Intraocular antiviral penetration.
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Antiviral Agents↗
Biomedical subjects
S J Isenberg
Publications and source records attributed to S J Isenberg.
The transconjunctival oxygen monitor.
The transconjunctival oxygen monitor, mounted on a polymethylmethacrylate conformer, continuously measures the tissue oxygen tension of the palpebral conjunctiva. It is preferable to transcutaneous monitors because it requires no heat and correlates arterial oxygen in cerebral blood flow by monitoring a tissue bed vascularized by the internal carotid artery. We used it on 19 adult patients. The monitor was valuable in correlating arterial oxygen in hemodynamically compromised and uncompromised patients. However, the measurements decreased abruptly when the conjunctival temperature fell below 33 C in the compromised patients. The only ocular complications were conjunctival chemosis and mild punctate keratopathy in some patients; these resolved within 48 hours. This device may be useful in monitoring tissue oxygen tensions in critically ill patients and neonates at risk for retinopathy.
Conjunctiva↗
Familial, congenital paralysis of horizontal gaze.
Eye movements were studied in a sister and brother with familial, congenital paralysis of horizontal gaze. Horizontal and vertical eye movements were recorded with DC electro-oculography and analyzed with a laboratory computer. All horizontal, conjugate eye movements were absent (saccades, pursuit, optokinetic nystagmus, vestibulo-ocular response, and visual-vestibular responses). Voluntary vergence eye movements were preserved and were used to track visual targets. An involuntary, horizontal, pendular nystagmus was found to represent disconjugate, smooth, vergence eye movements. Vertical saccades and vestibulo-ocular responses were normal. However, vertical pursuit, optokinetic nystagmus, and suppression of the vestibulo-ocular response by fixation were impaired. A developmental anomaly affecting motor neurons and interneurons in the abducens nuclei is suggested to be the cause of the absence of conjugate, horizontal eye movements.
Abducens Nerve↗
Oculocardiac reflex during postoperative muscle adjustment.
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Female↗
Cavernous sinus thrombosis as a cause of unilateral blindness.
Cavernous sinus thrombosis (CST) rarely causes blindness. It is sometimes difficult to differentiate clinically from a severe orbital cellulitis. We studied a case of CST that evolved from osteomyelitis and orbital cellulitis in a patient who had a rapid loss of vision to the level of no light perception. Detailed clinical and electrophysiologic tests were performed to pinpoint the cause of blindness.
Adult↗
The Rieger syndrome: a heritable disorder associated with glaucoma.
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Adult↗
Visual screening examination in children.
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Child, Preschool↗
The oculocardiac reflex as a surgical aid in identifying a slipped or 'lost' extraocular muscle.
The oculocardiac reflex during strabismus surgery has generally been regarded as a hazard capable of causing death. Six cases are presented which show a beneficial use of the oculocardiac reflex. Isolation of a previously slipped or 'lost' extraocular muscle can be difficult. In this series identification of the tissue as muscle was substantiated by observing a positive oculocardiac reflex when traction was placed on the suspected tissue. Each of the 6 dislodged extraocular muscles was the medial rectus muscle. Three of the muscles had been resected and 3 either recessed or tenotomised. In one patient, despite 6 previous strabismus operations, including 2 strabotomies on a muscle that slipped, and in another patient, who had a lapse of 6 years since the last strabotomy, when the slipped muscle was isolated, the oculocardiac reflex could still be elicited. To avoid abolishing the oculocardiac reflex during surgery the anaesthetist should be instructed to avoid the use of an intravenous parasympatholytic agent, such as atropine, at the time of induction and during the operation.
Adult↗
Occlusive retinal arteriolitis with neovascularization.
A 34-year-old white woman who had used oral contraceptives for six years showed an occlusive bilateral retinal arteriolitis that resulted in a branch arteriolar occlusion in the right eye and retinal neovascularization. Three years later, we observed active arteriolitis in the left eye with successive occlusion of several branch arterioles. The disease has shown spontaneous remissions and exacerbations. An extensive medical evaluation revealed only old pulmonary granulomatous disease and an elevated sedimentation rate in association with exacerbations of the arteriolitis.
Adult↗
Ocular features of multiple sulfatase deficiency and a new variant of metachromatic leukodystrophy.
Multiple sulfatase deficiency, a newly recognized autosomal recessive disorder caused by a deficiency of several sulfatase enzymes, is characterized by psychomotor retardation, ichthyosis, and mild organomegaly. Patients with metachromatic leukodystrophy, also an autosomal recessive disorder, have a deficiency of a single sulfatase enzyme, arysulfatase A. The ocular features of a patient with multiple sulfatase deficiency and a patient with a new biochemical variant of metachromatic leukodystrophy are described. The patient with multiple sulfatase deficiency had a unique, peripheral lens opacity and a panretinal degeneration. The patient with a new variant of metachromatic leukodystrophy exhibited a cherry-red spot.
Cataract↗
Traumatized eye with retinal damage from amniocentesis.
Amniocentesis has been previously reported to cause damage to the anterior segment of the eye with subsequent loss of vision. We report the first case of amniocentesis in which the needle penetrated the globe and punctured the retina and the first case in which vision was retained. At four months of age the injured eye was found to have a perilimbal conjunctival bleb, a scarred retinal hole, unilateral myopia, and mild amblyopia. At evaluation under anesthesia, a scleral perforation with exposed uvea was repaired.
Amniocentesis↗
Ligneous conjunctivitis: an autosomal recessive disorder.
Two siblings, a boy and a girl, developed a chronic, bilateral conjunctivitis with large recurrent pseudomembranes. The diagnosis of ligneous conjunctivitis was made by excisional biopsies in both. The family was referred for genetic counseling after the second child developed the disorder. On the basis of this family and previous reports, we believe that ligneous conjunctivitis is a genetic disorder inherited in an autosomal recessive pattern and that genetic counseling should be offered to the parents of affected children.
Child, Preschool↗
Bacterial flora of the conjunctiva at birth.
In the largest study to date of bacterial flora in newborns, we cultured the conjunctivae of 100 infants within 15 minutes after vaginal delivery and before any antimicrobial agents had been applied to the eye. All cultures were intensively analyzed for anaerobic and aerobic bacteria. By far the largest group of bacteria isolated were microaerophilic, such as Lactobacillus species and diphtheroids, accounting for 46.8% of positive cultures and 62.3% of all bacteria isolated. The second largest group were true anaerobic bacteria, such as Bacteroides and Propionibacterium species. The smallest group were aerobic bacteria. This incidence of non-aerobic bacteria in the conjunctiva of newborns is the highest reported to date. Our finding should alert clinicians to consider non-aerobic, especially microaerophilic, bacteria in the differential diagnosis of ophthalmia neonatorum. The high rate of supposedly sterile cultures reported in other studies may be explained at least partially by improper isolation of non-aerobic bacteria.
Bacteria↗
Characteristics of the iris in 100 neonates.
To better characterize the appearance of the iris at birth, we studied certain iris features of 100 normal newborns with slit lamp biomicroscopy. We noted the iris color, crypt-structure, and vascularity of the collarette and periphery of the iris. These features were considered in light of the child's birthweight, postnatal days of age, sex, and race. Iris vascularity correlated significantly with postnatal age at examination, and stage of crypt development was more advanced in males, and more evident in the blue and gray irides. Males also had a more advanced stage of iris development. In addition to our previous finding that iris vessels of cocaine intoxicated neonates were more tortuous and dilated than a control group, this study suggests that such vessels may also be more commonly found in sickly infants.
Aging↗
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↗
Periorbital cellulitis in infancy.
To our knowledge, no previous study of periorbital cellulitis has focused on its specific characteristics in infants only (less than 1 year of age.) We retrospectively studied 30 cases of infantile periorbital cellulitis treated at Harbor-UCLA Medical Center from 1977 to 1988. Characteristics of the disorder in our infants older than 1 month were similar to earlier reports of older children in terms of etiology, radiological and bacteriological findings, and course. However, compared with our older infants, our seven neonates (7 to 30 days old) had a higher incidence of ruptured dacryocele (29% vs 0%) and unknown source of the infection (43% vs 4%); but a lower incidence of preceding upper respiratory infection (14% vs 78%), abnormal sinus films (0% vs 22%), and positive blood cultures (14% vs 30%). Of the positive cultures, Hemophilus sp was the most common pathogen among the older infants (35%), while Streptococcus and Staphylococcus were the most frequent among the neonates (71%). All infections remained preseptal and responded well to intravenous antibiotics.
Cellulitis↗
The effect of torsional muscle dysfunction and surgery on eye position under general anesthesia.
Under general anesthesia, normal eyes exhibit 2.0 degrees to 2.5 degrees of extorsion. To investigate the effect of torsional muscle dysfunction and surgery on eye position under general anesthesia, we measured the torsional change before and after torsional muscle surgery in 26 eyes of 18 patients with clinical torsional muscle dysfunction. Under general anesthesia, compared with normals, eyes with preoperative intorter overaction or extorter underaction demonstrated a significant intorsional change (P < .01). However, eyes with intorter underaction or extorter overaction did not demonstrate a significant extorsional change. Postoperatively, while patients remained under general anesthesia, intorter weakening procedures produced measurable extorsion while intorter strengthening procedures and extorter weakening procedures produced measurable intorsion. Superior oblique tenotomy produced a greater net torsional change than inferior oblique weakening surgery (P < .01). Under general anesthesia, eyes with preoperative torsional muscle dysfunction exhibit torsion in the direction consistent with the dysfunction. After surgery on the torsional muscles, a measurable torsional effect can be demonstrated while the patient is still under general anesthesia.
Adolescent↗
The influence of perinatal infective factors on ophthalmia neonatorum.
BACKGROUND: Ophthalmia neonatorum still blinds approximately 10,000 babies annually worldwide. Identification of contributory maternal perinatal factors could possibly predict which babies are at greater risk for this disease. METHODS: In a randomized prospective study of ophthalmia neonatorum in Kenya, we studied the effect of prophylaxis with povidone-iodine, silver nitrate, and erythromycin in 3117 neonates. Four perinatal factors that may promote ophthalmia neonatorum were investigated: maternal vaginitis, birth in a nonsterile environment, presence of meconium at birth, and postnatal development of endometritis. RESULTS: No significant difference in the general ophthalmia neonatorum rate was found for any of the four factors (P > .14 by Fisher exact test). However, with regard to venereal ophthalmia neonatorum, the 26 infants born to mothers with vaginitis had a relative risk 5.1 times that of the rest of the infants (P = 0.0013). Their relative risk to develop gonococcal ophthalmia neonatorum in particular was 24.9 times the rest of the neonates (P = 0.0000031). Prophylaxis was with povidone-iodine in 12 infants, silver nitrate in two, and erythromycin in 12. The frequency of ophthalmia neonatorum was 25%, 100%, and 33%, respectively (differences not significant). CONCLUSION: Neonates born to mothers with vaginitis should be carefully observed for the first postnatal month for the development of ophthalmia neonatorum, even though a prophylactic agent has been used.
Anti-Bacterial Agents↗