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Biomedical subjects

T C Spoor

Publications and source records attributed to T C Spoor.

At least 19 recordsLinked to original sources
PubMed1992

Visual field defects in patients with normal-tension glaucoma and patients with high-tension glaucoma.

We compared the automated visual field test results of 24 patients with normal-tension glaucoma and 24 patients with high-tension glaucoma who were closely matched for the amount of visual field loss to determine any differences in the characteristics of visual field defects between the two groups. Patients were matched with a maximum allowable difference in mean deviation of 0.3 dB. Although the normal-tension group had a greater amount of focal visual field loss (pattern standard deviation), the difference was not statistically significant (P = .628). Additionally, there was no statistically significant difference in the amount of diffuse or focal visual field damage in the superior hemifields between the two groups; however, the patients with normal-tension glaucoma had a significantly greater amount of localized visual field loss in the inferior hemifield than the patients with high-tension glaucoma (P = .015). Our data support the hypothesis that a vascular mechanism may have a greater role in the pathogenesis of optic nerve damage and visual field loss in patients with normal-tension glaucoma than in patients with high-tension glaucoma.

Aged↗
PubMed1992

Quantitative evaluation of optic disc pallor in pseudotumor cerebri patients.

We quantified optic disc pallor in patients with pseudotumor cerebri with the Rodenstock Optic Nerve Head Analyzer before and after optic nerve sheath decompression. Mean frequency distribution of pallor peaked between the pallor values of 0.10 and 0.20 in four pseudotumor cerebri patients and between 0.50 and 0.60 in five normal subjects. The red dominant pallor reflectance in pseudotumor cerebri patients decreased significantly and shifted toward the reflectance of normal subjects gradually during the 9 weeks after successful optic nerve sheath decompression, coinciding with the ophthalmoscopic resolution of papilledema. The computerized pallor measurement with the Rodenstock Optic Nerve Head Analyzer allows an objective and quantitative assessment of papilledema in pseudotumor cerebri patients.

Adult↗
PubMed1991

Treatment of pseudotumor cerebri by primary and secondary optic nerve sheath decompression.

We performed optic nerve sheath decompression in 53 patients (101 eyes) with pseudotumor cerebri and visual loss. Sixty-nine eyes (85 patients) with acute papilledema uniformly had improved visual function after optic nerve sheath decompression. Of 32 eyes with chronic papilledema (18 patients), only ten had improved visual function after optic nerve sheath decompression. This difference was significant (P = .0001). Thirteen eyes required secondary or tertiary optic nerve sheath decompression after an initial successful result. Eleven of 13 eyes had improved visual function after repeat optic nerve sheath decompression. We believe that patients with acute papilledema and visual loss should be offered optic nerve sheath decompression, and if symptoms recur, repeat optic nerve sheath decompression is a safe and effective treatment option.

Acute Disease↗
PubMed1991

Optic nerve sheath decompression for the treatment of progressive nonarteritic ischemic optic neuropathy.

We performed optic nerve sheath decompression on four patients (five eyes) with visual loss secondary to nonarteritic anterior ischemic optic neuropathy. Four of the five eyes had marked improvement in visual function after the operation. Optic nerve sheath decompression is an effective treatment for patients with nonarteritic ischemic optic neuropathy and progressive visual loss.

Aged↗
PubMed1990

Treatment of traumatic optic neuropathy with corticosteroids.

We treated 21 patients (22 eyes) with traumatic optic neuropathy by using intravenous megadose methylprednisolone (13 patients) or high-dose dexamethasone (eight patients). Of 13 patients treated with megadose methylprednisolone, 12 had improved visual function, as did seven of nine eyes treated with intravenous dexamethasone. This difference was not significant (P = .3). Initial total blindness, mechanism of injury, or time from injury to treatment did not correlate with visual improvement.

Adolescent↗
PubMed1990

Blepharoptosis repair by fascia lata suspension with direct tarsal and frontalis fixation.

Nine patients with blepharoptosis and no levator palpebrae superioris muscle function were treated by fixating irradiated fascia lata to the tarsus and frontalis muscles under direct visualization. No recurrences were noted on follow-up, which ranged from four to 24 months. There were no postoperative infections or granuloma reactions. Cosmetically, the height, contour, and symmetry of the eyelid margin and eyelid crease were predictable and satisfactory. This modified method of frontalis suspension may provide a more predictable and cosmetically pleasing result in the treatment of blepharoptosis when minimal or no levator muscle function is present.

Adolescent↗
PubMed1990

Traumatic hyphema in an urban population.

We reviewed 241 patients (178 black and 63 white) who were examined and treated at the Detroit Medical Center between 1980 and 1989 for traumatic hyphema. Secondary hemorrhage occurred in 46 patients (19%) and was significantly higher in black patients (P less than .005). Thirty-one patients (67%) developing secondary hemorrhage had an initial hyphema filling less than 25% of the anterior chamber. Patients treated with aminocaproic acid had secondary hemorrhages at a rate of 11% (six patients) compared to 21% (40 patients) in patients who were not treated with aminocaproic acid. The high risk of secondary hemorrhage with potential ocular damage in patients with traumatic hyphema, especially black patients, supports the benefit of hospitalization and the administration of aminocaproic acid.

Adolescent↗
PubMed1989

A periosteal-temporalis fascia pedicle flap for repairing impending ocular perforations and extruding keratoprostheses.

We repaired four eyes in four patients with impending perforation using a vascular periosteal-temporalis fascia pedicle flap continuous to the periorbita of the orbital wall. Two eyes with extruding keratoprostheses, one eye with severe ocular surface dysfunction and a perforated, infected keratoplasty, and one eye with scleral ectasia were successfully reconstructed. Excellent visual acuity (20/25) was attained in one eye and functional visual acuity (20/100) was maintained in another. Structural integrity was maintained in all eyes. A vascularized flap was an excellent source of tissue for reconstructing eyes with impending perforation and scleral melting.

Adolescent↗
PubMed1988

Optic nerve sheath decompression for pseudotumor cerebri.

We studied optic nerve sheath decompressions for pseudotumor cerebri performed at the Kresge Eye Institute, Detroit, over the past year. Six patients (ten eyes) were operated on. Visual function improved in all ten eyes. A decision to operate was based on progressive loss of visual acuity or visual field unresponsive to medical therapy, accompanied by echographic evidence of a distended optic nerve sheath (positive 30 degrees test). Follow-up ranged from four to 11 months. Four patients underwent subarachnoid iopamidol (Isovue) contrast injection followed by orbital computed tomography. The subarachnoid space totally filled in all patients. No evidence of fibrosis or obstruction of the optic nerve sheath existed; however, leakage of dye from the optic nerve sheath could not be demonstrated. Postoperative complications included transient diplopia and transient atonic pupil (one patient each). Our results indicate that optic nerve sheath decompression improves and protects visual function in patients with pseudotumor cerebri who demonstrate progressive visual field loss and fluid in the optic nerve sheath.

Adult↗
PubMed1988

Treatment of optic neuritis with intravenous megadose corticosteroids. A consecutive series.

Twelve consecutive patients with optic neuritis of unknown etiology treated with 250 to 500 mg methylprednisolone every 6 hours are described. All patients improved, some dramatically and rapidly. Patients with swollen discs and visual loss for less than 6 weeks improved uniformly, rapidly, and completely. In some patients, progressive visual deterioration was reversed rapidly. Serum serologies and cerebrospinal fluids findings were of limited use in determining etiology or prognosis with treatment. Side effects included exacerbation of a preexisting psychosis, elevated glucose levels, and oral candidiasis. None required cessation of treatment. Patients with optic neuritis may benefit from intravenous megadose corticosteroids.

Adolescent↗
PubMed1987

Primary differentiated neuroblastoma of the orbit.

A 49-year-old woman had a 12-year history of a localized left orbital tumor that required five subtotal excisions, orbital radiotherapy, and finally an exenteration. The last procedure was performed after visual function had deteriorated and in order to prevent spread of the tumor into a surrounding compartment. The biopsy specimens from the first four surgeries showed a stroma-free spindle cell tumor with benign cytologic features and no mitotic activity, which exhibited palisading of nuclei, imbrication of delicate cytoplasmic processes (neuropil), true perivascular rosettes with cytoplasmic processes oriented perpendicular to vessel walls, and Wright rosettes. The biopsy after radiotherapy and the exenteration specimen contained more polyhedral (gemistocytoid) tumor cells with abundant eosinophilic cytoplasm and tapering cell processes; nuclear pleomorphism without mitotic activity was also seen. Electron microscopy showed the presence of neurosecretory dense-core granules in the perikaryon region of the tumor cells and in the myriad interweaving cytoplasmic processes (neurites); neither Nissl substance nor synapses were identified. Immunohistochemical staining for neuron-specific enolase was positive, but glial fibrillary acidic protein stained negative. This previously undescribed orbital tumor is interpreted as a primary differentiated neuroblastoma without evidence of ganglion cell differentiation that exhibited locally aggressive behavior. The distinctions between neuroblastic and neuroendocrine tumors are discussed.

Adult↗
PubMed1987

Ocular syphilis 1986. Prevalence of FTA-ABS reactivity and cerebrospinal fluid findings.

Serum FTA-ABS tests were obtained for 247 consecutive patients undergoing ambulatory oculoplastic surgery over a 5-month period. The incidence of FTA-ABS reactivity was 52.8%. Cerebrospinal fluid (CSF) from 50 patients with ocular signs of late syphilis and reactive serum FTA-ABS tests was examined. Only 12 (24%) of these patients had reactive serum VDRLs. Thirty patients (60%) had a lymphocytic pleocytosis, elevated protein, or both, in their CSF. No patients had reactive CSF VDRLs. It was concluded that FTA-ABS reactivity is common, serum VDRL tests are inadequate for diagnosing ocular syphilis, and a significant percentage of patients with ocular syphilis have abnormal CSF. More aggressive diagnosis and treatment of ocular syphilis is suggested.

Aged↗
PubMed1987

Diagnosis and management of traumatic optic neuropathies.

If a patient has vision immediately following trauma, with subsequent deterioration of visual acuity and/or field, and the presence of a relative afferent pupillary defect, compression of the optic nerve or its vascular supply is very likely. We currently lack a proven optimal treatment, but in the otherwise healthy patient, we suggest an intravenous (IV) loading dose of methylprednisolone 30 mg/kg, and a second 15-mg/kg dose 2 hours after the initial dose, followed by 15 mg/kg every 6 hours. Optic nerve decompression is indicated in this situation when corticosteroids have only a temporary effect, a diminishing one, or none at all. It may also be indicated when there is evidence of a traumatic optic neuropathy with a fractured or narrowed optic foramen or with dislocated bone fragments that directly impinge on the nerve. Optic nerve sheath decompression is indicated in progressive traumatic optic neuropathy when an enlarged fluid-filled sheath has been demonstrated sonographically.

Craniocerebral Trauma↗
PubMed1987

Penetrating orbital injuries.

Seemingly trivial adnexal injuries may be associated with extensive injuries to the globe, orbit, and brain. A meticulous ophthalmologic examination and orbital and brain computed tomography (CT) scans (axial and coronal views) are essential for complete evaluation of these patients. The ophthalmologist must remain an active participant in the management of these patients to preserve the integrity of the globe.

Adolescent↗