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Biomedical subjects

D R Meyer

Publications and source records attributed to D R Meyer.

At least 55 records · Page 3Linked to original sources
PubMed1996

Binocular indirect ophthalmoscopy using a standard fiberoptic surgical headlight.

Binocular indirect ophthalmoscopy may be performed in the operating room with a fiberoptic surgical headlight and condensing lens, eliminating the need for the indirect ophthalmoscope headpiece. The resultant aerial inverted stereo image has enhanced stereopsis but is otherwise identical to that obtained with the headpiece. Safe power settings for individual headlights can be determined with a photometer by measuring illuminance from a standard indirect ophthalmoscope and comparing this value to the intensities obtained at each voltage setting of the headlight. Illuminance from four different headlights was measured, and settings that yielded light output equivalent to the average indirect ophthalmoscope were designated for each headpiece. The maximum indirect ophthalmoscope illuminance values were averaged and found to be 2.0 watts/m2 (W/m2) for the 20-diopter (D) lens and 1.8 W/m2 for the 30-D lens. All of the headlights could be used at transformer settings that produced light intensities at or below the average maximum indirect ophthalmoscope illuminance. A stereoscopic image was obtained with each of the headlights, with both the 20-D and 30-D lenses. We conclude that standard fiberoptic surgical headlights may be used for stereoscopic fundus examination. The average maximal light intensity of fiberoptic surgical headlights is greater than that of the average indirect ophthalmoscope. However, each fiberoptic headlight can be operated at brightnesses equal to or below that of the maximum intensity of the indirect ophthalmoscope, and therefore, retinal toxicity is unlikely for brief retinal evaluations.

Depth Perception↗
PubMed1996

Reconsidering the increase in father-only families.

Previously reported estimates of rapid growth rates among father-only families did not account for cohabitation. An explicit treatment of cohabitation removes about half of the presumed growth. Nevertheless, we find that the number of father-only families grew at more than double the rate of mother-only families during the 1980s. Decomposition analyses show that the largest factor associated with the increase is that fathers now head a greater proportion of all formerly married single-parent families with children. Although the share of single-parent families headed by fathers is larger in 1990 than in 1980 even after controlling for cohabitation, it is smaller than in 1970.

Child↗
PubMed1995

Management of canalicular injury associated with eyelid burns.

PURPOSE: To develop a protocol for treatment of injuries to the puncta and canaliculi associated with eyelid burns. METHODS: We retrospectively reviewed the records of seven patients who required treatment of punctal and canalicular stenosis caused by burns to the medial eyelids. RESULTS: Seven patients were treated within 5 days of injury: one by punctal dilation and six by surgical debridement, punctoplasty or canaliculoplasty, and silicone intubation. All remained free of epiphora. CONCLUSIONS: Early evaluation and treatment of punctal and canalicular burn injuries are beneficial. If the puncta are only slightly stenotic, close observation with serial lacrimal testing and punctal dilation is recommended. If the puncta and lateral canaliculi are severely stenotic or obliterated, surgical débridement and punctoplasty or canaliculoplasty followed by placement of a silicone stent effectively prevents permanent lacrimal stenosis and epiphora.

Adult↗
PubMed1995

Early office-based vs late hospital-based nasolacrimal duct probing. A clinical decision analysis.

BACKGROUND: Controversy exists regarding the treatment of infants with symptomatic nasolacrimal duct obstruction. One philosophy advocates "early" nasolacrimal duct probing, generally in the office. An alternate strategy advocates medical management until the infant is approximately 12 months old to allow for spontaneous resolution, with those with persistent nasolacrimal duct obstruction usually treated by "late" probing in the hospital with the use of general anesthesia. METHODS: We used clinical decision analysis to compare these two opposing treatment strategies. A decision tree was constructed with the usual designations for probability nodes and decision points, comparing early probing at 6 months of age in the office and late probing at 12 months of age in the hospital. The initial decision point thus addressed treatment of children who still had symptomatic nasolacrimal duct obstruction at 6 months of age. One repeated probing under same-strategy conditions was performed for patients in whom initial office probing failed. Values for probability nodes were derived from the ophthalmic literature, including a 70% rate of spontaneous resolution of nasolacrimal duct obstruction between the ages of 6 and 12 months. RESULTS: Both the early office probing strategy and the late hospital probing strategy yielded success rates greater than 99%. Based on prevailing fees, the late hospital strategy cost $2,310,000 more than the early office strategy per 10,000 patients, even though fewer procedures were performed. CONCLUSION: Early office probing and late hospital probing have similar high success rates, albeit at a higher cost for the late hospital probing strategy.

Ambulatory Care↗
PubMed1995

Downgaze eyelid position in patients with blepharoptosis.

PURPOSE: To prospectively examine the change in upper eyelid position on downgaze in patients with blepharoptosis. METHODS: Upper eyelid margin to corneal light reflex distance (uMRD) was measured in primary gaze and in 30 degrees to 40 degrees downgaze in 50 consecutive patients with acquired ptosis and 10 consecutive patients with congenital ptosis. RESULTS: For the acquired ptosis group, the mean change in uMRD on downgaze was -0.8 mm (range, -2.5 to 1.0 mm), with one patient (2%) showing an increase, 10 (20%) no change, and 39 (78%) a decrease in upper eyelid position. For the congenital group, the mean change in uMRD on downgaze was +2.1 mm (range, 1.0-4.0 mm), with all patients demonstrating an increase in upper eyelid position. The difference between the group means was highly significant (P < 0.001). CONCLUSIONS: Worsening of ptosis on downgaze is common with acquired ptosis and likely represents a normal physiologic process, which may exacerbate functional impairment of activities (i.e., reading) in this gaze position. The consistent increase in upper eyelid position on downgaze in patients with typical congenital ptosis is an abnormal differentiating sign.

Adult↗
PubMed1995

Orbital barotrauma.

A 24-year-old man sustained orbital and facial injury when an industrial suction device attached to his face. Hemorrhage and edema within the orbital soft tissues were clinically evidenced by proptosis and restricted ocular motility and confirmed by computed tomography. No retinal hemorrhages or exudates were noted. Orbital soft tissue injury caused by sudden extreme decrease in extravascular atmospheric pressure (i.e., orbital barotrauma) is not well described in the ophthalmic literature. The findings in our case are remarkably similar to those seen with traumatic asphyxia and the ophthalmological hydrostatic pressure syndrome, two conditions attributed to an increase in intravascular pressure. Physiologically, our case and these conditions share a similar increase in transmural pressure at the capillary level that is responsible for fluid transudate and hemorrhage in the orbital soft tissues. Intraretinal hemorrhages and exudates typical of Purtscher's retinopathy were conspicuously absent in our patient.

Adult↗
PubMed1995

Epiphora secondary to punctal apposition in the setting of Graves' orbitopathy.

The authors describe a patient who had epiphora and lacrimal outflow obstruction associated with proptosis and prolapse of orbital fat into the eyelids. The patient's puncta remained opposed throughout the blink cycle. A bilateral transcutaneous orbital fat decompression was done via upper eyelid crease and lower eyelid infraciliary incisions. Significant extraconal fat was removed. Two months after surgery, the epiphora had completely resolved, and proptosis and eyelid fullness had decreased.

Adipose Tissue↗
PubMed1995

Alloplastic materials for orbital surgery.

Alloplastic materials are used as an adjunct to many types of ophthalmic surgery. This article reviews recent advancements in the use of alloplastic materials for orbital surgery, with emphasis on anophthalmic socket and bony orbital reconstruction. Several new porous materials and resorbable implants offer exciting prospects in the management of anophthalmos and orbital fractures.

Anophthalmos↗
PubMed1995

[Fistula carcinoma in chronic soft tissue infection].

Squamous cell carcinoma without accompanying osteomyelitis is a rare complication in chronic soft tissue inflammation. We report on a patient with soft tissue squamous cell carcinoma developing only two years after a war accident.

Aged↗
PubMed1994

Silicone intubation without intranasal fixation for treatment of congenital nasolacrimal duct obstruction.

PURPOSE: We assessed the efficacy and morbidity of silicone intubation without intranasal fixation to treat congenital nasolacrimal duct obstruction. METHODS: Forty eyes of 30 consecutive patients underwent silicone intubation to treat congenital nasolacrimal duct obstruction. The ends of the silicone tubing were tied together with a single square knot and were allowed to retract into the nose without intranasal fixation. Tubing removal was performed in the office via the medial canthus in all patients. No attempt was made to reposition prematurely dislodged tubing. RESULTS: The success rate for this series was 38 (95%) of 40 eyes in 29 (97%) of 30 patients. Of seven eyes that required unplanned early tubing removal for dislocated tubing, five eyes nevertheless showed complete resolution of nasolacrimal duct obstruction. Only one patient underwent a second silicone intubation under general anesthesia. CONCLUSIONS: Silicone intubation without the use of intranasal fixation is an effective strategy for treating congenital nasolacrimal duct obstruction. It spares most patients from a second procedure under general anesthesia and achieves success rates comparable to previous studies in which more complex techniques were used.

Child↗
PubMed1994

Quantitating the change in upper eyelid position during downgaze.

PURPOSE: To derive normative data on eyelid position in primary gaze, upgaze, and downgaze in subjects of various ages. METHODS: Upper eyelid margin to corneal light reflex distance (uMRD), lower eyelid to corneal light reflex distance (IMRD), and vertical interpalpebral fissure (IPF) measurements were obtained on 50 healthy subjects. RESULTS: In downgaze, a mean decrease of 1.0 mm uMRD (P < 0.001) and 2.3 mm IPF (P < 0.001) was noted. Linear regression analysis demonstrated that older subjects tended to have a greater decrease in uMRD on downgaze (P = 0.012). CONCLUSIONS: Decrease in upper eyelid position on downgaze is a common phenomenon. Increased blepharoptosis on downgaze noted in patients with acquired blepharoptosis may largely reflect normal physiologic processes.

Adult↗
PubMed1994

The adequacy of Supplemental Security Income benefits for aged individuals and couples.

Information is provided on the adequacy of benefits using state-level data on costs and benefits and multiple indicators of adequacy. Maximum Supplemental Security Income (SSI) benefits for aged persons are generally shown to be inadequate. However, when income from other sources is included, couples' SSI benefits appear more adequate when compared to the preferred measures, while those for individuals remain inadequate. Adequacy is also compared across states, and a multivariate analysis is conducted to determine factors that may predict the presence or amount of state supplementary payments. Policy options for improving the adequacy of benefits are discussed.

Aged↗
PubMed1994

Ophthalmic manifestations of acanthosis nigricans.

A 77-year-old man had fleshy papillomatous lesions on his eyelid margins, which initially were accompanied by lesions on his lips and tongue and plaques on his scrotum, areolae, neck, axillae, and hands. He had had adenocarcinoma of the sigmoid colon and stomach. Based on the clinical findings and histopathologic evaluation of the eyelids (showing papillomatous changes with hyperkeratosis and mild acanthosis), the diagnosis of acanthosis nigricans was made. Acanthosis nigricans may be benign or malignant; in this patient it was malignant. The malignant form is usually of gastrointestinal origin, and in adults may be a marker for an occult malignancy.

Acanthosis Nigricans↗