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Biomedical subjects

O A Cruz

Publications and source records attributed to O A Cruz.

31 records · Page 2Linked to original sources
PubMed1993

Microbial keratitis in childhood.

BACKGROUND: Microbial keratitis occurs infrequently in childhood. The leading ocular predisposing factors are trauma and preexisting corneal disease. Many of the age-related risk factors in adults play a minor role in children. METHODS: The authors retrospectively studied 51 eyes with ulcerative keratitis in 50 children younger than 16 years of age. This includes all patients treated at Bascom Palmer Eye Institute during an 11 1/2-year period from January 1, 1980, to June 30, 1991. The criterion for inclusion in the study was a discharge diagnosis of microbial (nonviral) keratitis. RESULTS: The principal risk factors identified in this study were trauma (44%), prior corneal surgery (24%), systemic illness (14%), and contact lens wear (12%). Systemic illness or an immunocompromised state existed in 7 (47%) of the 15 children younger than 3 years of age. There was a large male preponderance (68%). Forty-four (86.3%) of the 51 eyes were culture-positive; six (11.7%) were polymicrobial. Five of seven culture-negative patients had received prior topical antibiotic therapy. Pseudomonas aeruginosa (34%), Staphylococcus aureus (20%), and fungi (18%) were the most common organisms isolated. Seven (14%) eyes required surgery. CONCLUSION: This study presents important differentiating factors between adult and childhood nonviral microbial keratitis. Identification of principal risk factors in children may aid in early recognition and treatment of microbial keratitis.

Adolescent↗
PubMed1992

Visual results and complications of phacoemulsification with intraocular lens implantation performed by ophthalmology residents.

The authors retrospectively analyzed the visual outcome and incidence of complications of 181 consecutive cases of phacoemulsification performed by eight third-year ophthalmology residents. A posterior chamber intraocular lens was implanted in 179 of these eyes. Vitreous loss occurred in 5.5% of cases. The overall incidence of posterior capsule rupture was 9.9%; of the 18 posterior capsular ruptures, 72% were detected during cortical removal and 22% during nuclear emulsification. Postoperative follow-up for 177 eyes was at least 2 months, and 70% were followed for 6 months or longer. Final best corrected visual acuity of 20/40 or better was obtained in 92.6% of eyes. These results are comparable with previous reports of residents' experience in performing planned extracapsular cataract extraction. With appropriate training and faculty supervision, residents learning to perform phacoemulsification and intraocular lens implantation can achieve acceptable results.

Cataract Extraction↗
PubMed1991

Urine drug screening for cocaine after lacrimal surgery.

We investigated whether the results of routine urine drug screening for cocaine would be positive after dacryocystorhinostomy. Postoperative urine specimens were analyzed for the presence of benzoylecgonine, the major metabolite of cocaine, by gas chromatography-mass spectrometry. The results of urine tests of all 12 patients were positive for cocaine 24 hours postoperatively. Nine (75%) were positive 48 hours postoperatively, and three (33%) had detectable levels 72 hours after surgery. Patients given cocaine at the time of lacrimal surgery should be warned that they may test positive for cocaine for at least three days postoperatively.

Adult↗
PubMedDate not supplied

The use of cocaine as an anesthetic in lacrimal surgery.

We investigated if the results of routine urine drug screening for cocaine metabolites would be positive after dacryocystorhinostomy. Postoperative urine specimens were analyzed for the presence of benzoylecgonine, the major metabolite of cocaine, using the Syva Emit assay with an inhouse cutoff of 50 ng/mL. Confirmation of the presence of benzoylecgonine was performed by liquid-liquid extraction using 5.0 mL of urine that was derivatized with iodobutane (Aldrich), followed by gas chromatographic/mass spectrometric (GC/MS) analysis using selective ion monitoring. The GC/MS assay had a limit of detection of 12.0 ng/mL and a limit of quantitation of 24.0 ng/mL benzoylecgonine. The results of urine tests of all 12 patients were positive for cocaine 24 hours postoperatively, nine (75%) were positive 48 hours postoperatively, and three (33%) had detectable levels 72 hours after surgery. Patients given cocaine at the time of lacrimal surgery should be warned that they may test positive for cocaine for at least three days postoperatively.

Adult↗
PubMedDate not supplied

Evaluation of mitomycin to limit postoperative adhesions in strabismus surgery.

BACKGROUND: Ocular motility dysfunction following strabismus surgery may be the result of postoperative scarring or the formation of adhesions. Mitomycin C (MMC) has been used with encouraging results as an adjunct to standard treatment of hypertrophic conjunctival scars after strabismus surgery. It has been demonstrated that MMC does not inhibit muscle reattachment and might inhibit adhesions and scar formation in the rabbit. We investigated in a rabbit model effectiveness of MMC in reducing the formation of postoperative adhesions following reoperations and the tensile strength of the new musculo-scleral junction. METHODS: A prospective, masked-observer, controlled study was performed in rabbits. Symmetrical bilateral recessions of the superior and inferior rectus muscles were performed on each rabbit. A reoperation was performed 6 weeks later, in which the muscles were advanced back to their original insertion. During the reoperation, one eye served as the control while the other was treated with a 5-minute intraoperative exposure to topical mitomycin. RESULTS: Mitomycin reduced the formation of adhesions and the amount of postoperative scarring. The tensile strength of the musculo-scleral junction was reduced in the mitomycin-treated eyes but exceeded the force generated during extraocular ductions. CONCLUSION: MMC may be an effective adjunctive therapy in the treatment of strabismus associated with pre-existing adhesions or scarring.

Animals↗
PubMedDate not supplied

Screening for uveitis in juvenile rheumatoid arthritis.

BACKGROUND: Uveitis associated with juvenile rheumatoid arthritis (JRA) is an important cause of visual impairment in children. Because uveitis is often asymptomatic in this age group, frequent ophthalmologic screening examinations are recommended. Recent reports have found a decrease in the prevalence and severity of uveitis in JRA when compared to older data. METHODS: The charts of 52 consecutive patients with JRA seen over a 30-month period were retrospectively reviewed. RESULTS: Eye examination identified uveitis in five (12%) patients. All patients with uveitis were female, ANA positive, and had pauciarticular-onset arthritis. Three patients had the onset of uveitis before the age of 2. All patients have maintained good visual acuity and have not developed serious sight-threatening ocular complications over the follow-up period. CONCLUSIONS: Although the prevalence and severity of JRA-associated uveitis may be decreasing, we strongly recommend continued strict adherence to the current screening guidelines.

Antibodies, Antinuclear↗
PubMedDate not supplied

Early-onset accommodative esotropia.

PURPOSE: To determine the frequency of accommodative esotropia with onset by 6 months of age; to determine if the presence or absence of characteristics usually associated with infantile esotropia can help in the diagnosis; and to determine if antiaccommodative therapy is adequate treatment for the esotropia. METHODS: The charts of 100 patients with infantile esotropia, seen over a 2-year period (September 1995 to September 1997), were reviewed. We identified those with at least 2.25 diopters (D) of hyperopia and determined the presence of large angle esotropia (> 30 to 40 prism diopters [delta]), amblyopia, inferior oblique overaction, dissociated vertical deviation, latent nystagmus, and cross-fixation. The success of antiaccommodative therapy, if attempted, was also evaluated. RESULTS: Of 100 patients with infantile esotropia, 15 (15%) were found to have at least +2.25 D. This represented 8% of all patients with accommodative esotropia seen over the same time period. The average age at initial examination was 21 months, although the reported age of onset in all cases was 6 months or less. Two had surgery before presenting to our institute. Eleven of 13 (84%) had 40 delta or less. Six (40%) of the 15 had amblyopia, 5 (33%) had inferior oblique overaction, 3 (20%) had dissociated vertical deviation, 1 (7%) had latent nystagmus, and 4 (27%) had cross-fixation. Of the 13, 7 were given glasses initially, with 3 being fully corrected. Six were not given glasses, all had surgery, and all were given glasses postoperatively for a residual esotropia. CONCLUSION: Fifteen percent of infantile esotropia patients and 8% of accommodative esotropia patients have infantile accommodative esotropia. Other characteristics of infantile esotropia may be present, but are less frequent, and at least 40% are fully corrected with spectacles indicating that when the hyperopia is 2.25 D or greater, antiaccommodative therapy should be instituted before surgery.

Accommodation, Ocular↗
PubMedDate not supplied

Comparison of methods for determining the AC/A ratio in accommodative esotropia.

PURPOSE: The two most commonly used clinical methods of determining a high AC/A ratio are: 1) the gradient method, and 2) the distance/near disparity method. Significant differences can be found not only between these two methods, but also in the different techniques for the gradient method alone. The purpose of our study is to compare the gradient method using +3.00 lenses for near and -3.00 lenses for distance, and the distance/near disparity method. METHODS: Patients examined over a 2-year period (1995-1997) with a high AC/A ratio esotropia according to the distance/near disparity were grouped according to level of high AC/A ratio, then prospectively measured by the gradient method (using plus lenses for near and minus lenses for distance). All measurements were performed with full spectacle correction in place according to cycloplegic refraction, and with fixation on an accommodative target. RESULTS: Forty-five patients were included. Using both plus and minus lenses, a high AC/A ratio by the gradient method was found in 16 (36%) patients, (2 [12%] with a grade 1; 7 [44%] with a grade 2; and 7 [44%] with a grade 3, by the distance/near disparity method), a normal ratio was found in 6 (13%), and no patient had a low ratio. Twenty-three patients fell into a different category of AC/A ratio using plus lenses for near compared with minus lenses for distance. CONCLUSIONS: The distance/near disparity method appears to diagnose a high AC/A ratio much more frequently than the gradient method. There was some variability in the AC/A ratio with plus versus minus lenses when the gradient method was used. Further study using the gradient method in patients without a significant distance/near disparity is required.

Accommodation, Ocular↗
PubMedDate not supplied

Sensory strabismus--eso or exo?

PURPOSE: The type of horizontal strabismus from loss or impairment of vision is thought to depend on patient age at the time of vision loss. Association between the age at onset of vision loss and development of esotropia vs exotropia will be determined. METHODS: Patients with a diagnosis of sensory strabismus and visual acuity of 20/40 or poorer were reviewed as well as patients with diagnoses consistent with the development of sensory strabismus. Parameters considered were age at onset of vision loss and type of strabismus. Patients were excluded if the age at onset was not clear. RESULTS: Of 123 patients with sensory strabismus reviewed: 82 (67%) had unilateral vision loss; 41 (33%) had bilateral vision loss; 75 (61%) had congenital vision loss; 50 (67%) developed esotropia; 25 (33%) developed exotropia; 48 (39%) had acquired vision loss; 5 (10%) developed esotropia; and 43 (90%) developed exotropia. A significant difference was noted between age at onset and type of horizontal strabismus (X2= 37.44; P <.0001). CONCLUSION: Of patients with congenital vision loss, 67% developed sensory esotropia and 33% developed sensory exotropia. Of those with acquired vision loss, 10% developed sensory esotropia and 90% developed sensory exotropia. Patients with congenital vision loss are significantly more likely to develop esotropia, P <.005, and those with acquired vision loss are significantly more likely to develop exotropia, P <.001.

Age of Onset↗
PubMedDate not supplied

Childhood myasthenia.

Explore the source record for details and available documents.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Effects of intraoperative topical mitomycin-C on strabismus surgery in the rabbit: a preliminary study.

The effect of intraoperative topical exposure of mitomycin-C (MMC) on muscle reattachment and scarring in strabismus surgery was prospectively investigated in the rabbit by performing bilateral recession surgery in which one eye was treated with topical MMC (0.2 mg/mL) and the other eye served as the control. One week postoperatively, in random, masked fashion, the severity of postoperative adhesions was rated lower in the MMC-treated eyes. Also, histology demonstrated decreased fibrosis in the muscle reattachment sites in the MMC-treated eyes. The muscle tension in the reattached muscles was greater than 100 g in all of the eyes. This preliminary study indicates that topical MMC exposure may inhibit scarring in strabismus surgery without inhibiting muscle reattachment or causing other obvious adverse effects.

Administration, Topical↗