PubMed Health⌕ Search

Biomedical subjects

Edward G Buckley

Publications and source records attributed to Edward G Buckley.

10 recordsLinked to original sources
PubMed2006

Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts?

BACKGROUND: It generally is accepted that cataract surgery during the first 6 weeks of life is associated with the best visual outcomes for children with dense unilateral congenital cataracts. The latent period for children with dense bilateral congenital cataracts has not been clearly defined. METHODS: The best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected retrospectively on a series of 43 children with dense bilateral congenital cataracts from 4 institutions. All of the children underwent a lensectomy, posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger. RESULTS: Cataract surgery was performed at a mean age of 11.5 weeks for the better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were 20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks ( 10 weeks: 5/22 = 23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes; only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or better compared with 74% of children without preoperative nystagmus (P = 0.03). CONCLUSION: Previous reports have proposed that cataract surgery during the first 5 to 8 weeks of life is associated with better visual outcomes in children with dense bilateral congenital cataracts. Our results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The absence of preoperative nystagmus is a better predictor of a good visual outcome than the age at surgery.

Age Factors↗
PubMed2005

Posttraumatic abducens to oculomotor nerve misdirection.

INTRODUCTION: Paradoxical patterns of extraocular muscle, eyelid, or pupillary movements can occur following injury between divisions of the oculomotor nerve, trigeminal and abducens nerves, and trigeminal and oculomotor nerves. We report three cases of unusual ocular motility and eyelid movements that are a result of aberrant connections between the abducens and oculomotor nerves. METHODS: Three patients with unusual eye movement abnormalities after trauma were studied. A complete ophthalmic examination plus neuroradiologic evaluation were performed. RESULTS: Each patient manifested an aberrant connection between the 6th and 3rd cranial nerves resulting in third nerve function during sixth nerve stimulation. Two patients demonstrated complete third nerve palsies except for adduction on attempted abduction. The third showed improved bilateral ptosis on abduction. CONCLUSIONS: The neuroanatomical abnormalities involve intraorbital structures in one patient and central nervous system pathways in the others. Explanations such as retrograde regeneration, ephaptic transmission, or denervation supersensitivity do not appear to explain these unusual eye movements. The most likely mechanism involves some form of peripheral neuronal misdirection. These rare sixth to third nerve misdirection cases add support to the "neuronal misdirection hypothesis" of aberrant eye movements after trauma.

Abducens Nerve↗
PubMed2005

Pediatric optic nerve sheath decompression.

PURPOSE: To review our experience with optic nerve sheath decompression for pediatric pseudotumor cerebri. DESIGN: Retrospective chart review. PARTICIPANTS: Seventeen eyes in 12 children younger than 16 years of age. All patients were either unresponsive or intolerant to medication. INTERVENTION, METHODS, OR TESTING: An optic nerve sheath fenestration was performed. MAIN OUTCOME MEASURES: Optic nerve appearance, visual acuity, color vision, and visual fields. RESULTS: The average age at surgery was 10.1 years of age. The average follow-up was 39.6 months. Headache was the most common presenting symptom. All patients showed improvement in optic nerve edema. Visual acuity improved or stayed the same in all surgical eyes (P = 0.0078). One patient required a neurosurgical lumbar peritoneal shunt, and 2 patients required acetazolamide on the last follow-up appointment. No patient had postoperative infection, loss of vision, or strabismus develop. Five of the patients in this study required sheath decompression on the other eye. CONCLUSIONS: Optic nerve sheath decompression in children is safe, and the results are similar to those obtained in adults. Close follow-up is required, because 5 of 12 patients in this study required a contralateral optic nerve sheath decompression.

Adolescent↗
PubMed2004

Neurologic impairment 10 years after optic neuritis.

BACKGROUND: Participants enrolled in the Optic Neuritis Treatment Trial have been observed for more than a decade to assess the relationship between optic neuritis and the development of clinically definite multiple sclerosis. OBJECTIVE: To assess neurologic disability 10 to 12 years after an initial episode of optic neuritis. DESIGN: Longitudinal follow-up of a clinical trial. SETTING: Fourteen Optic Neuritis Treatment Trial clinical centers performed standardized neurologic examinations, including an assessment of neurologic disability. PARTICIPANTS: One hundred twenty-seven patients who had developed clinically definite multiple sclerosis. MAIN OUTCOME MEASURES: Functional Systems Scale and Expanded Disability Status Scale. RESULTS: The disability of most patients was mild, with 65% of patients having an Expanded Disability Status Scale score lower than 3.0. The degree of disability appeared to be unrelated to whether the baseline magnetic resonance imaging scan was lesion-free or showed lesions (P =.51). Among patients with baseline lesions, the degree of disability was unrelated to the number of lesions that were present on the scan (P =.14). Two patients died owing to severe multiple sclerosis, one of whom had no lesions revealed on the baseline scan. CONCLUSION: Most patients who develop clinically definite multiple sclerosis following an initial episode of optic neuritis will have a relatively benign course for at least 10 years.

Adult↗
PubMed2004

Surgical treatment of upgaze palsy in Parinaud's syndrome.

INTRODUCTION: Upgaze paralysis due to supranuclear defects can cause significant visual symptoms. There are only a few reports on the treatment of this problem in the literature. Patients with Parinaud's syndrome may also have retraction nystagmus and convergence on attempted upgaze that further complicates the treatment. METHODS: We performed a retrospective review of 48 patients with Parinaud's syndrome. Eleven patients were not able to elevate to the primary position and underwent surgery for the upgaze defect. Surgical treatments included transpositions in 2 patients, inferior rectus recessions in 8, which was combined with a superior rectus resection in one. RESULTS: Preoperative duction measurements demonstrated an average limitation on upgaze to -19 degrees (-10 to -30) below midline with zero representing midline. Postoperative measurements showed marked improvement to +19 degrees above midline (15 to 30). Inferior rectus recessions were as effective as transpositions in restoring function. In addition, there was a marked reduction in the retraction nystagmus and upgaze convergence as well. CONCLUSIONS: Visually significant upgaze limitation can be relieved with bilateral inferior rectus recessions in Parinaud's syndrome. Retraction nystagmus and convergence movements are also markedly improved.

Adolescent↗
PubMed2004

Visual function more than 10 years after optic neuritis: experience of the optic neuritis treatment trial.

PURPOSE: To assess visual function more than 10 years after an episode of optic neuritis in patients enrolled in the Optic Neuritis Treatment Trial. DESIGN: Longitudinal follow-up of a randomized clinical trial. METHODS: Vision testing included measures of visual acuity, contrast sensitivity, and visual field. Quality of life was assessed with the National Eye Institute Visual Function Questionnaire. RESULTS: Examinations were completed on 319 patients. In most patients, visual function test results in the eyes that experienced optic neuritis at study entry ("affected eyes") were normal or only slightly abnormal after 9.9 to 13.7 years. Visual acuity in the affected eyes was >or=20/20 in 74%, 20/25 to 20/40 in 18%, <20/40 to 20/200 in 5%, and <20/200 in 3%. On average, visual function was worse in patients with multiple sclerosis (MS) than in those without MS. Recurrent optic neuritis in either eye occurred in 35% of patients. Such attacks were more frequent in patients with MS (P <.001). The National Eye Institute Visual Function Questionnaire scores were lower when visual acuity was abnormal and when MS was present. CONCLUSIONS: Most patients retained good to excellent vision more than 10 years after an attack of optic neuritis. Recurrences were more frequent in patients with MS.

Adolescent↗
PubMed2003

High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.

OBJECTIVE: To identify factors associated with a high and low risk of developing multiple sclerosis after an initial episode of optic neuritis. METHODS: Three hundred eighty-eight patients who experienced acute optic neuritis between July 1, 1988, and June 30, 1991, were followed up prospectively for the development of multiple sclerosis. Consenting patients were reassessed after 10 to 13 years. RESULTS: The 10-year risk of multiple sclerosis was 38% (95% confidence interval, 33%-43%). Patients (160) who had 1 or more typical lesions on the baseline magnetic resonance imaging (MRI) scan of the brain had a 56% risk; those with no lesions (191) had a 22% risk (P<.001, log rank test). Among the patients who had no lesions on MRI, male gender and optic disc swelling were associated with a lower risk of multiple sclerosis, as was the presence of the following atypical features for optic neuritis: no light perception vision; absence of pain; and ophthalmoscopic findings of severe optic disc edema, peripapillary hemorrhages, or retinal exudates. CONCLUSIONS: The 10-year risk of multiple sclerosis following an initial episode of acute optic neuritis is significantly higher if there is a single brain MRI lesion; higher numbers of lesions do not appreciably increase that risk. However, even when brain lesions are seen on MRI, more than 40% of the patients will not develop clinical multiple sclerosis after 10 years. In the absence of MRI lesions, certain demographic and clinical features seem to predict a very low likelihood of developing multiple sclerosis. This natural history information is a critical input for estimating a patient's 10-year multiple sclerosis risk and for weighing the benefit of initiating prophylactic treatment at the time of optic neuritis or other initial demyelinating events in the central nervous system.

Acute Disease↗
PubMed2003

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members.

BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

Aphakia, Postcataract↗
PubMedDate not supplied

Sixth nerve palsy.

The diagnosis and etiologies of sixth cranial nerve palsies are reviewed along with nonsurgical and surgical treatment approaches. Surgical options depend on the function of the paretic muscle, the field of greatest symptoms, and the likelihood of inducing diplopia in additional fields by a given procedure.

Abducens Nerve Diseases↗