Biomedical subjects
Publications and source records attributed to R J Simmons.
We report a surgical technique for repair of a disinserted scleral flap involving the use of two 10-0 nylon sutures, which are placed through the base of the scleral flap, and through and out of the peripheral cornea. These two sutures create a water-tight flap at the repaired hinged area. The procedure may thus continue as a trabeculectomy, permitting postoperative staged argon-laser suture lysis as well.
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The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infant-mother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well.
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The use of 5-Fluorouracil (5-FU) to inhibit scarring following filtration surgery has been hampered by corneal epithelial defects and their accompanying inflammation. This toxicity, which occurs during the crucial period in which the risk of bleb failure is highest, has previously been a relative contraindication to further 5-FU use. We have found the early placement of a therapeutic bandage contact lens permits extended administration of 5-FU during this period, minimizing discomfort and inflammation as well as enhancing bleb survival.
Compared responses of parents of infants with cystic fibrosis, those with congenital heart disease, and those with healthy babies on the Parenting Stress Index. Diagnostic group differences were found mainly in the Child Domain with parents of ill infants reporting greater stress. Differences between mothers and fathers were found mainly in the Parent Domain. The groups did not differ in reports of stress arising from life events other than the target child's illness.
As part of a longitudinal study, children in three groups (healthy, n = 33; cystic fibrosis (CF) n = 28; congenital heart disease (CHD) n = 23) were seen between the ages of 12 and 18 months to assess infant-mother attachment and at two years to observe parent-child negotiation of autonomy/dependence in a puzzle task. Although the healthy group included the highest proportion of securely attached infants and the CHD group the lowest, the distribution of attachment patterns did not differ significantly between groups, or between any of the groups and established norms. At two years the healthy children had the most positive experience in the puzzle task while the children in the CF group had the least positive experience. When diagnostic groups were divided according to prior attachment status, the data for the healthy group were consistent with the prediction that securely attached children would have the most positive mother-child interaction at age two. This was not the case in either of the medically diagnosed groups. These data suggest that the influence of the early parent-child relationship may be altered by a child's health status. We may need different models to account for development in healthy and medically compromised children.
A case of malignant (ciliary block) glaucoma apparently induced by a large posterior chamber intraocular lens (PC-IOL) is presented. The involved eye was small, with an axial length of 21.7 mm and a preoperative refractive error of +8.25 D. An uncomplicated extracapsular cataract extraction with implantation of a PC-IOL with a 7 mm optic was performed. Within 1 week postoperatively, malignant glaucoma developed, for which surgical intervention was required. We recommend avoiding implantation of PC-IOLs with large optics in certain small eyes, since these implants may be more likely than lenses with smaller optics to induce malignant glaucoma in such eyes.
In an effort to achieve the early postoperative safety and stability provided by trabeculectomy plus the late lower intraocular pressure (IOP) advantages of full-thickness glaucoma filtration surgery, 43 eyes of 38 patients with chronic open-angle glaucoma had laser suture lysis after primary trabeculectomy. The technique of laser suture lysis afforded serial release of resistance to aqueous outflow through the newly performed trabeculectomy, allowing initial tight closure of the trabeculectomy to avoid the dangers of hypotony. Serial gradual loosening of the trabeculectomy closure decreased resistance to outflow through the trabeculectomy and thereby lowered the IOP to desired levels in a controlled, titrated manner. Complications decreased with experience. For 25 eyes with at least 6 months follow-up (average, 54 weeks), the average IOP decreased from 25.0 mmHg preoperatively to 12.2 mmHg postoperatively.
While many chronic illnesses are diagnosed in infancy, there is little systematic study of the impact of chronic illness on early social development and how parental adjustment to a chronically ill infant contributes to subsequent outcomes. This paper outlines some of the factors which affect parents' ability to care for chronically ill infants and preschoolers. It draws upon studies of infants with other medical problems, ongoing longitudinal study of infants with cystic fibrosis and congenital heart disease by the authors; and the authors' clinical experience.
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This study describes 11 patients, in whom filtering surgery was performed, who developed a leaking filtration bleb postoperatively. Average follow-up time was 3 1/2 years. In three patients, suturing of the conjunctiva was performed. In two, anterior chamber reformation and choroidal tap were required, and, in both cases, the leak sealed spontaneously without surgical repair. In two, the glaucoma shell tamponade technique was used to facilitate anterior chamber reformation. These reformed in both cases, and no subsequent shallow anterior chambers have been noted. In four cases, conservative therapy, which consisted of antibiotics, glaucoma medication with or without patching, and careful patient observation, was used to manage the leaking blebs. Complications observed were: iritis (1 case), early infection of the bleb (1), flat anterior chamber (1), and failure of the bleb to allow sufficient aqueous humor outflow (2).
A series of 54 eyes in 50 patients had preoperative predictions of postoperative visual acuity, using both a white-light interferometer (Lotmar Visometer) and a Snellen chart projector (Guyton-Minkowski Potential Acuity Meter). The predicted vision by each instrument was compared with the actual postoperative vision. Forty eyes in 36 of these patients, 25 with concurrent eye disease, had cataract extraction with intraocular lens implantation. Fifteen eyes in 15 patients, 11 with concurrent eye disease, had neodymium-YAG laser posterior capsulotomy. The Visometer gave more accurate predictions than the Potential Acuity Meter in cataract patients with open angle glaucoma, even with glaucomatous visual field loss, and in patients with a visual acuity of less than 20/400 due to advanced cataract formation.
A prospective, randomly assigned, double-masked study was designed to compare two solutions of sodium hyaluronate--Amvisc and Healon. All cases were planned extracapsular cataract extractions with posterior chamber intraocular lenses performed by a single surgeon in glaucomatous and nonglaucomatous eyes. Subjective performance of the products were rated in regard to ability to maintain the chamber, coat the intraocular lens, dilate the pupil, separate the leaves of the capsule, and be easily removed. Objective comparisons of intraocular pressure, anterior chamber reaction, and endothelial cell loss were also made. There was no subjective or objective difference between the two products.
Recurrent hyphema is a complication of anterior segment surgery that may present with a variety of signs and symptoms. The appropriate diagnosis of this syndrome may be overlooked because its presentation is frequently delayed, and its symptoms and signs are varied and frequently evanescent. Major forms of surgical intervention have been recommended for this syndrome, but we believe that many such cases can be treated relatively simply and effectively with argon laser goniophotocoagulation using topical anesthesia. We present five cases of recurrent hyphema from neovascularization of a surgical incision.
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Thirty-nine eyes of 34 patients with open-angle glaucoma who had been treated successfully with argon laser trabeculoplasty underwent either extracapsular cataract extraction with posterior chamber intraocular lens implantation or intracapsular cataract extraction without lens implantation. Cataract surgery did not have a significant effect on the magnitude of intraocular pressure reduction obtained with laser trabeculoplasty. This study supports the view that eyes with coexisting cataract and glaucoma may benefit from laser trabeculoplasty before cataract surgery.
We conducted a retrospective study of 67 patients (85 eyes) with severe glaucoma to determine whether argon laser trabeculoplasty could reduce intraocular pressures below the "normal" range. All patients had initial intraocular pressures of less than or equal to 19 mm Hg. Success was defined as a decrease in intraocular pressure of at least 20%, no increase in medications, stable visual field, and no subsequent glaucoma surgery. After an average follow-up period of 30 months, treatment was successful in 31 cases. One half of the failures occurred by six months and 11 failures (30%) occurred after 12 months. Sixteen patients were able to decrease their medications. Two patients achieved intraocular pressures between 6 and 9 mm Hg and 20 between 10 and 12 mm Hg.