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R Manners

Publications and source records attributed to R Manners.

7 recordsLinked to original sources
PubMed2000

The House-Brackmann system and assessment of corneal risk in facial nerve palsy.

PURPOSE: The House-Brackmann (HB) facial nerve grading system is widely used by ENT/head and neck surgeons, but is perhaps of less value to the ophthalmologist. Our aim was to assess the value of the numeric portion of this system in identifying those patients with facial nerve palsy who are at risk of corneal complications. We also sought to identify other factors that might be predictive of such complications. METHODS: Forty-two patients (43 palsies) were studied prospectively. The HB grade was recorded together with measurements of levator function, upper lid closure, Bell's phenomenon, lagophthalmos, ectropion, lower lid retraction and corneal sensation. Conjunctival injection and corneal staining were also graded. ROC (receiver operating characteristic) curves were used to assess the value of each parameter as a screening test for corneal complications. RESULTS: There was no cut-off of HB grade, levator function, Bell's phenomenon, ectropion or lower lid retraction that was sufficiently sensitive and specific to screen for corneal complications. However, on assessing lagophthalmos and upper lid closure, cut-offs with more favourable sensitivities and specificities were identified. CONCLUSIONS: The numeric portion of the HB grading system is not a useful guide in identifying those patients with facial nerve palsy who are at risk of corneal complications. Measurements of lagophthalmos and upper lid closure, alone or in combination with other tests, may be of more value.

Adult↗
PubMed2000

Aspirin and warfarin therapy in oculoplastic surgery.

BACKGROUND/AIMS: There are no nationally agreed guidelines on preoperative management of patients who are on aspirin or warfarin therapy. There is considerable evidence that complication rates in anticoagulated patients are low whereas there are higher rates of thromboembolic complications in those whose therapy is manipulated. This survey aimed to establish oculoplastic specialist and non-specialist ophthalmic surgeons' current management practice of patients before oculoplastic surgery who are taking aspirin or warfarin and to assess the rate of complications in these patients. METHOD: An anonymous postal questionnaire survey of all ophthalmic consultants and specialist registrars in the Wessex region along with oculoplastic specialists in the Southern region. RESULTS: The overall response rate was 92%. Preoperative management was influenced both by type of operation and by type of surgeon. A statistically significant higher proportion of surgeons would consider altering warfarin compared with aspirin treatment. For all procedures, non-specialists are unlikely to stop aspirin therapy, and are less likely to stop warfarin before all procedures apart from dacrocystorhinostomy. A significant proportion of surgeons (18%) would allow insufficient time for the coagulation status of the patient to change after altering treatment. A considerable proportion of surgeons (54%) reported that they had seen complications as a result either of stopping or continuing anticoagulation therapy. CONCLUSIONS: In this survey, at least half the surgeons questioned would consider stopping warfarin before oculoplastic procedures. Over half of all surgeons have seen complications related to aspirin or warfarin, some of which were serious. A suggested approach to minimising patient risk is given.

Anticoagulants↗
PubMed1998

Phenotypic heterogeneity may occur in congenital fibrosis of the extraocular muscles.

BACKGROUND/AIMS: Congenital fibrosis of the extraocular muscles (CFEOM) is an autosomal dominant, non-progressive disorder characterised by congenital ptosis and external ophthalmoplegia. CFEOM has previously been divided into several clinical entities; general fibrosis syndrome, strabismus fixus, vertical retraction syndrome, and congenital fibrosis of the inferior rectus. The purpose of this study was to identify families with CFEOM in this geographical region in order to perform a study of the clinical presentation of this disorder and to estimate its minimum prevalence in the population. METHODS: Four families were identified with CFEOM in the Wessex region from whom a full history with a pedigree was obtained. All individuals underwent ophthalmological examination. RESULTS/CONCLUSION: This study shows that several of the CFEOM entities can be present within one family suggesting that these are variants of the same condition. It is suggested that subclassification is, therefore, not appropriate. The minimum prevalence of this disorder was found to be 1/230,000.

Adolescent↗
PubMed1997

Familial glaucoma iridogoniodysplasia maps to a 6p25 region implicated in primary congenital glaucoma and iridogoniodysgenesis anomaly.

Familial glaucoma iridogoniodysplasia (FGI) is a form of open-angle glaucoma in which developmental anomalies of the iris and irido-corneal angle are associated with a juvenile-onset glaucoma transmitted as an autosomal dominant trait. A single large family with this disorder was examined for genetic linkage to microsatellite markers. A peak LOD score of 11.63 at a recombination fraction of 0 was obtained with marker D6S967 mapping to chromosome 6p25. Haplotype analysis places the disease gene in a 6.4-cM interval between the markers D6S1713 and D6S1600. Two novel clinical appearances extend the phenotypic range and provide evidence of variable expressivity. The chromosome 6p25 region is now implicated in FGI, primary congenital glaucoma, and iridogoniodysgenesis anomaly. This may indicate the presence of a common causative gene or, alternatively, a cluster of genes involved in eye development/function.

Chromosome Mapping↗
PubMed1990

Ocular trauma.

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Burns, Chemical↗