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Biomedical subjects

G B Bartley

Publications and source records attributed to G B Bartley.

At least 19 recordsLinked to original sources
PubMed1992

Tissue breakdown and exposure associated with orbital hydroxyapatite implants.

Tissue breakdown and exposure of a hydroxyapatite implant were observed in eight patients: in four of six patients after evisceration and in four of 31 after enucleation. The reasons for evisceration were a blind, painful eye and endophthalmitis in two patients each. The reasons for enucleation were a choroidal melanoma in two patients and endophthalmitis and irreparable traumatic damage in one patient each. The patients with endophthalmitis received the implant in a second surgical procedure after intensive antibiotic treatment. Small tissue defects healed spontaneously, whereas large defects showed little tendency to heal by secondary intention. Tissue breakdown over a hydroxyapatite implant may be related to delayed ingrowth of fibrovascular tissue, and possibly related to an inflammatory reaction incited by the hydroxyapatite. Careful case selection, facilitation of tissue penetration by drilling holes into the hydroxyapatite sphere, delayed fitting of the prosthesis, and vaulting of the posterior surface of the initial prosthesis to reduce pressure on the tissues covering the anterior pole of the implant may alleviate the problems of tissue breakdown and exposure.

Adolescent↗
PubMed1992

Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves' orbitopathy.

Graves' orbitopathy can be associated with horizontal, vertical, and torsional diplopia. Of 428 patients treated with transantral orbital decompression, 21 had incycloduction (mean, 12.8 degrees; range, 5 to 20 degrees) and five had excycloduction (mean, 12 degrees; range, 5 to 20 degrees). All 26 patients had had recessions of the medial or inferior rectus muscle (or both) before onset of torsional diplopia. Mean recession was 5.5 mm (range, 4 to 10 mm) and 5.3 mm (range, 2 to 10 mm) of medial rectus muscle and inferior rectus muscle, respectively. An A pattern was often associated with the condition. Superior oblique tenectomy and inferior oblique myectomy were performed most frequently for incycloduction and excycloduction, respectively. Superior oblique tenectomy induced a mean incycloduction decrease of 7.1 degrees (range, 0 to 12 degrees). Exotropia in downgaze was decreased, and a small ipsilateral hyperdeviation was induced. Bilateral inferior oblique myectomy in one patient decreased excycloduction 10 degrees without inducing new deviation. At follow-up (mean, 63.7 months) after last strabismus operation, 15 patients with incycloduction and two with excycloduction had no diplopia.

Adult↗
PubMed1992

Massive epithelium-lined inclusion cysts after scleral buckling.

Two patients with massive epithelium-lined inclusion cysts of the orbit became symptomatic five and 16 years after scleral buckling. Each patient described diplopia and displacement of the previously treated eye. An orbitotomy in the first patient disclosed a loculated epithelium-lined inclusion cyst that extended posteriorly from the insertion of the inferior rectus muscle nearly to the apex of the orbit. In the second patient, a loculated epithelium-lined inclusion cyst extended into the superior nasal portion of the orbit from its origin near the insertions of the superior and medial recti muscles. We speculated that epithelial cells of the conjunctiva were shed at the time of scleral buckling and became lodged in the exposed sulcus created by the surgical retraction of Tenon's capsule. Here they proliferated and formed the large epithelium-lined cysts. In each patient, removal of the cyst was followed by a decrease in diplopia as the displaced globe returned toward its normal position.

Aged↗
PubMed1992

Argon laser treatment of trichiasis.

The argon laser was used to treat trichiasis in 44 patients over a five-year period. During follow-up intervals of between one month and more than four years (mean, 13 months), ablation of misdirected cilia was accomplished with one treatment in 26 patients (59%). No complications were observed. Laser is less effective than cryotherapy for destroying aberrant eyelashes, but cryotherapy is less precise and incites greater posttreatment inflammation. Argon laser treatment is a useful option when only a few, scattered eyelashes require ablation or in patients with disorders such as ocular pemphigoid, in which the stimulation of inflammation is undesirable.

Adult↗
PubMed1992

Extensive defects of the sino-orbital region. Results with microvascular reconstruction.

We performed microvascular free-tissue reconstruction of extensive defects in the sino-orbital region in 11 patients. Reconstructions were immediate in 10 patients and delayed in one patient. There was loss of orbit in eight patients, maxilla in eight patients, cranial base in two patients, and skin and soft tissue of the face in six patients. Nine rectus abdominis flaps, one radial forearm flap, and one lateral arm flap were used. Palatal reconstruction with autologous tissue was successful in all patients. Cranial base repairs healed without sequelae or evidence of meningitis. Cosmetically, soft-tissue repair of facial skin was only satisfactory. For large defects, it was difficult to reconstruct the palate and facial soft tissue and to maintain nasal airway patency with a single microvascular procedure. Free-tissue transfers remain the safest and most versatile reconstructive procedure for massive sino-orbital defects after ablation of a tumor.

Adult↗
PubMed1992

Medical therapy for ocular allergy.

The ocular manifestations of allergy have traditionally been classified into four categories--namely, hay fever conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and contact lens-associated giant papillary conjunctivitis. Typically, hay fever conjunctivitis is characterized by mild conjunctival inflammation, whereas the other disorders may have severe inflammation and clinical manifestations. Potentially blinding corneal complications may result from vernal keratoconjunctivitis and atopic keratoconjunctivitis. Although hay fever conjunctivitis is clearly an immediate hypersensitivity reaction, the immunologic mechanisms that cause vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis are primarily unknown and speculative. Treatment of patients with ocular allergies is often challenging and may necessitate collaborative efforts of an ophthalmologist and an allergist. Herein we discuss conventional therapy and new, promising antiallergy drugs.

Anti-Inflammatory Agents↗
PubMed1992

Kayser-Fleischer rings in a patient with basal cell carcinoma: fortuitous diagnosis of presymptomatic Wilson's disease.

Kayser-Fleischer rings were detected during a routine ophthalmologic workup in a 25-year-old man with basal cell carcinoma of the eyelid. Although the importance of this association is uncertain, the routine preoperative evaluation of basal cell carcinoma led to the presymptomatic diagnosis of Wilson's disease. These disorders are discussed, as are the benefits of a multidisciplinary approach for the diagnosis and management of medical problems.

Adult↗
PubMed1992

Surgical management of nasolacrimal duct obstruction in patients with Wegener's granulomatosis.

The treatment of symptomatic nasolacrimal duct obstruction in patients with Wegener's granulomatosis is controversial. Dacryocystorhinostomy has been effective in patients with long-standing quiescent disease but has been complicated by the formation of nasal-cutaneous fistulas in others. Dacryocystectomy may be an alternative if epiphora is absent. The authors report 13 lacrimal bypass surgeries in 9 patients with Wegener's granulomatosis; there were 10 operations with adequate follow-up and 6 surgical successes. Failure was related to a history of dacryopyocele, localized disease activity in the nose and upper airway, extensive periorbital disease, the use of non-maintenance therapy to contain disease activity, and prior surgical failure. The authors' experience suggests that dacryocystorhinostomy is therapeutically viable in patients with Wegener's granulomatosis; intervention is optimal when the disease is quiescent without medication and is probably reasonable if activity is controlled with maintenance therapy. Anticytoplasmic antibody titers are useful to guide the timing of elective surgery.

Adult↗
PubMed1992

Emergency treatment of Graves' ophthalmopathy.

The ocular emergencies encountered in Graves' ophthalmopathy, namely optic neuropathy, corneal ulceration, subluxation of the globe, and severe periorbital oedema with chemosis have been discussed. Evaluation of the clinical signs and symptoms of these conditions, as well as their treatment, have been outlined. Of particular concern is the complaint of 'blurry vision' that may indicate the presence of optic neuropathy. Early recognition of this entity, with prompt referral to an ophthalmologist is important because there is an inverse relationship between duration of visual loss and efficacy of treatment. The ophthalmological evaluation of a patient with optic neuropathy may demonstrate decreased visual acuity, impaired colour perception, or an afferent pupillary defect. In addition, a visual field examination may be a helpful adjunctive test. Available therapy for optic neuropathy includes high-dose corticosteroids, supervoltage X-irradiation and orbital decompressive surgery. We have reviewed the literature concerning these modalities and outlined our approach to the treatment of optic neuropathy. In general, we recommend orbital decompression at an early stage for this condition. Another worrisome complaint is of 'eye pain'. In this case, distinction must be made between the causes that include ocular inflammation, corneal keratitis and corneal ulceration. The corneal ulceration is characterized by extreme eye pain and erythema, and may require surgical intervention. Severe ocular inflammation may respond well to a course of high-dose steroids. A combination of these ocular emergencies in a patient with Graves' ophthalmology necessitates careful consideration of the available treatment options.

Acute Disease↗
PubMed1992

Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 1.

The cause of acquired lacrimal drainage obstruction may be primary or secondary. Primary acquired nasolacrimal duct obstruction results from inflammation of unknown cause that eventually leads to occlusive fibrosis. Secondary acquired lacrimal drainage obstruction, the theme of this report, may result from a wide variety of infectious, inflammatory, neoplastic, traumatic, or mechanical causes. An etiologic classification system for acquired lacrimal drainage obstruction is proposed, and it is illustrated by representative patients from the author's practice and discussed with reference to published reports.

Adolescent↗