Oculocardiac reflex during manipulation of adjustable sutures after strabismus surgery.
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Humans↗
Biomedical subjects
S J Isenberg
Publications and source records attributed to S J Isenberg.
Incidence, risk factors, and morphology in operating microscope light retinopathy.
A review of 135 consecutive cataract operations identified ten cases (7.4%) of operating microscope light retinopathy. Ophthalmoscopically, these light retinopathy lesions appeared as a focal pigment epithelial change with varying degrees of pigment clumping in the center. Fluorescein angiography accentuated the lesion by demonstrating a sharply demarcated transmission defect, occasionally with multiple satellite lesions. The shape of the lesion matched the shape of the illuminating source of the particular operating microscope used during the surgery. The most significant risk factor associated with the production of these light retinopathy lesions was prolonged operating time. Mean total operating time for the ten patients with light retinopathy was 51 minutes longer than for those without (P less than .0001). Other significant associated factors were the presence of diabetes mellitus (P less than .03), younger age (P less than .05), and the use of hydrochlorothiazide (P less than .04).
Cataract Extraction↗
Ocular signs of cocaine intoxication in neonates.
We examined 13 cocaine-intoxicated neonates, proven by urine assay, by slit lamp and found that most had iris blood vessel abnormalities. Using an iris vascularity scale that ranged from Grade 0 with no visible vessels to Grade 4 with dilated and tortuous vessels, we found that the intoxicated infants had increased grades in the iris periphery and collarette (P less than .02) as compared to 36 control newborns who had no cocaine in their urine. Infants with dilated or tortuous iris vessels were more likely to be intoxicated by cocaine (P less than .01). The presence of dilated or tortuous iris vessels in a neonate should signal the physician to rule out cocaine intoxication.
Blood Vessels↗
Growth of the conjunctival fornix and orbital margin in term and premature infants.
Knowledge of the growth of the neonatal conjunctival fornix and anterior orbit will aid development of neonatal prosthetic conformers and conjunctival sensors for oxygen determinations, as well as help define orbital malformation syndromes. These data are not available in any prospective series in the literature. The authors studied 55 premature and term neonates and determined horizontal and vertical dimensions of the conjunctival fornix and orbital margin and palpebral fissure width. Each of the ocular parameters had statistically significant correlation coefficients in relation to weight and gestational age (P less than 0.05). Linear regression analysis showed significant relationships which predict conjunctival fornix, orbital margin, and palpebral fissure dimensions from body weight (P less than 0.05). Statistically significant correlation coefficients and linear regression relationships were found for horizontal, but not vertical, diameter measurements of the conjunctival fornix in relation to orbital margin and palpebral fissure dimensions (P less than 0.01).
Birth Weight↗
Tocopherol efficacy and safety for preventing retinopathy of prematurity: a randomized, controlled, double-masked trial.
To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P less than .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P less than .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.
Birth Weight↗
Is a third anesthesia necessary following bilateral cataract surgery in children?
When operating on bilateral pediatric cataracts, surgeons have performed retinoscopy and contact-lens fitting for the second eye during a third anesthesia or in the office. We evaluated the concordance between eyes for retinoscopy, intraocular pressure, corneal diameter, and base curve in 13 cases. The correlation coefficient was significant (P less than .01), which justifies ordering contact lenses for both eyes after an evaluation of the first eye. Bilateral contact lenses will hasten the treatment or prevention of amblyopia and usually will eliminate the need for a third anesthesia.
Anesthesia↗
Effects of sickle cell anemia on conjunctival oxygen tension and temperature.
Because conjunctival vessels are affected by sickle cell disease, we wanted to see if conjunctival PO2 (partial oxygen tension) and temperature were also affected and if these measurements could aid in managing these patients. Conjunctival PO2 and temperature in 23 asymptomatic homozygous patients with sickle cell anemia did not differ significantly from those in age-matched controls. However, 12 subjects in painful sickle cell crisis had a significantly lower conjunctival PO2 than before crisis despite no significant change in hematocrit and conjunctival temperature. Supplemental oxygen therapy significantly increased conjunctival PO2. When supplemental oxygen was removed, conjunctival PO2 decreased to the admission level despite clinical improvement. This finding supports the use of supplemental oxygen in treating crisis. Measuring conjunctival PO2 can give clinicians an assessment of the effect of sickle cell disease on a peripheral capillary bed and may provide the first objective method to reliably diagnose acute painful sickle cell crisis.
Adult↗
Macular development in the premature infant.
To classify the ophthalmoscopic appearance of the developing macula, I performed retinal examinations on 129 premature neonates. In normal infants, the classification ranged from 34 weeks of gestational age when pigment was first evident in the macula, through the development of the annular ring reflex of the macula and foveolar reflex, to a mature (adult-appearing) macula at 42 weeks. This sequence allowed the observer to estimate the gestational age of the older premature neonate from the appearance of the macular area. Babies who had, or subsequently developed, retinopathy of prematurity showed a statistically significant two-week delay in macular development in the later stages. This may be the first evidence of a direct macular insult in retinopathy of prematurity.
Birth Weight↗
Conjunctival hypoxia in diabetes mellitus.
A frequently cited theory for the pathogenesis of neovascularization in diabetic retinopathy is that retinal hypoxia and/or ischemia release a factor which stimulates neovascularization. To the authors' knowledge, there is no direct in vivo evidence in the human proving this theory. One hundred and twenty-two diabetic subjects were studied to see whether worsening retinopathy was associated with changes in conjunctival oxygen tension (pO2). Diabetics without retinopathy had a conjunctival pO2 which was similar to an age-matched normal population. Diabetics with only background retinopathy had a significantly lower conjunctival pO2 than those without retinopathy (P less than 0.01). Diabetics with proliferative retinopathy showed a conjunctival pO2 that was significantly lower than either of the first two groups (P less than 0.05). The lowest value of all was found in patients with rubeosis iridis. Duration of diabetes alone did not correlate significantly to conjunctival pO2. These findings support the hypoxic theory of diabetic neovascular retinopathy.
Adult↗
The ETHAN syndrome.
Two mechanisms by which patients compensate for congenital nystagmus are assumption of a head position that places the eyes in a "null zone" of least nystagmus, known as nystagmus compensation syndrome (NCS), and convergence to dampen nystagmus, known as nystagmus blockage syndrome (NBS). We followed five patients in two groups who combine these mechanisms. The first group presented with spontaneous alternation between nystagmus and a head turn with orthotropia (NCS), and a large-angle esotropia with a variable head position that persisted even when patched (NBS). The second group of patients presented with a constant large-angle esotropia that lessened their nystagmus and variable head posture (NBS). Following recession of both medial rectus muscles with or without placement of posterior fixation sutures, they developed an abnormal head posture with orthotropia (NCS). The presence of mild amblyopia may contribute to the alternation between the two compensatory mechanisms.
Adult↗
Chemical preparation of the eye in ophthalmic surgery. IV. Comparison of povidone-iodine on the conjunctiva with a prophylactic antibiotic.
We previously found that half-strength (5%) povidone-iodine solution significantly reduced the bacterial flora of the conjunctiva. To compare the antibacterial effect of a topical combination antibiotic (Neosporin ophthalmic solution) given three times daily for three days preoperatively with that of half-strength povidone-iodine solution given as part of the preoperative preparation, conjunctival cultures were studied from 35 patients undergoing ocular surgery. When used individually, the antibiotic and povidone-iodine solutions caused a similar and substantial decrease in the number of colonies and species of bacteria cultured. When both drugs were used together, the decrease was even more striking, making 83% of the conjunctivae sterile. To minimize bacterial flora before ocular surgery, we recommend that a broad-spectrum topical antibiotic be given for three days preoperatively and that half-strength povidone-iodine solution be used as part of the preoperative preparation.
Anti-Bacterial Agents↗
Retinal hemorrhage in retinopathy of prematurity associated with tocopherol treatment.
Two hundred eighty-seven infants were enrolled in a double masked, randomized, placebo controlled trial of early parenteral tocopherol given from day one. Among the 232 survivors with ophthalmologic follow-up, retinal hemorrhages occurred more frequently in the tocopherol group (16/111; 14.4%) than in the placebo group (8/121; 6.6%). The development of retinal hemorrhages correlated strongly with plasma tocopherol levels from three weeks to three months (P less than 0.05). Future studies of tocopherol should be aware of potential bleeding diatheses, and study this prospectively.
Cerebral Hemorrhage↗
Effects of cyclopentolate eyedrops on gastric secretory function in pre-term infants.
Because of a report of necrotizing enterocolitis and death of a neonate from cyclopentolate eyedrops, we prospectively studied the effects of cyclopentolate 0.5% and 0.25% ophthalmic solutions and of a placebo on gastric volume and acid secretions in 20 pre-term infants. Placebo and cyclopentolate 0.25% eyedrops had no significant effect on the tested gastric functions. However, cyclopentolate 0.5% eyedrops significantly decreased gastric acid secretion and volume. Since this effect may predispose to the development of gastroenteritis, we recommend that cyclopentolate 0.5% be avoided in preterm infants; a weaker concentration of cyclopentolate eyedrops, however, can be used for mydriasis.
Achlorhydria↗
Antimicrobial preparation of the eye for surgery.
An important source of postoperative eye infection is the indigenous flora in and around the eye. Therefore, proper preparation of the operative field is crucial. Through an international survey we determined that ophthalmic surgeons used widely varying techniques in the pre-operative antimicrobial preparation of the eye. On the basis of these survey responses we have studied to date the effect on the bacterial flora of the conjunctiva of three regimens. Irrigation of the conjunctiva with saline tended to increase the ocular flora; instillation of silver protein solution had no significant effect. Povidone-iodine drops (5%) significantly reduced both colony and species counts.
Anti-Infective Agents, Local↗
Changes in conjunctival oxygen tension and temperature with advancing age.
The conjunctival oxygen monitor reflects oxygen tension of the internal carotid artery without introducing the heating artifact characteristic of transcutaneous monitors. It is now being used in the ICU and the operating room to measure accurately and continuously Po2 and temperature of conjunctival tissue. We examined the effect of aging on these values in 101 healthy adult subjects. Mean conjunctival oxygen tension (58 +/- 14 torr) and temperature (34.9 +/- 0.6 degrees C) decreased significantly (p less than .01) with advancing age. Monitoring the conjunctival capillaries may prove to be a useful adjunct to patient care, but the effect of aging must be considered in any such measurement.
Adolescent↗
Effect of phenylephrine hydrochloride on conjunctival PO2.
Phenylephrine hydrochloride eyedrops induce vasoconstriction through alpha-adrenergic mechanisms. Ten subjects underwent a 46% reduction in conjunctival PO2 when 2.5% phenylephrine eyedrops were administered. Compared with a control group, this reduction was significant. The induced conjunctival hypoxia lasted about 80 minutes. These findings suggest a number of clinical implications.
Adult↗
The oculocardiac reflex in strabismus surgery.
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Adolescent↗