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Biomedical subjects

F A Billson

Publications and source records attributed to F A Billson.

At least 109 records · Page 6Linked to original sources

The place for vitrectomy in posterior segment infection.

The paper reviews experience with vitrectomy in five cases of endophthalmitis in which vision was severely reduced because of vitreous opacification. In two of the cases vitrectomy was performed after the infection had been aborted, and in three of the cases vitrectomy was performed during the stage of acute endophthalmitis when there was evidence that the condition was not responding to conservative medical treatment. In all cases, vitrectomy resulted in a dramatic improvement in vision. It is suggested that vitrectomy represents a major advance in the management of bacterial and fungal endophthalmitis.

Aged↗

Bilateral optic nerve hypoplasia.

In the past 10 years, 15 children with bilateral optic nerve hypoplasia have been studied at the Royal Alexandra Hospital for Children. There were 5 boys and 10 girls. Nine were first-born and they presented at a mean age of 5 months (range: 4 days to 25 months). Five presented with suspected blindness and 7 with abnormal eye movements (nystagmus or less commonly squint). The other 3 presented because of fits or developmental delay. Eight showed evidence of neural damage--microcephaly, seizures and/or abnormalities of tone. Four appeared to be of normal or near normal intelligence, 6 were mildly retarded and 5 severely so. Two patients had already died, one suddenly. Six of the 7 cases investigated in detail had evidence of hypothalamic pituitary dysfunction. Another one had a minimal hypothalamic abnormality. Four were severely growth retarded and 2 were receiving growth hormone replacement. Two males had micropenis and a girl had precocious puberty with partial diabetes insipidus. Neuroradiological investigations showed an absent septum pellucidum in only 5 cases. Five patients had other major CNS malformations. Five patients had normal CT scans; 3 of these 5 appeared of normal intelligence and all 5 had normal neurological examinations. Bilateral optic nerve hypoplasia is frequently associated with serious brain and endocrine abnormalities.

Brain↗

A longitudinal study of very low-birthweight infants. IV: An overview of performance at eight years of age.

A cohort of 169 very low-birthweight infants (800 to 1500g) was followed prospectively to the age of eight years. Information on 159 of the children was available at that age, and for a further five to the age of six years. A comparison group of 67 normal-birthweight children was also followed, but only 43 of these children were seen at the age of eight years. Eight of the very low-birthweight (VLBW) children were attending special schools and 156 attended normal schools: placement of the remaining five was unknown. Of the VLBW children who were adequately assessed, 15.9 per cent were either not reading or were retarded by more than 18 months. Mean VLBW full-scale IQ was 88.8, compared with 98.8 for the normal-birthweight group. A subgroup of 10 VLBW children with birthweights under 1000g had lower mean scores on all three WISC-R scales compared with those with birthweights between 1000 and 1500g. Of the adequately assessed VLBW children, 3.7 per cent had epilepsy, 3.7 per cent had significant sensorineural deafness and 2.4 per cent suffered from cerebral palsy. One or more visual defects were detected in 31.4 per cent of the children, though in only 3.8 per cent was the defect serious. At eight years, growth dimensions for the VLBW children were below the 10th percentile for 11.0 per cent in weight, 16.1 per cent in height and 15.0 per cent in head circumference. Degrees of handicap in the VLBW children were profound in 5.1 per cent, severe in 10.8 per cent and significant in 40.5 per cent: handicap was minimal or absent in the remaining 43.6 per cent. For the normal-birthweight group the percentages were 2.3, 0, 25.6 and 72.1 respectively. The VLBW children with minimal or no handicap were considered to have a satisfactory outcome. This was significantly correlated with the following: gestation over 30 weeks; birthweight over 1199g; no major apnoeic attacks; lowest postnatal weight before six days; return to birth weight before 21 days; peak serum bilirubin not exceeding 255 mumol/litre; and parental social-class between 2 and 5 on the seven-point Congalton Scale.

Child↗

Fungal retinitis: a case of Torulopsis glabrata infection treated with miconazole.

Presumptive embolic chorioretinal Torulopsis glabrata infection is described in a patient who had received prolonged intravenous antibiotic therapy. The ocular findings are compared and contrasted with embolic lesions due to Candida albicans. The patient was treated for 6 weeks with intravenous miconazole. During this time there was shrinkage of the ocular lesions, some improvement in vision and abolition of fungaemia. Improvement in tests of immune function during treatment suggests that an early immunological deficit was secondary to the infection. Intravenous miconazole is a relatively nontoxic alternative to amphotericin and deserves further evaluation in the treatment of ocular mycosis.

Adult↗

Visual loss in osteopetrosis.

We present the clinical and electrophysiological findings in three cases of osteopetrosis with visual loss. In all cases the findings on electroretinography suggested diffuse retinal degeneration, despite normal ophthalmoscopic appearance of the retinas. We suggest that retinal degeneration may be a common finding in osteopetrosis and a major cause of visual loss. Patients with osteopetrosis and poor vision should be examined using electrophysiological techniques to detect unsuspected retinal dysfunction.

Blindness↗

A longitudinal study of very low-birthweight infants. II: Results of controlled trial of intensive care and incidence of handicaps.

Between 1966 and 1970, infants with birthweights between 1000 and 1500g entered a randomized controlled trial to determine the short-term and long-term results of neonatal intensive care. Of 158 long-term survivors, five were lost to follow-up, but the multidisciplinary research team prospectively followed 143 children up to the age of eight years. Useful data were available for the other 10 children. Of the long-term survivors 74 had received routine, and 84 had received intensive nursery care. At eight years of age there were no statistically significant differences in the frequencies of a variety of individual abnormalities; fewer of the intensively managed children had cerebral palsy, but sensorineural deafness and ocular abnormalities occurred more frequently. Individual children were graded into four carefully defined groups: (a) profound handicap (4.4 per cent of entire study group); (b) severe handicap (10.1 per cent); (c) significant handicap (37.3 per cent); and (d) trivial or no handicap (41.8 per cent). Inadequate data were available for 6.3 per cent of the children. It was apparent that the improved survival attributed to intensive neonatal care was achieved at the expense of additional severely handicapped children, and this feature is discussed.

Cerebral Palsy↗

Optic neuropathy in ketogenic diet.

A symmetrical, bilateral optic neuropathy is reported in 2 patients being treated with ketogenic diets for seizure control. Laboratory tests suggested a thiamine deficiency, and both patients recovered normal visual function after several weeks of treatment with thiamine. The risk of optic nerve dysfunction occurring during the treatment with a ketogenic diet can be minimised if routine vitamin B supplements are given and periodic evaluation of optic nerve function undertaken.

Child↗

Trauma to the lacrimal system in children.

We repaired damage to the lacrimal drainage system in a series of 393 children who had lacrimal obstruction caused by congenital obstruction or facial injuries. Delayed surgery for traumatic obstruction of the nasolacrimal duct in children, including infants, was successful in all cases.

Dacryocystorhinostomy↗

Maternal anticonvulsants and optic nerve hypoplasia.

Seven patients with optic nerve hypoplasia, born of epileptic mothers, are presented. All the mothers took anticonvulsants during pregnancy. The possibility that maternal anticonvulsant therapy may play a role in the genesis of optic nerve hypoplasia is discussed in the light of what is known about the teratogenicity of these agents.

Abnormalities, Drug-Induced↗

The supranuclear disturbances of gaze in kernicterus.

Five patients with kernicterus and ocular motility disturbances are reported. All of the patients showed some defect in vertical gaze but not always upgaze. The most severely affected patient exhibited slowness of horizontal saccades in addition to a total vertical gaze palsy. In general, the severity of the ocular motility disturbance paralleled the severity of hearing loss. It is suggested that damage to the periaqueductal area accounts for disturbances in vertical gaze and the infrequent horizontal saccadic disturbances results from interruption of the descending centrifugal fibers. It is emphasized that kernicterus must be included in the differential diagnosis of any supranuclear vertical gaze disturbance.

Athetosis↗

Rheumatic diseases and the eye.

The ocular complications of the rheumatic diseases are common, frequently insidious and sight threatening, and deserve review to heighten awareness and facilitate earlier diagnosis and treatment.

Arthritis, Juvenile↗

Retinoblastoma in Victoria.

This paper reports all cases of retinoblastoma occurring in Victoria over a 20-year period between 1956 and 1976. It suggests that the natural history of treated retinoblastoma in an Australian community, is characterized by low mortality (8.3%), but significant morbidity. The most common problem in management of unilateral cases was one of diagnosis in contrast to bilateral cases, in which the problem was one of maintaining useful vision whilst at the same time eradicating a life-threatening tumour. Suggestions are made as to how management of retinoblastoma may be further improved, and the need for an active national register is discussed.

Australia↗

Low-carbohydrate diet optic neuropathy.

Visual loss occurring in two patients taking prolonged carbohydrate-restrictive diets is reported. The clinical data in these patients point to a specific diet deficiency of thiamine, causing a bilateral optic neuropathy. A discussion of current concepts of thiamine deficiency in neuroophthalmic disorders is presented. It is recommended that patients on low-carbohydrate diets for prolonged periods of time should receive thiamine supplements.

Adult↗