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Biomedical subjects

S R Lambert

Publications and source records attributed to S R Lambert.

At least 37 records · Page 2Linked to original sources
PubMed1999

Long-term results of corneal graft survival in infants and children with peters anomaly.

OBJECTIVE: To determine the long-term results of corneal graft survival after penetrating keratoplasty for Peters anomaly and to identify risk factors for graft failure. DESIGN: Noncontrolled interventional case series: a single-center retrospective review of a consecutive surgical series. PARTICIPANTS: The records of all children 12 years of age or younger who underwent penetrating keratoplasty for Peters anomaly between January 1971 and December 1992 were reviewed. All study eyes had completed a minimum of 3 years of follow-up from the date of first keratoplasty and had undergone most of their corneal surgery at Emory University. INTERVENTION: Characteristics of the recipient, the eye, the donor, and the surgical procedure were analyzed for their influence on survival of the first graft. Survival probabilities were estimated using the Kaplan-Meier method. Multivariate regression analysis was performed to estimate relative risks and adjusted survival probabilities. MAIN OUTCOME MEASURE: Graft clarity. RESULTS: One hundred forty-four penetrating keratoplasties were performed in 72 eyes of 47 patients. The median age at first keratoplasty was 4.4 months. The median follow-up was 11.1 years. Fifty-four percent of eyes received one graft, 18% received two grafts, and 28% received three or more grafts. The overall probability of maintaining a clear first graft was 56% at 6 months, 49% at 12 months, 44% at 3 years, and 35% at 10 years. The probability of second or subsequent grafts surviving for 3 years was less than 10%. Thirty-nine percent of eyes had a clear graft at the time of review; 36% of eyes had a clear first graft. Multivariate analysis identified disease severity, donor cornea size, coexisting central nervous system abnormalities, and quadrants of anterior synechiae as the strongest risk factors for graft failure. Supplemental multivariate analysis, restricted to observable preoperative variables, identified stromal vessels, total limbal opacification, and preoperative glaucoma as independent preoperative predictors of graft failure. Allograft rejection was the most frequently identified cause of graft failure. Major complications after keratoplasty were phthisis, retinal detachment, cataract, and glaucoma. CONCLUSIONS: The overall long-term probability of maintaining a clear graft after initial penetrating keratoplasty for Peters anomaly is 35% +/- 0.06%, with subsequent grafts rarely surviving. Eyes with severe disease, larger donor corneas, coexisting central nervous system abnormalities, and anterior synechiae have significantly poorer outcomes than eyes without these factors. These data should be carefully considered before recommending corneal transplantation for Peters anomaly, particularly after previous graft failure.

Anterior Eye Segment↗
PubMed1999

Effect of age at time of cataract surgery on subsequent axial length growth in infant eyes.

PURPOSE: To determine whether removal of the crystalline lens and placement of an intraocular lens (IOL) in human infant eyes retard the growth of the pseudophakic eye. METHODS: A unilateral lensectomy with placement of a posterior chamber IOL in the sulcus was performed in 11 infants between 2 and 4 months of age. Axial length measurements of both eyes were obtained preoperatively and postoperatively. RESULTS: Patients were followed for a mean of 5.6 years. In 7 patients, the mean axial growth was 0.46 mm less in the pseudophakic eye than in the fellow eye (range 0.15 to 0.70 mm). In 1 patient, there was no interocular axial length difference and in 3, the pseudophakic eye was longer. When measurements from the only patient with microphthalmia were excluded, the interocular difference in axial growth was highly significant (signed rank test, P = .006). Median visual acuity of the pseudophakic eyes at the last follow-up was 20/60 (range 20/30 to 20/200). The final visual acuity in the pseudophakic eyes did not correlate with the degree of interocular axial length difference (P > .05). CONCLUSIONS: Our study suggests there may be a reduction in axial growth in infantile eyes following cataract extraction and IOL implantation. This effect probably reduces the magnitude of the myopic shift in these eyes.

Aging↗
PubMed1999

Successful treatment of tractional corectopia using 2 mJ of energy with an Nd:YAG laser.

Although the Nd:YAG laser is most commonly used to perform posterior capsulotomies after cataract surgery, it has also been used to treat a variety of other anterior segment abnormalities including tractional corectopia, iridocorneal adhesions, persistent pupillary membranes, and posterior synechiae. Numerous reports on the use of the Nd:YAG laser to treat structures in the anterior segment have emphasized the need to use higher pulse energy for pupillary membranes, compared with the lower settings required for posterior capsulotomy. Steinert and Puliafito noted that single pulses of 4 to 12 mJ may be required to treat pupillary membranes "in a manner similar to that of a stonemason chipping at marble" in their description treating a membrane considerably thicker than what we describe. We report the successful treatment of tractional corectopia due to an anterior membrane strand in a child with only 2 mJ of total energy.

Eye Abnormalities↗
PubMed1999

Anterior hyaloid face opacification after pediatric Nd:YAG laser capsulotomy.

PURPOSE: The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population. METHODS: A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure. RESULTS: Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment. CONCLUSIONS: In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.

Cataract↗
PubMed1999

Unilateral intraocular lens implantation during the first six months of life.

PURPOSE: The purpose of this study was to determine the incidence of postoperative complications and the occurrence of myopic shift in infantile eyes after cataract surgery and implantation of an intraocular lens (IOL). METHODS: Cataract surgery and IOL implantation was performed on 11 infants with unilateral congenital cataracts who had a mean age of 10+/-6 weeks at 5 clinical centers. IOLs with a mean power of 26.2+/-2.3 D were implanted using a standardized protocol. The infants were then followed up for a mean of 13+/-6 months for postoperative complications and longitudinal changes in their refractive error. RESULTS: Eight of the 11 eyes had postoperative complications and were treated with a reoperation. Complications included open-angle glaucoma (n = 2), lens reproliferation into the visual axis (n = 2), pupillary membranes (n = 2), and corectopia (n = 2). A younger age at the time of surgery was positively correlated with the development of a postoperative complication requiring a reoperation (P = .03). A mean myopic shift of 5.49 D occurred in these eyes a year after surgery. No preoperative factors could be identified that correlated with the magnitude of the myopic shift. CONCLUSION: IOL implantation during infancy is associated with a high complication rate frequently requiring reoperation. A large myopic shift typically occurs that necessitates an initial or a late overcorrection with spectacles or a contact lens, depending on the power of the IOL implanted. Until ongoing randomized trials are completed, we recommend that surgeons exercise caution before implanting IOLs in the eyes of infants.

Age Factors↗
PubMed1999

Management of monocular congenital cataracts.

Monocular congenital cataracts have been treated for the past two decades with early surgery, contact lens correction and patching of the unaffected eye. While an occasional patient has had a good visual outcome with this treatment regiment, the majority end up being legally blind in the aphakic eye. Intraocular lenses (IOLs) are increasingly being used as an alternative means of optically correcting aphakia during infancy. A growing body of literature suggests that an IOL correction is associated with an improved visual outcome and a relatively low incidence of post-operative complications. A monkey model has also been used to study the safety and feasibility of correcting aphakia in neonates with IOLs. These studies have revealed that the visual outcome is as good if not better with an IOL correction. A multicentre clinical trial, the Infant Aphakia Treatment Study (IATS), is being organised in the United States to critically compare an IOL and contact lens correction for infantile aphakia.

Animals↗
PubMed1998

The effect of age on the retardation of axial elongation following a lensectomy in infant monkeys.

OBJECTIVE: To determine the effect of age on the retardation of axial elongation in neonatal monkey eyes following the extraction of the crystalline lens. METHODS: A monocular lensectomy was performed on 4 rhesus monkeys when they were 4 days, 2 weeks, 7.5 months, and 1 year of age. Longitudinal measurements of axial lengths and keratometry readings were made. RESULTS: The aphakic eye was 1.7 mm shorter than the unmanipulated fellow eye in the monkey undergoing surgery at 4 days of age and 1.1 mm shorter in the monkey undergoing surgery at 2 weeks of age. However, the aphakic eyes were only 0.2 mm and 0.1 mm shorter than their unmanipulated fellow eyes, respectively, in the monkeys undergoing surgery at 7.5 months and 1 year of age. CONCLUSIONS: The retardation of axial elongation following a lensectomy in infantile monkey eyes is age dependent. Little effect is observed in monkeys aged 7.5 months or older.

Aging↗
PubMed1998

Cyclic esotropia after a traumatic sixth nerve palsy in a child.

Cyclic esotropia is a rare phenomenon in which esotropia and orthophoria alternate over a period of 48 to 96 hours. The mechanism that underlies the phenomenon is unknown. Cyclic esotropia often occurs after a fusion-disrupting event. We report an unusual case of cycling esotropia with onset after a traumatic sixth nerve palsy. The cyclic phase persisted for 2 years, following a 48-hour alternate-day pattern. After strabismus surgery for the esotropic angle, the deviation disappeared and the patient remained orthotropic, with 1 year of follow-up to date.

Abducens Nerve Injury↗
PubMed1998

Pseudotumor cerebri in children.

PURPOSE: Demographic and outcome data in the era of modern neuroimaging are needed to describe pseudotumor cerebri in children. METHODS: We reviewed the medical records of children less than 18 years old who were diagnosed with pseudotumor cerebri between 1977 and 1997. We defined pseudotumor cerebri as (1) increased intracranial pressure, (2) normal or small ventricles, and (3) normal cerebrospinal fluid composition. The condition might be idiopathic or the result of a nontumor etiology. RESULTS: Thirty-seven patients had an initial diagnosis of pseudotumor cerebri. Two patients were subsequently diagnosed with a central nervous system malignancy and were excluded from further analysis. The remaining 35 patients included 10 patients with idiopathic pseudotumor cerebri and 25 patients with disorders reported to be associated with pseudotumor cerebri. The mean age was 10.6 years with a range of 3 to 17 years. Twenty patients (57%) were female and 13 patients (37%) were obese. At presentation 4 patients had a visual acuity less than 20/40 in the best eye and 10 patients had visual field deficits. Seventeen patients (49%) had cranial nerve deficits, all of which resolved with normalization of the intracranial pressure. Follow-up data were obtained on 30 patients. Only one patient had a final visual acuity less than 20/40 in the best eye, whereas six patients had residual visual field deficits. Ten patients (33%) had optic nerve atrophy. CONCLUSIONS: There was no gender predominance, and associated etiologic factors were common in these children with pseudotumor cerebri. Permanent visual loss occurs in some children with pseudotumor cerebri. Quantitative perimetry and optic nerve examination were more sensitive than visual acuity determination in detecting damage to the visual sensory system. In rare instances the patient diagnosed with pseudotumor cerebri will be found after extended follow-up to harbor an intracranial neoplasm.

Adolescent↗
PubMed1997

Strabismus and mitochondrial defects in chronic progressive external ophthalmoplegia.

PURPOSE: To describe the results of strabismus surgery on three patients with chronic progressive external ophthalmoplegia, a group of rare disorders characterized by ptosis and slowly progressive ophthalmoparesis that has been shown to result from defects in mitochondrial DNA. METHODS: Strabismus surgery using the adjustable suture technique was performed in three patients with strabismus and chronic progressive external ophthalmoplegia confirmed by clinical, biochemical, histopathologic, and genetic criteria. All three patients had mitochondrial DNA deletions. Two patients were exotropic; one patient was esotropic. RESULTS: Rectus muscle recessions were initially unsuccessful in correcting strabismus in one patient, although a subsequent procedure employing rectus muscle resections was successful in alleviating a significant head turn and improved ocular alignment. In the two other patients, a single procedure consisting of rectus muscle recessions combined with large rectus muscle resections successfully achieved good postoperative alignment. The amount of surgery performed in these three patients exceeded that predicted in standard strabismus tables. CONCLUSIONS: The myopathic process that results in chronic progressive external ophthalmoplegia renders rectus muscle recessions less effective compared with resections for correcting the associated strabismus seen in these patients. Rectus muscle resections therefore should be an integral procedure in the surgical management of the strabismus associated with chronic progressive external ophthalmoplegia.

Adult↗
PubMed1997

Myopic shift after intraocular lens implantation during childhood.

PURPOSE: The purpose of the study is to evaluate the myopic shift that occurs in children 3 to 9 years of age who undergo cataract extraction with primary intraocular lens (IOL) implantation. METHODS: A review of 18 children (mean, 6.3 +/- 0.5 year; range, 3-9 years) who had undergone primary IOL implantation was undertaken. Patients were observed for an average of 3.2 years. The initial and last postoperative refractive errors were compared. RESULTS: The mean myopic shift was -0.99 +/- 0.22 diopter (D) (median, 1.0 D) with a range of -3.25 to +0.38 D. The difference in the myopic shift of the children 3 to 5 years of age (-0.94 +/- 0.30 D) was not significantly different from the myopic shift occurring in the children 6 to 9 years of age (-1.07 +/- 0.35 D). The myopic shift was less than 1.5 D in 70% of the eyes and only 3 eyes had a myopic shift greater than 2 D. Ninety percent of the children achieved a visual acuity of 20/40 or better in their pseudophakic eye or eyes. CONCLUSIONS: Although each patient should be evaluated on an individual basis, the authors recommend undercorrecting most children 3 to 9 years of age by 1 D from the IOL power predicted to achieve emmetropia.

Cataract Extraction↗
PubMed1997

Intraocular lens implantation in infant monkeys: clinical and histopathological findings.

PURPOSE: To determine the long-term effects of intraocular lens (IOL) implantation in infant monkey eyes. SETTING: Yerkes Regional Primate Research Center, Emory University School of Medicine, Atlanta, Georgia, USA. METHODS: A 30.00 diopter (D), all-poly(methyl methacrylate) IOL with an overall diameter of 10.0 mm was implanted in the right eye of 11 infant monkeys. Seven monkeys developed postoperative complications and were not followed on a long-term basis. However, 4 monkeys were followed clinically for 4 1/2 years, after which their pseudophakic eyes were examined histopathologically. RESULTS: The final refractive error in the four pseudophakic eyes with long-term follow-up ranged from -4.75 to +0.75 D. Three of the four eyes had a Soemmering's ring. Only one haptic was in the capsular bag. whereas five had eroded into the iris root/ciliary body. The corneas and posterior segments of the eyes were normal. CONCLUSION: Two-thirds of the eyes having neonatal IOL implantation experienced significant postoperative complications. Haptic location was suboptimal in all four eyes followed for 4 1/2 years. The diameter of the IOLs implanted in these eyes was probably too large. Some of these complications might have been averted by implanting an IOL with a smaller diameter.

Animals↗
PubMed1997

Longitudinal changes in axial length in pseudophakic children.

PURPOSE: To evaluate the axial length changes that occur in children 3 to 9 years of age who had cataract extraction with primary intraocular lens (IOL) implantation. SETTING: Emory Eye Center, Emory University, and Egleston Children's Hospital, Atlanta, Georgia, USA. METHODS: A review of 17 eyes in 15 children (mean age 6.4 years; range 3 to 9 years) who had primary IOL implantation was undertaken. Patients were followed for an average of 3.1 years. The initial and final axial length measurements and refractive errors were compared. RESULTS: The overall change in mean axial length in the 17 eyes was 0.64 mm. The overall mean myopic shift was -1.01 diopters (D) (range -3.00 +0.50 D). Eyes with traumatic cataracts experienced more axial elongation than eyes with developmental/congenital cataracts (0.97 mm versus -0.01 mm; P = .03). Ninety-four percent of patients obtained a final visual acuity of 20/40 or better. CONCLUSION: Eyes with traumatic cataracts experienced more axial elongation than eyes with developmental/congenital cataracts after cataract extraction and IOL implantation.

Cataract↗
PubMed1997

Balloon dilatation for treatment of resistant nasolacrimal duct obstruction.

PURPOSE: Our purpose was to report our experience with balloon catheter dilatation for resistant nasolacrimal duct obstruction. METHODS: Patients enrolled had symptoms of nasolacrimal duct obstruction and (1) had failed previous probing or (2) were more than 2 years old. Balloon dilatation was performed with a LacriCATH lacrimal catheter (Atrion Medical Products, Birmingham, Ala.). A subset of patients had Silastic silicone rubber (Dow Corning, Midland, Mich.) intubation after balloon dilatation. Success was determined by clinical examination a minimum of 6 weeks later. RESULTS: Twenty-one lacrimal systems of 12 patients were treated (age range 4 months to 7 years). Of the patient subset treated with a LacriCATH lacrimal catheter alone, 9 of 18 systems demonstrated complete resolution of symptoms. Three of the 12 patients underwent balloon dilatation intraoperatively after attempts at Silastic silicone rubber intubation were unsuccessful. In two of these patients, who were younger, Silastic silicone rubber tubes passed easily after balloon treatment; however, in an older patient, age 5 years, intubation still could not be accomplished. CONCLUSION: Common clinical strategy for treatment of resistant nasolacrimal obstruction includes repeat probing, intubation of the nasolacrimal system with Silastic silicone rubber tubes, or dacryocystorhinostomy. Balloon catheter dilatation is an alternative or adjunct to consider. Factors that may affect the success of treatment include the age of the patient, the complexity of the nasolacrimal anatomy, and use of adjunctive systemic antibiotics and steroids.

Catheterization↗
PubMed1996

Congenital entropion and congenital corneal ulcer.

PURPOSE: We studied a case of corneal ulceration in utero from lower eyelid entropion. METHODS: A 3-week-old male infant was referred for examination of a left corneal ulcer that was present at birth and unresponsive to antibiotics. RESULTS: Examination disclosed a lower eyelid entropion that was treated surgically by a nonincisional method, leaving a central leukoma after re-epithelialization. CONCLUSION: Congenital lower eyelid entropion should be included in the differential diagnosis of congenital corneal opacities.

Corneal Opacity↗
PubMed1996

Optic nerve hypoplasia: absence of posterior pituitary bright signal on magnetic resonance imaging correlates with diabetes insipidus.

PURPOSE: Magnetic resonance imaging has been used to examine children with optic nerve hypoplasia for pituitary abnormalities who may be at risk for anterior pituitary hormonal deficiencies. We correlated the sellar and optic pathway anatomic findings on magnetic resonance imaging in children with optic nerve hypoplasia with findings from their endocrinologic and ophthalmologic examinations to determine whether magnetic resonance imaging findings predict anterior and posterior pituitary dysfunction. METHODS: A retrospective review identified five children with optic nerve hypoplasia and endocrinopathy who also underwent high resolution volumetric magnetic resonance imaging. RESULTS: All children had severe bilateral optic nerve hypoplasia and anterior pituitary hormone deficiencies. Three children had no recognizable intrasellar or ectopic posterior pituitary bright spot on magnetic resonance imaging; all had clinical evidence of diabetes insipidus. Two patients with a recognizable but ectopic posterior pituitary did not have diabetes insipidus. CONCLUSION: Children with optic nerve hypoplasia and no recognizable posterior lobe of the pituitary gland on magnetic resonance imaging are at risk for both anterior and posterior pituitary dysfunction, whereas those with a posterior lobe on magnetic resonance imaging appear to have intact posterior pituitary function.

Diabetes Insipidus↗