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Biomedical subjects

S R Seiff

Publications and source records attributed to S R Seiff.

At least 19 recordsLinked to original sources
PubMed1997

Outcomes of cataract surgery by residents at a public county hospital.

PURPOSE: To determine whether outcomes of extracapsular cataract surgery with intraocular lens implantation performed by residents at an urban county hospital are comparable to previously reported patient outcomes at Veterans Affairs and university hospitals. METHODS: We performed a retrospective analysis of all extracapsular cataract procedures with intraocular lens implantation, both by standard extracapsular cataract extractions and by phacoemulsification, performed by first-year, second-year, and third-year residents at San Francisco General Hospital from January 1, 1994, through June 30, 1995. RESULTS: Final best-corrected visual acuity of 20/40 or better was achieved in 183 (84%) of 218 eyes. When patients with preexisting eye disease limiting visual potential were excluded, 20/40 or better visual acuity was achieved in 159 (94%) of 169 eyes. Vitreous loss occurred in six (16%) of 37 eyes operated on by first-year residents, in six (10%) of 63 eyes operated on by second-year residents, and in seven (6%) of 118 eyes operated on by third-year residents. The mean change in vision was a gain of 6 lines of Snellen acuity. CONCLUSIONS: Patients undergoing cataract surgery performed by residents at an urban county hospital have visual outcomes equivalent to those of patients at Veterans Affairs and at university facilities.

Adult↗
PubMed1996

Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy.

PURPOSE: To determine the efficacy of silicone rod frontalis sling ptosis repair in selected patients. METHODS: The authors retrospectively studied 35 consecutive patients who underwent silicone sling ptosis repairs in 6 lids at the University of California, San Francisco. RESULTS: Preoperative diagnoses included congenital ptosis causing developmental delay or possible amblyopia in children younger than 3 years of age, chronic progressive external ophthalmoplegia, third-nerve palsy, myasthenia gravis, and ocular restriction secondary to glaucoma filtering valves. With a mean follow-up of 22 months, good-to excellent final lid height was achieved in all 61 lids. Recurrence of the ptosis occurred in four lids (7%), requiring replacement of the silicone rod in two lids and revision of the original sling in two lids to reach the final lid height. Chronic exposure keratopathy without corneal infection occurred postoperatively in 9 (15%) of 61 eyes, all in patients with an inadequate or absent Bell phenomenon. Chronic corneal problems did not develop in any of the children. Extrusion of the sling with or without infection occurred in three foreheads (5%) in two patients younger than 15 years of age. CONCLUSION: Silicone rod is an effective material for use in frontalis suspension in treating severe ptosis with poor levator function. Children younger than 3 years of age with congenital ptosis and developmental delay or possible amblyopia can undergo silicone frontalis suspension to achieve good visual results. The elasticity and ease of adjustment of the silicone rod are ideal characteristics for a suspensory material used to correct severe ptosis associated with a minimal or absent Bell phenomenon, such as in chronic progressive external ophthalmoplegia, myasthenia gravis, or third-nerve palsy.

Adolescent↗
PubMed1996

Hypertropia and the posterior blowout fracture: Mechanism and management.

OBJECTIVE: To better understand the pathophysiology and proper management of a subgroup of patients with orbital blowout fracture which manifests by a vertical diplopia and hypertropia on the affected side. PATIENTS AND METHODS: This report is based on a series of ten consecutive patients with orbital floor blowout fractures who had diplopia and hypertropia on the affected side. All patients were followed through at least 13 days of conservative care. Computed tomography demonstrated a characteristic depressed fracture of the posterior orbital floor extending to the posterior wall of the maxillary sinus in all patients. In many patients, the inferior rectus looped inferiorly and then rose to contact the globe at a steep angle. Diplopia did not spontaneously resolve in any patient. At surgery, the orbital contents were elevated to the posterior extent of the fracture, and the floor defects were bridge. Patients were followed for resolution of diplopia. RESULTS: Eight patients had resolution of the hypertropia and diplopia within 2 months of surgery, and two patients had residual diplopia in extreme downgaze but were significantly improved. CONCLUSIONS: When hypertropia and vertical diplopia are noted after orbital trauma, a posterior blowout fracture should be suspected. In these patients, infraduction may be diminished due to changes in the effective origin and insertion of the inferior rectus muscle. The diagnosis of a posterior blowout fracture should be supported by characteristic findings on computed tomography. If the motility abnormality persists for 10 to 14 days, posterior orbital exploration and fracture repair should be undertaken.

Adolescent↗
PubMed1995

Treatment of facial palsies with external eyelid weights.

PURPOSE: Because ocular exposure is a major complication of facial paralysis, an external gold eyelid load weight was evaluated for effectiveness in the treatment of this problem. METHODS: We prospectively studied 12 patients with unilateral facial paralysis who were treated with the external eyelid weights. Follow-up examinations included corneal exposure, amount of artificial tear usage, patient comfort, and complications associated with the weights. Treatment end points were the patient's decision to undergo a canthoplasty or placement of an implanted weight or resolution of the facial paresis to better than House's grade IV/VI. RESULTS: Of the 12 patients studied, ten had decreased corneal exposure on the affected side, with a coincident decrease in artificial tear drop use and increased comfort. One patient had no improvement in a corneal defect, and one was unable to apply the weight. Five patients had some difficulty in positioning the weight, which was related to upper eyelid dermatochalasis in four of the five. Only two weights were lost in over two years of total wearing time. CONCLUSIONS: External eyelid weights are useful in the treatment of ocular exposure associated with facial paralysis. The weights decreased corneal exposure, decreased reliance on artificial tear drops, and increased patient comfort. The weights were helpful as a trial before implantation of eyelid weights and as a longer-term treatment for ocular exposure in patients with temporary facial paralysis. Loose upper eyelid skin may limit their usefulness in some patients.

Adult↗
PubMed1995

Macular changes in pseudotumor cerebri before and after optic nerve sheath fenestration.

PURPOSES: Macular abnormalities such as chorioretinal striae, pigmentary disturbances, exudates, and subretinal hemorrhage or scar can occur in patients with pseudotumor cerebri. The purpose of this study is to determine the potential resolution of the macular abnormalities after optic nerve sheath fenestration, as well as the visual significance of these changes. METHODS: The authors retrospectively compared the preoperative and postoperative examinations of seven patients with pseudotumor cerebri-associated macular changes who underwent unilateral optic nerve sheath fenestration. RESULTS: Preoperatively, visual acuity was worse than 20/25 in two patients with macular exudates and in one with a subretinal scar. Chorioretinal striae and pigment mottling did not appear to decrease visual acuity. With a mean postoperative follow-up of 14 months, the patients with exudates had improvement in visual acuity and clearing of the exudates, unlike the patient with the subretinal scar. Chorioretinal striae, pigment mottling, and the subretinal scar did not resolve with surgery. CONCLUSIONS: This study suggests that chorioretinal striae and pigment mottling in the setting of pseudotumor cerebri, unlike exudates and subretinal scars, do not have a significant effect on visual acuity. After optic nerve sheath fenestration, only macular exudates decreased. Therefore, the persistence of striae, pigment mottling, and macular scars, in the face of resolved papilledema and improved visual fields, does not indicate failure of the optic nerve sheath fenestration.

Adult↗
PubMed1994

Anatomy of the terminal nerves in the upper eyelid.

Anatomic dissections on human cadaver heads were performed to determine the anatomy of the terminal nerves in the upper eyelid. Vertically oriented nerves, which are commonly identified in a preseptal location in the upper eyelid, were determined to be sensory nerves, most commonly originating from the supraorbital nerve (V1). Facial nerve (VII) dissections were also performed, with specific attention paid to the temporal branch. The facial nerve innervates the orbicularis muscle on its deep surface, both at the most temporal aspect of the muscle as well as along the supraorbital rim. No motor fibers could be traced into the upper eyelid and no anastomosis was noted between the temporal branch of the facial nerve (VII) and the supraorbital nerve (V1).

Eyelids↗
PubMed1993

The staged management of ophthalmic complications of facial nerve palsy.

A six-stage approach to the management of the ophthalmic complications of facial palsy was developed to aid the physician in logically organizing therapy and to provide patients with reassuring goals. This stepwise approach was applied prospectively in 120 consecutive facial palsy patients from 1986 to 1990. The six stages included (a) supportive care (with and without tarsorrhaphy), (b) planning facial reanimation, (c) lower eyelid and lateral canthal resuspension, (d) passive upper eyelid reanimation, (e) dynamic eyelid animation (palpebral springs), and (f) soft tissue repositioning including eyebrow lift and blepharoplasty. Each stage was considered in order, although action in each stage was not appropriate for all patients. All 120 patients received supportive care, which was all that was necessary to accomplish the therapeutic goals for 63 (52.5%). Eight patients received temporary tarsorrhaphies (7%) and 14 (12%) permanent. One hundred ten were considered for stage 2. Thirty-five underwent stage 3 procedures, 30 received gold weights in stage 4, 5 had palpebral springs placed in stage 5, and 6 underwent stage 6 procedures. This staged approach was effective in achieving corneal compensation, maintaining vision, and improving the quality of life in all patients.

Eyelid Diseases↗
PubMed1992

Decompression of the optic nerve sheath for vision-threatening papilledema caused by dural sinus occlusion.

Obstruction of the dural sinuses produces a clinical syndrome that resembles pseudotumor cerebri. In these patients, unremitting papilledema can cause blindness. We performed decompression of the optic nerve sheath in four patients who had occlusion of the dural sinuses. The operation achieved rapid relief of papilledema and recovery of vision. In three patients, fenestration of the nerve sheath of only one eye resulted in resolution of papilledema in both eyes. The procedure appears to relieve papilledema by filtering small quantities of cerebrospinal fluid into the orbit. It did not lower cerebrospinal fluid pressure in three patients who underwent lumbar puncture after surgery. Optic nerve sheath decompression is an effective operation for salvage of vision in patients with obstruction of the dural sinuses.

Adult↗
PubMed1992

Management of ophthalmic complications of facial nerve palsy.

Six stages--supportive care (with or without tarsorrhaphy), planning for facial reanimation, lower eyelid and lateral canthal resuspension, passive upper eyelid reanimation, dynamic eyelid reanimation, and soft tissue repositioning--should be considered in the management of the ophthalmic complications of facial nerve palsies. Each stage should be considered in order, although action in each stage may not be appropriate for all patients. In addition, after appropriate consideration, two or more staged procedures may be performed at the same time. Treatment may be held at any stage in which the cornea is compensated and the patient is comfortable and happy. By employing this staged approach, the surgeon has a method of organizing therapy in a logical fashion, and the patient is offered a set of reassuring goals, which combine to make the treatment plan more effective.

Eyelid Diseases↗
PubMed1991

Self-compression plates for orbital rim fractures.

The development and principles of self-compression plating, as well as a series of patients treated with this technique, are described. The use of such plates has specific advantages over other techniques for disorders encountered by the oculoplastic surgeon. The indications for plating were displaced trimalar fracture, displaced trimalar fracture with orbital rim fragment, and comminuted orbital rim fracture. Results were good; no complications have been observed to date. Comparison of compression plating to other methods for repair of orbital fractures is made. Self-compression plating with Vitallium plates is an effective modality for the treatment of a broad spectrum of patients with orbital rim fractures.

Adolescent↗