Surgical outcomes in adult patients after repair of anterior segment trauma sustained during childhood.

PURPOSE: To evaluate the outcomes and possible benefit of surgery performed on adults for anterior segment trauma sustained during childhood. SETTING: Private practice. METHODS: A retrospective review of patient records was performed. Adult patients who had anterior segment surgery for injuries that occurred during childhood were identified. The surgical outcomes were evaluated to determine whether intervention was beneficial in this subgroup of patients. RESULTS: Six patients were identified. Preoperative best corrected visual acuity (BCVA) was 20/200 or worse in all patients. After surgery, the BCVA in 3 patients had improved to 20/30 or better and in 1 patient, to 20/60. The other 2 patients had less improvement; however, each noted subjective improvement in vision. No major intraoperative or postoperative complications occurred. CONCLUSION: In the absence of evidence of accompanying posterior segment trauma, surgery in adults to correct anterior segment damage from childhood trauma was safe and often beneficial.

Effect of latanoprost on intraocular pressure in steroid-induced glaucoma.

PURPOSE: To study the effect of monotherapy with latanoprost 0.005% on intraocular pressure (IOP) in a prospective nonrandomized clinical trial of patients newly diagnosed with steroid-induced secondary open-angle glaucoma. PATIENTS AND METHODS: Eight patients (16 eyes) with newly diagnosed steroid-associated secondary open-angle glaucoma were prescribed latanoprost 0.005% once a day in each eye. The initial IOP before treatment served as an internal control for each eye. Intraocular pressure was remeasured after 1 month of monotherapy with latanoprost. Investigators (WJS) were blinded to initial IOP at the time of remeasurement. After discontinuation of steroids, IOP was rechecked. If IOP was stable, latanoprost was discontinued. Intraocular pressure was rechecked 2 to 4 weeks later to confirm an association with steroid use. RESULTS: Intraocular pressure was significantly decreased after treatment with latanoprost (18.3 +/- 2.8 mm Hg) compared with initial IOP (25.3 +/- 9.1 mm Hg). This change represented a 28% decrease in IOP compared with baseline levels. Average IOP after discontinuation of steroids and latanoprost (17.3 +/- 1.4 mm Hg) did not differ from IOP measured during treatment with latanoprost, but it was significantly less than the initial IOP before treatment. No adverse effects were noted. CONCLUSIONS: Monotherapy with latanoprost is safe and effective in patients with steroid-induced glaucoma. Advantages include lack of systemic side effects and convenient once-daily dosing.

Effect of latanoprost on intraocular pressure following cataract extraction.

PURPOSE: To compare the effect of latanoprost 0.005% with that of a placebo (balanced salt solution [BSS]) applied after phacoemulsification on intraocular pressure (IOP). SETTING: Pasco Eye Institute, New Port Richey, Florida, USA. METHODS: A group of patients having cataract extraction by phacoemulsification was randomized following surgery to receive one drop of latanoprost 0.005% (1.5 micrograms) or a placebo (BSS). Exclusion criteria included ocular diagnosis in addition to cataract, previous eye surgery, history of glaucoma, previous use of glaucoma medications, or vitreous loss during surgery. Standard phacoemulsification was performed through a scleral tunnel approach and a one-piece, poly(methyl methacrylate) intraocular lens implanted in the capsular bag. Approximately 24 hours after surgery, IOP was measured with a Goldmann applanation tonometer by the surgeon. The anterior chamber reaction was qualitatively graded from 1+ to 4+. RESULTS: The study included 103 eyes (latanoprost = 53; control = 50). Latanoprost treatment resulted in significantly lower postoperative (IOP) (16.4 mm Hg +/- 3.7 [SD]) than preoperative IOP (17.9 +/- 3.0 mm Hg) (P < .025). There was no decrease in postoperative IOP in the control group (18.2 +/- 3.5 mm Hg) compared with preoperative IOP (18.3 +/- 2.6 mm Hg). When two groups were compared, postoperative IOP after treatment with latanoprost was significantly less than control IOP (P < .01). Preoperative IOP was not significantly different in the placebo and latanoprost groups. Anterior chamber reaction was not increased by latanoprost; it averaged 1+ in both groups. CONCLUSIONS: Latanoprost may pharmacologically enhance uveoscleral outflow immediately after cataract extraction. In this study, latanoprost was a safe, effective method of reducing postoperative IOP.

Movement of developmentally disabled individuals among out-of-home residential facilities.

This paper reported on the movement of a large (N = 2271) probability sample of the nation's residents of public (PRF) and community (CRF) residential facilities for developmentally disabled children and adults. Estimates placed the national population at 217,410 in all facilities--73,709 in CRFs and 143,701 in PRFs--in the fall of 1978, when the sample was selected, although extrapolation from subsequent surveys suggest that the CRF numbers should be about 100,000. In the winter of 1979 direct care staff and administrators completed detailed information about each resident sampled, about themselves, and about their facilities. In 1980 they were asked if their residents had moved exactly one year later. Most residents (91%) had not moved; 1.3% had died; and about 8.5% had moved. Most moves featured greater integration into the community. Multivariate analyses indicated very little difference between moved and unmoved residents. Among moved subjects, three dimensions accounted for 62% of the common variance in placement status: (a) ability, (b) age, and (c) autonomy.

National census of residential facilities: a 1982 profile of facilities and residents.

A national census of all state-licensed residential facilities for mentally retarded persons was conducted in 1982. This census enumerated 243,669 mentally retarded residents living in 15,633 facilities on June 30, 1982. Information on characteristics of facilities (e.g., type, location, size, type of operator, reimbursement rates) is presented along with demographic/functional characteristics of residents (e.g., age, level of retardation, previous and subsequent placement). The census verified the existence of an extensive variety of residential living alternatives available to mentally retarded people.

Factors related to job stability of direct-care staff of residential facilities for mentally retarded people.

Direct-care staff turnover has frequently been cited as a major problem in the management of both public and nonpublic residential facilities. This article reports on a follow-up study of over 100 direct-care staff one year after an initial interview. Staff members were employees of facilities in a national, stratified random sample of public and nonpublic facilities. Demographic, experiential, job satisfaction, geographical, and institutional factors related to occupational status at the time of the follow-up are reported.

National survey of community residential facilities: a profile of facilities and residents in 1977.

In 1977, a national mail survey of all community residential facilities (CRFs) for mentally retarded persons throughout the United States was conducted by the staff of the Developmental Disabilities Project on Residential Services and Community Adjustment at the University of Minnesota. The results of 4,427 participating facilities were summarized in this report. Demographic information on facility size, location, ownership, and reimbursement rates was presented as well as general characteristics about the residents and their movement trends. The impact of the deinstitutionalization movement for mentally retarded persons was substantially verified by the results of this survey: between 1973 and 1977, the number of CRFs doubled. Wide variations in facility size and the extent to which states use community living arrangements to serve mentally retarded people were two notable trends confirmed by the survey results.