Biomedical subjects
Publications and source records attributed to B Biedner.
Senior's syndrome includes nephronophthisis with retinitis pigmentosa. In our patient, there was a combination of bilateral retinitis pigmentosa, cataracts, nephronophthisis, osteomalacia, growth and mental retardation, arterial hypertension, and aortic insufficiency. This case was unusual because all the features of Senior's syndrome existed along with bilateral cataracts from childhood.
Restrictive myopathy in Graves' orbitopathy is a disabling disorder, difficult to treat, involving clinically the inferior and medial recti. Most patients do not return to the normal, premorbid state of muscular alignment and the goal of treatment is to reach binocular vision in the important directions of gaze--straight ahead (primary position) and downgaze (reading position). The treatment in the acute, congestive stage is optical, prisms or patching, or medical. The medical treatment principally consists of a course of oral or intravenous corticosteroid treatment, and in selected patients orbital irradiation can be of benefit. Surgery is performed on the euthyroid patient after the muscular imbalance has stabilized, usually six months from the onset of the disorder. The mainstay of therapy is a large recession of the involved muscles, if possible on an adjustable suture. Sometimes marginal myotomies are added to the muscle recession. A fadenoperation on the contralateral, minimally involved inferior rectus has been suggested as a means of increasing muscular alignment in both primary position and downgaze. Thorough evaluation of the course of the disease, and the benefit of different treatment modalities is possible only with long term follow-up.
A 70-year-old man with arteriosclerosis of the carotid arteries developed acute occlusion of the central retinal artery and blindness during intravenous pyelography. 40 minutes after the occlusive episode he underwent paracentesis of the anterior chamber and vision returned (6/18). During the next 2 weeks, while receiving aspirin and then intravenous heparin, there were recurrent episodes of arterial occlusion and blindness that were immediately treated by repeated paracenteses of the anterior chamber. Visual activity again returned to 6/18 and his condition has remained stable as of his last clinic visit, 3 months after the first episode.
Congenital insensitivity to pain is a well-defined entity in the group of sensory deficiency syndromes. To the best of our knowledge, unilateral neuroparalytic keratitis associated with congenital insensitivity to pain has not been reported. We report such a case to alert clinicians to this potentially blinding problem.
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All eyes of children above the age of 1 year referred because of glaucoma were treated with trabeculotomy as the primary procedure. The surgery was modified by the excision of a rectangle of tissue in the deep scleral bed under the scleral flap instead of the classical radial incision. This serves to exteriorise Schlemm's canal while thinning the scleral tissue, without, however, entering the anterior chamber. A total of 7 eyes in 5 children between the ages of 1 and 9 years were operated upon. In 6 of the 7 eyes intraocular pressure has remained under 20 mmHg without treatment after follow-up of between 18 months and 4 years. In the seventh eye intraocular pressure was controlled for 2 years but has since required epinephrine drops twice daily for the maintenance of pressure below 20 mmHg. In 4 of the 7 eyes flat, diffuse conjunctival filtering blebs are present, but no complications have been encountered. We consider that trabeculotomy may be recommended for children with late-onset congenital glaucoma.
A case is presented of permanent visual loss and optic atrophy following irrigation of the lower canaliculus after probing, with a 20% solution of chloramphenicol. A false passage had apparently been created allowing the solution to gain access to the orbital tissues. The ensuing orbital edema probably caused a central retinal artery occlusion. This is a previously unreported complication of a common ophthalmologic procedure.
In order to investigate the correlation between the occurrence of pterygium and dryness of the eyes, a Schirmer's No. 1 test was done on both eyes in 60 patients with unilateral pterygia. No difference was found between the mean basic secretion of tears in the diseased eyes (15.33 +/- 8.09 mm) and the fellow eyes (15.65 +/- 7.89 mm), and both were in the normal range for this test. This data suggest that dryness of the eyes cannot be regarded as the cause of pterygium.
For the pilocarpine therapeutic test that we have devised, one drop (0.1 ml) of 2% pilocarpine hydrochloride (an arbitrarily chosen concentration) is instilled in the glaucomatous eye to be treated, and the intraocular pressure is measured hourly for four hours. If the IOP does not fall below 24 mm Hg, which is our chosen pressure limit, the response is considered to be inadequate therapeutically. Our study showed that if an inadequate therapeutic response is obtained, initiation of treatment with 2% pilocarpine is not indicated, since in patients with such a response, continued treatment with 2% pilocarpine will be ineffective in controlling IOPs on subsequent clinical visits. In only those cases of patients with an adequate response to the pilocarpine therapeutic test (with a fall in pressure below 24 mm Hg) was there the likelihood of having the glaucoma controlled with continued 2% pilocarpine treatment.
A case of fibrous histiocytoma of the orbit occurred in a 1-year-old infant. The tumor was excised, and no recurrence has been evident.
Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We compared a series of patients operated on through a limbal section to a series operated on through a corneal section. The incidence of increased IOP was significantly lower in the corneal section group. This supports the theory that trabecular damage is a major factor in causing early increased IOP after cataract extraction.
Two cases with special indications for intraocular lens implants are presented. The first case was of a 60-year-old monocular patient with congenital absence of the external nose and multiple limb deformities. The second case was of a young Bedouin girl with bilateral developmental cataracts who had poor living conditions and social objections to wearing spectacles. Intraocular lenses restored good vision.
Eight weeks after intracapsular cataract extraction with implantation of a Binkhorst iris-clip lens joined with a suture to a peripheral iridectomy at the 12 o'clock position, a 52-year-old woman struck the right side of her head. The corneoscleral wound ruptured for three fourths of its length and the artificial lens was located in the subconjunctiva in the superior-nasal quadrant of the eye. The lens was removed, the iris reposited, and the anterior chamber reformed, and the wound resutured. Her vision was 6/12 (20/40) at the time of discharge.
A 47-year-old factor VIII deficient haemophiliac successfully underwent bilateral cataract extraction. The use of cryoprecipitates to achieve haemostasis permitted retrobulbar anaesthesia and a peripheral iridectomy without complication. We consider that the use of cryoprecipitated factor VIII concentrate allows safe elective ocular surgery in patients with classic haemophilia.
Three cases are presented of late flat anterior chambers which were cured by echothiophate iodide treatment. Two of the cases required repeated instillations to achieve permanent restoration of normal chamber depth. We now recommend that echothiophate treatment be considered in cases of late flat anterior chamber unresponsive to standard medical treatment.
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Because of the conflicting opinions in the ophthalmic literature concerning the efficacy of Ketamine anesthesia in strabismus surgery, we decided to report out experience in 44 children operated upon between the ages of six months and six years. Satisfactory anesthesia was achieved in all cases except two who required intubation and inhalation technique in order to complete the surgery. No serious side effects were observed during or after the surgery. Its ease of administration, freedom from side effects, and satisfactory anesthesia, make Ketamine our primary anesthetic choice for strabismus surgery in children.
The rare association of two syndromes of paradoxical innervation, bilateral Duane's retraction syndrome and congenital crocodile tears is presented. This association assumes a central localization to explain both anomalies.