular surgery following penetrating keratoplasty: the risks and advantages.
Graft survival has been evaluated for patients who underwent subsequent intraocular surgery (extra-capsular cataract surgery or trabeculectomy) between 1983 and 1989. The patients were different from the majority of keratoplasty patients as evidenced by the indications for keratoplasty; corneal perforation was the indication in 24% of cases. Perforated and inflamed eyes were treated aggressively at the time of the acute event, including emergency keratoplasty and intensive topical steroids. Visco-elastic fluids were routinely used during secondary surgery and topical steroids were administered intensively post-operatively. The incidence of post-operative graft rejection was low (less than 14%). Rejection episodes were diagnosed early, prior to the appearance of a Khodadoust line, and were treated aggressively with intensive topical steroids. Glaucoma which was not controlled by topical therapy was surgically managed by trabeculectomy in the first instance. If this failed, tube drainage was performed and long-term topical steroids were administered. The only risk factor identified was uncontrolled glaucoma, P = 0.1. The probability of graft survival (at five years) was 0.83 after cataract surgery and 0.62 after trabeculectomy, but wide confidence limits indicate the difference is not significant.
Cataract↗
Recurrent macular corneal dystrophy following penetrating keratoplasty.
The recurrence of macular corneal dystrophy within a corneal graft has been described in a number of case reports. In this study, we reviewed 41 transplants in 31 eyes of 16 patients undergoing keratoplasty for macular corneal dystrophy confirmed by histopathological examination. The follow-up time ranged between 25 and 408 months from initial diagnosis. Six eyes of four patients had repeat keratoplasty because of clinical recurrence and visual impairment. Pathological confirmation was available in five of the six eyes. Peripheral clinical recurrence was observed in two more eyes. The size of the graft used was inversely related to the recurrence.
Adult↗
Manipulative damage to the endothelium of infant and adult donor corneas.
Six human donor corneas were studied with the scanning electron microscope to quantify the hazards to the endothelium during the excision of corneoscleral buttons. Although the number studied was small, it was found that: (1) striae were more numerous in the flaccid, very young, donor corneas (under 1 year old) than in the more rigid adult corneas: (2) iridocorneal endothelial touch can result in loss of the posterior membrane and death of the touched endothelial cells. This corroborates the findings of other investigators. Both findings are important, because these conditions reduce the quality of the donor cornea for transplantation.
Adolescent↗
The changing management and improved prognosis for corneal grafting in herpes simplex keratitis.
Graft survival in a previously reported cohort of patients recruited between 1967 and 1978 (10.6 years' mean follow-up) was reviewed and compared with that for a cohort recruited between 1979 and 1987 (3.8 years' mean follow-up). This allowed analysis of improved graft survival due to changes in management, introduced after critical review of the first group in 1978. The salient changes included transition from intracapsular to extracapsular cataract surgery (P = 0.001) and treatment of rejection episodes with antiviral prophylaxis. Extracapsular cataract surgery improved graft survival (P = 0.07) benefiting inflamed eyes which more frequently required concomitant surgery (P = 0.005). Survival of rejection episodes was improved by antiviral prophylaxis (P = 0.02), and the incidence of recurrent keratitis was reduced (P = 0.0005). The complete and prompt removal of loose sutures improved graft survival (P = 0.025). Long-term survival of first grafts was 70%, and management changes improved overall survival (P = 0.036) despite an increased number of eyes (P = 0.05) grafted when inflamed.
Cataract Extraction↗
Cryptosporidiosis in white patients in South Africa.
From January to December 1987, faecal specimens received from 3186 white children and adults with diarrhoea were examined for the presence of cryptosporidial oocysts. They were found in 129 patients, an incidence of 4.1%. Most of the infections were in children less than 5 years of age, giving an incidence of 6.2% in this age group. Cryptosporidium was usually the only pathogen detected, additional pathogens being identified in only 19 cases. A marked seasonal increase in incidence was seen in 107 cases (82.9%) between January and May, that is in late summer and early autumn in South Africa.
Adolescent↗
The management of post-keratoplasty glaucoma by trabeculectomy.
The results of 35 consecutive trabeculectomies in eyes developing medically uncontrollable glaucoma following penetrating keratoplasty are presented, with a mean follow-up of 3 years from the time of drainage surgery. Five eyes remained phakic until trabeculectomy was performed. Additional medical therapy was necessary to control the intraocular pressure in 32 eyes, which therefore were considered to have failed to be controlled by trabeculectomy and 90% of these failed within 6 months of filtration surgery. Despite additional medical therapy, in 17 eyes, further drainage surgery was required and 90% of this surgery took place within the first 14 months. Adverse prognostic factors were multiple grafts and synechiae closure of the drainage angle.
Acetazolamide↗
Large corneal grafts can be successful.
Seventeen grafts of 10 mm in diameter or larger have been performed on 16 eyes of 15 patients. The major indications for surgery were infections or perforations or both. Follow-up has ranged from 8-54 months (mean 26.4). The 4 year survival probability was 0.64. Although the procedure was successful in saving all but one eye and restored useful vision in the majority, complications including cataract, glaucoma, graft rejection episodes and infections were encountered. The management of these complications is described. At final review, 13 eyes had clear grafts including those in whom regraft had been performed. These results have only been achieved by close co-operation between patients and the medical team responsible for their care.
Adolescent↗
Diagnosis of rotavirus infection.
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Child↗
Posterior corneal folds and endothelial cell damage in human donor eyes.
Posterior folds in human donor corneas stored as whole eyes in moist chambers, or isolated in McCarey-Kaufman medium at 4 degrees C, have been studied by light and scanning electron microscopy to determine whether or not endothelial cells on the folds are damaged. Extensive, often irreversible cell damage was found associated with most of the folds. Hence posterior folds in donor corneas are of importance in that they indirectly reduce the quality of the donor cornea for transplantation.
Aged↗
Routine testing for rotavirus and Cryptosporidium in children with gastro-enteritis.
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Animals↗
The relative frequency of subgroup I and II rotaviruses in black infants in South Africa.
Between March 1983 and December 1986, a total of 1571 stool specimens were collected from black South African infants and young children with acute gastroenteritis, and tested for the presence of rotavirus. Monoclonal antibodies against the major inner capsid protein were used in an enzyme linked immunosorbent assay to determine the subgroup specificity of the rotavirus isolates. Subgroup II rotaviruses occurred more frequently than subgroup I isolates (74.4% vs 12.3%), while 13.3% could not be typed and may indicate the presence of a third subgroup. Two of the subgroup I isolates had a long RNA profile (ie, faster moving gene segment 11) typical of the subgroup II human rotaviruses, and a single subgroup II strain had a short RNA profile possibly indicating an in vivo rotavirus reassortant.
Antibodies, Monoclonal↗
Longterm prognosis for corneal grafting in herpes simplex keratitis.
A previously reported cohort of patients was reviewed after mean follow-up of 10.9 years. The overall probability of survival was 45%, but first grafts had a greater probability of survival than second (P = 0.12) or further (P = 0.19) grafts. Preoperative active keratitis adversely affected survival (P = 0.123). The major cause of failure was graft rejection. Regrafts were more likely to fail from rejection episodes (P = 0.0005). Antiviral prophylaxis improved the outcome for rejection (P = 0.005) and reduced the incidence of HSK recurrence complicating rejection. Suppurative keratitis occurred in 12.4% of grafts as a complication of epitheliopathy including HSK recurrence. The outcome in these cases was particularly poor. Loose continuous graft sutures resulted in graft failure in 10.6% of grafts which may be improved by using interrupted suturing. Our results suggest the longterm prognosis for grafting in herpes simplex keratitis are not as good as may have been predicted from previous analyses.
Cornea↗
Enteropathogens isolated from children with gastro-enteritis at Ga-Rankuwa Hospital, South Africa.
A prospective 3-year study for enteric pathogens associated with diarrhoea in children was undertaken at Ga-Rankuwa Hospital, South Africa. Rotavirus was the most commonly isolated pathogen (24%), showing a marked seasonal distribution, with an autumn peak in activity. Enterotoxigenic and enteropathogenic Escherichia coli were frequently identified, and Salmonella, Shigella and Campylobacter were also isolated. Cryptosporidium and Giardia lamblia were the most frequently seen parasites. Rotavirus, E. coli, Salmonella and Campylobacter occurred predominantly in children less than 1 year old, whilst Shigella and the parasites were prevalent at all ages.
Animals↗