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Biomedical subjects

D K Coats

Publications and source records attributed to D K Coats.

At least 37 records · Page 2Linked to original sources
PubMed2000

Surgical management of strabismus after rupture of the inferior rectus muscle.

BACKGROUND: Rupture of an inferior rectus muscle is an uncommon problem. The resulting absence of infraduction and large hypertropia that result when the muscle cannot be repaired are challenging to manage surgically. METHODS: We treated 2 patients who had traumatic rupture of the inferior rectus muscle. Both patients underwent an inferior transposition of the inferior halves of the medial and lateral rectus muscles without disinsertion (modified Jensen transposition procedure). RESULTS: Both patients had a persistent small overcorrection in the primary gaze position. One patient was treated with a second strabismus surgery consisting of a recession of the contralateral superior rectus muscle; the other was treated with prism glasses. Both achieved restoration of depression to approximately 40 degrees and single binocular vision in the primary position at distance, near, and in the reading position. CONCLUSION: This modified Jensen transposition procedure of the horizontal rectus muscles appears to be highly effective in the treatment of the hypertropia and infraduction deficit produced by rupture of the inferior rectus muscle. It also appears to be suitable for use in situations when other rectus muscles are absent or unavailable for surgical manipulation.

Aged↗
PubMed2000

Threshold retinopathy of prematurity in neonates less than 25 weeks' estimated gestational age.

INTRODUCTION: The survival rate of extremely premature infants has increased. No recent study has investigated the characteristics of retinopathy of prematurity (ROP) or the incidence of threshold ROP in the most severely premature infants. We undertook this study to determine the risk of developing ROP and threshold ROP in the growing sub-population of infants <25 weeks' estimated gestational age (EGA). METHODS: A retrospective review of infants born before the 25th week of gestation between the years 1994 and 1997 was performed. Of 49 infants examined (97 eyes), 42 were born in the 24th week of gestation and 7 were born in the 23rd week. Mean follow-up was 6.3 months (range, 2.5-37 months). Ophthalmology screening examinations were initiated at 5 weeks of age and continued until the infants were no longer at risk for serious ROP. RESULTS: ROP developed in all (97) eyes. Thirty-nine of 97 (40%) eyes in 20 of 49 (41%) infants developed threshold ROP, diagnosed at a mean post-conceptional age of 34 weeks. Thirteen (13%) eyes of 7 (14%) patients developed prethreshold disease and regressed without treatment. CONCLUSION: There is an increased incidence of threshold disease in infants </=25 weeks' EGA compared with children of greater EGA. Threshold disease may occur at an earlier post-conceptional age in this subgroup of neonates.

Gestational Age↗
PubMed2000

Outpatient management of traumatic hyphemas in children.

OBJECTIVE: There are no outcome reports in the literature for outpatient management of traumatic hyphemas in children. Therefore we studied such cases at our institutions. DESIGN: Retrospective chart review. PARTICIPANTS: 25 children less than 16 years of age with grade I traumatic hyphemas. INTERVENTION: Inactivity at home with frequent office visits to monitor progress and complications. Treatment otherwise varied but virtually all patients received protective eye shields and topical steroids. MAIN OUTCOME MEASURES: Rate of rebleeding and final visual acuity. RESULTS: Three patients (12%) suffered a rebleed; one required surgery for clot evacuation. One of the three did not receive topical steroids and if he is excluded, rebleed rate is 2/24 or 8.3%. The hyphema resolved without sequelae in the other 22 patients. All patients had a final visual acuity of 20/40 or better except three patients (12%) who had concurrent vision-limiting ocular injuries and/or disease. Final visual acuity was 20/30 or better in all three patients with rebleeds. CONCLUSIONS: Our rebleed rate was within the broad range of rebleed rates reported in the literature. However, improved efforts to identify children at highest risk for rebleeding, to maximize compliance with treatments, and to consider systemic agents in selected cases, could further reduce the rebleed rate and increase acceptance and safety of outpatient management in pediatric traumatic hyphemas.

Adolescent↗
PubMed1999

Treatment outcome in fellow eyes after laser photocoagulation for retinopathy of prematurity.

PURPOSE: To determine the concordance in structural outcome between fellow eyes in patients undergoing diode laser peripheral retinal photocoagulation for threshold retinopathy of prematurity. METHODS: Records from 103 patients undergoing bilateral diode laser peripheral retinal photocoagulation for retinopathy of prematurity at three academic medical centers were reviewed. Information regarding infant gestational ages, birth weights, characteristics of retinopathy of prematurity, laser treatment variables, complications, and structural outcomes were obtained. The data were analyzed to determine the rate of successful structural outcomes among all eyes as well as the interocular outcome concordance. RESULTS: A successful structural outcome was observed in 182 (88%) of the 206 eyes. Eighty-eight patients (85.4%) had bilateral favorable outcomes. Nine patients (8.7%) had bilateral unfavorable outcomes, and six patients (5.8%) had one favorable and one unfavorable eye. The outcome was concordant between fellow eyes in 94.2% of patients. This rate was higher than predicted if fellow-eye outcomes were truly independent (P < .00001) and did not depend on study center, laser settings, or location of the retinopathy of prematurity. Serious complications related to treatment were uncommon. CONCLUSIONS: Diode laser peripheral retinal photocoagulation is a safe and effective procedure for treating threshold retinopathy of prematurity. The concordance of structural outcomes between fellow eyes is higher than expected by chance and suggests that patient-specific factors play a key role in treatment response.

Birth Weight↗
PubMed1999

Familial exudative vitreoretinopathy mimicking persistent hyperplastic primary vitreous.

PURPOSE: To report an unusual case of familial exudative vitreoretinopathy in an infant. METHODS: Case report. A 6-day-old girl had unilateral microphthalmia in the right eye, with a retrolental plaque initially diagnosed as persistent hyperplastic primary vitreous. Three months later, peripheral retinal vascular changes and a fibrovascular ridge were noted in the left eye, suggesting familial exudative vitreoretinopathy as the cause in both eyes. RESULTS: The microphthalmic right eye was unsalvageable. The left eye developed an exudative retinal detachment despite photocoagulation of the peripheral avascular retina. Additional cryotherapy resulted in resolution of the detachment and regression of the vascular changes. CONCLUSIONS: With highly asymmetric involvement, neonatal familial exudative vitreoretinopathy can mimic persistent hyperplastic primary vitreous. Fellow eye involvement can progress rapidly.

Cryotherapy↗
PubMed1999

Early strabismus surgery for thyroid ophthalmopathy.

OBJECTIVE: To determine whether strabismus surgery during active thyroid ophthalmopathy is beneficial for selected patients. DESIGN: Case series. PARTICIPANTS: Eight patients with severe restrictive strabismus due to thyroid ophthalmopathy underwent early strabismus surgery and were followed for a minimum of 16 months after their initial surgery. INTERVENTION: All eight patients underwent strabismus surgery while their thyroid ophthalmopathy was evolving. MAIN OUTCOME MEASURES: Success was determined by the ability to fuse in the primary position at distance and near without an abnormal head position, and the absence of vision-threatening complications related to strabismus surgery. RESULTS: All eight patients achieved successful long-term alignment. Four patients (50%) required more than one operation. CONCLUSIONS: Strabismus surgery during active thyroid ophthalmopathy can result in long-term stable alignment and may be a useful alternative in selected patients with marked disability due to thyroid ophthalmopathy.

Adult↗
PubMed1999

PHACE: a neurocutaneous syndrome with important ophthalmologic implications: case report and literature review.

OBJECTIVES: To introduce PHACE syndrome (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Coarctation of the aorta and other cardiac defects, and Eye abnormalities) to the ophthalmologic literature; to report the first case of PHACE syndrome associated with congenital glaucoma; and to review the ocular and systemic findings that may occur in this entity. DESIGN: Case report and literature review. METHODS: The authors report a child with PHACE syndrome and congenital glaucoma and review the ophthalmologic and systemic manifestations of this syndrome. RESULTS: A 9-month-old girl with PHACE syndrome was treated. She had a large right facial hemangioma, central nervous system (CNS) abnormalities, and cardiac anomalies. Glaucoma was detected in her left eye, and she underwent glaucoma surgery. She did well following two glaucoma procedures, and the facial hemangioma is responding to medical treatment. CONCLUSIONS: Ophthalmologists who examine children with large facial hemangiomas should consider PHACE syndrome in the differential diagnosis and should obtain appropriate CNS imaging studies and cardiac evaluation when the diagnosis is suspected. Congenital glaucoma should be added to the list of PHACE-associated ocular anomalies.

Abnormalities, Multiple↗
PubMed1999

Therapeutic outcomes of cryotherapy versus transpupillary diode laser photocoagulation for threshold retinopathy of prematurity.

INTRODUCTION: We undertook this study to compare the clinical outcomes in patients treated for threshold retinopathy of prematurity (ROP) with transpupillary diode laser photocoagulation versus transscleral cryotherapy. METHODS: A retrospective chart review was performed of patients treated for threshold ROP at our institution between 1988 and 1997. Cryotherapy was used to treat patients before 1992, and diode laser was used thereafter. One hundred fifteen eyes of 63 patients underwent cryotherapy, and 130 eyes of 70 patients underwent laser treatment. Because strong concordance exists between fellow eyes treated for ROP, statistical analysis was done for right eye outcomes only. Demographics, short-term complications, and treatment parameters were compared on the entire cohort of patients. Structural outcomes were compared between a group of 79 cryotreated eyes (39 OD, 40 OS) and a group of 113 laser-treated eyes (56 OD, 57 OS). Mean cycloplegic refraction was compared between a group of 38 cryotreated eyes (18 OD, 20 OS) and a group of 90 laser-treated eyes (46 OD, 44 OS). Visual acuity for preverbal and nonverbal children was estimated and converted to a Snellen visual acuity equivalent. Geometric mean visual acuity was then compared between a group of 44 cryotreated eyes (22 OD, 22 OS) and a group of 92 laser-treated eyes (47 OD, 45 OS). Patients were included in each outcome analysis if adequate documentation was present in the patient record. RESULTS: Demographics and short-term complications were not significantly different between the 2 groups. In the statistical group, 22 of 39 right eyes (56.4%) in the cryotherapy group versus 49 of 56 right eyes (87.5%) in the laser group had resolution of ROP after treatment (P = .0008). Mean spherical equivalent cycloplegic refraction at 12 months of age and over the follow-up period was not significantly different between the cryotherapy and laser groups. Estimated geometric mean visual acuity in the cryotherapy group was 20/103 and in the laser group was 20/49 at 12 months of age (P= .0099). CONCLUSIONS: Diode laser photocoagulation was associated with a better long-term structural outcome and visual acuity compared with cryotherapy for the treatment of threshold ROP. Refractive error was not significantly different between the 2 groups over an equivalent follow-up period.

Child, Preschool↗
PubMed1999

Incidence of presumed cytomegalovirus retinitis in HIV-infected pediatric patients.

INTRODUCTION: Large population studies of adult patients suggest an incidence of cytomegalovirus (CMV) retinitis as high as 19% to 20% as a late complication of adult HIV infection. We conducted this prospective study of a large cohort of HIV-infected children to determine the incidence of CMV retinitis in HIV-infected children. METHODS: From January 1984 to August 1997, 173 HIV-infected children were followed up for an average of 55.3 months (13-164 months). The patients were seen in the Department of Pediatrics at least once every 6 months. Ophthalmologic examinations were initiated when a patient's CD4 count dropped below 50 or sooner if required for ophthalmologic or other indications. Ophthalmologic examination was then repeated every 6 months. RESULTS: A total of 116 (67%) of 173 patients underwent ophthalmologic examination. Four (3.4%) of 116 patients had CMV retinitis at a mean time of 17.3 months (8-38 months) after their CD4 counts dropped below 20. None of the 4 patients with CMV retinitis had subjective visual complaints despite advanced retinitis. Three patients had bilateral and 1 patient had unilateral CMV retinitis. CONCLUSIONS: CMV retinitis occurred infrequently in HIV-infected pediatric patients and was diagnosed only in patients with a CD4 count below 20. Routine ophthalmologic screening examinations may not be necessary in pediatric patients until the CD4 count is below 20. Because children may not complain of decreased vision, at-risk children should undergo frequent ophthalmologic examination.

AIDS-Related Opportunistic Infections↗
PubMed1999

Optic neuritis in children: clinical features and visual outcome.

BACKGROUND: The purpose of this paper is to study the clinical spectrum of pediatric optic neuritis. We evaluated the presenting features, neuroimaging findings, cerebrospinal fluid abnormalities, associated systemic disease, and visual outcome in patients with this condition. METHODS: A retrospective analysis was performed on all patients who came to Baylor College of Medicine with optic neuritis during a 6-year period from 1991 to 1997. The degree of initial visual loss, subsequent visual recovery, and associated disease were reviewed. Magnetic resonance images and cerebrospinal fluid findings were also analyzed. RESULTS: Twenty-five patients (39 eyes) 21 months of age to 18 years of age were included in the study, with a mean follow-up of 11 months. Fourteen patients (56%) had bilateral optic neuritis, and 11 patients (44%) had unilateral disease. Thirty-three of 39 eyes (84%) had visual acuity of 20/200 or less at presentation. Twenty-one of 25 patients (84%) were given intravenous methylprednisolone (10 to 30 mg/kg/day). Thirty of 39 eyes (76%) recovered 20/40 visual acuity or better. Three of 39 eyes (7%) recovered vision in the 20/50 to 20/100 range. Six of 39 eyes (15%) recovered vision of 20/200 or less. Twenty-three of 25 patients (92%) underwent magnetic resonance imaging of the brain. A normal magnetic resonance image of the brain was associated with recovery of 20/40 or better visual acuity in 6 of 6 affected eyes (100%). Seven patients were 6 years of age or younger at presentation. Six of 7 (85%) had bilateral disease, and 12 of 13 (92%) affected eyes recovered 20/40 visual acuity or better. Eighteen patients were 7 years of age or older at presentation. Eight of 18 (44%) had bilateral disease, and 10 of 18 patients (56%) had unilateral disease. Eighteen of 26 affected eyes (50%) recovered 20/40 visual acuity or better. CONCLUSION: Pediatric optic neuritis is usually associated with visual recovery; however, a significant number (22%) remain visually disabled. A normal magnetic resonance image of the brain may be associated with a better outcome. Younger patients are more likely to have bilateral disease and a better visual prognosis.

Adolescent↗
PubMed1999

Childhood blindness.

PURPOSE: The objective of this study was to summarize available data regarding pediatric blinding diseases worldwide and to present the most up-to-date information on childhood blindness in the United States. METHODS: We obtained data from a complete search of the world literature and from direct contact with each of the schools for the blind in the United States. RESULTS: Five percent of worldwide blindness involves children younger than 15 years of age; in developing countries 50% of the population is in this age group. By World Health Organization criteria, there are 1.5 million children worldwide who are blind: 1.0 million in Asia, 0.3 million in Africa, 0.1 million in Latin America, and 0.1 million in the rest of the world. There are marked differences in the causes of pediatric blindness in different regions, apparently based on socioeconomic factors. In developing countries, 30% to 72% of such blindness is avoidable, 9% to 58% is preventable, and 14% to 31% is treatable. The leading cause is corneal opacification caused by a combination of measles, xerophthalmia, and the use of traditional eye medicine. There is no national registry of the blind in the United States, and most of the schools for the blind do not keep data regarding the cause of blindness in their students. From those schools that do have this information, the top 3 causes are cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia. There has been a significant increase in both cortical vision loss and retinopathy of prematurity in the past 10 years. CONCLUSIONS: There are marked regional differences in the prevalence and causes of pediatric blindness, apparently based on socioeconomic factors that limit prevention and treatment schemes. In the United States the 3 leading causes of pediatric blindness are cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia. There is a need for more complete and more uniform data based on the established World Health Organization reporting format.

Adolescent↗
PubMed1999

Acquired Pseudo-Brown's syndrome immediately following Ahmed valve glaucoma implant.

A 76-year-old woman noted vertical and horizontal diplopia one day following placement of an Ahmed valve in the superonasal quadrant of her left eye. She was unable to elevate her left eye, especially in adduction. She refused implant removal and strabismus surgery alone failed to satisfactorily resolve her problem. On forced duction testing, the implant became wedged between the globe and orbit superonasally. Subsequent repositioning of the valve resulted in resolution of her motility problem. Implant-orbital disproportion can produce a pseudo-Brown's syndrome. Surgeons are encouraged to perform forced duction testing at the time of glaucoma implant placement to detect and prevent this complication.

Aged↗
PubMed1998

Disinfection of eyelid speculums for retinopathy of prematurity examination.

OBJECTIVE: To evaluate the effectiveness of 70% isopropyl alcohol swabs in disinfecting eyelid speculums after examination for retinopathy of prematurity. METHODS: Two phases. Phase 1: 46 autoclave-sterilized eyelid speculums randomized into either a cleaned or control group following examination for retinopathy of prematurity. Speculums in the cleaned group were disinfected with a 70% isopropyl alcohol swab while control speculums were not cleaned. Bacterial and fungal cultures were then obtained. Phase 2: 20 autoclave-sterilized eyelid speculums inoculated with a clinically relevant dilution of adenovirus serotype 5 or herpes simplex virus type 2. Inoculated speculums were randomized into either a cleaned or control group. RESULTS: Phase 1: 17 (70.8%) of 24 cultures from the cleaned group yielded bacteria compared with 21 (95.5%) of 22 controls. Fungi were isolated from only 1 control and from no cleaned speculums. Phase 2: all speculums inoculated with adenovirus supported growth of the organism irrespective of cleaning with 70% isopropyl alcohol swabs. None of 5 cleaned speculums inoculated with herpes simplex virus type 2 supported viral growth, compared with 3 (60%) of 5 cultures positive for growth in the control group. CONCLUSION: Cleaning eyelid speculums with 70% isopropyl alcohol swabs provided inadequate disinfection against bacteria following examination for retinopathy of prematurity and against adenovirus in a laboratory simulation.

2-Propanol↗