PubMed Health⌕ Search

Biomedical subjects

David K Coats

Publications and source records attributed to David K Coats.

At least 37 records · Page 2Linked to original sources
PubMed2003

Impact of patching and atropine treatment on the child and family in the amblyopia treatment study.

OBJECTIVE: To assess the psychosocial impact on the child and family of patching and atropine as treatments for moderate amblyopia in children younger than 7 years. METHODS: In a randomized, controlled clinical trial, 419 children younger than 7 years with amblyopic eye visual acuity in the range of 20/40 to 20/100 were assigned to receive treatment with either patching or atropine at 47 clinical sites. After 5 weeks of treatment, a parental quality-of-life questionnaire was completed for 364 (87%) of the 419 patients. Main Outcome Measure Overall and subscale scores on the Amblyopia Treatment Index. RESULTS: High internal validity and reliability were demonstrated for the Amblyopia Treatment Index questionnaire. The overall Amblyopia Treatment Index scores and the 3 subscale scores were consistently higher (worse) in the patching group compared with the atropine-treated group (overall mean, 2.52 vs 2.02, P<.001; adverse effects of treatment: mean, 2.35 vs 2.11, P =.002; difficulty with compliance: mean, 2.46 vs 1.99, P<.001; and social stigma: mean, 3.09 vs 1.84, P<.001, respectively). CONCLUSION: Although the Amblyopia Treatment Index questionnaire results indicated that both atropine and patching treatments were well tolerated by the child and family, atropine received more favorable scores overall and on all 3 questionnaire subscales.

Adult↗
PubMed2003

Migration and apparent disappearance of silicone tube following treatment of nasolacrimal duct obstruction.

PURPOSE: To describe the unusual complication of migration and apparent disappearance of silicone tubes following intubation of the lacrimal drainage system. DESIGN: Interventional case reports. METHOD: Report of two patients with an unusual tube migration process. RESULTS: Silicone stents migrated nasally, with healing of the erosion tract in the wake of the migrating tube. One tube became completely internalized. CONCLUSIONS: Meticulous inspection of the medial canthal area in patients with suspected spontaneous extrusion of silicone stents from the lacrimal drainage system is warranted. Examination under anesthesia and nasal endoscopy may help locate tubes in cases of suspected nasal migration.

Child↗
PubMed2003

Limitation of opposing ductions following augmented horizontal rectus muscle transposition.

PURPOSE: To report the effect on ductions in opposing gaze following augmented horizontal rectus muscle transposition to treat cyclovertical muscle palsies. METHODS: Record review of 5 patients who underwent augmented horizontal rectus muscle transposition for treatment of vertical gaze misalignment secondary to cyclovertical muscle palsy. RESULTS: Ductions in the direction of the palsied muscle improved in all patients. Four patients (80%) developed significant limitation of vertical gaze in the direction opposite that of the palsied muscle. CONCLUSIONS: Augmented transposition surgery for vertical muscle palsy can produce considerable limitation of ductions in the direction opposite to that of the paralyzed muscle.

Adult↗
PubMed2003

SubTenon's infusion of steroids for treatment of orbital hemangiomas.

PURPOSE: To introduce an alternate technique for the treatment of infantile orbital hemangiomas. DESIGN: Non-comparative case series. PARTICIPANTS: Seven consecutive children with orbital hemangiomas. INTERVENTION: Posterior subTenon's steroid infusion using a blunt-tip cannula. MAIN OUTCOME MEASURES: Clinical stabilization, improvement, or resolution. RESULTS: Significant and sustained involution of the hemangiomas occurred in all cases. No local or systemic complications occurred. CONCLUSIONS: The results of subTenon's steroid infusion for the treatment of orbital hemangiomas in children are encouraging and may be associated with fewer intraoperative risks compared with direct intralesional injection.

Betamethasone↗
PubMed2003

Nasolacrimal outflow drainage anomalies in Down's syndrome.

PURPOSE: To describe structural abnormalities of the lacrimal drainage system and outcomes after treatment for lacrimal outflow obstruction in children with Down's syndrome. DESIGN: Retrospective comparative interventional case series. PARTICIPANTS: Thirty-eight eyes of 22 consecutive Down's syndrome patients who underwent surgical treatment for nasolacrimal drainage obstruction (mean age, 32 months) and 59 eyes of 44 non-Down's syndrome patients who underwent surgical treatment after 2 years of age. MAIN OUTCOME MEASURES: Resolution of symptoms after surgery and presence of anatomic abnormalities of the lacrimal drainage system other than persistent Hasner's membrane. RESULTS: Among the Down's syndrome eyes, complete or partial resolution was noted in 34 (89%) of 38 eyes; 7 (18%) eyes underwent more than 1 procedure. Twenty-eight (74%) of 38 eyes had anatomic anomalies other than persistent Hasner's membrane; anomalies proximal to the nasolacrimal sac predominated. In comparison, 50 (85%) non-Down's syndrome eyes experienced complete or partial resolution, and 19 (32%) had anatomic abnormalities other than persistent Hasner's membrane; anomalies distal to the nasolacrimal sac predominated. CONCLUSIONS: Compared with older non-Down's syndrome patients, nasolacrimal outflow obstruction in Down's syndrome patients is more often complicated by anomalies of the lacrimal drainage system proximal to the lacrimal sac. Despite this, surgery can be similarly successful. Awareness of the possible peculiarities of lacrimal outflow obstruction in Down's syndrome patients may allow better selection and use of available treatment options.

Adolescent↗
PubMed2003

Recurrent conjunctivitis as a presentation of munchausen syndrome by proxy.

PURPOSE: To report a case of Munchausen syndrome by proxy, which manifested as recurrent bilateral keratoconjunctivitis in an infant. DESIGN: Interventional case report. INTERVENTION: The patient underwent numerous diagnostic studies, including two endoscopies, skin biopsy, conjunctival pH measurement, and a skeletal survey. She underwent daily eye examinations until the corneal and conjunctival epithelial defects resolved. MAIN OUTCOME MEASURE: Resolution of cutaneous, mucosal, corneal, and conjunctival epithelial defects. RESULTS: A punch biopsy of the right postauricular area was performed, and pathology subsequently determined that the findings seemed to be the result of an exogenous injury. The conjunctival pH was 8.0, consistent with exposure to an exogenous, caustic agent. The acute ocular lesions resolved. CONCLUSIONS: Munchausen syndrome by proxy can be seen with ophthalmic manifestations and should be considered in the differential diagnosis when ocular abnormalities cannot be explained after a thorough and methodical evaluation.

Conjunctivitis↗
PubMed2003

Epithelial healing and ocular discomfort after photorefractive keratectomy in children.

OBJECTIVE: To document the rate of healing of the corneal epithelial defect created by photorefractive keratectomy (PRK) and the degree of discomfort experienced by children treated with PRK. SETTING: Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA. METHODS: Ten patients between 3 and 10 years of age were treated with PRK for severe anisometropia. All had anisometropic amblyopia refractory to conventional therapy with glasses or contact lenses and occlusion therapy. The size of the corneal epithelial defect was documented daily until the defect healed completely. Postoperative discomfort was documented daily using a pain-assessment scale until the epithelial defect healed completely. RESULTS: Two children were treated with PRK for hyperopic anisometropia; the rest were treated for myopic anisometropia. Cumulatively, the corneal epithelium had healed completely by day 3 in 6 patients (60%), by day 4 in 9 patients (90%), and by day 5 in all patients. The mean healing time was 3.5 days. Patients experienced mild discomfort on the day of surgery and on the first postoperative day. They had minimal pain on day 2. After day 2, no patient reported pain or other discomfort. CONCLUSIONS: The corneal epithelial defect created by PRK healed promptly and was associated with minimal postoperative discomfort in children treated with the protocol described.

Anisometropia↗
PubMed2003

The management of strabismus in adults--I. Clinical characteristics and treatment.

INTRODUCTION: This is the first in a series of articles intended to evaluate the management of strabismus in adults, including clinical outcomes and the quality, cost, and value of treatment from the perspectives of patients and health care providers. Here we present clinical characteristics, complexity of surgery, treatment success, and resolved complaints in a group of adult patients who underwent strabismus surgery. METHODS: This is a multicenter retrospective study analyzing the type and amount of ocular misalignment before and after surgery in adult patients with strabismus onset before (BVM, or age < 9 years) or after (AVM, or age >/= 9 years) visual maturation. Success was evaluated in terms of alignment, motility, and the presence of diplopia; subjective success was measured in terms of resolved complaints. The complexity of surgery was determined using the Intensity/Complexity Index and compared with success rates. RESULTS: Data are reported on 299 patients (90 BVM and 145 AVM) whose eyes were successfully aligned in 63% of the BVM cases and 81% of the AVM cases. Subjective complaints resolved at similar rates in the BVM and AVM subgroups. Successful alignment was not correlated with complexity of surgery, but motility and sensory success rates were correlated with complexity of surgery. CONCLUSION: Within each of the BVM and AVM subgroups, this study of adult strabismus showed similar surgical success rates compared with published data. This qualifies these patient groups as clinically typical of adults undergoing strabismus surgery. Additional studies will expand on health value analyses.

Adolescent↗
PubMed2003

Quantification of incidental needle and suture contamination during strabismus surgery.

PURPOSE: To quantify the level of bacterial contamination of needles and sutures immediately after use in strabismus surgery. METHODS: Strabismus surgery was performed on 56 eyes from 31 pediatric strabismus surgical cases. Preoperative site preparation included instillation of 5% povidone-iodine in the conjunctival fornices in all cases. A total of 124 needles and 127 sutures were cultured immediately after final scleral passage. RESULTS: Seventeen of the 31 cases (54.8%) produced at least one positive specimen. Nineteen per cent of the needles and 25.2% of the sutures were culture positive. The bulk of positive specimens (96.7% of needles, 91.3% of sutures) produced 3 or less colony forming units, corresponding to 7 or less total viable organisms per needle or sutures in accordance with the dilution scheme. Coagulase-negative staphylococci overwhelmingly predominated. CONCLUSIONS: Needles and sutures used in strabismus surgery can become contaminated during surgery despite preoperative povidone-iodine preparation. The number of viable bacterial contaminants is usually below the level known to consistently produce experimental endophthalmitis. However, a few needles and sutures carried a high contaminant load, suggesting the possibility that contaminated needles and sutures could potentially cause postoperative intraocular infection.

Adolescent↗
PubMed2002

Association of candidemia and retinopathy of prematurity in very low birthweight infants.

OBJECTIVE: To determine if the presence of candidemia in infants is associated with an increased incidence of threshold retinopathy of prematurity (ROP). DESIGN: Retrospective, case-controlled study. PARTICIPANTS AND CONTROLS: Forty-six infants admitted to the Texas Children's Hospital Neonatal Intensive Care Unit between 1989 and 1999 with a birth weight 1500 g or less, estimated gestational age (EGA) 28 weeks or less, and in whom candidemia developed were matched to a control group of 46 infants based on corresponding birth weight, EGA, and year of birth. METHODS: Records of each infant were reviewed to determine the presence and severity of ROP. MAIN OUTCOME MEASURES: Development of threshold ROP, including retinal detachment. RESULTS: Forty-three infants (93.5%) with candidemia and 39 (84.8%) without candidemia had ROP. Twenty-four infants (52.2%) with candidemia reached threshold and required surgical intervention, compared with 11 infants (23.9%) without candidemia (adjusted odds ratio [OR], 7.4; 95% confidence interval [CI], 1.7-32.1; P = 0.008). Retinal detachment developed in 10 of 24 candidemic infants (41.7%) who reached threshold ROP, compared with 2 of 11 infants (18.2%) without candidemia (OR, 4.4; 95% CI, 0.73-26.9; P = 0.1). CONCLUSIONS: Candidemia is associated with increased risk of threshold ROP. Infants with Candida sepsis should be monitored closely for the development of ROP and progression after treatment.

Candidiasis↗
PubMed2002

Use of augmented rectus muscle transposition surgery for complex strabismus.

PURPOSE: Full tendon rectus muscle transposition surgery augmented with posterior fixation sutures has been shown to be effective in the treatment of abducens palsy and Duane's syndrome. The purpose of this study is to summarize our experience with the use of this procedure and a three fourths partial tendon transposition modification of this procedure for a variety of complex vertical and horizontal paralytic eye movement disorders. DESIGN: Retrospective noncomparative interventional consecutive case series. PARTICIPANTS: Eighteen patients with paralytic strabismus. INTERVENTION: Full tendon rectus muscle transposition procedure augmented with posterior fixation sutures (13 patients) or a three fourths partial tendon transposition augmented with posterior fixation sutures (5 patients). MAIN OUTCOME MEASURES: Resolution of diplopia in the primary position and improved ocular alignment. RESULTS: Comparing preoperative to postoperative status, presence of primary position diplopia decreased from 64% to 14%, anomalous head posture decreased from 56% to 6%, and primary position alignment improved in all patients. CONCLUSIONS: Full tendon rectus muscle transposition surgery augmented with posterior fixation sutures and the vessel-sparing three fourths partial tendon transposition modification of this technique are effective for the treatment of a variety of complex vertical and horizontal paralytic ocular motility disorders.

Adolescent↗
PubMed2002

Acquired cataracts after diode laser photocoagulation for threshold retinopathy of prematurity.

PURPOSE: To report the incidence of acquired cataract after diode laser photocoagulation for threshold retinopathy of prematurity at our institution. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred fifty-three infants (293 eyes) with threshold retinopathy of prematurity. INTERVENTION: Transpupillary diode laser photocoagulation. MAIN OUTCOME MEASURE: Acquired cataract formation. RESULTS: One cataract (0.003%) in 293 eyes occurred after transpupillary diode laser photocoagulation. This cataract consisted of peripheral cortical punctate lenticular opacities that were not progressive or visually significant. CONCLUSIONS: The risk of acquired cataract after transpupillary diode laser photocoagulation for threshold retinopathy of prematurity is low. Transpupillary diode laser photocoagulation may be safer than argon laser photocoagulation for treatment of threshold retinopathy of prematurity.

Cataract↗
PubMed2002

Surgical management of the lens and retrolenticular fibrotic membranes associated with persistent fetal vasculature.

PURPOSE: To evaluate a surgical technique that allows safe, effective, near-total removal of retrolenticular fibrotic membranes in eyes with persistent fetal vasculature syndrome (PFVS). SETTING: Pediatric ophthalmologist's academic practice. METHODS: This retrospective review comprised 5 children (6 eyes) who had excision of a retrolenticular fibrovascular membrane during cataract surgery over a 6-month period. Long, spoke-like radial incisions of the membrane were made to the ciliary processes, resulting in wedge-shaped segmentation of the membrane. A vitrector was used to excise each wedge and perform an anterior vitrectomy. RESULTS: The mean age at time of surgery was 8 months (range 1 to 24 months) and the mean follow-up, 9 months (range 2 to 13 months). The membrane was successfully removed in all eyes. One eye of a patient who did not comply with the postoperative medical regimen or follow-up developed pupillary block glaucoma requiring pupilloplasty and trabeculectomy. CONCLUSION: This anterior surgical technique to remove tenacious retrolenticular membranes associated with PFVS was effective, allowing near-total removal of the offending fibrovascular membrane.

Capsulorhexis↗
PubMed2002

Up-slanting palpebral fissures and oblique astigmatism associated with A-pattern strabismus and overdepression in adduction in spina bifida.

PURPOSE: To describe the spectrum of adnexal and ophthalmologic features in spina bifida. METHODS: A retrospective review of the medical records of 73 patients was conducted. Data concerning ocular motility, palpebral fissure orientation, presence and axis of astigmatism, visual acuity, amblyopia, and stereopsis were analyzed. RESULTS: Forty-three (59%) of the 73 patients had strabismus: 28 (65%) had esotropia, 12 (28%) had exotropia, and 3 (7%) had orthotropia in primary gaze and a significant A-pattern. Of the strabismic patients, 20 (47%) had an A-pattern, of which 13 (65%) demonstrated overdepression in adduction. Twenty-seven (84%) of the 32 patients with documented palpebral fissure orientation had exaggerated up-slanting palpebral fissures. Forty-nine (77%) of 64 patients exhibited astigmatism greater than 0.75 D in at least 1 eye, with a mean power of 1.6 D. The axis of cylinder was oblique in 76% of these patients. The astigmatic axis was consistently oriented perpendicular to the eyelid fissure orientation in the group of patients with up-slanting palpebral fissures, with the mean axis of cylinder being incyclorotated (OD axis, 77; OS axis, 108). Up-slanting palpebral fissures were associated with a 15-fold increased chance that the axis of cylinder would be incyclorotated (P =.07, chi-square test). An orbital computed tomographic (CT) scan of a spina bifida patient with A-pattern esotropia, overdepression in adduction, and up-slanting palpebral fissures demonstrated significant incyclorotated extraocular muscle pulley heterotopy. CONCLUSIONS: Exaggerated up-slanting palpebral fissures are a prominent feature in spina bifida. Up-slanting palpebral fissures in spina bifida patients are associated with incyclorotated oblique astigmatism, A-pattern strabismus, and overdepression in adduction. These associations might be related to an anomaly of orbital skeletal or extraocular muscle pulley development. Further prospective study is encouraged.

Adolescent↗
PubMed2002

Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies.

PURPOSE: To report an atypical case of Spontaneous Intracranial Hypotension (SIH) with bilateral trochlear nerve palsies and an oculomotor nerve palsy. DESIGN & METHOD: Case report and literature review. RESULTS (CASE REPORT): A 42 year old man was treated for SIH. His neurological symptoms resolved following neurosurgical treatment with the exception of diplopia due to bilateral trochlear nerve palsies and a pupil-sparing oculomotor nerve palsy. The cranial nerve palsies are believed to be secondary to brainstem ischemia and compression occurring during the acute phase of events. They did not spontaneously improve, but were treated successfully with eye muscle surgery. CONCLUSION: SIH is a rare disease that has been associated with a variety of symptoms and signs including cranial neuropathies. A diagnosis of SIH should be considered in a patient presenting with headache, diplopia secondary to cranial neuropathy and typical radiologic features. This is the first reported case in which bilateral trochlear nerve paresis has been reported in association with this condition.

Adult↗
PubMed2002

Major review: the clinical spectrum of pediatric myasthenia gravis: blepharoptosis, ophthalmoplegia and strabismus. A report of 14 cases.

BACKGROUND: Myasthenia gravis is infrequently encountered in pediatric ophthalmology practice. The purpose of this study is to evaluate the clinical spectrum of this condition in children and to identify factors that may aid the clinician in its diagnosis and management. SUBJECTS AND METHODS: A retrospective chart review was performed on all pediatric patients presenting with myasthenia gravis to the Departments of Pediatric Ophthalmology and Neuro- ophthalmology at the Texas Children's Hospital from 1989-1999. Information regarding mode of presentation, myasthenic classification, ocular and systemic involvement, diagnostic investigations, therapy and outcome was collected and evaluated. RESULTS: Fourteen patients were included in the study whose ages ranged from 1-17 years at presentation. One patient had congenital myasthenia gravis and 13 had juvenile myasthenia gravis. Thirteen of 14 (93%) patients presented with ocular findings; two of whom had associated systemic disease at presentation. Six of 14 (43%) patients had systemic involvement during the course of their illness, of whom three (21%) had respiratory compromise requiring assisted ventilation. Thirteen of 14 (93%) patients received pyridostigmine as first line treatment. Ten of 14 (71%) patients had a favorable response. A favorable response was defined as improvement in the extraocular motility to within 10 prism diopters of orthotropia with resolution of the blepharoptosis. Three of 14 patients (21%) received a combination of pyridostigmine and steroids, all of whom had a favorable response. Seven of 14 patients (50%) underwent thymectomy; all had a favorable response. Two of 14 patients (14%) required both blepharoptosis and strabismus surgery. CONCLUSION: Pediatric myasthenia gravis may present initially to the ophthalmologist and should be considered in any pediatric patients with blepharoptosis and an ocular motility disturbance. Prompt diagnosis may be associated with significant reduction in morbidity. A favorable response to medical and surgery therapy was noted in most of our patients.

Adolescent↗