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Biomedical subjects

E G Buckley

Publications and source records attributed to E G Buckley.

At least 37 records · Page 2Linked to original sources
PubMed1997

Secondary posterior chamber intraocular lens implantation in pediatric patients.

PURPOSE: To report results of secondary posterior chamber intraocular lens (IOL) implantation in previously aphakic pediatric patients. METHODS: In 19 pediatric patients, 19 aphakic eyes (11 after infantile and eight after traumatic cataract surgery) received secondary sulcus-fixated posterior chamber IOL implants. RESULTS: Visual acuity of 20/40 or better was achieved with IOL implantation and overrefraction in three of 11 infantile (27%) and six of eight traumatic cataract patients (mean follow-ups, 18.1 months [range, 8 to 29 months] and 18.0 months [range, 6 to 28 months]), respectively. Eighteen of 19 patients (95%) demonstrated postoperative vision equal to or better than preoperative levels; 15 of 19 patients (79%) showed improved vision after IOL implantation. The mean +/- SD difference between actual and predicted postoperative refraction at 1 month was -0.97 +/- 0.96 diopter. Average refractive error at last examination was -0.40 +/- 2.43 diopters. Amblyopia therapy was performed in 14 patients. One IOL required repositioning 8 months postoperatively. Strabismus was present in 14 patients before and 13 patients after IOL implantation, requiring surgery in four patients. CONCLUSIONS: Secondary IOL implantation can be performed successfully in carefully selected pediatric patients. Visual acuity results are better in eyes with a history of traumatic cataract and are influenced by patient compliance. The short-term risks of the procedure appear no greater than those of primary IOL implantation, and complications resemble those seen in adults.

Cataract↗
PubMed1997

Medial rectus fadenoperation for esotropia only at near fixation.

PURPOSE: The patient with a large esodeviation at near and a minimal if any deviation at distance who is unable to discontinue bifocal wear or demonstrates a decrease in binocular function presents a difficult therapeutic dilemma to the strabismologist. The medial rectus fadenoperation has been proposed as a method of reducing the accommodative convergence/accommodation (AC/A) ratio and may be a reasonable approach to correct a deviation that is present only at near fixation. We examined our results with this type of operation in these difficult patients. METHODS: A review of consecutive patients who underwent a bilateral medial rectus fadenoperation (no recession) for high AC/A ratio esotropia with a significant esodeviation only at near was performed. Preoperative and postoperative motility and sensory status were evaluated. RESULTS: Sixteen patients meeting the criteria were identified. The preoperative mean distance deviation was 8.8 PD of esodeviation and the mean near deviation was 33 PD of esodeviation. The mean AC/A ratio (by the gradient method) preoperatively was 7.4 PD/D. The average age at surgery was 8 years. Six (38%) had undergone prior strabismus surgery. Average follow-up was 36 months (range 12 to 98 months). Postoperatively the mean distance deviation was 3.2 PD of esodeviation and the mean near deviation was 10.3 PD of esodeviation. The mean decrease in the near deviation was 22.8 PD. The mean postoperative AC/A ratio was 2.9. Ninety-five percent of the patients normalized their AC/A ratios and 70% attained 400 arc-sec of stereopsis postoperatively (vs 44% preoperatively. The majority of patients (86%) were able to maintain satisfactory near ocular alignment without bifocals. CONCLUSIONS: The fadenoperation appears to be useful in this patient population by reducing the distance-near disparity and the AC/A ratio, by decreasing the necessity for bifocal wear, and by improving binocular function at near.

Accommodation, Ocular↗
PubMed1996

New and recurrent tumors in germinal retinoblastoma: is there a treatment effect?

Patients with germinal retinoblastoma (those with bilateral disease or positive family history) have a mutation which puts them at risk for developing new tumors. It is unclear whether the frequency of new tumor development is effected by the type of treatment employed. It may be hypothesized that external beam radiation "sterilizes' the whole retina, and thus decreases the risk of new and recurrent tumors. We reviewed our experience with 66 eyes in 47 patients over the past ten years. We did not find a significant difference in the incidence of new and recurrent retinoblastoma among eyes treated with external beam radiation versus focal modalities.

Brachytherapy↗
PubMed1996

The educational needs of staff grade doctors and dentists in Scotland.

OBJECTIVE: Since its introduction in 1990, the Staff Grade has expanded to comprise almost 10% of the career grade establishment in Scotland. A study of this new grade was carried out to determine its progress and whether educational needs were being met. DESIGN: A questionnaire was sent to all doctors and dentists in the Staff Grade asking about reasons for applying; working environment; educational needs and perceptions of the grade. SUBJECTS: In Scotland 45% of Staff Grade doctors and dentists are male and 55% are female. The majority of posts are held by UK qualified women and overseas qualified men. RESULTS: Post holders are well qualified. 56% hold at least one full Membership or Fellowship qualification. The main reasons for applying for a Staff Grade post are domestic commitments and the desire for a permanent post. Staff Grade doctors are often used to strengthen 'middle grade' services and cover awkward times. The majority feel the educational content of their job is sufficient. Of those who were dissatisfied, most complained of a lack of formal education. In general the doctors and dentists feel they are viewed with respect by colleagues. Comments showed that senior staff are more positive towards the grade than juniors. 21% of Staff Grade doctors and dentists still hope to achieve Consultant status, although the greater majority do not think it likely they will reach this level. CONCLUSIONS: In the short term the introduction of the grade has been a success. The service needs which otherwise would be difficult to meet have been covered by the appointment of Staff Grade doctors and dentists. For the individual the Staff Grade has often been the answer to personal rather than professional aspirations. Some battle against colleagues' misconceptions that the grade is for 'failed Consultants'. Isolation is a problem for others. There is a desire to keep knowledge up to date, but heavy workload and problems in scheduling prevent many from attending educational activities. If the Staff Grade is to be an attractive option in the long term, there needs to be some form of career progression for the doctors and dentists within it.

Adult↗
PubMed1995

Long-term visual results of children after initially successful vitrectomy for stage V retinopathy of prematurity.

PURPOSE: To assess the effectiveness of vitrectomy for stage V retinopathy of prematurity (ROP) at the authors' institution, 33 patients with ROP who had initially successful total or partial anatomic retinal attachments (51 eyes) were evaluated for visual function and long-term anatomic stability. In addition, this study was an attempt to differentiate levels of visual function in children with very low vision and attendant developmental delays. METHODS: Visual function was assessed before retinal examination by an experienced pediatric vision specialist. The behavioral visual assessment was divided into seven segments with two to five tasks in each segment designed to establish a level of functional vision, ranging from light perception to form identification (and ambulation). The status of the retina was classified by the patient's retinal surgeon. RESULTS: The median follow-up was 61 months, and median age at the time of examination was 68 months. Of 51 eyes treated, form identification was achieved in 5, and all five patients had ambulatory vision. Of 51 eyes, 15 had no light perception, 11 had light perception, 6 could localize light, 10 could follow lights, and 4 were able to detect form. Only one eye in ten children with comparable ROP in each eye underwent surgery, and vision improved in six of ten of the surgical eyes. Redetachment was high, with 35 retinas totally or partially detached and only 13 retinas fully attached 61 months after surgery. CONCLUSION: The visual results are very low and disappointing. Initially successfully attached retinas can detach. There is some evidence that vitrectomized eyes function better than nonvitrectomized eyes. There is also evidence that visual function lower than form identification is useful to these children and that they are able to use their limited vision better than previously though.

Child↗
PubMed1995

Strabismus after retinal detachment surgery: etiology, diagnosis, and treatment.

Between 5% and 25% of patients may experience persistent diplopia after surgery for retinal detachment. The complexity of the presentation poses a distinct challenge to both the retinal and the strabismus surgeon. Careful evaluation to determine factors contributing to the strabismus and assessment of fusional capabilities are essential before treatment. A combination of the appropriate surgical approach with nonsurgical adjuncts such as prisms or botulinum toxin is often successful in relieving symptoms.

Diplopia↗
PubMed1993

Management of the posterior capsule during pediatric intraocular lens implantation.

One of the major obstacles in pediatric intraocular lens implantation has been the subsequent dense opacification of the posterior capsule. We used a modification of the standard pediatric cataract surgical procedure, which involved endocapsular cataract extraction, posterior chamber intraocular lens implantation, pars plana posterior capsulotomy, and pars plana anterior vitrectomy in 20 consecutive patients with unilateral traumatic, radiation-induced, and developmental cataracts. Visual axes were rapidly restored in all patients without further intervention for posterior capsule opacification. Visual acuity returned to 20/40 or better in all patients and 75% of all patients (15 patients) reached maximum improvement by five weeks. No complications attributed to intraoperative removal of the posterior capsule occurred.

Adolescent↗
PubMed1993

125I embedded in an orbital prosthesis for retreatment of recurrent retinoblastoma.

The application of radiation therapy in the retreatment of unilateral recurrent retinoblastoma presents a very difficult dilemma in which consideration must be given to preservation of vision in the remaining eye while tumoricidal doses of irradiation are delivered. A technique is described in which a methylmetraculate eye sphere carrying a single Iodine-125 seed was used to deliver local irradiation to the orbital tissues in a patient with multiple episodes of recurrent retinoblastoma. The tissue dose at 2 mm depth was 2630 cGy while the dose to the retina of the remaining eye and to the optic chiasm was negligible.

Brachytherapy↗
PubMed1992

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.

BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

Acute Disease↗
PubMed1991

Leptomeningeal dissemination of optic pathway gliomas in three children.

We treated three children with optic pathway gliomas who had progressive disease associated with metastatic spread to the leptomeninges. One patient had radiographic resolution of leptomeningeal disease after treatment with intravenous carmustine and oral mercaptopurine but died of progressive pulmonary fibrosis. The second patient was treated with intravenous thiotepa, and the leptomeningeal disease remained stable. The third patient was treated with intravenous vincristine sulfate, cyclophosphamide, cisplatin, and etoposide and had a significant size reduction of the leptomeningeal lesion. Although leptomeningeal dissemination is a seemingly rare event, it is important that all children with optic pathway gliomas be considered for this possibility, particularly after the onset of new, atypical neurologic symptoms.

Antineoplastic Agents↗
PubMed1991

A simple transposition procedure for complicated strabismus.

We combined a recession or resection of recti muscles with a vertical or horizontal transposition to correct a complicated paralytic ocular deviation in eight patients. The transposed muscles were reattached to the globe parallel to the spiral of Tillaux and adjacent to the paralyzed muscle. Postoperatively, seven patients demonstrated fusion in the primary position or required a slight head turn to fuse. There were no surgical complications, and no patient developed symptomatic cyclotropia, diplopia, or anterior segment ischemia.

Adolescent↗
PubMed1991

Use of botulinum toxin in strabismus after retinal detachment surgery.

Botulinum toxin was used to treat 20 patients with strabismus after retinal detachment surgery. Preinjection motility deviations ranged from 10 to 60 prism diopters (D). Postinjection deviations ranged from 0 to 20 prism D, with 75% being 10 D or less. Eighty-five percent achieved fusion that persisted, with 73% requiring only one or two injections. Only muscles in the eye that had undergone retinal reattachment surgery were injected. The average period of follow-up was 12 months. Complications were rare and all resolved spontaneously. Botulinum toxin appears to be useful as a primary treatment modality for persistent strabismus following retinal detachment surgery, possibly obviating the need for complicated strabismus surgery.

Adolescent↗