Biomedical subjects
R A Saunders
Publications and source records attributed to R A Saunders.
Reliability of road accident statistics.
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Age factor in powered two-wheeled road traffic accidents?
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Treatment of superior oblique palsy with superior oblique tendon tuck and inferior oblique muscle myectomy.
Twelve patients underwent quantitated superior oblique tendon tuck and ipsilateral inferior oblique muscle myectomy in the primary treatment of unilateral superior oblique muscle palsy. Preoperatively, each patient exhibited a vertical deviation of 30-55 prism diopters in at least one position of gaze. Following a single operation, satisfactory ocular alignment was obtained in all but one case, with fusion demonstrable in clinically significant gaze positions. Eight of 12 patients had no measurable vertical deviation in primary position, and two others had residual hyperphorias of only two prism diopters. No tucks were removed for postoperative Brown's syndrome. Superior oblique tendon tuck combined with ipsilateral inferior oblique muscle myectomy appears to be a safe and effective treatment for large angle superior oblique muscle palsy.
Incomitant vertical strabismus. Treatment with posterior fixation of the inferior rectus muscle.
Three patients with evidence of inferior rectus muscle paresis were surgically treated for diplopia in downgaze following blowout fracture of the orbit or operative trauma. In each case, surgery involved the placement of two posterior fixation sutures 13 or 14 mm behind the physiologic insertion of the inferior rectus muscle in the contralateral eye. In one case, posterior fixation was combined with a small inferior rectus muscle recession. All three patients experienced relief of their diplopia and improvement in their binocular field of vision. There were no untoward sequelae and no surgically induced changes in primary position alignment.
A randomized comparison of surgical procedures for infantile esotropia.
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Aneurysmal bone cyst of the ethmoid sinus.
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Evaluation of and access to posterior orbital tumors.
Head and neck surgeons enter the peripheral orbit for the therapy and/or biopsy of the most common expanding lesions, i.e., thyroid ophthalmopathy, direct extension of paranasal disease, pseudotumor and metastases. It is in this space between the bony orbital walls and the extraocular muscle cone that a majority of primary orbital neoplasms occur. The four basic approaches to posterior orbital tumors are: lateral orbitotomy through the temporal fossa with a modified Kronlein procedure, medial orbitotomy utilizing a Lynch incision and lacriminal sac mobilization, superior orbitotomy via a Naffziger frontotemporal crainotomy, and inferior exposure/decompression through the maxillary sinus. Case examples of the former two approaches are presented. None of these standard procedures allows full exposure of the posterior orbit. A combined cranio-facial-orbital access to this region utilizing a modified maxillectomy and frontotemporal craniotomy is detailed.
Anterior segment ischemia syndrome following rectus muscle transposition.
Two patients developed clinically significant anterior segment ischemia following full tendon transposition of the superior and inferior recti muscles nine and 20 years after they underwent horizontal rectus muscle surgery. Ipsilateral carotid artery ligation in one patient and possible hyperlipoproteinemia type II in the other were discovered postoperatively and may have contributed to the circulatory disturbances observed. In adult patients with paretic strabismus, the most important function of the paretic muscle may be maintenance of circulation to the anterior segment of the eye.
Superior oblique transposition for third nerve palsy.
Four eyes of three adult patients underwent anterior transposition and advancement of the superior oblique tendon without trochleotomy in the surgical management of oculomotor nerve palsy. In each of the cases, this procedure proved unsatisfactory, either because of inadequate horizontal alignment, postoperative hyperdeviations, or paradoxical ocular movements. Even in these difficult cases, "supermaximum" horizontal rectus muscle surgery appeared to result in satisfactory ocular alignment.
The care and feeding of a development officer.
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Empirical fitting of hard contact lenses in infants and young children.
A method of empirically fitting hard contact lenses in infants and young children is described. It can be performed without the benefit of "K" readings and does not require the patient to be anesthetized. Lens fit is judged by fluorescein pattern, degree of finger tightness on the cornea, and indirect determination of steepness by comparing baseline refraction with final over-refraction using a contact lens of known power. This simplified technique has been found to be reliable and practical with good lens fit obtained in most patients. The visual results achieved in unilateral aphakic patients using this method are comparable to those found elsewhere in the literature.
Differential intraocular pressure in strabismus diagnosis.
An evaluation of the differential intraocular pressure test in the diagnosis of non-comitant strabismus is described and the results compared with findings in ten normal subjects. Increased intraocular pressure occurring when an eye cannot complete a full duction indicates both the existence of a restriction and the presence of underlying muscle force generation. The differential intraocular pressure test is easily performed, non-invasive, generally reliable, and can be performed on children who are unlikely to cooperate with other types of diagnostic procedures. Although false-negative results may occur, this test nevertheless provides useful additional information to that normally obtained in a motility examination. When combined with passive forced ductions, an accurate picture of both active and passive components of the strabismus may be determined.
Upper airways obstruction and apnoea in preterm babies.
Measurements of tidal flow, volume, and oesophageal pressure were recorded on a group of 8 severely preterm infants with periodic respiration. Analysis of the flow trace for evidence of cardiac artefact, and the tidal volume trace to identify at what point of the tidal cycle apnoea starts, indicated that upper airways obstruction was associated with about half these attacks. It is surmised that this is produced by glottic closure.
A recommended scheme for the evaluation of kits in the clinical laboratory.
A scheme for kit evaluation in the individual clinical chemistry laboratory is presented. Recommendations for assessing accuracy, precision, and stability are included along with a scheme for preparing for the evaluation and writing the final report.
The role of eye disorders in learning disability.
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Unilateral cataracts in children.
Our experience in the surgical treatment of unilateral cataracts in children has been presented. Over two-thirds of the patients who were visually mature at the onset of their cataract regained useful vision in the operated eye while less than 10% of the visually immature patients did so. Our findings approximate those found in the literature. While improved visual acuity is the most important objective of unilateral cataract surgery in children, other benefits such as a cleared optical axis often make such surgery desirable, even when the prospect for visual recovery is poor.
Grantsmanship: it can be learned. Part II.
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