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Biomedical subjects

D A Hiles

Publications and source records attributed to D A Hiles.

At least 19 recordsLinked to original sources
PubMed1992

Risk factors for complications following pediatric epikeratoplasty.

We studied the prevalence and types of complications that occurred in children treated with epikeratoplasty to identify risk factors. A review of the clinical records of 88 consecutive patients (106 eyes; 114 procedures) revealed that no complications occurred in 58 grafts (54%). Refractive complications (refractive error greater than 3.00 diopters spherical equivalent from emmetropia or astigmatism greater than 3.00 diopters) occurred in 30 eyes (28%). Medical complications occurred in 22 eyes (19%); these included epithelial defects (14 grafts), interface opacities (six grafts), graft vascularization (eight grafts), graft infection (two grafts), graft necrosis (five grafts), graft haziness (four grafts) or opacification (11 grafts), and graft dehiscence (three grafts). Eleven grafts (10%) were removed and five eyes received new grafts. Epikeratoplasty in children will be more successful if risk factors such as patient age less than one year, microcornea, corneal endothelial cell dysfunction, mental retardation, and combining the procedure with cataract surgery are avoided.

Adolescent↗
PubMed1991

Visual results after early surgical treatment of unilateral congenital cataracts.

The authors reviewed the records of 25 consecutive patients who had been operated on for unilateral congenital cataracts at 1 year of age or younger and who had been followed for a period of 5 years or longer. Excluded were patients who demonstrated retinal and optic nerve anomalies. Five eyes achieved 20/40 or better Snellen visual acuity, 5 eyes achieved 20/50 to 20/100 visual acuity, and 15 eyes had 20/200 or less visual acuity. All patients with visual acuity of 20/40 or better had cataract surgery performed before 17 weeks of age, the critical period, and surgery was scattered within this time frame. For surgery performed between 17 weeks and 1 year of age, the best achieved visual acuity in children with surgically significant unilateral congenital cataracts was between 20/50 and 20/100. There was no correlation between the age at the time of surgery and the attainment of these visual levels in this patient subset.

Age Factors↗
PubMed1979

Complications of implant surgery in children.

Rapid recognition and appropriate therapy will prevent or remediate most of the complications occurring in children after cataract aspiration and IOL implantation. Some of the complications of pediatric IOL implantations are related to the increased scleral pliability and decreased rigidity which predispose scleral collapse, vitreous loss, flat anterior chamber and corneal endothelial damage. A second group of complications is associated with the enhanced inflammatory and fibrotic responses peculiar to a child's eye. This group includes operative striate keratitis and iridocyclitis, late IOL precipitates, secondary and postpseudophakos membranes, iris erosion and synechiae formation, and IOL tilt and displacement. Although the intraocular lens is a possible means of visual rehabilitation for children with traumatic cataracts or unilateral infantile cataracts, its long-term risk/benefit ratio must still stand the test of time.

Adolescent↗
PubMed1979

Central corneal endothelial cell counts in children.

Our data indicate that corneal endothelial cell density in a normal eye remains essentially unchanged from ages five to 20. Changes in cell density and morphology during the first five years of life need further investigation. In this study, the mean endothelial cell count of a normal population of children was 2696 cells/mm2. Children undergoing cataract aspiration had a mean cell loss from the normal of 7.2%. The cell loss rates for push-pull aspiration-irrigation or phacoemulsification cataract extraction were not statistically different. The implantation of an intraocular lens was associated with a 33.3% endothelial cell loss when compared to the control or normal population of eyes. A mean loss of 38.0% was noted when the IOL eyes were compared to their normal fellow eyes.

Adolescent↗
PubMed1979

Peripheral iris erosions associated with pediatric intraocular lens implants.

Eight children in whom 2-loop iridocapsular lenses or 2-loop iris suture lenses were implanted have exhibited peripheral iris erosion adjacent to the IOL haptic, through the iris stroma, and eventually through the iris pigment epithelium. The process appears to be very gradual and these patients have exhibited no signs of iris irritation of hyphema. No treatment has been instituted.

Adolescent↗
PubMed1979

Occlusion therapy for exodeviations occurring in infants and young children.

The authors treated 38 patients with exodeviations by occlusion of the preferred eye for three to six hours daily for an average of 15 months. This treatment resulted in a significant improvement in the latency of the deviation as well as a decrease in the size of the strabismic angle. The majority of those patients responding to this method of therapy initially had good central and maintained fixation in each eye, an exodeviation of 20 prism diopters or less at both 6 and 1/3 m, and the presence of fusional vergence amplitudes.

Bandages↗
PubMed1978

Distichiasis complicating allergic rhinoconjunctivitis.

Three patients had four lid distichiasis and signs and symptoms of allergic rhinoconjunctivitis. The findings consisted of ocular irritation with tearing, photophobia, periodic lid swelling, rhinorrhea, and boggy nasal mucosa. Treatment of the allergic rhinoconjunctivitis was unsuccessful until the distichiasis was relieved. Exacerbations of signs and symptoms recurred when lashes regrew. A neural reflex relationship exists to explain most of the symptom complex resulting from ocular irritation. In the evaluation of patients with rhinoconjunctivitis, trichiasis should be looked for, especially if there is noticeable photophobia present.

Child↗
PubMed1977

The need for intraocular lens implantation in children.

The intraocular lens offers an additional experimental parameter to be considered for the visual rehabilitation of children with traumatic or unilateral infantile cataracts. The disadvantages of aphakic spectacles or contact lens and amblyopia have committed many of these eyes to the status of visual cripples. In this series of 41 patients, with a maximum of 24 months follow-up, it has been concluded that the IOL may be successfully implanted.

Adolescent↗
PubMed1977

Intraocular lens implantation in children.

The intraocular lens offers an additional parameter to be considered for the visual rehabilitation of children with traumatic or infantile cataracts. The disadvantages of aphakic spectacles or contact lens have committed many of these eyes to the status of visual cripples. Bearing in mind all of the complications and the lack of long-term follow-up, the IOL warrants careful consideration for use in this group of cataract patients. In this series of 27 patients with a maximum of 18 months' follow-up, it is concluded that the IOL may be successfully implanted and that, thus far, no eye has been made worse than the patients preinsertion status.

Adolescent↗
PubMed1977

Surgery of traumatic cataracts.

Ninety eyes undergoing surgery for the removal of traumatic cataracts were evaluated. In the total group, the visual results fell generally into the 2 categories of satisfactory or poor. Most commonly, the latter patients sustained extensive preoperative trauma or were visually immature at the time of the injury. Forty-eight eyes, or 54% of this series, achieved an acuity of 20/80 or better, with 38, or 42%, achieving a corrected acuity of 20/20 to 20/30. There were 20 eyes in the patients 6 years of age and under, and a visual result of 20/60 or better was obtained in 7 of those eyes.

Adolescent↗
PubMed1977

Vitreous loss following infantile cataract surgery.

An improved understanding of the role of the vitreous in ocular pathology has led to a more rational approach to the prevention and management of vitreous loss during infantile cataract extractions. Infantile cataract surgery, properly performed by modifications of the Scheie aspiration and Kelman phacoemulsification techniques, should be associated with an incidence of vitreous loss no greater than that for adult extractions by current intracapsular or extracapsular techniques. Preexisting ocular lesions, faulty technique, and an inexperienced operator all contribute to the occurrence of vitreous loss. Improved techniques, surgical expertise, and an understanding of the factors that predispose to vitreous loss can reduce its incidence. Proper management of vitreous loss will decrease or eliminate its untoward sequelae; eyes so managed can be visually rehabilitated with the same ease or difficulty as similar eyes in which vitreous was not lost. The authors do not, however, advocate either the accidental or intentional disturbance of the intact vitreous body.

Adolescent↗