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Biomedical subjects

P L Custer

Publications and source records attributed to P L Custer.

33 records · Page 2Linked to original sources
PubMed1993

Optic nerve sheath decompression for glaucomatous optic neuropathy with normal intraocular pressure.

OBJECTIVE: To report our therapeutic experience with optic nerve sheath decompression in patients with normal-pressure glaucoma. DESIGN: A case series of seven eyes from six patients with glaucoma and normal intraocular pressures who continued to have progressive visual field loss despite conventional therapy. SETTING: A hospital-based, referral glaucoma service. PATIENTS: Three men (67, 67, and 72 years of age) and three women (58, 61, and 70 years of age). INTERVENTIONS: Optic nerve sheath decompression. MAIN OUTCOME MEASURES: Visual field data and visual acuity measurements were obtained at regular intervals during the postoperative periods (range, 3 to 18 months). RESULTS: Two of seven eyes from six patients appear to have enjoyed an initial significant improvement in their visual fields with improved visual acuity in one eye of one patient. The visual fields, however, appear to have deteriorated 18 months after the initial procedure in these two patients. In the remaining four patients, no further improvement or deterioration was observed within a limited follow-up period. CONCLUSIONS: The transient improvement in the visual fields of one eye from each of two patients documents an initial successful use of optic nerve sheath decompression in patients with nerve fiber bundle damage in the absence of optic nerve head swelling. However, the long-term potential of optic nerve sheath decompression in these patients may be of limited value.

Aged↗
PubMed1993

Postcataract ptosis. A randomized, double-masked comparison of peribulbar and retrobulbar anesthesia.

PURPOSE: A randomized, double-masked study of 317 patients was conducted to determine if the incidence of postcataract ptosis is greater with retrobulbar or two-injection peribulbar injection anesthesia. METHODS: Surgery consisted of a planned extracapsular extraction with posterior chamber lens implantation, and no superior rectus bridle suture was used. Ptosis was quantitatively documented preoperatively and postoperatively at 1, 2, 5, and 90 days by the surgeon, photographically at 90 days by a masked observer, and subjectively by the patients. Postcataract ptosis was defined as a drop in the lid margin of 2 mm or greater after correcting for any change in the fellow eye. RESULTS: The incidence of ptosis at 90 days in patients given peribulbar anesthesia was 5.8% and in patients given retrobulbar anesthesia 5.5%, and this difference was not statistically significant (P = 0.90). Eighteen percent of patients in both groups reported a change in the appearance of their eyelids. There was a moderate, positive correlation among patients who reported a change in their lid position and objective measurements of ptosis. Preoperative clinical measurements of vertical lid fissure width and levator function, and the appearance of the lid crease or superior sulcus were not predictive for the development of postoperative ptosis at 90 days; the best predictor was the presence of ptosis in the immediate postoperative period. CONCLUSION: The incidence of postcataract ptosis is the same whether two injection peribulbar or retrobulbar anesthesia is used.

Aged↗
PubMed1990

Cutaneous approaches to the orbital skeleton and periorbital structures.

Multiple cutaneous approaches to both the superior and inferior orbit have been reviewed. Incisional choices are optimally based on both facial esthetics and orbital function, which are achieved by an understanding of the unique anatomy of this region. The superior orbit is best approached by a blepharoplasty (lid crease) incision in conjunction with a lateral extension if additional exposure is necessary. Almost all aspects of the bony orbit can be reached with the exception of the frontal bone superior to the supraorbital rim. When wide exposure of the orbital skeleton is necessary, a bicoronal scalp flap is most effective in a nonalopecic patient. The inferior orbit can be approached by a ciliary, blepharoplasty, or conjunctival incision with a lateral canthotomy. None has proven esthetic advantages over the others, with the exception of the conjunctival incision when used alone. The lid incisions must be used with the understanding that orbital function must be assessed both pre- and postoperatively and meticulous attention paid to protection and care of the anterior globe. In addition, because of the thinness of the tissues being manipulated, edema, bruising, and final settling of lid form may require more postoperative time than is typical of more peripheral approaches.

Conjunctiva↗
PubMed1990

Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit.

Wooden foreign bodies in the orbit are not detectable by standard roentgenography. Reports in the literature on the ability of computed tomography (CT) to detect orbital wooden foreign bodies have varied. To evaluate whether magnetic resonance imaging (MRI) would offer any advantage over CT in detecting wood in the orbit. MRI and CT were performed on an in vitro model of wooden foreign bodies in the orbit. Woods of different types and sizes were studied in vegetable fat backgrounds chosen to simulate orbital fat. On CT, most types of wood were hypodense to fat. Appropriate window settings were critical in the detection of wood by CT: in this model, a window width of 1000 Hounsfield units was optimal. On MRI, all types of wood were hypointense to fat. Small pieces of wood were surrounded by an MRI truncation artifact consisting of hyperintense spots. T1-weighted images demonstrated wood better than T2-weighted images and required less scanning time than either proton density or T2-weighted images, MRI was superior to CT in detecting the smallest pieces of wood. The role of MRI in the detection of orbital wooden foreign bodies in clinical practice remains to be determined.

Eye Foreign Bodies↗
PubMed1990

Conceptual approach to eyelid reconstruction.

A variety of techniques are available to repair congenital, traumatic, or surgical eyelid defects. The unique functional requirements of the orbital tissue must be considered when choosing the most ideal surgical procedure. It is essential to preserve conjunctival integrity and eyelid closure to maintain corneal protection. Full eyelid mobility should ideally be restored. These goals can generally be achieved with the correct closure of small eyelid defects. Larger deficits are usually best replaced by the use of grafts and flaps developed from the orbital region because this tissue most closely matches the functional needs of the eye. Close ophthalmic follow-up is necessary in the postoperative period to monitor and treat any ocular complication.

Eyelids↗
PubMed1989

Use of a scalp vein infusion set in oculoplastic surgery.

The scalp vein infusion set is a sterile, readily available device which has been used in a variety of oculoplastic procedures. Segments of the infusion tubing have been employed as bolsters for eyelid traction, tarsorrhaphy, and skin sutures. The tubing may also be placed in wounds for improved drainage. The material has enhanced postoperative wound care and has not been associated with significant complications.

Humans↗
PubMed1988

Neurilemoma as a presenting feature of neurofibromatosis.

A previously healthy 38-year-old woman presented with gradually progressive ptosis and downward deviation of her left eye and a palpable left superonasal orbital mass. The mass was excised, and histopathologic examination revealed a tumor composed of spindle cells arranged in both Antoni A and B patterns. Presence of S-100 antigen was determined by immunoperoxidase staining. The diagnosis was neurilemoma. A right apical extraparenchymal mass detected on a preoperative chest roentgenogram and computed tomography was most consistent with a benign neurogenic tumor. The presentation was that of a recently discovered neurilemoma in a patient with preexisting, but previously undiagnosed, neurofibromatosis.

Adult↗
PubMed1988

Eyelid fistula following Wies entropion repair.

Fistula formation following eyelid surgery is uncommon. A patient developed an eyelid fistula and tearing shortly after a Wies entropion procedure and was effectively treated by excising the involved portion of the eyelid.

Aged↗
PubMed1985

Blepharochalasis syndrome.

Patients with chronic forms of blepharochalasis often develop eyelid deformities characterized by blepharoptosis and prolapse of the orbital fat and lacrimal gland. Some individuals have an acquired form of blepharophimosis, secondary to the dehiscence of the canthal tendons. In this late stage of the condition, the tendons still adhere to the periosteum of the orbital rims and loss of fixation occurs at the distal attachment between the tendons and the eyelid tissues. This results in a horizontally shortened palpebral fissure and a rounded deformity of the lateral canthal angle. Surgery remains the primary treatment.

Adult↗
PubMed1978

Coronary capillary permeability and tissue volumes for sucrose and water in dogs: a comparison of bolus and constant infusion multiple-indicator methods.

This study was undertaken to determine the accuracy with which heart interstitial and water volumes could be determined from multiple-indicator dilution experiments on the coronary circulation in open-chest dog preparations. Sucrose permeability by extraction calculations was found to average 0.26 +/- 0.02 cm3 . (min . g tissue)-1. The extravascular sucrose volume averaged 0.15 cm3 . g-1 tissue by both multiple-indicator and post-mortem methods. Indicator-dilution tritiated water curves labelled 85% of the post-mortem water content.

Animals↗
PubMedDate not supplied

Trans-nasal flap for medial canthal reconstruction.

The trans-nasal flap is an effective method for repairing medial canthal defects following Mohs' surgery. This procedure transposes redundant skin from the nasal bridge into the defect. The construction of the flap, which minimizes the risk of medial canthal webbing, yielded excellent cosmetic results in 22 patients.

Eyelids↗
PubMedDate not supplied

Contoured, atraumatic lacrimal retractor.

A new lacrimal retractor has been designed for use in external dacryocystorhinostomy. This low-profile, self-retaining instrument incorporates solid blades, affording optimal exposure while protecting nearby tissue.

Dacryocystorhinostomy↗