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Biomedical subjects

D H Steel

Publications and source records attributed to D H Steel.

15 recordsLinked to original sources
PubMed2006

Double masked randomised controlled trial to assess the effectiveness of paracetamol in reducing pain in panretinal photocoagulation.

AIM: To assess the effectiveness of pre-emptive analgesia with paracetamol in reducing pain associated with panretinal photocoagulation (PRP) in a prospective, double masked, randomised controlled trial. METHOD: 60 patients undergoing PRP for the first time were enrolled and randomised to paracetamol or placebo, taken for 2 days starting 24 hours before the laser treatment. The laser treatment was performed following a standardised protocol. Pain during and after treatment was assessed using the McGill pain questionnaire (MPQ) and visual analogue scales (VAS). RESULTS: The statistical analysis looked for differences between the two study groups immediately after the laser surgery and 24 hours later. There was no statistically significant difference in the primary outcome measure of perception of pain during and 24 hours after PRP, between the paracetamol and placebo group. However, none of the patients in the paracetamol group reported increased total pain at 24 hours, whereas six patients in the placebo group reported increased pain; this difference (21%) was significant to p = 0.01. CONCLUSIONS: Pre-emptive analgesia with paracetamol did not significantly reduce pain associated with PRP. This study has described for the first time the type of pain associated with PRP, which is perceived mainly as a discomfort. The main attributes of the pain that patients described, were sharp, flashing, tiring, intense, piercing, intermittent, and brief.

Acetaminophen↗
PubMed2000

A randomized controlled study of the use of transscleral diode laser and cryotherapy in the management of rhegmatogenous retinal detachment.

PURPOSE: Cryotherapy, the most common modality used to create a chorioretinal adhesion during retinal reattachment surgery, is associated with the dispersion of viable pigment epithelial cells and breakdown of the blood-ocular barrier, which are thought to be causative in a number of postoperative events, including macular pucker, proliferative vitreoretinopathy (PVR), and cystoid macular edema. Transscleral diode laser has been used successfully to create a chorioretinal adhesion in retinal reattachment surgery (diopexy) and experimentally has been shown to cause less pigment dispersion and blood-ocular barrier breakdown than cryotherapy. The authors carried out a prospective randomized study to compare the results and complication rates of transscleral diopexy with those of cryopexy during surgery for rhegmatogenous retinal detachment (RRD). METHODS: Data from 120 patients with recent onset RRD without significant PVR who were suitable for scleral buckling surgery and randomized to treatment using diode laser or cryotherapy were analyzed. The primary outcome measure was reattachment at 6 months with one operation. Secondary outcome measures were pain and swelling on the first postoperative day, cystoid macular edema as assessed angiographically at 6 weeks, and visual acuity, macular epiretinal membrane, and pigment migration under the fovea at 3 months. RESULTS: There was no significant difference between the primary and secondary outcome measures between the two treatment groups, with a primary success rate of 83% in the diode group and 92% in the cryotherapy group. Pain and postoperative swelling on the first postoperative day were equivalent. Cystoid macular edema was angiographically present in 12% in the diode group and 14% in the cryotherapy group. Visual acuity of at least 20/40 was achieved in 54% of patients in both groups. The rate of PVR was 5% in the diode group and 3% in the cryotherapy group. CONCLUSION: In this study of patients with uncomplicated RD without significant preoperative PVR, the experimentally shown benefits of transscleral diode laser did not result in significant improvement in the results of reattachment surgery compared with cryotherapy.

Cryotherapy↗
PubMed1999

The incidence of systemic side-effects following subconjunctival Mydricaine no. 1 injection.

PURPOSE: To investigate the cardiovascular response to the subconjunctival injection of 0.25 ml of Mydricaine No. 1 during vitrectomy surgery. METHODS: Pulse and blood pressure were recorded at 5 min intervals before and following the subconjunctival injection of Mydricaine No. 1 in a group of 49 sequential patients undergoing vitrectomy surgery under general anaesthetic during a 6 month period. These responses were compared with a sequential and similar group of 35 patients during the following 6 months. RESULTS: Ten patients in the group administered Mydricaine, but no patients in the control group, developed a sinus tachycardia of > 100 beats/min for more than 10 min which was attributable to the mydriatic regime used. The occurrence of this response was not predictable based on the patients' age, weight or the presence of conjunctival erythema. The magnitude and temporal course of the tachycardia observed were variable. Blood pressure recordings showed no clinically significant changes during the tachycardias. CONCLUSION: Twenty per cent of patients administered 0.25 ml of Mydricaine No. 1 subconjunctivally develop a significant sinus tachycardia following injection. This response is unpredictable and all patients given Mydricaine should be monitored carefully after injection.

Adolescent↗
PubMed1998

Measurement of the retinal nerve fibre layer with scanning laser polarimetry in patients with previous demyelinating optic neuritis.

OBJECTIVES: Subjective visual deficits are common after demyelinating optic neuritis despite the frequent return of normal visual acuity. Visual and electrodiagnostic tests have demonstrated evidence of these persisting functional abnormalities, which are thought to be secondary to demyelination and variable axonal loss in the optic nerve. Scanning laser polarimetry (SLP) is a new image analysis technique which uses the polarising properties of the retinal nerve fibre layer (RNFL) to produce a quantitative measure of its thickness. This study was carried out to assess the prevalence, extent, and pattern of RNFL loss after demyelinating optic neuritis using SLP. METHODS: Twenty four patients with a history of previous demyelinating optic neuritis were re-examined. Examination included measurement of logmar visual acuity, Pelli-Robson contrast sensitivity, and the presence of a relative afferent pupil defect and optic atrophy. SLP was performed and a mean RNFL profile from a series of three images from each eye was constructed. This was compared with normative data from 20 age matched normal subjects. The lower 99.9% confidence limit of the normal data was calculated and used as the cut off criterion for abnormality. RESULTS: There were a total of 31 eyes with a history of demyelinating optic neuritis and SLP disclosed an abnormality in 29 (94%) of these. Twenty three eyes recovered an acuity of 0.0 or better, 21 of which had evidence of RNFL loss on polarimetry. Scanning laser polarimetry was the only abnormality found in nine of the 31 eyes (29%). The pattern and extent of RNFL loss was very variable and there was no significant difference in these indices between patients with multiple sclerosis compared with those with isolated demyelinating optic neuritis. CONCLUSION: Scanning laser polarimetry can provide a quantitative measure of RNFL loss after demyelinating optic neuritis, demonstrating its occurrence in a high percentage of patients recovering normal visual acuity.

Adult↗
PubMed1997

Botulinum toxin for the temporary treatment of involutional lower lid entropion: a clinical and morphological study.

PURPOSE: A prospective study was designed to evaluate the use of botulinum toxin as a temporary treatment in patients awaiting surgical repair for involutional entropion and to compare its use with lid taping. METHODS: Botulinum toxin was administered to 30 patients with involutional entropion (35 eyelids). These patients had all previously been using lid taping and lubricant ointment as a temporary measure whilst awaiting lid surgery. Patients' symptoms and signs were assessed before and after toxin injection. The date of entropion recurrence was recorded. Eyelid tissue from 8 patients treated with toxin and 3 control patients who had not been given toxin was obtained after surgical entropion repair and examined histologically to ensure the botulinum toxin had no potential detrimental effects on the results of surgery. RESULTS: The toxin was simple and quick to administer. Anatomical success was achieved in 33 of the 35 eyelids with significant improvements in symptoms and signs. The mean duration of action of the toxin was 12.5 weeks. Lower lid laxity was inversely correlated with duration of toxin action. There were no consistent changes in orbicularis oculi morphology after toxin injection. CONCLUSION: Botulinum toxin is a highly effective temporary treatment for involutional entropion with few complications and no adverse effects on the results of surgical entropion repair.

Bandages↗
PubMed1997

Silicone assisted, argon laser confinement of recurrent proliferative vitreoretinopathy related retinal detachment: a technique to allow silicone oil removal in problem eyes.

AIMS/BACKGROUND: Recurrent peripheral retinal detachments may occur in eyes treated with vitrectomy and silicone oil for retinal detachments complicated by proliferative vitreoretinopathy (PVR). The aim of this study was to assess whether laser photocoagulation could be used in the presence of silicone oil to confine and stabilise recurrent PVR related peripheral retinal detachments enabling the timely removal of the oil. METHODS: 10 patients with recurrent peripheral retinal detachments after vitrectomy and silicone oil insertion were treated with posturing and subsequent focal argon laser to circumscribe the area of recurrent detachment. RESULTS: This technique alone was sufficient to limit the area of retinal detachment in seven of the cases. The remaining three cases required relieving retinotomies because of increasing retinal detachment despite the laser. In all 10 cases the silicone oil was later removed without progression of the detached areas. CONCLUSION: Silicone assisted argon laser 'confinement' can be effective in stabilising eyes with peripheral retinal detachments allowing the subsequent removal of silicone oil.

Adult↗
PubMed1996

Unilateral congenital ptosis with ipsilateral superior rectus muscle overaction.

PURPOSE: Congenital ptosis may be accompanied by weakness of the ipsilateral superior rectus muscle. We report the finding of a hypertropia of the ipsilateral eye in patients with isolated unilateral congenital ptosis that became manifest only in upgaze. METHODS: Seventy consecutive patients with congenital ptosis were recalled and 58 reexamined. Examination included assessment of visual acuities, palpebral apertures, levator muscle function, and an orthoptic examination. Particular attention was paid to the assessment of upgaze. RESULTS: Thirty-eight patients had an isolated unilateral congenital ptosis. Four patients had bilateral ptosis, six had upgaze deficits, and ten others had a variety of other syndromes associated with ptosis. Seventeen of the 38 patients with isolated unilateral congenital ptosis were found to have an ipsilateral hypertropia on upgaze. The size of the vertical deviation varied from 5 to 30 prism diopters and, in the more severe cases, produced a cosmetic problem that became more noticeable after successful ptosis surgery. In one of these patients, a superior rectus muscle posterior fixation suture was effective in reducing the hypertropia. CONCLUSION: Of a number of possible causes for the ipsilateral hypertropia in upgaze in patients with unilateral congenital ptosis that we observed either a misdirection syndrome within the superior division of the oculomotor nerve or an exaggerated Bell's reflex is the most likely.

Adolescent↗
PubMed1995

Uniocular fields of fixation in thyroid eye disease.

Immunosuppressive therapy is well established in the treatment of thyroid eye disease (TED). The best response has been observed in those with active (wet phase) disease of short duration. A prospective study was designed to observe the effects of orbital radiotherapy and oral immunosuppression on patients with TED, and to assess whether any pre-treatment parameters were predictive of the outcome. Significant improvements in uniocular fields of fixation (UFOF) and in the Mourits' disease activity scale were seen after treatment. The degree of improvement in UFOF was positively correlated with the level of initial disease activity. The use and technique of UFOF in assessing disease phase and activity are discussed.

Adult↗
PubMed1994

Acute bilateral optic disc neovascularization.

PURPOSE: A case of bilateral acute neovascularization of the optic disc and peripapillary epiretina of unknown etiology in a previously healthy 26-year-old woman is discussed. METHODS: The clinical course of the disease, investigation, and treatment are presented in detail. RESULTS: Histopathologic examination of epiretinal tissue removed from the second eye at vitrectomy provided evidence of inflammatory disease and suggested a possible etiology. CONCLUSION: The cause of this patient's disease remains uncertain. Known causes of this disease were excluded as far as possible. Histopathologic examination of the epiretinal membrane from the second eye demonstrated an unusually increased inflammatory response and multiple intracytoplasmic inclusion bodies in neutrophils resembling mollicute-like organisms.

Acute Disease↗
PubMed1979

Relationship between anxiety and performance in scuba diving.

The present research examined the relationship between the anxiety levels of 62 beginning Scuba diving students and standardized performance tests from the Y.M.C.A. training program. Results suggested that there was no relationship between anxiety and performance on relatively simple tasks, while there was a relationship between anxiety and performance on the more complex diving maneuvers.

Achievement↗
PubMed1978

Anxiety levels of beginning Scuba students.

Anxiety levels of 29 beginning Scuba students in college classes were determined at rest and prior to standardized Scuba tests. Resting trait and state anxiety levels were significantly lower than norms. Only moderate increases in state anxiety were noticed throughout the testing sequence.

Anxiety↗