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Biomedical subjects

R S Hepler

Publications and source records attributed to R S Hepler.

13 recordsLinked to original sources
PubMed1992

Results of inpatient and outpatient cataract surgery. A historical cohort comparison.

PURPOSE: The transition from inpatient to outpatient cataract surgery during the last decade was not accompanied by prospective investigation of its effect on visual outcomes or surgical complications. The authors performed this study to assess the impact of this transition on surgical results. METHODS: The authors reviewed 600 extracapsular cataract extractions performed by 4 experienced ophthalmic surgeons during a 36-month period; in 300 cases, patients were hospitalized after surgery (inpatient group), and, in 300 cases, patients were never hospitalized (outpatient group). The same surgical techniques were used in all cases. Visual outcome and rates for operative and postoperative complications were compared. RESULTS: There were no statistically significant differences between the inpatient and outpatient groups for visual acuity. Excluding patients with pre-existing nonlenticular ocular disease, a best-corrected visual acuity of 20/40 or better was achieved in 93.1% of inpatient cases and in 97.2% of outpatient cases 6 months after surgery. Postoperative, clinically apparent cystoid macular edema was more common in the inpatient group (P = 0.03); however, after exclusion of patients with diabetes, hypertension, age younger than 65 years, and eyes with pre-existing nonlenticular disease, there was no statistically significant difference between groups. No significant differences in rates for other operative and postoperative complications were identified, including wound dehiscence, unplanned postoperative filtering blebs, infectious endophthalmitis, retinal detachment, persistent iridocyclitis, glaucoma, and corneal edema. CONCLUSION: This study does not demonstrate that the transition to outpatient cataract extractions has had an adverse effect on surgical outcomes.

Aged↗
PubMed1979

Orbital embryonal rhabdomyosarcoma and intracranial schwannoma.

A 39-year-old woman had a large benign intracranial schwannoma of the Gasserian ganglion. Thirty-two years previously, she had an embryonal rhabdomyosarcoma of the orbit. She had been treated by enucleation, local excision, and low-dose supplemental irradiation (1,400 rads). This is the longest survival of which we are aware following any treatment modality in such tumors. No correlation between the two tumors has been established.

Adult↗
PubMed1979

Arachnoidal cyst invading the orbit.

Ipsilateral glaucoma developed in a 51-year-old man with a left-sided temporal lobe arachnoidal cyst. Ultrasonic examination disclosed a cystic orbital lesion adjacent to the optic nerve. Following intracranial decompensation of the arachnoidal cyst, the intraocular pressure dropped markedly. Ultrasonography showed a collapse of the presumed optic nerve sheath cyst. While the exact mechanism producing glaucoma in this patient remains unclear, there was an apparent relationship between the elevated intraocular pressure and the arachnoidal cyst.

Arachnoid↗
PubMed1977

Atypical fibrous histiocytoma of the orbit: an electron-microscopic study.

A young woman developed progressive proptosis of her right eye, accompanied by retinal striae, exposure keratopathy and a severe decrease in visual acuity, reflecting optic neuropathy. An atypical fibrous histiocytoma was found within the orbit. She received orbital exenteration and irradiation. 2 years later she is free of clinical recurrence.

Adult↗
PubMed1976

Cryosurgery in removal of orbital tumors.

Two cases in which medially placed retro-orbital tumors were approached transfrontally have been presented. The computerized tomographic scanner was important in the localization of both lesions. Although of different histologic types, both tumors were friable and vascular. This friability and vascularity would have caused severe difficulties in removal had it not been for the facility with which a cryoprobe froze and grasped tumor tissue. The importance of this instrument, previously unemphasized, has been pointed out.

Aged↗
PubMed1976

Antral-ethmoidal decompression in Graves' disease. Five-year experience.

The orbital manifestations of Graves' disease frequently constitute the major and distressing portion of the morbidity in this poorly understood process. Patients with optic neuropathy, exposure keratopathy or disfiguring proptosis may be aided considerably by decompression to permit swollen orbital contents to move into the maxillary and ethmoid sinus cavities. Experience with 38 patients treated over a five-year period indicates that antral-ethmoidal decompression is a logical, successful form of therapy and generally free of serious complications. it may provide benefit earlier in the course of Graves' exophthalmopathy than has been accepted in the past.

Decompression↗
PubMed1975

Myotonic pupils in Charcot-Marie-Tooth disease. Successful relief of symptoms with 0.025% pilocarpine.

Twenty-seven members of a family with dominantly inherited Charcot-Marie-Tooth disease (CMTD) were examined. Fifteen members had CMTD and 13 of these had varying amounts of myotonic pupillary abnormalities similar in some ways to Adie tonic pupil syndrome. Those with graver neurologic disease showed greater pupillary abnormalities. Ten of the 15 patients had pupillary constriction with methacholine chloride (Mecholyl) and some of these had extensive iris atrophy. Several affected patients received symptomatic relief from 0.025% pilocarpine. Seven other patients with CMTD who were not related to our initial family were checked for myotonic pupils; two had findings similar to our initial family. Pupillary abnormalities in certain patients with CMTD appear secondary to a parasympathetic denervation of the iris sphincter and ciliary muscle, as shown by a positive methacholine test, and probably represent part of the autonomic nervous system dysfunction associated with the polyneuropathy in CMTD.

Adult↗
PubMed1975

Loss and recovery of vision with suprasellar meningiomas.

Central visual acuity losses were documented in a group of 23 patients with surgically and histologically verified suprasellar meningiomas. The pattern demonstrated was that of acute, gradual or fluctuating loss in one eye, followed by later loss of central acuity in the other eye. Both optic nerves and chiasm were invariably involved either by stretching or compression. Neither preoperative field abnormalities nor central acuity deficits could be correlated with the anatomical location of the tumor, nor could postoperative changes in vision be correlated with tumor size. Lengthy duration of acuity loss and severe visual deficit did not preclude postoperative recovery of vision. Improvement in sight most frequently occurred within the first several weeks after operation, and further return of vision was not noted after 1 year.

Blindness↗
PubMedDate not supplied

Management of optic neuritis.

To improve understanding and effectiveness of therapy in optic nerve disease, various causes of so-called optic neuritis should be identified when possible. The clinical characteristics of demyelinating optic neuropathy can be contrasted with those of ischemic optic neuropathy, nutritional optic neuropathy, true optic nerve inflammation (e.g., luetic), optic nerve infiltration with tumor, and compression neuropathy caused by adjacent tumor. Radiologic studies and other means of investigating patients with optic neuritis are reviewed. Arguments in favor of, and against, treatment of presumed demyelinating optic neuritis are presented along with representative corticosteroid treatment regimens. The natural tendency toward spontaneous improvement of optic neuritis makes the effect of treatment difficult to assess.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Adie's tonic pupil.

Explore the source record for details and available documents.

Adie Syndrome↗