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Biomedical subjects

R A Saunders

Publications and source records attributed to R A Saunders.

At least 37 records · Page 2Linked to original sources
PubMed1995

Grating visual acuity in eyes with retinal residua of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.

OBJECTIVES: To compare grating visual acuity of eyes with varying severity of retinal residua of retinopathy of prematurity to grating visual acuity of eyes that did not have acute-phase retinopathy of prematurity, showed no ocular abnormalities on follow-up, and were from patients who passed neurodevelopmental screening questions. DESIGN: Monocular grating visual acuity was measured by means of the Teller acuity card procedure when children reached 1, 2, 3 1/2, and 4 1/2 years of age. PATIENTS: A total of 1398 children with birth weights less than 1251 g whose acute-phase retinopathy of prematurity was documented as part of the Multicenter Cryotherapy for Retinopathy of Prematurity Study and who participated in follow-up visual acuity testing. RESULTS: Eyes with no or mild residua of retinopathy of prematurity showed a mean visual acuity similar to that of the comparison group. Eyes in a subgroup with abnormally straightened temporal retinal vessels showed a mean visual acuity approximately 1 octave below that of the comparison group. Mean visual acuity scores from eyes with macular heterotopia ranged from 1 octave (at 1 year) to more than 2 octaves (at 4 1/2 years) below the mean visual acuity of the comparison group. Mean visual acuity scores for the few eyes in the retinal fold or partial detachment group that had quantifiable visual acuity were well below the means for the comparison group. CONCLUSIONS: Acute-phase retinopathy of prematurity that regresses without retinal residua produces no deficit in grating visual acuity between 1 and 4 1/2 years of age. In contrast, eyes with macular heterotopia show a visual acuity deficit, and the deficit is greater at older than at younger ages. Eyes with retinal fold or partial detachment that have measurable visual acuity show large visual acuity deficits at all ages.

Acute Disease↗
PubMed1994

Effect of acute-phase retinopathy of prematurity on grating acuity development in the very low birth weight infant. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.

PURPOSE: To examine the development of grating acuity in four groups of eyes in the Multicenter Study of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP): eyes with no ROP; eyes with less-than-prethreshold ROP; eyes with prethreshold ROP; and eyes with threshold ROP that were randomized to serve as controls (not treated with cryotherapy). METHODS: Subjects were 1398 children with birth weights < 1251 g whose acute-phase ROP was documented as part of the CRYO-ROP study. Monocular grating acuity was measured using the Teller acuity card procedure when children reached 1, 2, 3 1/2, and 4 1/2 years of age. RESULTS: Eyes in the no-ROP and less-than-prethreshold groups showed nearly identical acuity development. Eyes with prethreshold ROP showed mean acuity similar to the no-ROP group at 1 and 2 years, but slightly below the no-ROP group at 3 1/2 and 4 1/2 years. Only 50% of eyes in the threshold untreated ROP group had measurable acuity. These eyes showed mean acuity scores that were approximately 1 octave below those of the no-ROP group at all four test ages. When data from eyes with ROP residua or other ocular abnormalities, and data from eyes of children who were unable to pass the study developmental screening items, were excluded, acuity development was similar among groups. CONCLUSIONS: Mild (less-than-prethreshold) ROP has no effect on the development of grating acuity in children between 1 and 4 1/2 years of age. Moderate (prethreshold) ROP is associated with reduced acuity at 3 1/2 and 4 1/2 years. In general, severe (threshold untreated) ROP results in moderate to severe reductions in acuity at all ages between 1 and 4 1/2 years. However, a small number of children with severe ROP show normal acuity development.

Acute Disease↗
PubMed1993

Topical anesthesia during infant eye examinations: does it reduce stress?

We studied the effect of topical anesthesia on infant stress and corneal haze during the routine eye examination for retinopathy of prematurity. Using a double-blind protocol, 55 premature infants weighing less than 1501 g at birth were selected randomly to receive normal saline or proparacaine HCl 0.5% eye drops as a corneal wetting agent at their initial eye examination. Before, during, and after the procedure, infant stress was evaluated by heart rate, respiration rate, blood pressure, and transcutaneous oxygen saturation. Subjective assessment of the infant's cry intensity and corneal haze also were recorded. Adequate data were collected on 42 patients. Using analysis of variance and chi-square tests, we found no difference in any of these parameters between the two patients groups. These data suggest that topical anesthetic agents offer no advantage over normal saline eye drops during the examination of premature infants.

Administration, Topical↗
PubMed1992

Tying the knot. Is it always necessary?

Securing the final muscle position during adjustable-suture strabismus surgery is usually accomplished by tying the sutures in a knot in the early postoperative period. Even patients who have satisfactory ocular alignment without adjustment require manipulation of inflamed ocular tissues to secure the muscle. In our experience, approximately half of these cases are not adjusted. We have devised a technique in which postoperative knot tying is required only in those patients who actually undergo adjustment. In our series of 42 patients who underwent adjustable-suture surgery, 22 cases were not adjusted and 30 cases were left untied. No instances of muscle slippage occurred. We believe this reduction in postoperative manipulation represents an improvement in adjustable-suture strabismus surgery.

Humans↗
PubMed1992

Aneurysmal oculomotor nerve palsy in an 11-year-old boy.

Cerebral aneurysms are rare in children. When they occur, they usually present with a history of subarachnoid hemorrhage. Gabianelli et al. (1) recently reported a 14-year-old girl with an isolated oculomotor nerve palsy due to aneurysm. In their discussion, they state that arteriography is, "Unnecessary in patients under 10 (years of age) if the symptoms and signs of subarachnoid hemorrhage are absent or high resolution computerized tomography scan or adequate magnetic resonance imaging scan is normal." To date, their patient is the youngest reported in the literature with an isolated oculomotor nerve palsy proved to be caused by cerebral aneurysm. We report herein an 11-year-old boy who presented with an oculomotor nerve palsy due to aneurysm with minimal preceding symptoms and no other signs of intracranial disease.

Carotid Artery Diseases↗
PubMed1990

Acute-onset Brown's syndrome associated with pansinusitis.

We treated a 5-year-old girl and a 6-year-old boy with acquired Brown's syndrome associated with pansinusitis. In both patients, the diagnosis was established roentgenographically, and the patients were treated with oral antibiotics. Systemic corticosteroids were used in one case, although their clinical value was uncertain. Patients presenting with acute-onset Brown's syndrome of undetermined cause should undergo computed imaging of the orbits and paranasal sinuses.

Amoxicillin↗
PubMed1989

Management of strabismus with botulinum A toxin.

Three hundred eight patients with strabismus were treated with botulinum A toxin (Oculinum) chemodenervation; 153 were followed by the authors for at least 6 months. In this study group, 97 received botulinum A toxin injections as the primary method of treatment of their ocular deviation. Fifty-six received injections after traditional extraocular muscle surgery. Botulinum A toxin was useful for management of patients with recent surgical overcorrections and for management of some patients with sixth cranial nerve palsy. Chemodenervation of an extraocular muscle was not as successful as traditional strabismus surgery for treatment of infantile esotropia and other comitant deviations. Botulinum A toxin injection was ineffective in patients who had restrictive strabismus. This drug has limited application in the management of patients with strabismus.

Abducens Nerve↗
PubMed1989

Road safety management: interviewing casualties.

Riders of powered two-wheeled vehicles injured whilst riding their machines were interviewed either at hospital or at home in order to supplement data already held from police records. Of those 70 casualties interviewed, 49 (70%) were not known to the police via their Stats 19 records. Of these 49, 17 (35%) were classified as serious in accordance with Department of Transport criteria. The paper considers the management implications and methodological requirements needed to cope with under-reporting and obtaining supplementary data within an operational setting.

Accident Prevention↗
PubMed1988

Rectus muscle position in V-pattern strabismus. A study with coronal computed tomography scanning.

Coronal computerized tomographic (CT) scans were obtained on ten children with previously unoperated V-pattern strabismus and ten control patients to determine the relationship of rectus muscles to the globe. All patients with V-pattern had sufficient overaction of the inferior oblique muscles to warrant bilateral surgical weakening. Control patients had no strabismus or isolated horizontal deviations without A- or V-patterns. Using a horizontal reference line constructed along the anterior cranial fossa, the mean horizontal rectus-muscle axes were found to approximate the expected value of 180 degrees closely. The vertical rectus muscle axes were excyclotorted in both groups. However, there was no significant difference in the mean superior temporal quadrant angles formed by the intersection of the horizontal and vertical rectus muscle axes. Analysis of covariance with age as the covariant demonstrated a significant relationship (P less than 0.01) between age and the superior temporal quadrant angle measured in each eye. Our data suggest that apparent rectus muscle malposition identified by CT scanning is a function of age and cannot be implicated as an important cause of V-pattern strabismus.

Age Factors↗
PubMed1988

Anterior segment ischemia after three rectus muscle surgery.

Nine patients underwent simultaneous or staged detachment of the vertical and medial rectus muscles in the treatment of sixth nerve palsy or Duane's retraction syndrome. In five adult patients (34, 35, 41, 45, and 65 years of age), clinically significant anterior segment ischemia developed postoperatively. Known medical risk factors were present in only one case. With the exception of corectopia, there were no apparent sequelae and all involved eyes returned to preoperative visual acuity within 9 weeks of surgery. Anterior segment ischemia may be a frequent complication of strabismus surgery in adult patients when the superior, inferior, and medial rectus muscles are detached from the globe.

Abducens Nerve↗
PubMed1988

Penetrating intracranial wood wounds: clinical limitations of computerized tomography.

The case history of a patient with a periorbital penetrating wooden foreign body is presented. The computerized tomography (CT) densities of several different sources of wood were compared using an experimental model. The clinical usefulness and practical limitations of CT in the evaluation of intracranial foreign bodies is discussed, and the management of this type of injury is reviewed.

Brain Injuries↗