Biomedical subjects
R L Hiatt
Publications and source records attributed to R L Hiatt.
Examination under anesthesia.
Examination under anesthesia, particularly in children, is a common practice in ophthalmology. It may yield valuable information as to the cause and management regimen of the condition under study. The proper equipment should be available to the clinician to expedite the examination. Rapid and useful information thus obtained can justify the risk and expense incurred when this modality is used. Efficient use of the equipment is essential to yield the best examination.
Adjustable sutures in strabismus surgery.
The benefits of the adjustable suture technique for strabismus surgery include the surgeon's ability to place the eye at the exact position desired in the immediate postoperative period. Depending on the type of deviation, this may be orthophoric, slight esophoric, or slight exophoric. Unexpected postoperative results are prevented which can occur when measurements and classical surgery are done in special problems such as paretic and restrictive strabismus and in reoperations. In addition precise alignment can be made in patients with weak fusion or fusion only in certain fields of gaze, and this should decrease the need for reoperation.
The spectrum of child and parent response to eye disease.
Patient and parent response to the presence or supposed presence of eye disease is a major factor in handling pediatric ophthalmology patients. The response may vary from passive acceptance of a blinding disease to hysteria, neurosis, or even psychosis. A literature review has shown that there is wide variation of understanding by the practitioner of the importance of this phase of ophthalmic practice. The author has drawn on three decades of ophthalmic practice. When blindness, for example, is threatened, our "normal" responses change, and what we judge as normal should also. Ways of evaluating and treating patient or parent responses are suggested, along with guidelines for using consultants and others. This may play a role in malpractice suits.
Mucolipidosis IV. Histopathology of conjunctiva, cornea, and skin.
The condition of a 4-year-old white girl of Ashkenazi Jewish parents was diagnosed as mucolipidosis IV on the basis of marked corneal clouding and severe psychomotor retardation, in the absence of facial-skeletal dysplasia or abnormal mucopolysacchariduria. The results of histochemical and ultrastructural studies of conjunctiva, skin, and corneal epithelium confirmed the combined storage of acid mucopolysaccharide and complex lipid substances. An unusual histopathologic feature of mucolipidosis IV is the predisposition of extreme storage involvement of corneal epithelial cells with relative sparing of the keratocytes, which is a finding of potential therapeutic implication. In addition, application of electron microscopic study of cultured amniotic cells and conjunctival biopsy specimens to assess for the parents the mother's subsequent pregnancy additional emphasizes the value of ultrastructural studies in the diagnosis of lysosomal storage disease.
Decompensated strabismus.
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Abnormal head positions due to ocular problems.
This paper involves the research of 30 patients, all of whom exhibited a head tilt, turn, or a combination of the two. We report the sensory aspects of 8 of these individuals and demonstrate the fusional ability of each patient. In the majority of the cases, the results were positive. It was found that most abnormal head positions were developed to maintain fusion.
Study of corneoscleral lacerations.
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Production of anterior segment ischemia.
Anterior segment ischemic changes can occur without detachment of any muscles. The most common cause of such ischemic changes of the anterior segment is the removal of too many rectus muscles in one operation. Twenty dog eyes and eight monkey eyes were subjected to the disinsertion and detachment of various combinations of extraocular muscles. The dogs were sacrificed at intervals from 30 to 90 days. During the observation period, they were observed for gross and slit-lamp changes. The enucleated eyes were studied microscopically for signs of ischemic and necrotic changes. Two patients who were studied, observed, and treated for anterior segment ischemia following muscle surgery are described. The changes which occur after extraocular muscle surgery are extensive and include corneal edema, cataract, chemosis, corneal changes, decreases in intraocular pressure, decreases in outflow or glaucoma, and frank necrosis. The variables which lead to this reaction are described in detail. Also, some unanswered queries, such as the duration of the reaction and the time interval of the reaction after multiple muscle operations are discussed.
Muscle transfer procedures.
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The effect of dexamethasone on borderline ocular hypertension.
The topical steroid testing with dexamethasone 0.1% (Decadron) of one eye of 36 specially selected borderline ocular hypertensive patients produced a positive response in 25%. Similar testing of the second eye of 4 monocular open angle glaucoma patients produced a positive response in 75%. The test was thought to provide guidance for closer observation of the positive reactors, indications for therapy, and a reduction in patient clinic visits.
Production of anterior segment ischemia.
Anterior segment ischemia changes can occur without detachment of any muscles. The most common cause of such ischemic changes of the anterior segment is the removal of too many rectus muscles in one operation. Twenty dog eyes and eight monkey eyes were subjected to the disinsertion and detachment of various combinations of extraocular muscles. They were sacrificed at intervals from 30 to 90 days. During the observation period, they were observed for gross and slit lamp changes. The enucleated eyes were studied microscopically for signs of ischemic and necrotic changes. Two patients who were studied, observed, and treated for anterior segment ischemia following muscle surgery are described. The changes which occur after muscle surgery are extensive and include corneal edema, cataract, chemosis, corneal changes, decreases in intraocular pressure, decreases in outflow or glaucoma and frank necrosis. The variables which lead to this reaction is described in detail. Also, some unanswered queries, such as the duration of the reaction and the time interval of the reaction after multiple muscle surgeries, are discussed.
Miotics vs glasses in esodeviation.
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Extraocular muscle transplantation.
1. The transplantation of extraocular homografts in dogs and humans has been described. 2. The extraocular muscle tissue transplanted remains viable, but loses its characteristics of muscle tissue during the period of the normal healing process following extraocular muscle surgery. 3. Autogenous homograft of extraocular muscle has an advantage over artificial synthetic material with the absence of extrusion and less reaction. 4. This is a clinically usable procedure today, especially in the amblyopic ehe with high deviation to accomplish an additional lengthening of one extraocular muscle, particularly if extraocular muscle surgery has previously been performed.