Biomedical subjects
J F Acheson
Publications and source records attributed to J F Acheson.
Coagulation abnormalities in ischaemic optic neuropathy.
The aetiology of non-arteritic ischaemic optic neuropathy (ION) is multifactorial with local anatomical and systemic haemodynamic abnormalities both playing a role. A careful search for treatable vascular disease risk factors is required to allow rational therapy, to optimise the visual prognosis and to allow new insights into pathogenesis. We describe 7 cases in which there was an associated thrombophilic (prothrombotic) state; 4 had deficiencies of the physiological anticoagulants proteins C and S and antithrombin III and 2 had anti-phospholipid antibody (lupus anticoagulant) syndromes. A further patient had reduced levels of the physiological fibrinolytic agent tissue plasminogen activator (t-PA). In 5 patients other risk factors for small vessel occlusive disease were also present, and 4 had recurrent episodes of ION in the same eye. The visual prognosis in these patients may be improved by anticoagulation with warfarin.
Optic nerve sheath decompression for the treatment of visual failure in chronic raised intracranial pressure.
The records of all patients undergoing optic nerve sheath decompression for visual failure in chronic raised intracranial pressure performed over a 15 year period have been reviewed. The aim was to study the visual outcome and relation to any shunting procedures. Fourteen patients (20 eyes) were identified in whom follow up information of at least one year was available. Eleven patients had benign intracranial hypertension (idiopathic intracranial hypertension) and three had dural venous sinus occlusive disease. Eight patients had unilateral surgery and six had bilateral surgery. Visual acuity and fields either improved or stabilised in 17 out of 20 eyes and three deteriorated. Of the eight patients undergoing unilateral surgery, the other eye remained stable in seven and deteriorated in one. Four patients required optic nerve sheath decompression despite previous shunting or subtemporal decompression. Five patients required shunts or subtemporal decompression after optic nerve sheath decompression because of persistent headache in three cases and for uncontrolled visual failure in two cases. No patients lost vision as a direct consequence of surgery. It is concluded that optic nerve sheath decompression is a safe and important therapeutic option in the management of chronic raised intracranial pressure complicated by visual loss. Vision can be saved after shunt failure, and in other cases may be maintained without the need for a shunt. Shunts may still be required, however, after optic nerve sheath decompression, especially for persistent headache.
Reversible visual failure due to exudative retinal detachments in a patient with uncontrolled systemic hypertension.
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Penetrating keratoplasty in severe ocular graft versus host disease.
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Cryosurgery for acute retinopathy of prematurity: factors associated with treatment success and failure.
Cryosurgery for stage 3 plus acute retinopathy of prematurity (ROP) increases the probability of disease regression, but up to 25% of eyes may progress to retinal detachment and blindness in spite of treatment. In a series of 37 eyes in 23 patients treated at the Hammersmith Hospital an overall 75% of eyes reached a favourable outcome. We present these results in detail and analyse the apparent causes of treatment failure. Poor anatomical results (total retinal detachment and traction detachment involving the macula) were associated with inappropriate cryoprobe design and with zone 1 and rush-type disease. Poor functional results in the presence of a largely flat retina (marked macular ectopia and high myopia) appeared to be associated with delayed treatment during the period of evolution of the stage 3 lesion, and with the appearance of a more highly differentiated vascular shunt with early localised forward vitreous invasion. Suggestions for the refinement of existing gradings of acute ROP are made.
Vaso-occlusive retinopathy in the primary anti-phospholipid antibody syndrome.
We report two patients with contrasting patterns of retinal vascular occlusion associated with the primary anti-phospholipid antibody syndrome. The immuno-pathological features and clinical associations are discussed. This condition is of interest to ophthalmologists because of its association with thrombosis in the eye, brain and elsewhere and because it provides new insights into the pathogenesis of retinal vascular disease in young patients.
Surveillance for retinopathy of prematurity in practice: experience from one neonatal intensive care unit.
We have reviewed the results of a six year surveillance programme for acute Retinopathy of Prematurity (ROP) in order to see how the yield of cases reaching clinically significant stage 3 can safely be maximised, and to assess the effectiveness of an examination technique which does not require a speculum or scleral indentation. An overall 137 (44.8%) developed some signs of ROP and 35 (10.8%) reached stage 3. Seventeen of these were born at 25 weeks or less gestational age, and included four with rush-type disease. None of those born at or over 30 weeks developed stage 3. It is concluded that infants born at 31 weeks or more do not need to be included in a surveillance program, and this protocol will increase the yield of significant disease. In addition, cases of stage 3 which may require cryosurgery will not be missed using an atraumatic examination technique.
Ocular morbidity due to monofilament nylon corneal sutures.
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Extraocular muscle surgery in myasthenia gravis.
Myasthenia gravis is typically a disease of young people in active employment who need a field of binocular single vision. Although it is systemically controllable with a good chance of spontaneous remission, persistent loss of binocularity may cause chronic disability. We report our experience of extraocular muscle surgery in five patients with stable myasthenia gravis and persistent double vision. Extraocular muscle involvement was selective, giving rise to incomitant and concomitant squints, with individual muscle overactions as well as underactions. Treatment was by conventional recession and resection procedures with the additional use of Faden and adjustable sutures where appropriate. In all five cases a larger, stable field of binocular single vision was established. It is concluded that extraocular muscle surgery may be beneficial in selected cases of myasthenia gravis.
Serious eye injuries due to war games.
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Comment on the article by Stafford-Brady et al.
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Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the 'primary' antiphospholipid syndrome.
Seven cases of occlusive ocular vascular disease affecting retinal and choroidal vessels were found among 84 consecutive patients with raised levels of anticardiolipin antibodies attending the lupus arthritis clinic at St Thomas's Hospital from 1985 to 1987. Six patients with systemic lupus erythematosus (SLE) and one with a 'primary antiphospholipid syndrome' had occlusive ocular vascular disease affecting a variety of vessels. This gives a prevalence of occlusive ocular vascular disease of 8% in this subgroup of patients, significantly higher than the 0.5-2.0% previously reported in patients with SLE. Four of these patients also suffered from cerebrovascular disease, supporting the previously documented association between occlusive ocular vascular disease and central nervous system disease in SLE. Additionally, other features of the antiphospholipid syndrome were frequently present. These findings suggest that patients with SLE and raised anticardiolipin antibodies have a higher risk of developing occlusive ocular vascular disease than has been previously reported.
Ptosis and supranuclear downgaze paralysis.
A patient developed the unusual combination of a supranuclear downward gaze paralysis and bilateral ptosis. It was caused by a single midbrain glioma. Other ocular motor functions were intact. The neuropathologic examination showed a tumor growing mainly around the third ventricle and the aqueduct. The findings agree with recent experimental evidence that a network of neural elements involved in eyelid control lies in the supraoculomotor area immediately dorsal to the oculomotor nucleus.
Management of retinal vein occlusion.
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Changing patterns of early complications in cataract surgery with new techniques: a surgical audit.
We have undertaken a retrospective review of samples of case records from patients undergoing cataract surgery at St Thomas's Hospital over the years of the introduction of new extracapsular techniques and the widespread use of intraocular lens implants. We found no significant change in the proportion of patients achieving a corrected visual acuity of better than or equal to 6/12 three months after surgery. However, the pattern of complications was found to have changed in three respects. Firstly, there was a fall in the frequency of raised intraocular pressure requiring treatment associated with the abandonment of intracapsular surgery and the use of chymotrypsin. Secondly, a considerable number of patients who had had extracapsular extractions suffered from visually disabling posterior capsular thickening (13%). Thirdly, there was a downward trend in the rates of vitreous loss and of reduced vision at three months due to vitreous haemorrhage, vitritis, and retinal detachment in the patients undergoing extracapsular cataract surgery.
Eye injuries caused by directed jets of water from a fire hose.
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