Biomedical subjects
Publications and source records attributed to P H Wallar.
We studied the rate of primary and secondary capsulotomy in 300 consecutive extracapsular cataract extraction (ECCE) patients, followed from one to four years. Overall capsulotomy rate was 14%; the secondary capsulotomy rate was 3%. The incidence of secondary capsulotomy was greatest between 24 and 36 months, and decreased thereafter.
A 42-year-old woman developed a ciliary body mass which indented the lens equator and produced a dense focal cataract in the right eye. The clinical diagnosis was malignant melanoma of the ciliary body, and the lesion was removed by a large iridocyclectomy. Histopathologic examination revealed an acquired adenoma of the non-pigmented ciliary epithelium. The clinical and histopathologic features of this rare intraocular tumor are discussed with emphasis upon its differentiation from malignant melanoma.
Anticonvulsants remain necessary during pregnancy and the removal of such drugs is not recommended. However, on the available evidence, the physician may expect an increased risk of malformation including eye abnormalities as has been outlined. The abnormalities include growth deficiencies and delayed motor/mental development together with dysmorphic features, the most common of which seems to be cleft lip/cleft palate. Additionally, many of these children suffer from eye abnormalities including hypertelorism, ptosis, strabismus, epicanthal folds, and in this case abnormalities of the lacrimal apparatus.
Ninety eyes undergoing surgery for the removal of traumatic cataracts were evaluated. In the total group, the visual results fell generally into the 2 categories of satisfactory or poor. Most commonly, the latter patients sustained extensive preoperative trauma or were visually immature at the time of the injury. Forty-eight eyes, or 54% of this series, achieved an acuity of 20/80 or better, with 38, or 42%, achieving a corrected acuity of 20/20 to 20/30. There were 20 eyes in the patients 6 years of age and under, and a visual result of 20/60 or better was obtained in 7 of those eyes.
Aspiration and its modifications have been shown to be a superior operative procedure for neonatal, congenital, infantile, and acquired cataracts. However, the visual results obtained in the infantile cataractous eye, whether the opacity is complete or partial, still remain within the same range as the results of other operative techniques reported over the last 3 decades. Adequate visual results often cannot be obtained because of the associated systemic and/or ocular defects or failure of optical and amblyopia treatment. Perhaps increased efforts should be made to perform surgery at even earlier ages in those patients with complete, or in some cases, partial, cataracts in which surgery is contemplated. In children with partial cataracts who are able to function well, the lens should be allowed to remain in place and conservative measures of visual preservation should be undertaken for as long as possible. This allows the eye more time to develop normal visual functions with an intact lens and accommodative mechanisms. It should be stressed again that the sole success or failure of surgery for infantile cataracts cannot always be the visual acuity. The real measure is the child's ability to function successfully in his environment for the remainder of his life.
A review of 104 patients with acute orbital cellulitis during the past decade showed that the frequency of hospital admissions for this disease has increased recently. Roentgenograms showed paranasal sinus in 77 of 91 patients. Haemophilus influenzae and Diplococcus pneumoniae were recovered from the blood of 20 and 6 patients, respectively. Four children had concomitant H influenzae meningitis. Bacteremia was demonstrated in 29% and more common in those with extensive orbital involvement, those not receiving antibiotics at the time of culture, and those less than 2 years old. Some of the 26 patients with less extensive involvement were bacteremic (17%), had leukocytosis, or roentgenographic evidence of sinusitis. Most children received large doses of ampicillin sodium and methicillin sodium intravenously until signs and symptoms had almost abated. With this regimen, there were no orbital, ocular, or other complications.
Few guidelines have been advanced for the management of brain damaged children with strabismus. Conservative therapy with lenses, prisms, occlusion, atropine and late surgery has been suggested but without specific methods or ages being advocated. The authors undertook the treatment of these children utilizing the standard principles of strabismus therapy as applied to neurologically normal children. A further consideration is a satisfactory cosmetic appearance which wins greater self, peer and parental acceptance in these handicapped children. The results of therapy of this series of patients with cerebral palsy indicates that satisfactory alignment can be achieved in the majority even in the presence of severe motor involvement and/or mental retardation. Ninety percent of those patients with treated accomodative esotropia achieved a satisfactory alignment. Those patients with non accommodative esotropia had a satisfactory alignment in 77% of the patients operated upon and those with exotropia achieved this result in 86% of the patients operated upon. Only five (2%) patients spontaneously reduced their angles to cosmetically acceptable ranges. Overcorrections occurred in 10 (11%) patients in the surgically treated nonaccommodative esotropes and 4 (3%) of these patients required further corrective surgery. Only one exotropic patient was rendered esotropic postoperatively. The average age of initial surgery in the esotropic patients was 3.9 years and 5.7 years in the exotropic patients. The older ages for surgical intervention reflects the more conservative approach to these neurologically abnormal children and allow an increased time interval for the development of a stable preoperative oculomotor alignment.
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A four-year-old female child with Kugelberg-Welander syndrome has been presented. She demonstrated ptosis, exotropia, and decreased vision with unilateral high myopia. Unlike the Werdnig-Hoffman type of spinal muscular dystrophy Kugelberg-Welander disease has a protracted, somewhat benign course, necessitating proper evaluation and care of the ocular problems of these patients. The most common among these problems are the presence of severe to moderate ptosis and strabismus which appears usually to be an exotropia.
Ninety eyes undergoing surgery for the removal of traumatic cataracts have been evaluated. In this group, the visual results relate to the coincident complications and amblyopia. Most commonly, they may be related to the extent of the preoperative trauma to the injured eye or to the age of the patient at the time of the injury. Forty-eight eyes (54%) achieved an acuity of 20/20 to 20/80 with 38 (42%) eyes achieving acuity of 20/20 to 20/30. A visual result of 20/80 or better was obtained in 12 eyes of the 29 patients six years of age or less.