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Biomedical subjects

J F Acheson

Publications and source records attributed to J F Acheson.

At least 19 recordsLinked to original sources
PubMed1998

Dissociated effects of botulinum toxin chemodenervation on ocular deviation and saccade dynamics in chronic lateral rectus palsy.

AIM: Changes in saccade velocity/amplitude characteristics (main sequence) and attenuation of distance esotropia in response to botulinum toxin (BTX-A) chemodenervation of the antagonist medial rectus were studied in a group of nine patients with chronic lateral rectus palsy. METHODS: Serial measurements of ocular deviation and infrared oculograms of saccadic eye movements to targets at 5 degrees-20 degrees of lateral gaze were made before injection and at 2, 4, 8, 16, and 20 weeks after injection. RESULTS: At 2 weeks after injection, the ocular deviation changed by a mean of 34.5 prism dioptres and the 5 degrees and 10 degrees adduction saccades were significantly slowed (p < 0.02 Wilcoxon signed rank test). By the second examination, however, the adducting saccade peak velocity had returned to normal while the mean ocular deviation remained significantly changed (p = 0.01 Wilcoxon matched pairs). By 20 weeks the mean ocular deviation was not significantly different from that before injection (p = 0.14 matched pairs). CONCLUSIONS: The ocular realignment caused by BTX-A may persist after saccadic function has been restored. This may be because toxin may have a more profound and long lasting effect on the orbital singly innervated fibres which are active tonically at rest to hold gaze whereas there is relative sparing of the additional motor units recruited during fast eye movements.

Abducens Nerve↗
PubMed1997

The spectrum of eye disease in children with AIDS due to vertically transmitted HIV disease: clinical findings, virology and recommendations for surveillance.

BACKGROUND: Eye disease in children infected with HIV is uncommon, but there is little information on which children require screening or surveillance and the management of those with retinitis. METHODS: We examined 12 children with symptomatic HIV disease (of a cohort of 98 HIV-positive children) using indirect ophthalmoscopy. When retinitis was found it was documented photographically at the time of diagnosis and on follow-up. RESULTS: Four cases of infective retinitis were diagnosed: three with probable cytomegalovirus retinitis and one with progressive outer retinal necrosis. CONCLUSION: Detection of reactivation is difficult and we recommend fundus photography under general anaesthesia wherever possible. Children with other end-organ disease, symptomatic eye disease and advanced HIV disease with severe immunosuppression require ophthalmological surveillance.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Vision.

Explore the source record for details and available documents.

Electroretinography↗
PubMed1994

Coagulation abnormalities in ischaemic optic neuropathy.

The aetiology of non-arteritic ischaemic optic neuropathy (ION) is multifactorial with local anatomical and systemic haemodynamic abnormalities both playing a role. A careful search for treatable vascular disease risk factors is required to allow rational therapy, to optimise the visual prognosis and to allow new insights into pathogenesis. We describe 7 cases in which there was an associated thrombophilic (prothrombotic) state; 4 had deficiencies of the physiological anticoagulants proteins C and S and antithrombin III and 2 had anti-phospholipid antibody (lupus anticoagulant) syndromes. A further patient had reduced levels of the physiological fibrinolytic agent tissue plasminogen activator (t-PA). In 5 patients other risk factors for small vessel occlusive disease were also present, and 4 had recurrent episodes of ION in the same eye. The visual prognosis in these patients may be improved by anticoagulation with warfarin.

Adult↗
PubMed1994

Optic nerve sheath decompression for the treatment of visual failure in chronic raised intracranial pressure.

The records of all patients undergoing optic nerve sheath decompression for visual failure in chronic raised intracranial pressure performed over a 15 year period have been reviewed. The aim was to study the visual outcome and relation to any shunting procedures. Fourteen patients (20 eyes) were identified in whom follow up information of at least one year was available. Eleven patients had benign intracranial hypertension (idiopathic intracranial hypertension) and three had dural venous sinus occlusive disease. Eight patients had unilateral surgery and six had bilateral surgery. Visual acuity and fields either improved or stabilised in 17 out of 20 eyes and three deteriorated. Of the eight patients undergoing unilateral surgery, the other eye remained stable in seven and deteriorated in one. Four patients required optic nerve sheath decompression despite previous shunting or subtemporal decompression. Five patients required shunts or subtemporal decompression after optic nerve sheath decompression because of persistent headache in three cases and for uncontrolled visual failure in two cases. No patients lost vision as a direct consequence of surgery. It is concluded that optic nerve sheath decompression is a safe and important therapeutic option in the management of chronic raised intracranial pressure complicated by visual loss. Vision can be saved after shunt failure, and in other cases may be maintained without the need for a shunt. Shunts may still be required, however, after optic nerve sheath decompression, especially for persistent headache.

Adult↗
PubMed1993

Churg-Strauss vasculitis presenting with severe visual loss due to bilateral sequential optic neuropathy.

A 44-year-old man with severe visual loss due to an acute bilateral sequential optic neuropathy is described, where the associated pulmonary disease and peripheral eosinophilia led to a diagnosis of Churg-Strauss syndrome (allergic angiitis). The mechanism of the optic neuropathy was most probably acute ischaemia of the anterior optic nerve due to direct involvement of the short posterior ciliary arteries by inflammatory disease of the vessel wall.

Adult↗
PubMed1992

Cryosurgery for acute retinopathy of prematurity: factors associated with treatment success and failure.

Cryosurgery for stage 3 plus acute retinopathy of prematurity (ROP) increases the probability of disease regression, but up to 25% of eyes may progress to retinal detachment and blindness in spite of treatment. In a series of 37 eyes in 23 patients treated at the Hammersmith Hospital an overall 75% of eyes reached a favourable outcome. We present these results in detail and analyse the apparent causes of treatment failure. Poor anatomical results (total retinal detachment and traction detachment involving the macula) were associated with inappropriate cryoprobe design and with zone 1 and rush-type disease. Poor functional results in the presence of a largely flat retina (marked macular ectopia and high myopia) appeared to be associated with delayed treatment during the period of evolution of the stage 3 lesion, and with the appearance of a more highly differentiated vascular shunt with early localised forward vitreous invasion. Suggestions for the refinement of existing gradings of acute ROP are made.

Acute Disease↗
PubMed1991

Vaso-occlusive retinopathy in the primary anti-phospholipid antibody syndrome.

We report two patients with contrasting patterns of retinal vascular occlusion associated with the primary anti-phospholipid antibody syndrome. The immuno-pathological features and clinical associations are discussed. This condition is of interest to ophthalmologists because of its association with thrombosis in the eye, brain and elsewhere and because it provides new insights into the pathogenesis of retinal vascular disease in young patients.

Abortion, Habitual↗
PubMed1991

Surveillance for retinopathy of prematurity in practice: experience from one neonatal intensive care unit.

We have reviewed the results of a six year surveillance programme for acute Retinopathy of Prematurity (ROP) in order to see how the yield of cases reaching clinically significant stage 3 can safely be maximised, and to assess the effectiveness of an examination technique which does not require a speculum or scleral indentation. An overall 137 (44.8%) developed some signs of ROP and 35 (10.8%) reached stage 3. Seventeen of these were born at 25 weeks or less gestational age, and included four with rush-type disease. None of those born at or over 30 weeks developed stage 3. It is concluded that infants born at 31 weeks or more do not need to be included in a surveillance program, and this protocol will increase the yield of significant disease. In addition, cases of stage 3 which may require cryosurgery will not be missed using an atraumatic examination technique.

Birth Weight↗
PubMed1991

Extraocular muscle surgery in myasthenia gravis.

Myasthenia gravis is typically a disease of young people in active employment who need a field of binocular single vision. Although it is systemically controllable with a good chance of spontaneous remission, persistent loss of binocularity may cause chronic disability. We report our experience of extraocular muscle surgery in five patients with stable myasthenia gravis and persistent double vision. Extraocular muscle involvement was selective, giving rise to incomitant and concomitant squints, with individual muscle overactions as well as underactions. Treatment was by conventional recession and resection procedures with the additional use of Faden and adjustable sutures where appropriate. In all five cases a larger, stable field of binocular single vision was established. It is concluded that extraocular muscle surgery may be beneficial in selected cases of myasthenia gravis.

Adolescent↗