Biomedical subjects
Malcolm R Ing
Publications and source records attributed to Malcolm R Ing.
A prospective study of alternating occlusion before surgical alignment for infantile esotropia: one-year postoperative motor results.
INTRODUCTION: Alternating occlusion before surgical alignment has been suggested by some strabismologists as a possible method to enhance the treatment of infantile esotropia. PURPOSE: This report presents 1-year outcome results of a prospective trial of patients with infantile esotropia who were assigned randomly to alternating occlusion or control groups. METHODS AND MATERIALS: Forty-four patients with infantile esotropia were measured at entry into the study, at the time of surgery, at 6 weeks, and 1 year postoperatively. Alternating occlusion was full time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The control group that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed when the patients were between the ages of 6 and 13 months. RESULTS: Overall, the patients showed an increase of 9.14 prism diopters (PD) during a mean preoperative follow-up of 4.2 months. Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned within 10 PD at 6 weeks also were aligned 1 year postoperatively. The results were similar for the alternate occlusion group and the control group. CONCLUSION: In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.
"Tort reform would improve medical care".
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Marshall M. Parks, M.D. memorial issue: remembrances.
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A prospective study of alternating occlusion prior to surgical alignment for infantile esotropia: one-year postoperative motor results.
PURPOSE: Alternating occlusion prior to surgical alignment has been suggested by some strabismologists to possibly enhance the treatment of infantile esotropia. This report presents the data for 44 patients prospectively enrolled by random assignment to an alternating occlusion or no occlusion subgroup followed for 1 year postoperatively. METHODS: All patients were measured at entry into the study, at the time of surgery, and at 6 weeks and 1 year postoperatively. Alternating occlusion was full-time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The subgroup that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed between the ages of 6 and 13 months. RESULTS: The patients, as a whole, showed a significant increase of 9.14 prism diopters when followed for a mean of 4.2 months prior to initial surgery (P < .00027). Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned at 6 weeks were also aligned at the 1-year postoperative date. The results were similar for both the control group and the patients treated with alternating occlusion. CONCLUSION: In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.
Outcome study of the development of fusion in patients aligned for congenital esotropia in relation to duration of misalignment.
PURPOSE: The results of recent studies have shown that the presence and quality of stereopsis in patients with congenital esotropia and subsequent surgically alignment are dependent upon the duration of the misalignment during the first 2 years of life. The purpose of this study was to investigate the presence of fusion in patients with different durations of misalignment whose eyes were aligned at different ages by age 2 years. METHODS: Data previously obtained in a study of 90 patients with congenital esotropia aligned by 2 years of age, examined in a masked independent evaluation for binocularity, were analyzed. Patient age at alignment and duration of misalignment were correlated with the presence of fusion. RESULTS: Fusion was present in 94% of all patients aligned by age 2 years and in 94% of patients with < or =21 months of misalignment. There was no statistically significant difference between those aligned by 6, 12, or 24 months (P > 0.05, power = 0.8). No significant difference was found between those aligned with duration of misalignment < or = 6, between 7 and 12, or between 13 and 21 months. CONCLUSION: Unlike the findings of stereopsis studies, there was no significant difference in the proportion of patients who achieved fusion in congenital esotropes who had up to 21 months of misalignment and whose eyes were aligned at different ages within the first 24 months of life.
Correcting esotropia--time is of the essence!
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Outcome study of stereopsis in relation to duration of misalignment in congenital esotropia.
PURPOSE: A recent outcome study of Randot stereopsis in congenital esotropia reported early surgical alignment is associated with a higher percentage of patients with stereopsis and a higher quality of stereopsis because early surgery minimized the duration of misalignment. We compared the Titmus stereopsis with the duration of misalignment and the age of alignment for a group of patients who were surgically aligned by 24 months of age. METHODS: The data previously obtained in a study of 90 patients aligned by 2 years of age, examined in a masked, independent evaluation for binocularity was analyzed. The age of alignment and duration of misalignment was correlated with the percentage of patients with stereopsis and quality of the stereopsis result as determined by the Titmus vectograph overlay. RESULTS: Patients aligned by 6 or 12 months of age or within 6 or 12 months of duration of misalignment did not differ in percentage with stereopsis. However, patients aligned after 12 months of age did show a decrease percentage with stereopsis (P <.05, power 0.8). The quality of the stereopsis that was established was similar for those aligned by 6 or 12 months (P >.05, power 0.8). The quality of stereopsis, however, was decreased for patients with duration of misalignment greater than 12 months (P <.001, power 0.8). CONCLUSION: Alignment within 1 year of age or within 12 months of misalignment favorably affects the percentage of patients who develop stereopsis in the treatment of congenital esotropia. The quality of the stereopsis result is affected by the duration of the misalignment, rather, than the age of alignment per se.
Incidence of stereopsis after treatment of infantile esotropia with botulinum toxin A.
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