Biomedical subjects

A J Morrell

Publications and source records attributed to A J Morrell.

28 records · Page 2Linked to original sources

PubMed1992

Neuroleptanalgesia and extracapsular cataract extraction.

Peribulbar and retrobulbar anaesthesia are commonly used techniques in cataract extraction. They offer satisfactory analgesia and akinesia but serious complications although uncommon are consistently reported. Intravenous sedation combined with a facial nerve block offers an alternative method of anaesthesia. This is a retrospective study of patients who underwent extracapsular cataract extraction using this technique between 1 January 1986 and 1 September 1990. The operating conditions were judged to be very suitable with minimal peroperative complications. The postoperative ocular complication rate was low (minimum follow-up 3 months) and no serious medical complications were noted: 93.8% of patients achieved 6/12 vision or better. This study demonstrates that it is possible to achieve satisfactory ocular analgesia and akinesia during cataract extraction under local anaesthesia without the use of a periocular injection.

Adult↗

PubMed1992

Current practice of cataract extraction and anaesthesia.

A questionnaire regarding preferred methods of cataract extraction and anaesthesia was sent to 456 consultant ophthalmologists in England and Wales. Replies were received from 86% (n = 392), 83% (n = 380) having completed the questionnaire in full. The most frequently employed surgical approach was non-automated extracapsular cataract extraction. Only 2% of surgeons (n = 8) used phacoemulsification routinely and 2% (n = 7) used intracapsular extraction. Intraocular lens implantation was the standard practice of 99% of surgeons (n = 376). There has been a dramatic increase in the popularity of local anaesthesia, which was employed routinely (in more than three-quarters of their cases) by 20% of surgeons (n = 76). Retrobulbar infiltration remains the most common method of administration. Sedation was given routinely by 45% of surgeons (n = 171) when using local anaesthesia. Medical contraindications and patient preference were considered the most important reasons for selecting local anaesthesia rather than general. The exclusive use of general anaesthesia in cataract surgery appears to be diminishing.

Age Factors↗

PubMed1991

Electroretinography as a prognostic indicator or neovascularisation in CRVO.

A prospective study was carried out to compare the efficacy of electroretinography, fundus fluorescein angiography and clinical examination in identifying those at risk of rubeotic glaucoma following central retinal vein occlusion (CRVO). Our preliminary observations are described. The findings suggest a complementary role for electroretinography in the management of CRVO. Particularly significant were interocular differences in 30 Hz flicker latency, the ability to elicit pattern ERGs and the ratio of scotopic and photopic a:b wave amplitudes. Of the clinical measures the depth of the relative afferent pupil defect was a sensitive indicator of rubeosis. Factors of lesser statistical prognostic value included poor visual acuity and the extent of deep retinal haemorrhages. Fundus fluorescein angiography in this study had limited value in predicting those patients at risk of rubeosis.

Electroretinography↗

PubMed1991

Normalisation of refractive error after steroid injection for adnexal haemangiomas.

A longitudinal study of 27 patients with infantile haemangiomas is reported. It confirmed the efficacy of local steroid injection as a method of treatment; 81.5% of patients showed a marked improvement, with the lesion reducing to 25% or less of its original size. Involution was most marked in the first two weeks but continued for up to four months after injection. Amblyopia was present in 43% of children and was usually the result of induced refractive error rather than obstruction of the visual axis or strabismus. Anisometropia was found in 68% of children, with a high incidence of asymmetric astigmatism on the side of the haemangioma. Following local steroid injection a marked reduction in astigmatism was noted in 53.8% of children, a lesser reduction in 15.4%, and no reduction in 30.8%. Successful treatment of the haemangioma, therefore, may not remove the risk of amblyopia, and regular refraction and visual assessment remain mandatory.

Adolescent↗

PubMed1991

Tonic pupils and human parvovirus (B19) infection.

We document the case of a young woman with bilateral internal ophthalmoplegia and subsequently tonic (Adie's) pupils, corneal epitheliopathy, and uveitis due to human parvovirus B19 infection. To our knowledge, this is the first reported case of ocular complications of this virus.

Adolescent↗

PubMed1989

Recognising aponeurotic ptosis.

Thirteen patients who had ptosis surgery undertaken for disinsertion of the aponeurosis of the levator palpebrae superioris were reviewed. Pre-operatively all the patients had characteristic clinical signs of levator disinsertion which was confirmed at surgery and corrected by reposition of the disinserted aponeurosis. Five of these patients were initially mistakenly diagnosed as having a neurological cause for their ptosis. The diagnosis of this type of ptosis may easily be missed.

Blepharoptosis↗

PubMed1989

Intercapsular versus extracapsular cataract extraction.

Forty-five eyes that have undergone routine extracapsular cataract extraction with insertion of a posterior chamber intraocular lens were compared with a similar group of eyes that had undergone intercapsular extraction. Capsular fixation was more predictable following intercapsular (78%) than it was following extracapsular extraction (22%). Gonioscopy revealed prominence of the lens haptic in 22% of the intercapsular group, with peripheral anterior synechiae (PAS) in 18%; haptics were prominent in 78% of the extracapsular group, with synechiae in 55%. Lens eccentricity of 2 mm or more was seen in 2 patients (4%) following intercapsular and in 10 (22%) following extracapsular extraction. Pupil irregularities were noted in three of the intercapsular group (7%) and in eight of the extracapsular group, (13%) with peripheral iris tucking alone in three. These data strongly support the view that intercapsular is superior to extracapsular cataract surgery in terms of facilitating capsular fixation of posterior chamber intraocular lenses.

Aged↗

PubMed1989

Trabeculectomy as an introduction to intraocular surgery in an ophthalmic training program.

Ninety seven trabeculectomies for open-angle glaucoma performed by either consultants (senior surgeons) or surgeons in training (resident junior staff) were retrospectively analyzed with reference to the outcome of surgery and the complication rate. The results obtained by the trainees were comparable with those obtained by experienced surgeons, suggesting that trabeculectomy is a suitable operation to be performed by surgeons in training.

Evaluation Studies as Topic↗

PubMedDate not supplied

Corneal perforation and decompensation after automated lamellar keratoplasty for hyperopia.

We describe a case of corneal perforation and decompensation after automated lamellar keratoplasty (ALK) in a middle-aged hyperopic man who had had unsuccessful holmium laser thermokeratoplasty. The corneal decompensation responded to gluing and application of a bandage contact lens but despite treatment, the corneal flap remained precariously poised with a localized area of thinning that is predisposed to future perforation and decompensation. This case highlights the potential for serious complications and subsequent visual morbidity after ALK.

Automation↗

PubMedDate not supplied

Sequential Descemet's membrane detachments and intraocular lens haze secondary to SF6 or C3F8.

PURPOSE: To report an unusual complication of treatment in the case of a Descemet's membrane detachment. METHODS: Observational case report. RESULTS: A 79-year-old woman presented for elective cataract surgery. Ocular risk factors identified preoperatively included moderately shallow anterior chambers bilaterally, previously treated with bilateral YAG peripheral iridotomies. After a clear corneal section during phacoemulsification, large Descemet's tears on introducing the micro finger and phaco probe were noticed. Conversion to an extracapsular technique was necessary because of poor view. Similar peroperative Descemet's detachments were noticed in the contralateral eye during phacoemulsification by a senior surgeon a year later. Postoperatively, the Descemet's detachments were managed by intracameral SF6 and later C3F8 gas. A few weeks later, a fine haze was noticed under the anterior surface of the intraocular lens (IOL). Corneal edema persisted and corneal decompensation ensued. Both eyes needed penetrating keratoplasties. The right eye needed an IOL exchange due to IOL haze. CONCLUSIONS: In this case the SF6 or C3F8 gas may have produced the unexpected effect of an anterior IOL haze. The mechanism of this phenomenon is unknown. To the knowledge of the authors, this effect has not been observed previously with SF6 or C3F8 gas. This haze was visually significant and required an IOL exchange. To the knowledge of the authors this is the first report of this nature. The authors advise caution when using intracameral SF6 or C3F8 gas for repair of Descemet's membrane detachment with this type of IOL.

Aged↗