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Biomedical subjects

R S Freeman

Publications and source records attributed to R S Freeman.

51 records · Page 3Linked to original sources
PubMedDate not supplied

Residual incomitant DVD following large bilateral superior rectus recession.

A recent survey of 25 experienced strabismus surgeons indicated that a very large superior rectus recession is the procedure of choice for DVD. We report a series of seven patients who exhibited a persistent DVD following large superior rectus recession. Furthermore, the DVD was markedly incomitant, much greater in adduction than in abduction. This residual DVD would mimic inferior oblique overaction on version testing, although proving to be purely DVD on critical observation. This "overaction" is apparently due to the marked weakening of the superior rectus and was not always predictive of the location and amount of persistent DVD. This previously unreported complication of large superior rectus recession is important to recognize so that alternative surgical approaches may be contemplated. It is hoped that more accurate observations and measurements both preoperatively and postoperatively will lead to a more orderly approach to DVD surgery.

Child↗
PubMedDate not supplied

The use of part-time occlusion for early onset unilateral exotropia.

Eleven patients (9 months to 5 years of age) with intermittent or constant exotropia of predominantly one eye on distant gaze were studied to investigate the effect of part-time occlusion. No patient had constant exotropia on near fixation. Visual acuity was found to be equal in both eyes. All patients were treated by part-time patching of the non-deviating eye from four to six hours a day and tapered as appropriate. If exotropia recurred after conversion to a heterophoria, part-time occlusion was reinstated. With occlusion, all patients converted to hetero- or orthophoria, at least temporarily. Mean follow-up (to last visit or surgical intervention) was 22 months (range 3 to 37 months). Three patients (27%) later developed constant exotropia (mean 28.3 months after beginning occlusion) and underwent surgery. Three patients (27%) became and remain orthophoric without further patching. Part-time occlusion for preschool patients with exodeviations that are predominantly unilateral can postpone surgical intervention and convert exotropia to orthophoria or exophoria.

Child, Preschool↗
PubMedDate not supplied

Cloudy lenses and issues: a pedigree of unoperated congenital cataracts.

The issue of when congenital cataracts should be removed seems to be well resolved, with most recommendations stating that all significant central lens opacities should be removed by 4 months of age, with removal most commonly occurring the first month. Although there are many strong recommendations regarding congenital cataracts in the literature, little has been written about the initial decision of whether or not to operate. A pedigree is presented of multiple generations with inherited bilateral central cataracts. Two affected children, who did not undergo surgery, were followed from birth. These two children developed essentially normal vision, despite seemingly significant central opacities. This pedigree emphasizes the need to further examine prognostic factors regarding bilateral infantile cataracts and to analyze the initial surgical decision. Because this condition does not often occur and a large number of patients is necessary to determine the predictive value, a large, collaborative study is required to make significant headway in this area. If we can identify the factors that have strong predictive value for good vision after cataract surgery, we may start to define the profile of children who will have good vision, with or without surgery.

Cataract↗
PubMedDate not supplied

Cloudy lenses and issues: a pedigree of unoperated congenital cataracts.

1. Although there are many strong recommendations regarding congenital cataracts in the literature, little has been written about the initial decision of whether to operate. 2. Because this condition does not often occur and a large number of patients is necessary to determine the predictive value, a large, collaborative study is required to make significant headway in this area. 3. If we can identify the factors that have strong predictive value for good vision after cataract surgery, we may start to define the profile of children who will have good vision, with or without surgery.

Cataract↗