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Sachin Kedar

Publications and source records attributed to Sachin Kedar.

8 recordsLinked to original sources
PubMed2006

Pediatric homonymous hemianopia.

INTRODUCTION: Homonymous hemianopia is a disabling condition caused by numerous lesions affecting the retrochiasmal visual pathways. Little is known about homonymous hemianopia in childhood. METHODS: All patients seen in the Neuro-Ophthalmology Unit at Emory University with homonymous hemianopia (confirmed by Goldmann, Humphrey, or confrontation visual fields) between 1989 and 2004 were included. Demographic characteristics, clinical features, and evolution of the visual field defects were compared between the pediatric group (18 years of age or younger) and the adult group (older than 18 years). RESULTS: Among 852 patients with homonymous hemianopia, there were 81 children (86 homonymous hemianopias) and 771 adults (818 homonymous hemianopias). Formal visual field testing was obtained in 93% of pediatric cases and 96% of adults; a majority of patients in both groups were evaluated with Goldmann visual field testing. Demographic and visual field characteristics were similar in both groups. Significant differences were noted for the causative lesions and their location. Traumatic brain injury (34%) and tumor (27%) were the most common causes of homonymous hemianopia in the pediatric group, whereas infarction (63%), traumatic brain injury (12%), and hemorrhage (11%) were the most common causes in the adult group. Most lesions involved the optic radiations (37%), followed by the occipital lobes (26%), in the pediatric group, whereas occipital lobes (47%), followed by optic radiations (32%), were most commonly involved in adults. Approximately one third of the pediatric patients were seen in follow-up, and one third of these homonymous hemianopias spontaneously improved over the course of time. Of the 16 pediatric homonymous hemianopias evaluated within 1 month of onset of the cerebral disorder, 8 (50%) improved. CONCLUSION: Trauma and tumors are the most common cause of homonymous hemianopia in childhood. Although spontaneous improvement can be expected in approximately one third to one half of patients within the first few months, the recognition of homonymous hemianopia frequently is delayed in this population.

Adolescent↗
PubMed2006

Periosteal fixation in third-nerve palsy.

PURPOSE: We present a new technique of anchoring the eyeball to the nasal periosteum using a nonabsorbable suture in acquired isolated third-nerve paresis. METHODS: This was a case series of 4 consecutive adult subjects with isolated third-nerve paresis. After a 12-mm lateral rectus muscle recession in all 4 subjects, we passed 5-O double-armed polyester (NW683 Ethibond; Ethicon, Division of Johnson and Johnson Ltd., Aurangabad, India) on spatulated needles through the periosteum overlying the anterior lacrimal crest (exposed as in a Dacryocystorhinostomy procedure) at its superior part. The needles were brought anterior to the medial rectus muscle insertion and tightened enough to align the eye in 8-10 prism diopters adducted position. RESULTS: Ocular alignment in the primary gaze was satisfactory at 6-12 months of follow up. CONCLUSIONS: The use of a nonabsorbable polyester suture to anchor the globe to the nasal periosteum is an additional technique that holds promise to align the eyes in the primary gaze.

Adult↗
PubMed2006

Homonymous hemianopia in stroke.

BACKGROUND: Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging. METHODS: We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH documented by formal perimetry or confrontation visual fields and had undergone brain imaging. HHs were divided into those caused by stroke and by non-stroke conditions. The clinical and visual field characteristics were compared in the two groups. RESULTS: Among 850 patients with 902 HHs, 629 (69.7%) resulted from stroke, of which 531 (84.4%) were from infarction and 98 (15.6%) from primary intraparenchymal hemorrhage. Non-stroke causes included head trauma (123), brain tumor (102), neurosurgical procedures (22), multiple sclerosis (13), and miscellaneous conditions (13). Occipital lesions most commonly resulted from stroke. The configuration of the HH did not predict where in the retrochiasmal visual pathway the responsible lesion lay. CONCLUSIONS: Ischemic stroke causes most HHs from lesions in the occipital lobe that generally do not produce other neurologic manifestations. The configuration of the HH does not predict the location of the lesion within the retrochiasmal visual pathway.

Adolescent↗
PubMed2005

Simultaneous bilateral retinal artery occlusions associated with a mitral valve mass.

A 52-year-old woman with simultaneous bilateral retinal artery occlusions and normal trans-thoracic echocardiography was found to have a mitral valve lesion on trans-esophageal echocardiography. Bilateral retinal artery occlusions suggest a source of emboli at the level of the heart or aortic arch. Such cases should be evaluated not merely by trans-thoracic echocardiography, but by trans-esophageal echocardiography, which better visualizes the aortic arch and left heart cavities.

Calcinosis↗
PubMed2003

Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks.

BACKGROUND: The purpose of the present paper was to compare the techniques of conventional scleral buckling and combined pars plana vitrectomy and scleral buckling procedures in rhegmatogenous retinal detachments with unseen retinal breaks. METHODS: Forty-four consecutive eyes with uncomplicated, primary rhegmatogenous retinal detachments with a clear media and unseen retinal breaks were randomized to two groups. The scleral buckling group underwent 360 degrees scleral buckling, cryopexy and external subretinal fluid drainage. In the combined surgery group, 360 degrees scleral buckling, pars plana vitrectomy, air-fluid exchange, endolaser and injection of 14% perfluoropropane gas was done. RESULTS: At 3 months follow up the primary reattachment rate was 80% (16/20 cases) in the combined surgery group, and 70% (14/20 cases) in the scleral buckling group (P = 0.716). The visual acuity improved significantly from a preoperative median of hand movement (HM; range: HM to 6/60; similar in both the groups), to a median of 6/60 (range: perception of light to 6/18) in the combined surgery group and a median of 6/36 (range: HM to 6/18) in the scleral buckling group, the difference between the two groups not being statistically significant (P = 0.4). The number of intraoperative and postoperative complications was more in the combined surgery group. (four cases were lost to follow up and were doing well when last examined.) CONCLUSION: Conventional scleral buckling was found to be a safe and effective technique in the primary management of uncomplicated, rhegmatogenous retinal detachments with unseen retinal breaks when the media is clear.

Adolescent↗
PubMed2000

Traumatic globe luxation with optic nerve transection.

Luxation of the globe is a rare event that results from severe trauma to the orbit, often causing orbital rim and wall fractures. Though associated globe rupture often necessitates enucleation, repositioning of the globe can be attempted in these cases if the globe is intact. We report a case of globe luxation and optic nerve transection with its surgical management. A 17-year-old male presented with anterior luxation of the right globe and optic nerve transection following blunt trauma to the orbit. Computerized tomography revealed an anteriorly subluxated globe with complete transection of the optic nerve and multiple fractures of the orbital walls. The orbit was explored and the globe repositioned in the orbit with reattachment of the muscles. Postoperatively, the globe was in normal position with moderate motility and excellent overall cosmesis. Though the visual prognosis in these cases is usually extremely poor and depends on the extent and duration of injury, preservation of the globe not only helps the patient recover psychologically from the trauma but also allows better cosmesis.

Journal Article↗