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Biomedical subjects

E M Helveston

Publications and source records attributed to E M Helveston.

At least 19 recordsLinked to original sources
PubMed1992

Ophthalmology. The resident's perspective.

To determine how and why current residents in ophthalmology chose their medical specialty, we formulated and distributed a questionnaire to all ophthalmology residents in accredited programs. The results of the survey gave insight into not only their decision-making processes in choosing ophthalmology, but also their backgrounds, the factors that were important in choosing their residency program, and their future plans in ophthalmology. A wide variety of factors was involved in the decision to pursue a career in ophthalmology. In addition, we found current residents to be well qualified academically and generally satisfied with their decision to enter ophthalmology.

Career Choice↗
PubMed1992

A new classification of superior oblique palsy based on congenital variations in the tendon.

BACKGROUND: Superior oblique palsy is the most frequent isolated cranial nerve palsy seen in strabismus practice. It is traditionally diagnosed according to etiology as acquired, congenital, or idiopathic, but surgical treatment is based on deviation not etiology. Observations at surgery led to speculation that the superior oblique tendon is different in congenital compared with acquired superior oblique palsy and that this difference should be considered in surgical treatment. METHODS: The authors reviewed the charts of 82 patients (89 eyes) undergoing surgery on the superior oblique tendon for superior oblique palsy. In each case, the palsy had been diagnosed preoperatively as acquired, congenital, or idiopathic, and, at surgery, characteristics of the tendon anatomy were described. RESULTS: Thirty-eight superior oblique tendons (36 patients), diagnosed as congenital superior oblique palsy, included 33 abnormal tendons and 5 normal tendons. Twenty-four tendons (21 patients), diagnosed as traumatic superior oblique palsy, included 22 normal and 2 abnormal tendons. Twenty-seven tendons (25 patients), diagnosed as idiopathic, included 19 normal and 8 abnormal tendons. Abnormal tendons were divided into 4 categories: (1) redundant, (2) misdirected, (3) inserted in posterior Tenon's capsule, and (4) absent. CONCLUSIONS: The authors conclude that congenital superior oblique palsy is usually associated with a structural abnormality of the superior oblique tendon (87%). Whereas acquired superior oblique palsy usually has a normal tendon (92%). Superior oblique underaction in acquired superior oblique palsy results from a neural deficit. Potential variance in anatomy of the superior oblique tendon should be considered when undertaking surgery for superior oblique palsy.

Adolescent↗
PubMed1992

Surgical treatment of subluxated lenses in children.

BACKGROUND: Surgical removal of subluxated lenses had traditionally been discouraged because of concerns about poor surgical results and unacceptably high complication rates. METHODS: The authors reviewed the surgical results of 29 eyes in 15 consecutive patients who were operated on for subluxated lenses. RESULTS: Best-corrected visual acuity improved in all 29 eyes and was limited only by amblyopia. There were no significant complications in follow-up ranging from 5 months to 12 years. CONCLUSION: Modern surgical techniques using vitrectomy instruments allow the vitreous to be handled more effectively and have led to improved results and lower complication rates. Surgery for subluxated lenses can be done effectively and safely when indicated.

Child↗
PubMed1991

Measurement of low vision in children and infants.

The authors evaluated a preferential looking technique (Teller acuity cards) and a set of gross behavioral indicators (visual function battery) for the ability to rank visually impaired children and infants on the basis of their visual function. Fourteen older children with a diagnosis of cicatricial retinopathy of prematurity who were capable of giving Snellen acuities and a group of 31 preverbal infants with decreased vision due to a variety of causes were tested. Teller acuity card and visual function battery findings were highly correlated with each other (and with Snellen acuities in the older group); however, the Teller acuity cards provided better discrimination in the moderately visually impaired range, whereas the visual function battery was better in the severely impaired range. It is concluded that, in children and infants, visual function over the entire spectrum of low vision can be characterized by using a combination of the Teller acuity cards and the visual function battery.

Adolescent↗
PubMed1991

Large recession of the horizontal recti for treatment of nystagmus.

Ten patients had large recession of four horizontal recti at one procedure for treatment of nystagmus. Six patients had congenital motor nystagmus, two had oculocutaneous albinism, and two had optic nerve hypoplasia. Anomalous head posture with null point was also present in five patients. The rectus muscles were placed at or behind the equator in all but one case. Three patients with both esotropia and nystagmus had the medial recti placed 1 mm behind the equator and the lateral recti or at 1 mm anterior to the equator. Visual acuity improved an average of 1 line at distance and/or near in 8 patients who cooperated for testing. Although nystagmus was not eliminated in any patient, its its amplitude decreased in eight of ten patients, and anomalous head posture improved in three of five patients. In all patients, near vision was better than distance vision both preoperatively and postoperatively. Ductions were diminished minimally after the large recession and there were no other complications from surgery.

Adolescent↗
PubMed1990

The value of strabismus surgery.

Strabismus surgery is indicated for a variety of conditions stemming from misalignment of the eyes, abnormal head posture, and nystagmus. Although part of the value of such surgery lies in the fact that it improves appearance, it differs from cosmetic surgery, because, unlike the latter, it is designed to restore only normal configuration for ocular alignment--straight and/or aligned with the object of regard. A wide array of diagnostic tests are used to determine the precise treatment required, the goal of which is to provide comfortable vision, normal head position, and normal human appearance. In some cases nonsurgical techniques can be used to treat strabismus, but there is no evidence that visual training is an effective means of straightening eyes in those cases where surgery is considered the treatment of choice. For the most common strabismus, essential infantile or "congenital" esotropia, 80+% of infants have "straight" eyes after the initial operation, and 90% after a second operation, most of these with "straight eyes" have residual deviation of 5 prism diopters of esotropia or less. More than 50% of surgically treated patients have stable, long-term satisfactory results. Considering the effort required on the part of the ophthalmologist, together with the physical and psychological benefit to the patient, the cost of strabismus surgery should be equal to that of any major ophthalmic surgical procedure. That strabismus surgery is compensated at a lower rate, than for example, cataract surgery, suggests that strabismus surgery is an excellent value.

Cost-Benefit Analysis↗
PubMed1979

Reoperations in strabismus.

Reoperations in strabismus are done for overcorrection, undercorrections, and new strabismus problems such as dissociated vertical deviation and ptosis. Each patient requiring reoperation should be thoroughly evaluated on the basis of current findings with the understanding that some alteration in anatomy will be found. Restrictions must be freed and muscle force balanced to first provide straight eyes in the primary position and secondly the best vision possible. With persistence, 80% to 90% of patients requiring reoperation can expect a satisfactory end result.

Adult↗
PubMed1979

Coated Vicryl (polyglactin 910) suture in extraocular muscle surgery.

A newly available coated Vicryl (Polyglactin 910) suture was evaluated in laboratory and clinical trials for use in extraocular muscle surgery. The suture retains the increased strength and low antigenicity of uncoated Vicryl suture, while providing easier passage through tissue and improved tying characteristics. The improved handling properties result from the coating which produces a smoother suture surface.

Adolescent↗
PubMed1978

Augmented recession of the medial recti.

Bimedial rectus recession with measurement from the limbus was combined with conjuctival recession 85 children undergoing surgery for esotropia. Using this augmented recession technique, the prism diopters of correction per millimeter of surgery done were 4.8 compared with 3.2 found in 56 control patients. Postoperatively, the conjunctiva had a satisfactory cosmetic appearance and ductions were normal.

Adolescent↗
PubMed1977

Treatment results of retinoblastoma at Indiana University Hospitals.

This paper summarizes a review of all cases (70) of retinoblastoma seen at Indiana University Hospitals over the past 25 years (from 1952 to 1977) to determine the results of treatment and causes of failure. All cases from July, 1967, to the present were managed by the same group of physicians, thus following a consistent philosophy of treatment for those patients. Thirty-two patients treated during this latter period have survived a minimun of two years and are alive. Visual acuity of 20/20 has been preserved in all 16 patients with unilateral disease and a range of 20/50 to 20/20 in 12 of the 16 patients with bilateral disease. Because of the highly specialized diagnostic and therapeutic techniques and equipment required for optimal treatment results, it is recommended that patients with retinoblastomas be referred to treatment centers specializing in the management of this disease.

Child↗
PubMed1976

Extraocular muscle lacerations.

Five cases of laceration of an extraocular muscle without involvement of the globe or significant involvement of the adnexa occurred after injury with a pencil, mower blade, screen door, and building nail, and at surgery when the surgeon operated on the wrong muscle. The inferior rectus muscle was involved in three cases, the lateral rectus muscle in one, and the medial rectus muscle in one, Traumatic muscle laceration involves the inferior or medial rectus muscles more often than the other muscles. This may occur for two reasons: these muscles are closer to the corneoscleral limbus, and they are more visible during the protective blink with associated upward and usually outward movement of the globe (Bell's phenomenon). When the lacerated muscle could be found, it was repaired either by reinsertion to the sclera or reunion of the severed muscle segments. When the muscle could not be found, a muscle transfer procedure was carried out. Patients with fusion before injury regained fusion in part of the visual field after muscle repair.

Adolescent↗
PubMed1976

Synthetic absorbable suture for strabismus surgery.

Polyglactin 910 (Vicryl), a synthetic absorbable braided suture in 5-0 or 6-0 size, was satisfactory for recession and resection of extraocular muscles. It produced an acute allergic reaction in only one of 89 cases (1.5%) as compared to a 19% reaction when collagen suture of like size was used. Polyglactin 910 suture, when left partially exposed, may be irritating and can cause excessive reaction when used at the conjunctival limbus.

Collagen↗
PubMed1976

Surgical weakening of the inferior oblique.

1. The inferior oblique may be weakened effectively by recession, disinsertion, or myectomy, disrupting the muscle continuity between Lockwood's ligament and the muscle's insertion. 2. A successful unilateral inferior oblique weakening produces 20 prism diopters less hypertropia or more hypotropia in the field of action and has less effect away from the muscle's field of action; a bilateral weakening of the inferior oblique produces 20 prism diopters less exotropia or more esotropia in upgaze. 3. Complications of inferior oblique weakening are persistent overaction, operation on the wrong muscle, and the adherence syndrome. 4. The adherence syndrome is not related to the myectomy procedure specifically but is probably related to (or caused by) fat rupture with hemorrhage, which may accompany any type of inferior oblique weakening. 5. The adherence syndrome can be avoided by careful surgical technique.

Humans↗