Biomedical subjects
Publications and source records attributed to R Spires.
Eye surgery is performed on patients of all ages, with most of these procedures performed on an outpatient basis. Common opthalmic terminology and anatomy are presented. In addition, the intraoperative procedures and postoperative care following surgery to correct strabismus, cataracts, glaucoma, and retinal detachment are described.
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1. Conventional techniques of pars plana vitrectomy, retinal membrane stripping, scleral buckling, fluid-air or fluid-gas exchange, and silicone oil injection are ineffective in 25% of the complex retinal detachments reported. 2. The properties of perfluorocarbon liquid--clear, water immiscible, specific gravity twice that of water--make it an important adjunct to treatment of complex retinal detachments. 3. Of great interest is the fact that research has shown that visual outcome is significantly better for eyes using perfluorocarbon to initially flatten the retina.
1. Visual loss improves when optic nerve sheath decompression is used in treating progressive nonarteritic ischemic optic neuropathy. 2. Repeated neuro-ophthalmic examinations, including visual acuity, visual field testing, and color vision testing, should be done weekly to detect progression of nonarteritic ischemic optic neuropathy. 3. Postoperatively, the neuro-ophthalmologist monitors for visual acuity, proptosis, evidence of retro-orbital hemorrhage, loss of normal motility, evidence of pupil malfunction, and disc hemorrhages.
1. Acute retinal necrosis (ARN) represents a specific pattern of clinical presentations for certain herpes virus infections in the posterior segment of the eye. These include varicella zoster virus and herpes simplex virus. 2. Patients with ARN usually complain of mild to moderate ocular or periorbital pain, foreign body sensation, and a red eye. Visual symptoms usually include hazy vision, floaters, and, rarely, decreased peripheral vision. 3. Medical treatment of choice is intravenous acyclovir. Surgical treatment of choice is pars plana vitrectomy. If retinal detachment is present, vitrectomy with endolaser, internal drainage of subretinal fluid, air-fluid exchange, and long-acting gas tamponade are recommended.
Retinopathy of prematurity (ROP) is a bilateral retinal disease found in premature infants born at less than 36 weeks gestation or weighing less than 1,600 g. Several recent studies have suggested a multifactorial basis for ROP development. Risk factors include apnea treated by mask or bag ventilation, repeated blood transfusions, prolonged parenteral nutrition, hypoxemia, hypercarbia, hypocarbia, and supplemental oxygen administration. Disease stages are: stage 1--demarcation line; stage 2--intraretinal ridge; stage 3--ridge plus extraretinal fibrovascular proliferation; and stage 5--total retinal detachment.
Hydroxyapatite is a natural, porous material that allows the recipient's blood vessels and fibrous tissues to grow onto the implant, thus becoming a "living" portion of the orbital tissues. Natural eye movement, resistance to extrusions, rare complications, and flexibility in fitting the socket are the reasons oculoplastic surgeons are using the hydroxyapatite implant. Hydroxyapatite spheres are contraindicated in situations where other types of orbital implants are contraindicated; ie, severe trauma with possible orbital infection orbits that have poor vascularization and healing qualities, such as after irradiation, and with orbital infection.
1. Pterygia, triangular sheets of fibrovascular tissue that invade the cornea, have recurrence rates of 30% to 50% with currently available surgical procedures. 2. Mitomycin, an antimetabolite-antibiotic agent, has been reported to be effective in preventing recurrences of surgically excised pterygia when used adjunctively as eye drops. 3. Because mitomycin-C is an antineoplastic agent, appropriate policies and proper patient education are important.
1. Sickle cell disease in the eye primarily affects the retina. Other ocular findings include conjunctival sickling sign, lid edema secondary to sickle crisis, iris atrophy, and iris neovascularization. 2. Treatment of proliferative sickle cell retinopathy depends on the stage of the disease. Feeder vessel photocoagulation has been shown to be effective in closing sea fans and reducing the incidence of visual loss in Stage III disease. 3. Education and awareness to the potential complications of proliferative retinopathy leads us to the awareness that prevention is the best treatment for sickle cell retinopathy.
1. Aspergilli are unique fungi found in soil, household dust, and vegetable matter. 2. Blurred vision is the most common early complaint of Aspergillus-induced endophthalmitis. It may be accompanied by pain, photophobia, and iridocyclitis. Later visual loss can be significant. 3. Retinal findings include cloudy vitreous, preretinal and subretinal exudate, and retinal hemorrhages. 4. Treatment is a pars plana vitrectomy with vitreous biopsy and intravitreal injection of amphotericin B.
1. Contact Laser transscleral cyclophotocoagulation using the Nd:YAG laser is an approach for delivering laser energy to the ciliary body for cyclodestructive treatment. 2. The Contact Laser method is useful in treating refractory glaucoma, including neovascular glaucoma, inflammatory glaucoma, aphakic glaucoma, juvenile glaucoma, and other types of glaucoma in which medical and/or surgical treatment has failed. 3. Schuman and colleagues found that maximum lowering of the pressure occurs 1 to 4 weeks postprocedure.
1. The successful treatment of patients with hyphemas depends on identification of risk factors, proper medical management, and prompt surgical intervention when indicated. 2. There are a number of management issues that the ophthalmologist deals with in treating traumatic hyphemas. These include inpatient versus outpatient treatment, limiting activity, weighing the advantages/disadvantages of Amicar to control secondary hemorrhages, and treating secondary glaucoma. 3. Two indications for surgical management include uncontrolled IOP or the development of corneal blood staining. 4. Hyphema patients require long-term, yearly follow-up to monitor for secondary glaucoma.
1. Direct carotid-cavernous sinus fistulas usually result from multi-trauma or head injuries. These patients are more likely to be seen at trauma based hospitals. 2. Ocular manifestations of direct carotid-cavernous sinus fistulas include exophthalmos, swollen eyelids, ocular pulsation, pulsating exophthalmos, conjunctival chemosis, arterialization of conjunctival vessels, exposure keratopathy, a bruit over the affected eye (heard by the patient as a swishing sound), diplopia, visual loss, and ophthalmoscopic abnormalities that include moderate dilation of retinal veins, optic disc swelling, and intraretinal hemorrhage. 3. The ultimate diagnostic test for direct carotid-cavernous sinus fistulas is cerebral arteriography of both the internal and external carotid arteries. 4. The optimal treatment of a direct carotid-cavernous sinus fistula is closure of the abnormal arteriovenous communication with preservation of internal carotid artery patency. Detachable, flow-guided balloons are presently used to close most direct carotid-cavernous sinus fistulas.
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1. Signs and symptoms of pseudotumor cerebri include papilledema with imaging studies that reveal a normal brain; elevated intracranial pressure with normal cerebrospinal fluid contents; and abducens palsies with diplopia. 2. The most common presenting symptom is headache. Preverbal children may be irritable. Infants often are sleepy or apathetic. Other symptoms include dizziness and ataxia. 3. Loss of acuity or visual field is the only serious permanent complication of pseudotumor cerebri; children often complain of "blurred vision."
1. Direct carotid-cavernous sinus fistulas usually result from multi-trauma or head injuries. These patients are more likely to be seen at trauma-based hospitals. 2. Ocular manifestations of direct carotid-cavernous sinus fistulas include exophthalmos, swollen eyelids, ocular pulsation, pulsating exophthalmos, conjunctival chemosis, arterialization of conjunctival vessels, exposure keratopathy, a bruit over the affected eye (heard by the patient as a swishing sound), diplopia, visual loss, and ophthalmoscopic abnormalities that include moderate dilation of retinal veins, optic disc swelling, and intraretinal hemorrhage. 3. The ultimate diagnostic test for direct carotid-cavernous sinus fistulas is cerebral arteriography of both the internal and external carotid arteries. 4. The optimal treatment of a direct carotid-cavernous sinus fistula is closure of the abnormal arteriovenous communication with preservation of internal carotid artery patency. Detachable, flow-guided balloons are presently used to close most direct carotid-cavernous sinus fistulas.
1. Excessive outflow of aqueous through the newly formed sclerostomy is the key factor in precipitating hypotony and other serious complications. 2. Glaucoma shell tamponade is used to temporarily impede the outflow of aqueous at the filtration site in order to allow the eye to stabilize. 3. The "torpedo" dressing is critically important to the success of the shell tamponade.
1. Women with no immunity to Toxoplasma organisms acquire toxoplasmosis during pregnancy; the infection spreads to the fetus by transplacental transmission. 2. Blurred vision, floaters, photopsia, pain, and redness are common complaints of the active retinochoroiditis. 3. The diagnosis of ocular toxoplasmosis can be confirmed by blood tests, the most common being the indirect fluorescent antibody (IFA) and the enzyme-linked immunosorbent assay (ELISA).