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Steve Charles

Publications and source records attributed to Steve Charles.

9 recordsLinked to original sources
PubMed2006

Anesthesia considerations for vitreoretinal surgery.

The vast majority of vitreoretinal procedures can be safely, comfortably, and efficiently performed under local anesthesia with minimal sedation. Compared with general anesthesia, properly performed monitored local anesthesia offers the patient an increased level of safety, reduced recovery times, and prolonged postoperative pain relief. Nonetheless, the choice of anesthesia technique must be based on the needs of the patient, the requirements of the surgeon, and the skills of the anesthesia provider, ever keeping in mind that our ultimate goal is a satisfied patient with a good visual outcome.

Anesthesia↗
PubMed2006

Management of vitreous loss and dropped nucleus during cataract surgery.

The intraoperative management of complication during cataract surgery of vitreous loss and dropped nucleus strongly influences the outcome, and a well-rehearsed plan for both staff and surgeons is needed. Preventative measures, early recognition, damage control, and resolution are discussed in this article. Maintenance of appropriate pressure relationships and tissue planes limits vitreous prolapse and the surgeon's primary goal is to avoid vitreous traction resulting in retinal tears and detachment. A pars plana approach to anterior vitrectomy with staining of the prolapsed vitreous is the most effective technique. Although residual lens material should be removed from the anterior and posterior chambers, once a fragment is lost to the posterior segment, the authors advocate referral for a standard three-port posterior vitrectomy with fragmenter as needed because the goal of the cataract surgeon is to offer the patient a clean, pseudophakic anterior segment and the best chance for an optimal visual recovery.

Cataract Extraction↗
PubMed2006

Anatomical and visual results of vitreoretinal surgery for stage 5 retinopathy of prematurity.

PURPOSE: To provide a historical perspective on outcomes of surgery for infants with stage 5 retinopathy of prematurity (ROP) as performed by a single surgeon over a 24-year period. DESIGN: Retrospective observational cohort study. METHODS SETTING: Clinical practice of the Charles Retina Institute. PATIENTS: The 601 infants with stage 5 ROP in at least one eye who were referred for surgery between 1977 and 2001. Charts were reviewed for demographic data and postoperative anatomical and visual acuity outcomes in eyes that underwent surgery. MAIN OUTCOME MEASURES: The postoperative anatomical status of the retina and visual function were assessed after surgery. Anatomical outcome was categorized as success (macula attached), partial success (macula detached), failure (total retinal detachment), or lost eye (opaque cornea, secluded pupil, or phthisis). Visual function was classified as>20/200, 20/200-5/200, hand movement, light perception, or no light perception. Multivariable logistic regression was used to explore relationships between outcomes and baseline characteristics. RESULTS: Only a minority of eyes had prior cryotherapy (15%) or laser photocoagulation (7%) therapy. The mean follow-up was 44 months for the 956 eyes treated surgically. The 608 eyes with available follow-up data were classified as follows: 28% success, 5% partial success, 55% failure, and 11% lost eye. Visual function of light perception or better was achieved in 74% of the 183 eyes with data on visual acuity. Controlling for other baseline factors, early postpartum age at the time of surgery was a statistically significant predictor of failure/lost eye (OR=2.08, 95% CI 1.09-3.97) and no light perception (OR=5.13, 95% CI 1.45-18.14). Surgery for stage 5 ROP on the fellow eye was also a predictor of failure/lost eye (OR=2.38, 95% CI 1.39-4.08). CONCLUSIONS: Surgery resulted in anatomical success for approximately one third of infant eyes with stage 5 ROP, and only a minority of eyes (8 of 183) achieved visual acuity better than 5/200. However, some initially successfully attached retinas redetached. Although this study is limited by follow-up and may represent a group of patients with a more vascularly active disease state due to the low proportion of patients with prior peripheral ablation, this cohort of infants provides results against which future interventions may be compared.

Birth Weight↗
PubMed2005

Correspondence.

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Basement Membrane↗
PubMed2005

Incidence and management of elevated intraocular pressure after silicone oil injection.

PURPOSE: To determine the incidence and clinical features of chronic elevated intraocular pressure after pars plana vitrectomy and silicone oil injection for complicated retinal detachments, and to evaluate the clinical management of eyes with secondary glaucoma. METHODS: This was an observational consecutive case series of 450 eyes in 447 patients who were treated with pars plana vitrectomy and silicone oil injection. Patients who developed secondary glaucoma were treated medically with antiglaucoma medications and surgically with glaucoma drainage implants placed in an inferior quadrant. Main outcome measures were intraocular pressure, number of glaucoma medications, surgical success, and complications. RESULTS: Fifty-one of 450 eyes (11%) developed elevated intraocular pressure after pars plana vitrectomy and silicone oil injection whereas 399 eyes (89%) did not have a rise in intraocular pressure. Of the 51 eyes that developed elevated intraocular pressure, 40 (78%) were treated only with glaucoma medicines. Medical therapy reduced the intraocular pressure from a mean +/- SD of 26 +/- 13.4 mm Hg before treatment to 18 +/- 9.1 mm Hg after medical treatment (P = 0.002). The 11 of 51 eyes (22%) with elevated intraocular pressure that failed medical therapy were treated surgically with Ahmed Glaucoma Valve implantation within 12 months of silicone oil injection. In the surgical group, intraocular pressure was reduced from a mean +/- SD of 44 +/- 11.8 mm Hg before surgery to 14 +/- 4.2 mm Hg at the most recent follow-up after surgery (P < 0.001). The number of antiglaucoma medications was reduced from 3.5 +/- 0.7 before surgery to 1.2 +/- 0.5 at the most recent follow-up after surgery (P < 0.001). CONCLUSION: Chronic intraocular pressure elevation occurs in a minority (11%) of patients who are treated with silicone oil. Most of these eyes are effectively treated with antiglaucoma medications. Eyes that do not respond to medical therapy may be effectively managed with glaucoma drainage implant placement in an inferior quadrant.

Adolescent↗