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Biomedical subjects

S J Isenberg

Publications and source records attributed to S J Isenberg.

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

A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum.

BACKGROUND: Neonatal conjunctivitis (ophthalmia neonatorum) continues to cause blindness because the agents used prophylactically to prevent this condition are not completely effective and are not widely available in many parts of the world. Povidone-iodine ophthalmic solution is an effective antibacterial agent with broad antibacterial and antiviral activity to which no bacteria are known to be resistant, and it is far less expensive and less toxic than the agents currently used to prevent neonatal conjunctivitis. METHODS: We conducted a masked, prospective trial involving 3117 infants born over a period of 30 months in a hospital in Kenya. Shortly after birth each infant received a 2.5 percent solution of povidone-iodine (n = 1076), a 1 percent solution of silver nitrate (n = 929), or 0.5 percent erythromycin ointment (n = 1112) in both eyes. Randomization was achieved by rotating the three medications after each was used for a week. RESULTS: Of the neonates treated with povidone-iodine, 13.1 percent had infectious conjunctivitis, as compared with 17.5 percent of those treated with silver nitrate (P < 0.001) and 15.2 percent of those treated with erythromycin (P = 0.01). Povidone-iodine was more effective against Chlamydia trachomatis than was silver nitrate (P < 0.001) or erythromycin (P = 0.008). There were 104 cases of noninfectious conjunctivitis (9.7 percent) in the povidone-iodine group, as compared with 129 in the silver nitrate group (13.9 percent, P < 0.001) and 148 in the erythromycin group (13.3 percent, P = 0.004). Many cases of noninfectious conjunctivitis were probably due to a toxic reaction to the treatment itself. The incidence of Neisseria gonorrhoeae and Staphylococcus aureus infections was similar in the three groups. CONCLUSIONS: A 2.5 percent ophthalmic solution of povidone-iodine as prophylaxis against ophthalmia neonatorum is more effective than treatment with silver nitrate or erythromycin, and it is less toxic and costs less.

Erythromycin↗
PubMed1995

The effect of povidone-iodine solution applied at the conclusion of ophthalmic surgery.

PURPOSE: Povidone-iodine 5% solution decreases the incidence of postoperative endophthalmitis when used on the eye for preoperative preparation. We sought to determine whether it also minimized conjunctival bacterial flora immediately after surgery by preventing bacteria present on the surface of the eye from entering surgical wounds. METHODS: In 42 eyes of 40 patients, at the conclusion of surgery, on an alternating basis, each patient received either a drop of a broad-spectrum antibiotic solution (polymyxin B sulfate-neomycin sulfate-gramicidin) or a 5% povidone-iodine solution in the operated-on eye. Bacterial cultures were taken before and after surgery and 24 hours later. The 38 unoperated-on eyes in the unilateral cases served as control eyes. RESULTS: Relative to the control group, povidone-iodine was effective in preventing an increase in the number of colony-forming units (P = .035), while the antibiotic was not. At 24 hours after surgery, the species count was lower in the eyes receiving povidone-iodine than in the antibiotic-treated eyes (P = .034) and was increased in the antibiotic group since the completion of surgery (P = .013), but was lower in the povidone-iodine and antibiotic groups than in the control eyes for both groups (P < .01). CONCLUSIONS: Povidone-iodine 5% solution applied to the eye at the conclusion of surgery was more effective at minimizing the number of colony-forming units and species for the first postoperative day than was a broad-spectrum antibiotic. While not true for the antibiotic, the antimicrobial effect of povidone-iodine lasted for at least 24 hours after the completion of surgery.

Bacteria↗
PubMed1995

Growth of the internal and external eye in term and preterm infants.

BACKGROUND: Better knowledge of the growth patterns of the external and internal eyes of neonates would permit more accurate diagnosis of disorders that affect ocular size such as infantile glaucoma and microphthalmos. Such disorders preferentially may affect certain parts of the internal eye but not other parts. No previous study statistically has evaluated internal ocular growth in preterm newborns. METHODS: A-scan ultrasonography was applied directly to the corneas of 101 healthy preterm and term newborns to determine axial length, anterior chamber depth, lens thickness, and vitreous chamber depth. The growth of these structures was evaluated by correlation and regression analyses. RESULTS: At term, the mean measurements were axial length, 16.2 mm; anterior chamber depth, 2.0 mm; lens thickness, 3.8 mm; and vitreous chamber depth, 10.5 mm. Postconceptional age correlated to axial length (P < 0.001), anterior chamber depth (P = 0.032), and vitreous chamber depth (P < 0.001), but not to lens thickness (P = 0.48). By regression analysis, the eyes of males grew faster than those of females (P < 0.001) mainly due to the vitreous chamber. CONCLUSION: In the last trimester and first 2 postnatal months, lens thickness remains constant, while the anterior chamber and, especially, the vitreous chamber deepen.

Anterior Chamber↗
PubMed1994

Povidone-iodine for ophthalmia neonatorum prophylaxis.

PURPOSE: The agents currently used to prevent ophthalmia neonatorum are less than optimal, with reports indicating evidence of bacterial resistance, ineffectiveness, and toxicity. Povidone-iodine ophthalmic solution, which has been shown to be effective in the preoperative preparation of the eye, generates no resistance, is an effective antimicrobial agent, and has low toxicity. We evaluated the effectiveness and safety of povidone-iodine for ophthalmia neonatorum prophylaxis. METHODS: A bacterial culture was taken from the conjunctiva of each eye of 100 infants within 30 minutes of birth. A drop of 2.5% povidone-iodine solution was then placed on one eye, while the other eye received either one drop of silver nitrate 1% ophthalmic solution or 0.5% erythromycin ointment. Conjunctival bacterial cultures were again taken two to four hours after birth. At each culture and at 24 hours after birth, the eyes were examined for toxic changes. To measure the effectiveness of the medications, the number of bacterial colony-forming units and species from each culture was compared. RESULTS: All three agents significantly reduced the number of colony-forming units, but povidone-iodine caused the most significant decrease. The number of species was reduced significantly by povidone-iodine (P = .00051) and silver nitrate (P = .007), with povidone-iodine yielding the most significant decrease. Erythromycin did not significantly reduce the number of species. Silver nitrate demonstrated more ocular toxicity at the 24-hour determination point than did either of the other two medications (P < .001). CONCLUSIONS: Povidone-iodine 2.5% ophthalmic solution is an effective antibacterial agent on the conjunctiva of newborns and causes less toxicity than silver nitrate.

Colony Count, Microbial↗
PubMed1994

Are the pupils of premature infants affected by intraventricular hemorrhage?

The size and reactivity to light of the pupil in infants with intraventricular hemorrhage has been variously described in the literature. These descriptions have included miosis, reactivity to light, nonreactivity to light, and anisocoria. We studied the size and light reactivity of 20 infants with intraventricular hemorrhage compared with 30 controls. Both groups displayed a mean pupil diameter in relative darkness of 3.0 to 4.0 mm at various postconceptional ages (P > .05). The age of first response to light was about 30 weeks after conception in each group (P > .05). The severity of intraventricular hemorrhage as determined by ultrasound was not related to the pupil diameter in relative darkness. In general, the pupils of neonates are not affected by intraventricular hemorrhage.

Cerebral Hemorrhage↗
PubMed1993

The effect of anterior transposition of the inferior oblique muscle.

The effect of anterior transposition of the insertion of the inferior oblique muscle was compared with the results from conventional inferior oblique muscle recession in 50 patients. Even though both groups of patients had a similar degree of overaction preoperatively, postoperative inferior oblique muscle action was weaker (P < .01) and upgaze more limited P < .01) in the anterior transposition group. These data suggest that anterior transposition serves to convert the inferior oblique muscle from an elevator to a depressor on attempted elevation. Because anterior transposition is such a powerful weakening operation, we suggest that it be reserved for patients with moderate to severe inferior oblique muscle overaction. To avoid postoperative hypotropia in upgaze, anterior transposition should be performed in both eyes for bilateral inferior oblique muscle overaction and not unilaterally.

Eye Movements↗
PubMed1993

The effectiveness of daily wear contact lenses for the correction of infantile aphakia.

OBJECTIVE: To evaluate the effectiveness and safety of daily wear contact lenses in the treatment of infantile aphakia. DESIGN: A study of prognosis using a cohort followed up for a mean of 58 months. SETTING: All operations, contact lens care, and follow-up were conducted at a university referral center. PATIENTS: Of 111 children undergoing surgery for cataract between 1980 and 1990, 51 (68 eyes) met the criteria of age younger than 2 years at the time of surgery and of cataract of nontraumatic origin. Patients were evaluated for visual acuity, complications, number of contact lenses worn per year, and changes in contact lens refractive power per month. A subgroup of 28 eyes of patients undergoing surgery before age 7 months and followed up for at least 24 months was studied. INTERVENTION: Following cataract surgery, all patients were fitted with daily wear contact lenses. MAIN OUTCOME MEASURE: Final visual acuity and complications were studied. The distribution of mean contact lens power for each month of age was determined. RESULTS: During the follow-up period, no serious complications were encountered. The visual acuity outcome was better following bilateral cataract surgery than unilateral surgery (P < .001 using chi 2 analysis) and was comparable with that achieved with extended wear contact lenses. CONCLUSION: Daily wear contact lenses were found to be safe and effective in the treatment of infantile surgical aphakia. The daily care was easily learned by the parents.

Aphakia, Postcataract↗
PubMed1992

A comparison of silver nitrate with erythromycin for prophylaxis against ophthalmia neonatorum.

Although prophylactic eyedrops to treat ophthalmia neonatorum is mandated nationwide, states and hospitals are free to choose specific drugs. To compare two of these agents, we studied the incidence and characteristics of ophthalmia neonatorum in two UCLA teaching hospitals over a five-year period. One, which used 1% silver nitrate solution exclusively, had 50 cases in 34,772 births, a frequency of 0.14%. The other used 0.5% erythromycin ointment exclusively and had 43 cases in 12,652 births, a frequency of 0.34%. Ophthalmia neonatorum was more frequent in the hospital using erythromycin (p less than 0.001), as was chlamydial conjunctivitis (p less than 0.02). Although not statistically significant, gonococcal conjunctivitis was found in four infants, all in the hospital using silver nitrate. Because silver nitrate was found more effective in decreasing the total frequency of all cases of ophthalmia neonatorum, and cases caused by Chlamydia and gram-negative bacteria specifically, this drug still should be considered as a primary prophylactic agent against ophthalmia neonatorum.

Bacteria↗
PubMed1990

The fixed and dilated pupils of premature neonates.

We examined on a weekly basis the pupils of 30 preterm infants. In relative darkness (less than 10 foot-candles [ft.-c.] of illumination), the pupils measured a mean of 4.7 mm in the youngest infants (26 weeks' postconceptional age) when the corneal diameter was 7.0 mm. The pupils became progressively smaller, reaching 3.4 mm at 29 weeks' postconceptional age (P less than .001). The pupils did not constrict to the stimulating light (600 ft.-c.) until a mean of 30.6 weeks' (+/- 1 week) postconceptional age. Mydriasis should not be considered indicative of a central nervous system disorder, and a pupil unresponsive to light should not be considered suggestive of blindness until a preterm infant reaches at least 32 weeks' postconceptional age.

Aging↗
PubMed1990

Overnight admission of outpatient strabismus patients.

The trend to outpatient strabismus surgery prompted us to determine the frequency of, and the reasons for, postoperative overnight hospital admission following such surgery. In one year, 303 outpatient strabotomies were performed at the Jules Stein Eye Institute on patients over 15 months old. Twenty-four (7.9%) were admitted overnight postoperatively. Compared with controls, those admitted were older (37 vs 20.5 years), and had a longer duration of anesthesia (145 vs 116 minutes) and surgery (104 vs 75 minutes) (P less than .01 for each). The time that surgery commenced and the use of perioperative medications were not significant factors. The most frequent reasons for overnight admission were nausea (38%) despite prophylaxis and the use of bilateral patches (16%). To minimize postoperative admissions, better strategies should be developed to decrease the frequency of significant postoperative nausea, the duration of surgery and anesthesia, and, if possible, the use of bilateral patches.

Adolescent↗
PubMed1989

The pupils of term and preterm infants.

We studied the pupils of 100 term and preterm infants between 26.5 and 46 weeks' postconceptual age. The mean (+/- S.D.) pupil diameter in a dark environment (less than 10 foot-candles of illumination) was 3.6 mm (+/- 0.9). Anisocoria of 0.5 to 1.0 mm was found in nine infants. The pupils did not consistently respond to 600 foot-candles of light before 32 weeks' postconceptual age, but responded increasingly thereafter. This progressive light response correlated significantly with postconceptual age, weight, Apgar scores, and corneal diameter (P less than .01). In the perinatal period, neurologic or radiologic examination may be warranted if the pupil diameter in a dark environment is less than 1.8 mm or greater than 5.4 mm or if the pupils do not respond to light challenge after 31 weeks' postconceptual age.

Cornea↗
PubMed1989

Outpatient topical use of povidone-iodine in preparing the eye for surgery.

Povidone-iodine 5% solution placed on the eye immediately before ophthalmic surgery within the preoperative preparation significantly reduces the conjunctival bacterial flora. In 40 patients undergoing ophthalmic surgery, the authors compared the outpatient use of povidone-iodine for 3 days before surgery with a 3-day course of a combination antibiotic ophthalmic solution (Neosporin) placed on the other eye. All patients also received topical povidone-iodine on the operating table directly preceding surgery. Cultures taken just before preparation of the operative field showed a similar reduction of bacteria by each regimen. Cultures taken after preparation but before commencement of surgery showed a further reduction for both regimens, but more for eyes previously treated with the antibiotic (P less than 0.02). To minimize the conjunctival bacterial flora before surgery, the authors continue to recommend instillation of a broad-spectrum antibiotic for 3 days before surgery, followed by application of povidone-iodine solution to the eye immediately before surgery within the preoperative preparation.

Ambulatory Care↗
PubMed1988

Source of the conjunctival bacterial flora at birth and implications for ophthalmia neonatorum prophylaxis.

To understand better the source of conjunctival bacteria in neonates, we studied 106 infants immediately after birth before any eyedrops were applied. The 50 infants delivered by cesarean section had significantly fewer species (0.50 +/- 0.85 vs 1.84 +/- 1.33) and colony forming units (272 +/- 1,019 vs 1,790 +/- 3,779) cultured per subject than the 56 infants delivered vaginally. In infants delivered by cesarean section within three hours of membrane rupture, 24 of 30 (80%) of the conjunctival cultures were sterile, while the rest bore a few cutaneous bacteria (0.23 +/- 0.50 species and 2 +/- 9 colony forming units per subject). The conjunctivae of infants delivered vaginally bore significantly more bacteria characteristic of vaginal flora: microaerophilic as Lactobacillus or truly anaerobic as Bifidobacterium. Neonates delivered by cesarean section more than three hours after membrane rupture showed a bacteriologic flora mixture quantitatively and qualitatively midway between those two groups. Infants delivered by cesarean section within three hours of membrane rupture may not need prophylactic eyedrops because of the type and scarcity of conjunctival bacteria.

Bacteria↗
PubMed1988

Conjunctival anaerobic and aerobic bacterial flora in paediatric versus adult subjects.

Although the bacterial flora of the conjunctiva in children and adults has been studied, there has been no previous comparison between these two age groups of anaerobic as well as aerobic bacteria. Conjunctival cultures from 229 eyes of 144 uninfected subjects were analysed for aerobic, microaerophilic, and anaerobic bacteria. Adults showed a greater number of species per eye than did younger subjects (1.47 versus 1.13; p less than 0.05). Anaerobic species, predominantly Propionibacterium, were obtained from 27.1% of all eyes, but from a significantly greater percentage (30.2% versus 12.8%) of adults' than children's eyes (p less than 0.04). Streptococcus spp. were cultured from 14.9% of the children's eyes as opposed to only 2.2% from adults (p less than 0.005). Understanding the differences in conjunctival flora between normal adults and children aids the interpretation of culture results and leads to properly defining and treating potential pathogens.

Adolescent↗
PubMed1988

Enhancing surgery for acquired esotropia.

In acquired esotropia, operating only on the non-accommodative angle often results in undercorrection. To decrease the frequency of this outcome, we enhanced surgery in a preliminary study by operating for a target angle equal to half the sum of the distant non-accommodative angle (minimum 12 prism diopters) plus the distant angle measured without correction. The mean augmentation in 12 patients undergoing bimedial rectus recession was 0.8 +/- 0.2 mm, and in eight patients who had a previous bimedial rectus recession and were undergoing a bilateral rectus resection it was 1.7 +/- 0.8 mm. With a mean follow-up of 26 +/- 20 months, 13 patients were within 10 prism diopters of orthotropia and four were undercorrected. Three overcorrected patients were orthophoric after reducing the hyperopic correction. All 17 patients old enough to cooperate had stereopsis or a positive Worth four-dot test at some point postoperatively.

Child↗