Search PubMed⌕ Search

Biomedical subjects

D K Coats

Publications and source records attributed to D K Coats.

53 records · Page 3Linked to original sources
PubMed1998

Rectus muscle recession and resection without scleral sutures.

PURPOSE: To eliminate the risk of scleral perforation during strabismus surgery in susceptible patients, we introduce a technique to allow predictable rectus muscle recession and resection without the placement of scleral sutures. METHODS: Three patients with thin sclera underwent rectus muscle surgery by use of a double-arm suture technique that avoids placement of sutures directly into the sclera. Two of the patients had esotropia and underwent bilateral lateral rectus muscle resections and a unilateral recess/resect operation, respectively. One of the patients had exotropia and underwent bilateral lateral rectus muscle recessions. RESULTS: All three patients achieved postoperative alignment to within 15 PD of orthotropia and had no evidence of slipped or lost muscle when examined 2 months postoperatively. The appearance of the ocular surface was excellent in all three cases. CONCLUSIONS: Predictable and secure rectus muscle recession and resection can be performed without the placement of scleral sutures in patients in whom scleral suturing may be hazardous.

Aged↗
PubMed1998

Early-onset refractive accommodative esotropia.

INTRODUCTION: We studied the natural history of pure refractive accommodative esotropia after spectacle correction in patients with onset before 1 year old to determine whether their outcomes and characteristics were different from those of patients with more typical age at onset of refractive accommodative esotropia. METHODS: We retrospectively reviewed the charts of 17 children with onset of refractive accommodative esotropia before 1 year old. Records of 26 children with onset after 2 years old were reviewed as controls. RESULTS: The mean ages at diagnosis were 9 months and 48 months for the study and control groups, respectively. All 17 study patients and all 26 control patients were initially well aligned with spectacles at distance and near. Follow-up averaged 34 months for study patients and 41 months for control patients. Three study patients (17.6%) and 1 control patient (3.8%) had eventual deterioration and required strabismus surgery (P = .28). None of the study patients developed amblyopia, whereas 42% of control patients did (P = .001). Seven of 15 (47%) of the study patients with known birth history were born prematurely, whereas only 3 of 24 (12%) control patients were born prematurely (P = .03). CONCLUSIONS: Refractive accommodative esotropia was diagnosed at as early as and age 4 months. Prematurity appeared to be a risk factor. Amblyopia was not detected in any patient with early-onset refractive accommodative esotropia. Treatment with full hyperopic spectacle correction led to long-term stable alignment, with relatively few patients requiring surgery.

Accommodation, Ocular↗
PubMed1998

Etiology and surgical management of horizontal pontine gaze palsy with ipsilateral esotropia.

INTRODUCTION: An esotropia ipsilateral to a horizontal pontine gaze palsy has been infrequently reported. We discuss the etiology and review the surgical management of this ocular motility defect. METHODS: Four patients with radiographically documented dorsal pontine lesions and persistent horizontal gaze palsy with esotropia ipsilateral to the gaze palsy were treated. In each patient, the esotropia was present in attempted primary gaze, producing symptomatic diplopia. An anomalous face turn was required to attain single binocular vision. RESULTS: All 4 patients underwent surgical correction to alleviate the anomalous head position and diplopia. Bilateral, asymmetric surgery was required to achieve a long-term successful result. Single binocular vision in the primary position with elimination or marked improvement of the compensatory head posture was initially achieved in all 4 patients. One patient, who had not undergone asymmetric strabismus surgery to reconcile incomitance produced by the esotropia, rapidly developed a residual esotropia. CONCLUSIONS: Ophthalmologists should recognize that concurrent esotropia may occur in patients with horizontal pontine gaze palsy. Single binocular vision in the primary position, an expanded binocular visual field, and alleviation of a compensatory head position are achievable with strabismus surgery.

Abducens Nerve Diseases↗
PubMed1998

Unrecognized microscopic hyphema masquerading as a closed head injury.

OBJECTIVE: To present a child with an unrecognized microscopic traumatic hyphema and acute glaucoma who was initially treated as a closed head injury patient. DESIGN: Case report and discussion. RESULTS: Symptoms attributable to unrecognized occult ocular injury in a child with sickle cell trait resulted in evaluation and treatment of the child for a closed head injury. Evaluation included a computed tomography scan of the head and lumbar puncture. An ophthalmologic consultation later revealed a microscopic hyphema and acute glaucoma as the etiology of the child's signs and symptoms. CONCLUSIONS: Children who present with neurologic symptoms and a history of ocular trauma should undergo an ophthalmologic examination as soon as possible. Hyphema, even if not readily visible on physical examination, can result in the development of acute glaucoma with signs and symptoms that resemble a closed head injury.

Child↗
PubMed1997

Intraoperative traction testing to detect incomplete inferior oblique myotomy/myectomy.

PURPOSE: Incomplete transection of the inferior oblique muscle during myotomy or myectomy is an important preventable cause of ineffective inferior oblique weakening surgery. Intraoperative traction testing has been suggested as a means of detecting an incomplete inferior oblique transection. The usefulness of intraoperative traction testing to detect incomplete myotomy was evaluated. METHODS: The subjective "tightness" of the inferior oblique muscle was evaluated after partial and complete myotomy to determine how partial myotomy affected inferior oblique traction testing and to determine whether intraoperative traction testing is an effective means of ensuring that a complete myotomy has been achieved. Serial traction testing was performed on 10 inferior oblique muscles at the time of myotomy and scored, 0+ to 4+ tightness. Testing was performed before myotomy and after 50%, 90%, and total myotomy. RESULTS: In 8 of 10 eyes traction testing remained strongly positive until the inferior oblique muscle had been completely transected. The average inferior oblique muscle tightness of these eight muscles was +1.69 before myotomy and after 50% and 90% myotomy. The tightness decreased to 0 after 100% myotomy. In two cases no inferior oblique muscle could be detected after 50% and 90% myotomy, respectively. These two muscles had preoperative traction testing of +0.5 and +1.00, respectively. CONCLUSIONS: Intraoperative traction testing is a practical and effective method of detecting incomplete inferior oblique myotomy/myectomy, but the test should be interpreted with caution in patients with loose premyotomy muscles.

Adolescent↗
PubMed1997

Anomalous head posture with early-onset homonymous hemianopia.

PURPOSE: We have noted the frequent finding of an ipsilateral head turn in children with early-onset homonymous hemianopia. We report a series of patients with these findings and propose a theory to explain this association. METHODS: Ten patients with early-onset homonymous hemianopia and anomalous head posture were examined. Head computed tomography and magnetic resonance imaging confirmed a cerebral lesion as the cause of the hemianopia in all patients. RESULTS: All patients had onset of central nervous system disease prenatally or before age 18 months. A head turn toward the visual field defect with a gaze preference contralateral to the visual field defect was present in all patients. CONCLUSIONS: Early-onset homonymous hemianopia should be included in the differential diagnosis of anomalous head posture.

Age of Onset↗
PubMedDate not supplied

Facial asymmetry and tendon laxity in superior oblique palsy.

Both facial asymmetry and superior oblique tendon laxity are associated with congenital superior oblique muscle palsy (SOP). It is unknown whether facial asymmetry and tendon laxity are related to each other, perhaps even causally. We evaluated 29 patients with SOP for presence of facial symmetry, tendon laxity, or both, and correlated these findings with presence or absence of chronic head tilt. Sixteen of 21 (76%) unilateral congenital SOP patients had facial asymmetry and 17 (81%) had tendon asymmetry. Ninety-four percent had either or both abnormalities, but only 57% had tendon laxity (palsy) on the side opposite the facial hypoplasia. All patients with facial hypoplasia had a head tilt toward the hypoplastic side of the face, regardless of which side the palsy was on. These findings, along with previous studies of congenital muscular torticollis, infer that the two anatomic abnormalities associated with congenital SOP (facial asymmetry and tendon asymmetry) do not occur as part of the same developmental sequence, but the facial asymmetry develops as a consequence of a chronic head tilt from a young age.

Adolescent↗
PubMedDate not supplied

Predictive value of temporal retinal disease in retinopathy of prematurity.

PURPOSE: Screening examinations for retinopathy of prematurity (ROP) can be stressful to the premature infant. The temporal retina is the most easily visualized area of the peripheral retina. This study was undertaken to determine whether evaluation of the temporal peripheral retina provides a reliable indicator of the ROP status of the entire retina. METHODS: A total of 690 ROP eye examinations were performed on 156 premature infants. Eye examinations of 95 patients were reviewed retrospectively and of 61 patients prospectively. All patients were born at less than 34 weeks estimated gestational age (EGA) and had a birth weight less than 1600 g. No examinations were performed prior to 4 weeks of age. Each eye examination was considered independently. The fundus examination was recorded using the International Classification of Retinopathy of Prematurity. The temporal four clock hours of retina were classified as the "temporal" retina. The remainder of the peripheral retina was classified as "nontemporal." RESULTS: A highly significant correlation (Pearson correlation coefficient = 0.88) between the severity (ie, stage) of temporal ROP and the severity of nontemporal ROP was noted. The status of temporal ROP was found to be more advanced or the same as nontemporal retina in 91.2% of the examinations. Nontemporal disease was found to be more severe than temporal disease in 8.8% of the examinations, but only 0.4% of examinations indicated nontemporal disease that was worse than temporal disease by more than one stage. CONCLUSIONS: The temporal retinal disease status in ROP is strongly predictive of the disease status of the entire retina. An abbreviated retinal examination of the temporal clock hours provides a reliable indicator of the highest stage of ROP present in the entire retina. Such a screening examination, although not recommended for routine screening, may be useful when a complete ROP examination cannot be performed because of physiologic instability or poor visibility.

Forecasting↗