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Biomedical subjects

M O'Keefe

Publications and source records attributed to M O'Keefe.

At least 73 records · Page 4Linked to original sources
PubMed1997

Laser intrastromal keratomileusis for high myopia and myopic astigmatism.

BACKGROUND: Laser intrastromal keratomileusis (LASIK) is an evolving technique which enables high degrees of myopia (> 8.0 dioptres) and myopic astigmatism to be corrected. This paper describes initial experience with this procedure. It also details the methodology, the results, the problems encountered, and discusses retreatment procedures. METHODS: 51 eyes (48 primary cases and three retreatments) underwent LASIK for simple myopia or compound myopic astigmatism. After the keratotomy was fashioned with a Chiron corneal shaper, the ablation was performed with either a Summit or Meditec excimer laser. The actual preoperative astigmatism ranged from -0.5 D to -6.0 D (in the astigmatic myopic LASIK (AML) series), while the range of preoperative myopia in the combined myopic LASIK (ML) and AML series was -8.0 D to -37.0 D. Of the ML cases, group 1 (-8.0 to 15.0 D (dioptres)), group 2 (> -15.0 to -20.0 D), and group 3 (> -20.0 D) had mean preoperative myopia values (spherical equivalent) of -11.26 D, -16.84 D and -27.78 D. The same groupings (1, 2, and 3) for the AML cases had respective values of -9.702, -17.4, and -23.08. In the AML series the mean preoperative astigmatism was -2.109 D. Follow up ranged from 8 to 27 months (mean 15.8 months). Six of the cases required retreatment. RESULTS: There was a reduction in best corrected visual acuity (BCVA) (of 1 Snellen line) in seven of the primary cases (14.5%) (three in the ML group and four in the AML group), and in one of the retreatment cases. The BCVA improved in 28 cases (58%) in the primary treatment group. The mean correction attempted (spherical equivalent) for the ML groups 1, 2, and 3 was 10.51 D, -14.5 D, and -27.78 D, versus a mean correction achieved of -9.445 D, -15.625 D, and -21.571 D. Similarly, for the AML groups, attempted correction values were -9.702 D, -17.4 D, and -23.08 D, while the values achieved were -6.95 D, -51.425 D, and -15.708 D. Regression was minimal and stabilisation of the refractive result was achieved in all groups, except group 3 of the ML series, by the 3 month examination period. The mean postoperative astigmatism in the AML series was -0.531 D. Vector analysis of the AML series showed that the mean surgically induced astigmatism was +0.93 D. The most common complication encountered was undercorrection, which occurred in 35 cases-23 cases in the ML group and 12 cases in the AML series. Twenty eight per cent of the ML cases, and 25% of the AML cases were within plus or minus 1.5 D of the attempted refraction. CONCLUSION: For the correction of high myopia and myopic astigmatism, LASIK results in less postoperative pain and relatively little subepithelial haze compared with high myopic photorefractive keratectomy. Furthermore, a stable refraction and reasonably predictable outcome occurs much earlier. High myopia up to -37.0 D can be corrected, albeit with some limitations at the extremes of myopia-in terms of the amount of myopia correctable; this represents a limitation of the technique. Retreatment is a technically straightforward and effective way to treat undercorrection. Undercorrection, the main complication seen in our series, should become less common when the ablation algorithms are further refined.

Adolescent↗
PubMed1997

Retinopathy of prematurity screening, stress related responses, the role of nesting.

AIMS/BACKGROUND: In a prospective study the degree of distress caused by retinopathy of prematurity (ROP) screening in a cohort of preterm infants was assessed and the modifying effects of nesting in reducing their discomfort was evaluated. METHODS: 38 preterm infants were included in the study. 19 infants were placed in a nest with boundaries (intervention group) and 19 infants were placed on a cot blanket (control group). Observations were made 2 minutes before, throughout, and 2 minutes after ROP examination. The factors observed were crying responses, neurobehavioural activity, and physiological changes (heart rate, oxygen saturation). Recordings were made using a video camera for crying and neurobehavioural activity and an Oxypleth monitor for heart rate and oxygen saturation. RESULTS: During ROP screening, the total group of 38 infants (nested and non-nested combined) displayed increased neurobehavioural activity (p < 0.01) and crying (p < 0.01). The increased activity and crying coincided with the invasive part of the procedure. The distress caused by ROP screening was significantly less for the nested group compared with the non-nested group for both movement activity (p < 0.01) and crying (p < 0.01). The physiological data, heart rate, and oxygen saturation were not statistically significant. CONCLUSION: ROP screening is distressing for preterm infants. Nesting can significantly reduce this discomfort. The findings in this study are of value in designing more optimal ROP examination schedules for infants.

Beds↗
PubMed1997

Unilateral papilloedema in a 12 year old girl--a surprising diagnosis.

A previously well 12 year old girl presented with diminished visual acuity and haziness of her left eye. Her examination confirmed visual loss in her left eye and significant disc blurring on fundoscopy. Extensive investigations including computerised tomography of the brain and orbit were normal. Her serum angiotensin converting enzyme (ACE) levels were elevated and subsequent Kveim test was positive confirming the diagnosis of ocular sarcoidosis. She did respond to a course of systemic steroids and over the following 3 years her eye signs and symptoms did correlate well with the ACE level. To date she has not had any systemic or respiratory symptoms. Thus sarcoidosis should be considered in the differential diagnosis of ocular pathology of unexplained aetiology.

Child↗
PubMed1996

Regression after photorefractive keratectomy for myopia.

OBJECTIVE: To evaluate the effect of topical steroid treatment in eyes that showed refractive regression after photorefractive keratectomy (PRK) to correct myopia. SETTING: Mater Private Hospital, Dublin, Republic of Ireland. METHODS: In this prospective study with a minimum of 6 months follow-up, 289 eyes were treated over 2 1/2 years. Of these eyes, 23 had myopic regression of 0.75 diopters (D) or more. Topical steroid treatment was given to reverse the regression. Refraction and uncorrected visual acuity before and after treatment were measured. RESULTS: Twelve eyes in the regression group had at least 18 months of follow-up. At the final examination, eight of these eyes had an uncorrected visual acuity of 20/40 or better; six were within 1.00 D of intended refraction. CONCLUSION: Refractive regression after PRK for myopia was permanently reversed in some eyes; final stable refraction was close to the intended value in about half.

Administration, Topical↗
PubMed1996

Refractive outcome in eyes with retinopathy of prematurity treated with cryotherapy or diode laser: 3 year follow up.

AIMS: To compare the refractive error 1 to 3 years after cryotherapy or diode laser treatment for threshold retinopathy of prematurity. METHODS: Twenty six infants treated with diode laser and 17 infants treated with cryotherapy underwent cycloplegic refraction during follow up. RESULTS: After 3 years of follow up, 94.1% of patients had myopia (right eye if bilateral) following cryotherapy and 45.5% of patients had myopia following diode laser treatment. The difference between the two proportions was 48.7% (95% confidence interval 17.8 to 80.1, p = 0.004). In the cryotherapy group 55% of patients were highly myopic (> -6.00 dioptres) while in the laser group there were no high myopes. CONCLUSIONS: In the diode laser group there were significantly fewer myopes than in the cryotherapy group up to 3 years after the procedure. There was no trend towards increasing myopia in the laser treated group and the refraction in these eyes stabilised after 1 year. In the cryotherapy group there was a significant increase in the degree of myopia between year 1 and year 3 of follow up (p = 0.02). Diode laser treatment is thought to be as effective as cryotherapy, and has the added benefit of reducing myopia, in the treatment of ROP.

Astigmatism↗
PubMed1996

Advanced cicatricial retinopathy of prematurity--outcome and complications.

AIMS: To assess the outcome and complications of patients with advanced retinopathy of prematurity (ROP). METHODS: All patients with eyes achieving stage 4 or 5 retinopathy of prematurity were reviewed. Twenty one eyes were diagnosed during ROP screening in maternity hospitals and 10 eyes were of infants transferred for treatment. RESULTS: Thirty one eyes of 17 patients were included. Thirteen eyes were treated for acute disease but progressed to stage 4 or 5; seven had cryotherapy and six diode laser photocoagulation. Cataract was found in 17 eyes (54.8%), glaucoma in seven eyes (22.6%), microphthalmos in 15 (48.4%), and corneal opacification in four eyes (12.9%). Fifteen eyes had surgical procedures; two (6.5%) had trabeculectomy, four (12.9%) had lensectomy, and nine (29%) retinal detachment repair. Transferred infants had their initial eye examination later than infants in hospitals screened by the authors and 80% of them had progressed beyond threshold ROP by the time they were transferred for treatment. Twenty nine eyes (93.6%) had visual acuities of 3/60 or less and only two eyes (6.5%) achieved 6/18 or less. CONCLUSION: The visual outcome of the eyes undergoing retinal re-attachment surgery was disappointing. Cataract, microphthalmos, and glaucoma were the most frequent complications, and surgical intervention was often required. The need for children who are blind as a result of ROP to have long term follow up is shown.

Cataract↗
PubMed1996

Long-term follow up of primary trabeculectomy for infantile glaucoma.

BACKGROUND: The treatment for infantile glaucoma is surgical. Treatment options include goniotomy, trabeculotomy, combined trabeculotomy-trabeculectomy, and trabeculectomy. METHODS: Patients who had a follow up of 5 years or longer after primary trabeculectomy were examined to determine the long term stability in infantile glaucoma. RESULTS: In eyes with primary infantile glaucoma 92.3% achieved control of their glaucoma with a single trabeculectomy; 100% achieved control with two trabeculectomies; 85.7% of eyes with secondary infantile glaucoma achieved control with a single trabeculectomy. There were no serious complications experienced in either group. CONCLUSION: Primary trabeculectomy is a safe and successful operation for infantile glaucoma.

Case-Control Studies↗
PubMed1995

Assessment and treatment of impotence.

Impotence is a common problem. History is primarily relied on to diagnose psychogenic impotence. Sex therapy is an effective treatment. Antihypertensive and psychiatric medicines often cause impotence, but most medicines should be considered a cause if this is supported by the history. Hormonal causes should be suspected in a patient with decreased libido or decreased testicular size, and testosterone should be measured in these cases. Hormone replacement may restore sexual function in hypogonadal men. Doppler sonogram or arteriography should be used to diagnose vascular impotence for men who would be good surgical candidates. Only young men without other illness are considered. There is little need to test neurologic function because there is no specific treatment for neurogenic impotence. These patients and patients who do not respond to the aforementioned treatments should be offered the vacuum erection device, penile self-injection therapy, or penile prosthesis. Choice depends on comorbid illness as well as patient preference. A basic algorithm for the evaluation and treatment of impotence is given in Figure 2.

Algorithms↗
PubMed1995

Diode laser photocoagulation to the vascular retina for progressively advancing retinopathy of prematurity.

AIMS: To estimate the effectiveness of diode laser photocoagulation of the retina posterior to the ridge in eyes with retinopathy of prematurity (ROP). METHODS: Diode laser photocoagulation was applied posterior to the fibrovascular ridge in stage 4a ROP in six eyes of four infants and in advancing stage 3+ in two eyes of one infant. Seven eyes had previously been unsuccessfully treated with diode laser photocoagulation anterior to the ridge. RESULTS: Six eyes of four children had total regression, two eyes of two children had flat maculae with residual peripheral tractional detachment and maintained vision. CONCLUSION: These preliminary results indicate that diode laser photocoagulation posterior to the ridge may be a useful treatment in late stage 3 and stage 4A ROP following failed laser treatment to the avascular retina in threshold stage 3 disease.

Disease Progression↗
PubMed1994

Management of congenital dacryocele.

Congenital dacryocele is a distension of the naso-lacrimal sac usually present at birth or in the first three months of life. It occurs commonly in females and may present with dacryocystitis. Treatment includes probing and antibiotics if infection is present.

Female↗
PubMed1994

Herpes simplex keratitis in children.

Ophthalmic findings are reported in 31 eyes of 28 children with herpes simplex keratitis. Twenty two had dendritic ulcers, and nine had geographic ulcers or disciform stromal keratitis. After resolution of keratitis, 80% (19/22) of children with dendritic ulcers achieved corrected visual acuity of 6/9 or better, 50% (11/22) had induced astigmatism, 45% (9/22) had one to five recurrences. In the group with geographic or disciform lesions, 89% (8/9) had reduced corrected vision, 78% (7/9) had induced astigmatism which was predominantly against the rule, and 87% (7/9) had one to six recurrences.

Acyclovir↗
PubMed1994

Refractive outcome following diode laser versus cryotherapy for eyes with retinopathy of prematurity.

The refractive error in 15 eyes with threshold retinopathy of prematurity treated with diode laser photocoagulation was compared with 25 eyes with the same disease severity treated by cryotherapy. Myopia was present in 40% (six eyes) of the first group ranging from -1.50 to -3.50 dioptres; while 92% (23 eyes) showed myopia which ranged from -0.50 to -8.00 dioptres in the cryotherapy group. Sixty per cent (nine eyes) were hypermetropic at less than +3.0 dioptres in the laser group, while only 8% (two eyes) of the cryotherapy group showed hypermetropia. There was no significant difference in astigmatism between the two groups. Eyes with threshold disease treated with diode laser photocoagulation developed significantly less myopia than those treated with cryotherapy (p = 0.0006, two tailed value).

Cryosurgery↗
PubMed1994

To be the best.

Like many other health care organizations, Irving Healthcare System focuses on quality, cost effectiveness and efficiency. We are willing to do what is necessary to provide the best quality care possible, secure our future position in health care and make our organization an efficient and effective one.

Multi-Institutional Systems↗
PubMed1994

The first six months. So easy to miss....

Most presentations to general practitioners in the first six months of life are for common childhood conditions. These include upper respiratory tract infections, infectious gastroenteritis, other viral illness associated with fever, feeding difficulties, management of sleep disturbances, constipation and routine immunisation. Rarely, more sinister disorders may be present and differentiating them from the common benign problems represents a constant clinical challenge.

Age Factors↗