Biomedical subjects

D A Hiles

Publications and source records attributed to D A Hiles.

At least 73 records · Page 4Linked to original sources

PubMed1977

Visual results following infantile cataract surgery.

Aspiration and its modifications have been shown to be a superior operative procedure for neonatal, congenital, infantile, and acquired cataracts. However, the visual results obtained in the infantile cataractous eye, whether the opacity is complete or partial, still remain within the same range as the results of other operative techniques reported over the last 3 decades. Adequate visual results often cannot be obtained because of the associated systemic and/or ocular defects or failure of optical and amblyopia treatment. Perhaps increased efforts should be made to perform surgery at even earlier ages in those patients with complete, or in some cases, partial, cataracts in which surgery is contemplated. In children with partial cataracts who are able to function well, the lens should be allowed to remain in place and conservative measures of visual preservation should be undertaken for as long as possible. This allows the eye more time to develop normal visual functions with an intact lens and accommodative mechanisms. It should be stressed again that the sole success or failure of surgery for infantile cataracts cannot always be the visual acuity. The real measure is the child's ability to function successfully in his environment for the remainder of his life.

Adult↗

PubMed1977

Indications for infantile cataract surgery.

Explore the source record for details and available documents.

Age Factors↗

PubMed1976

Acute orbital cellulitis.

A review of 104 patients with acute orbital cellulitis during the past decade showed that the frequency of hospital admissions for this disease has increased recently. Roentgenograms showed paranasal sinus in 77 of 91 patients. Haemophilus influenzae and Diplococcus pneumoniae were recovered from the blood of 20 and 6 patients, respectively. Four children had concomitant H influenzae meningitis. Bacteremia was demonstrated in 29% and more common in those with extensive orbital involvement, those not receiving antibiotics at the time of culture, and those less than 2 years old. Some of the 26 patients with less extensive involvement were bacteremic (17%), had leukocytosis, or roentgenographic evidence of sinusitis. Most children received large doses of ampicillin sodium and methicillin sodium intravenously until signs and symptoms had almost abated. With this regimen, there were no orbital, ocular, or other complications.

Acute Disease↗

PubMed1976

Surgery for congenital esotropia.

The diagnosis of esotropia in an infant is not generally a difficult one for a skilled ophthalmologist to confirm. Uncovering all the subtleties of the disease presents the greater challenge and taxes the skills involved in examining infants. The numerous treatment regimens available leave the surgeon who does this operation only occasionally in doubt as to when it is best to operate and by what method. The safest guidelines for the ophthalmologist are (1) to be sure of his diagnosis and all of its ramifications and (2) to operate on these patients by the method he feels will best totally correct both the horizontal and vertical defects in one operation. It is also known, however, that not all of these infants will be corrected by this single procedure and that additional surgery, both early and delayed, will be necessary. Similarly, amblyopia and accommodative esotropias will need to be treated in a significant segment of these patients. The stability of the final result depends upon the success of the treatment in all parameters. The results obtained are far from ideal. Some patients achieve the optimum with good and equal acuity in each eye, straight eyes, peripheral fusion, fusional amplitudes, and reduced stereopsis. Other patients will have reduced visual acuity secondary to amblyopia; deficient or no binocular cooperation; and larger eso-angles or even consecutive exo-angles - both of which will require further surgery. Congenital esotropia is a fascinating entity that requires more research before its etiology and pathogenesis will finally be understood. Only then will therapy produce a satisfactory and lasting result.

Humans↗

PubMed1976

Trabeculectomy for adolescent onset glaucoma in the Sturge-Weber syndrome.

Two patients with adolescent onset glaucoma associated with Sturge-Weber Syndrome have been presented. Both patients were successfully treated with ab externo trabeculectomy. This procedure is suggested as an additional means for controlling the late onset glaucoma associated with the syndrome without provoking additional complications or deterioration. Early treatment is emphasized before the irreversible changes of chronic glaucoma become manifest.

Adolescent↗

PubMed1975

Current concepts in the management of strabismus in children with cerebral palsy.

Few guidelines have been advanced for the management of brain damaged children with strabismus. Conservative therapy with lenses, prisms, occlusion, atropine and late surgery has been suggested but without specific methods or ages being advocated. The authors undertook the treatment of these children utilizing the standard principles of strabismus therapy as applied to neurologically normal children. A further consideration is a satisfactory cosmetic appearance which wins greater self, peer and parental acceptance in these handicapped children. The results of therapy of this series of patients with cerebral palsy indicates that satisfactory alignment can be achieved in the majority even in the presence of severe motor involvement and/or mental retardation. Ninety percent of those patients with treated accomodative esotropia achieved a satisfactory alignment. Those patients with non accommodative esotropia had a satisfactory alignment in 77% of the patients operated upon and those with exotropia achieved this result in 86% of the patients operated upon. Only five (2%) patients spontaneously reduced their angles to cosmetically acceptable ranges. Overcorrections occurred in 10 (11%) patients in the surgically treated nonaccommodative esotropes and 4 (3%) of these patients required further corrective surgery. Only one exotropic patient was rendered esotropic postoperatively. The average age of initial surgery in the esotropic patients was 3.9 years and 5.7 years in the exotropic patients. The older ages for surgical intervention reflects the more conservative approach to these neurologically abnormal children and allow an increased time interval for the development of a stable preoperative oculomotor alignment.

Adolescent↗

PubMed1975