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Biomedical subjects

M B Kappagoda

Publications and source records attributed to M B Kappagoda.

At least 19 recordsLinked to original sources
PubMed2001

Orbital inflammation in a patient with extrascleral spread of choroidal malignant melanoma.

An elderly woman presented with fever, dehydration, orbital inflammation, total external and internal ophthalmoplegia and blindness, resembling the clinical appearance at presentation of severe orbital inflammatory disease or mucormycosis. Orbital computed tomography scanning demonstrated a retrobulbar orbital mass. Subsequent B-scan ultrasound examination confirmed the orbital mass but also demonstrated a mass within the eye. At lateral orbitotomy, extrascleral spread of an entirely necrotic intraocular melanoma was demonstrated. As computed tomography scanning may not be able to delineate an entirely necrotic intraocular malignant melanoma, B-scan ultrasonography should be considered in patients with orbital inflammation, especially in the presence of a retrobulbar mass.

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PubMed2000

Primary phacoemulsification for uncontrolled angle-closure glaucoma.

PURPOSE: To report the results of primary phacoemulsification to treat uncontrolled angle-closure glaucoma. SETTING: Private practice and teaching hospital department. METHODS: This retrospective interventional case series assessed 3 patients having phacoemulsification and posterior chamber intraocular lens implantation for uncontrolled intraocular pressure (IOP) after acute primary angle-closure glaucoma. RESULTS: Intraocular pressure control was achieved in all patients postoperatively. CONCLUSIONS: Primary phacoemulsification with the option of future trabeculectomy should be considered in selected patients with persistent appositional angle closure and uncontrolled IOP after angle-closure glaucoma.

Adult↗
PubMed2000

Superior oblique palsy in a patient with a history of perineural spread from a periorbital squamous cell carcinoma.

A 74-year-old man experienced vertical diplopia. Two years earlier, he was diagnosed with a squamous cell carcinoma of the periorbital frontal skin, with perineural spread involving the ophthalmic division of the right trigeminal nerve and the right facial nerve. The clinical findings were consistent with a right fourth cranial nerve palsy. Computerized tomography and magnetic resonance imaging demonstrated a discrete mass involving the belly of the right superior oblique muscle. An anterior orbitotomy and biopsy demonstrated a mass extending into the belly of the superior oblique muscle. Histology revealed an infiltrating squamous cell carcinoma. The possibility of perineural, direct, or metastatic spread to the superior oblique muscle should be considered in a patient with a history of squamous cell carcinoma of the head and neck. The authors believe this case to be the first report of superior oblique underaction due to involvement of the muscle by squamous cell carcinoma, presumably because of perineural spread. Diagnosis was made possible by neuroimaging and histopathology. There was good short-term resolution of the patient's diplopia after radiotherapy.

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PubMed1999

Computed tomography of the lacrimal drainage system: retrospective study of 107 cases of dacryostenosis.

PURPOSE: To evaluate the role of computed tomography in patients with dacryostenosis. METHODS: One hundred seven cases of dacryostenosis (94 patients) were assessed by thorough clinical and lacrimal history and examination, and lacrimal region computerized tomography (CT). The lacrimal drainage system examination included the state and position of the puncta; Jones testing; lacrimal syringing; and, in the latter half of the study, telescopic nasal endoscopy. The patients were drawn from the hospital outpatients and private office of the operating lacrimal surgeon in this series (I.C.F.). Of the 107 cases, 79 either underwent dacryocystorhinostomy surgery or had this planned. RESULTS: In 14 of the 107 cases (12 patients), preoperative CT led to an alteration of patient management, usually referral to an otolaryngologist for further evaluation or treatment. In addition to the detection of two tumors extrinsic to the sac, conditions such as ethmoiditis, lacrimal sac mucoceles, soft tissue opacity in the nasolacrimal duct, gross nasal polyposis, fungal sinusitis, and a dacryolith were observed by CT. CONCLUSION: Similar to the role of functional endoscopic sinus surgery in otolaryngology, CT imaging will become increasingly important in the assessment of many patients with symptoms of lacrimal drainage obstruction.

Dacryocystorhinostomy↗
PubMed1998

Artist's impression of endocapsular phacoemulsification surgery.

A 77-year-old artist having endocapsular phacoemulsification surgery and intraocular lens implantation illustrated her visual impressions of the procedure in 6 stages, from draping to lens implantation. Her illustrations and commentary indicate that she experienced clear visualization of instruments and colorful abstract imagery. These paintings were shown to 30 consecutive patients to assess their usefulness in preoperatively informing and preparing patients for surgery. With the widespread use of local and topical anesthesia, it is pertinent to the ophthalmic surgeon to understand what patients may seen when vision is retained during the procedure.

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PubMed1998

Intraoperative complications of 1000 phacoemulsification procedures: a prospective study.

PURPOSE: To determine the frequency and nature of intraoperative complications of endocapsular phacoemulsification cataract surgery. SETTING: Dalcross Private Hospital and the Departments of Ophthalmology, Concord Hospital and Prince of Wales Hospital, Sydney, Australia. METHODS: This prospective study included the first 1000 cases of planned endocapsular phacoemulsification cataract surgery performed by an experienced surgeon. A standardized proforma was completed at the time of surgery. Data recorded included pre-existing ocular abnormalities, duration of surgery, nuclear sclerosis grade, and intraoperative complications. RESULTS: Major complications comprised posterior capsule tears with vitreous loss (1.4%), isolated posterior capsule tears (0.7%), and zonulysis (0.1%). Minor complications included anterior capsule tears (3.8%), iris prolapse (0.6%), and ciliary body incision (0.2%). There was a significant trend toward complications as the nuclear sclerosis grade increased. The incidence of major complications was 9.3% in the first 150 cases and 0.9% in the last 850. This represents a relative risk of 9.9 (95% confidence interval 4.2 to 23.0) of a major complication occurring in the first 150 compared with the later 850 cases. CONCLUSION: The frequency of major and minor complications fell sharply after the first 150 operations and was maintained. This study may provide a guide for beginning phacoemulsification surgeons and a basis for experienced surgeons to compare their performance outcomes.

Adult↗
PubMed1996

Prospective study of the SI-40NB foldable silicone intraocular lens.

PURPOSE: To evaluate the surgical performance and postoperative outcomes of 100 consecutive implantations of the new AMO PhacoFlex SI-40NB foldable intraocular lens (IOL). SETTING: Concord Hospital and Dalcross Private Hospital, Sydney, Australia. METHODS: This prospective study comprised 100 consecutive patients who had endocapsular phacoemulsification cataract surgery with implantation of the AMO SI-40NB IOL, which has a silicone optic and poly(methyl methacrylate) (PMMA) haptics. Patients were excluded if trabeculectomy was performed concomitantly. The main outcome measures were control of folding, ease of implantation, centration, intraoperative and postoperative complications, and visual acuity. A minimum of 4 months follow-up was planned. RESULTS: Mean follow-up was 4.3 months +/- 2.1 (SD) (range 1 to 12 months). The lens permitted excellent control of folding and insertion, as well as excellent centration at surgery and 4 months. There was one lens-related intraoperative complication because of crimping of the trailing lens haptic. Postoperative complications were minimal, and 92% of patients achieved a visual acuity of 20/20 or better at 1 and 4 months. Excluding the eyes with retinal pathology, 100% achieved 20/20 or better at 4 months. CONCLUSION: The AMO SI-40NB three-piece silicone IOL with PMMA haptics provided excellent operative control, centration, and visual outcome and is suitable for small incision cataract surgery.

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PubMed1995

Herpes zoster chorioretinopathy.

Chorioretinitis and subsequent choroidal and retinal pigment epithelial atrophy following herpes zoster ophthalmicus (HZO) have rarely been reported. We report two patients, who several months following attacks of acute HZO, developed posterior fundus features of yellow, non-pigmented, punched-out areas of retinal pigment epithelial and choroidal pigment atrophy, which we have termed herpes zoster chorioretinopathy. An occlusive vasculitic process is proposed as the pathogenesis for this chorioretinopathy, and may be similar to that seen in the delayed cerebral vasculitis following HZO. A previous history of HZO should be sought in patients with a unilateral, multifocal, non-pigmented chorioretinopathy, as this may represent a characteristic delayed feature.

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PubMed1995

Prospective study of 210 consecutive cases of endocapsular phacoemulsification using the AMO SI-30NB 3-piece foldable lens.

PURPOSE: To assess the acceptability of clinical outcome achieved with use of the SI-30NB lens, as well as the incidence of any lens related complications. METHODS: This prospective study evaluated 210 consecutive eyes undergoing endocapsular phacoemulsification cataract surgery (EPECS), with implantation of the AMO SI-30NB foldable three-piece lens, commencing with the first patient in our practice receiving this implant. There was 99% follow-up for at least three months, with a mean of nine months, and a range of three to 14 months. Incisions were a maximum of 3.2 mm in size, and this allowed minimisation of astigmatism, and maximisation of early visual rehabilitation. RESULTS: The final visual acuity results were excellent, with 95% of cases achieving corrected vision of 6/12 or better. All cases without pre-existing ocular pathology achieved corrected vision of 6/6, apart from a single case which achieved 6/9, but the patient died before follow-up. The lens-related complication rate was less than 1% (two patients). No decentration of any other implant occurred, and no patient complained of edge glare. There were no cases of iris chafing or pigment dispersion. Only three patients (1.4%) required Yag posterior capsulotomy in the first 14 months of the study. Central bag-bag fixation was achieved in 206 of the 210 cases in the study (98%). CONCLUSION: The results achieved using the SI-30NB lens with a small incision phaco procedure were excellent. Lens-related complications occurred in only two cases and very few cases have had problems with posterior capsular opacification.

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PubMed1995

Clinical exophthalmometry: a comparative study of the Luedde and Hertel exophthalmometers.

Exophthalmometry, the quantitative assessment of the position of the globe in the orbit, is a clinically useful measurement. The purpose of this study was to examine the performance of a simple exophthalmometer that would lend itself to accurate and convenient use in clinical practice. In this study, two observers independently performed exophthalmometry on 100 eyes using the Hertel and Luedde instruments. The results were compared between instruments and between observers. There was no statistically or clinically significant difference between measurements taken with the Luedde as compared with the Hertel instrument. The Luedde exophthalmometer has a number of advantages over the Hertel exophthalmometer, and represents a simple, inexpensive and equally reliable means of evaluating clinically the anteroposterior position of the eye in the orbit.

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PubMed1995

Multiple endocrine neoplasia type two B. A case report with light and electron microscopic and immunohistochemical correlation.

PURPOSE: To describe a case of multiple endocrine neoplasia type two B (MEN IIB) where ocular and systemic clinicopathological findings are correlated, in association with light and electron microscopic and immunohistochemical findings. METHODS: A 23-year-old man presented with mucosal neuromas of the lips, tongue and eyelids, a Marfanoid habitus and prominent corneal nerves. These findings led to the diagnosis of multiple endocrine neoplasia type two B. The patient subsequently developed phaeochromocytoma and metastatic medullary thyroid carcinoma (MTC) which led to his demise. Correlation of light and electron microscopic and immunohistochemical findings with the systemic and ocular findings is presented to emphasise the aggressiveness of MTC in MEN IIB. Clinicopathological correlation was obtained by examining the eyes post mortem. RESULTS AND CONCLUSIONS: Three new findings in MEN IIB have been established by this study. The enlarged corneal nerves can now be regarded as ganglioneuromas. Medullary thyroid carcinoma metastases were found in the choroid. Light and electron microscopic examination of the eye showed ganglioneuromas of the nerves in the limbus, trabecular meshwork, uveal tract and posterior ciliary nerves; this finding may account for the glaucoma occasionally seen in patients with MEN IIB.

Adrenal Gland Neoplasms↗
PubMed1990

The eye and the hand: a clinical review.

The visual system is highly susceptible to involvement in many systemic disorders. Disorders of tissues common to the eye and the hand, such as vascular, connective and neural, may have striking clinical signs in both. Thus signs in the hand may provide useful diagnostic clues in the assessment of disorders of the visual system. The hand may even be causative in traumatic or infective eye diseases. This review provides a schema for a suitable hand examination and documents the eye and hand features of various common and uncommon disorders. The importance to the ophthalmologist of a careful hand examination is emphasised.

Eye Diseases↗
PubMed1988

Kimura's disease of the orbit.

A 70-year-old man presented with proptosis and ptosis of the right eye. An orbital mass was palpable and computed tomography scanning and magnetic resonance imaging scanning confirmed its superior orbital position, with extension back to the orbital apex. Definitive biopsy, undertaken via an anterior orbitotomy, demonstrated the lesion to be Kimura's disease. The patient was managed conservatively, and most of his symptoms resolved. Kimura's disease involving the orbit is briefly reviewed in this paper.

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