bluuebunny/crossref_metadata_2025 huggingface dataset:
Microspherophakia in Association With the Rhizomelic Form of Chondrodysplasia Punctata
Authors: Eustis H Sprague , Yaplee Steven M , Kogutt Marvin , Ginsberg Harley G
Published: April 2021

ABSTRACT

Chondrodysplasia punctata is a multisystem disorder, primarily involving the musculoskeletal system, skin, and eyes. Children with the rhizomelic form of this syndrome have characteristic facies with a saddle-nose deformity, hypertelorism, and frontal bossing. The musculoskeletal changes include proximal limb shortening, flexion contractures, congenital hip dislocations, and the characteristic radiographic finding of epiphyseal stippling of the axial skeleton and long bones. The most common ocular findings are cataracts and optic atrophy. We describe herein the first reported case of microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.
Use of High Dose Chloral Hydrate for Ophthalmic Exams in Children: A Retrospective Review of 302 Cases
Authors: Fox Barbara E S , O'Brien Carol O , Kangas Kathy J , Murphree A Linn , Wright Kenneth W
Published: April 2021

ABSTRACT

Although chloral hydrate sedation has been proposed as an alternative to evaluation under anesthesia for pediatric patients who are unable to cooperate with routine test procedures, a careful study of the drug's safety and effectiveness is lacking. This study reports the effectiveness and safety of high-dose chloral hydrate for ophthalmic examination in 302 patients between the ages of 1 month and 5 years. The patients had nothing to eat or drink for 4 hours prior to drug administration. The patients were monitored during sedation and Until fully awake. Eighty-eight percent of the patients (266/302) were successfully sedated without a supplemental dose. There were no reports of any complications including emesis, respiratory distress or depression, behavioral problems, changes in vital signs, patient injury, or hospital admission. The high-dose chloral hydrate protocol described, results in safe and generally successful sedation of pediatric patients for ophthalmic examination.
Surgical Treatment Options in Cyclotropia
Authors: von Noorden Gunter K , Chu Milton W
Published: April 2021

ABSTRACT

We report our experience with a procedure involving the transposition and realignment of the vertical recti muscles, in two cases. In the first case, 11° of unilateral excyclotropia was corrected by a one muscle width nasal transposition of the ipsilateral inferior rectus muscle. In the second case, excyclotropia was created in both eyes by a one-half muscle width nasal transposition of both superior recti, and, in a second operation, reversed by a horizontal realignment of these muscles.

We found this procedure to be useful in the treatment of both incyclo- and excyclotropia.
Topical Treatment of Periocular Capillary Hemangioma
Authors: Elsas Frederick J , Lewis Angela R
Published: April 2021

ABSTRACT

Five patients with vision-threatening per i oc u Ia r capillary hemangiomas were treated with topical clobetasol propionate cream. Two received steroid eye drops. All experienced a decrease in the size of their hemangioma. Topical treatment of periocular capillary hemangioma appears to be well tolerated and, in selected cases, may eliminate the need for intraJesJonal injection of corticosteroids.
Loss of Fusion and the Development of A or V Patterns
Authors: Miller Marijean M , Guyton David L
Published: April 2021

ABSTRACT

To test the hypothesis that loss of fusion predisposes the ocular motor system to the development of A or V patterns, we reviewed the pre- and postoperative courses of patients with intermittent exotropia overcorrected with horizontal muscle surgery. Of 332 patients who had surgery, 21 experienced at least 1 month of consecutive esotropia. An equal number of age-matched patients who maintained fusion postoperatively served as controls. No patient in either group had a preoperative A or V pattern. At the first return visit, at least 4 weeks postoperatively, 4 (19%) of the 21 patients with consecutive esotropia showed an A or V pattern, whereas none of the 21 control patients did so. At the end of follow up (mean of 27 months for patients with consecutive esotropia and 29 months for controls), 9 (43%) of the 21 patients with consecutive esotropia showed an A or V pattern versus 1 (5%) of the 21 controls. These findings strongly suggest that loss of fusion is instrumental in the development of A or V patterns, consistent with "sensory torsion" theory of A and V pattern development.
Saccadic Velocity Analysis in Patients With Divergence Paralysis
Authors: Lim Lucious , Rosenbaum Arthur L , Demer Joseph L
Published: April 2021

ABSTRACT

Twelve patients with clinical findings of divergence paralysis underwent horizontal saccadic velocity testing. Peak velocities were measured using digitally sampled electro-oculography during 10°, 20°, and 30° saccades. Results were compared with those of 12 age-matched controls. The peak saccadic velocities of each eye in adduction and 10° abduction did not differ from those of age-matched controls (P>.05). The 20° and 30° abducting saccades showed mildly reduced saccadic velocities when compared with controls (P<.05). The finding of only mildly reduced abduction saccadic velocities bilaterally is not consistent with bilateral lateral rectus palsy. The data support the hypothesis that divergence paralysis represents a distinct clinical entity unrelated to abducens nerve paresis and argues for the existence of an active divergence center.

We further report the surgical results of five patients who were treated with strabismus surgery. A 4.0 to 6.0 mm bilateral lateral rectus muscle resection corrected 16 to 30 Δ of esotropia at distance without resulting in an overcorrection at near. Bilateral lateral rectus muscle resection is an effective therapy for divergence paralysis.
Improvement in Visual Acuity in Children With Ectopia Lentis
Authors: Speedwell Lynne , Russell-Eggitt Isabelle
Published: April 2021

ABSTRACT

The early development of vision in an eye with a dislocated lens is often poor, leading to disappointing postoperative results due to amblyopia. A retrospective review of the best corrected visual acuity of 49 eyes of 27 children with ectopia lentis, who were rendered aphakic either spontaneously or by lensectomy, showed a gradual improvement. Nineteen eyes achieved an early postoperative acuity of 6/12 or better. Of the remaining 30 eyes, 21 were followed up for 1 or more years. During this period, an improvement of two or more Snellen visual acuity lines was noted in all but one of the eyes.
Random Dot Stereoacuity Following Surgical Correction of Infantile Esotropia
Authors: Birch Eileen E , Stager David R , Everett Mary E
Published: April 2021

ABSTRACT

Surgical correction of Infantile esotropia prior to age 2 is associated with a higher prevalence of fusion and stereopsis than surgical correction after 2 years of age. The advantages and disadvantages of surgical intervention at the early or late end of this window have been debated in the literature. In the present study, random dot (RD) Stereoacuity outcomes were evaluated in order to determine whether a binocular sensory benefit is associated with early or late surgery. Participants were 73 healthy children enrolled in a prospective study of visual development in infantile esotropia. All children had initial surgical correction at 5 to 16 months of age. RD Stereoacuity was evaluated at approximately 5 years of age (59.7 ±14.9 months). Overall, 41.1% of children demonstrated RD stereopsis. The percentage of children demonstrating RD stereopsis was not significantly different among groups that were surgically corrected at 5 to 8 months (43.8%), 9 to 12 months (47.4%), and 13 to 16 months (31.8%). However, among those children who achieved RD stereopsis, the prevalence of fovea! (60 sec) or macular (61 to 200 sec) Stereoacuity was significantly higher among those who had surgery at 5 to 8 months (42.9%; Z= 2.06, p<0.02) or 9 to 12 months (55.6%; Z= 2.38, p· 0.009) than among those who had surgery at 13 to 16 months (0.0%). Although surgical correction of infantile esotropia during the first year of life is not associated with a higher prevalence of RD stereopsis, it Is associated with better RD Stereoacuity among those children who achieve stereopsis following surgery.
20th Annual Frank Costenbader Lecture-Adult Strabismus
Authors: Scott William E , Kutschke Pamela J , Lee Won Ryul
Published: April 2021

ABSTRACT

Background: A retrospective analysis of adults with strabismus was done to examine the potential risks and the possible benefits of surgical treatment and to describe the types of adult strabismus.

Methods: Eight hundred ninety-two patients were analyzed. Age at time of surgery ranged from 9 years to 89 years. The average follow up was 34 months. Major types of strabismus were grouped by their original diagnoses. The group of patients with horizontal strabismus, which usually had an onset before 9, was termed the before visual maturity (BVM) group. The group of patients with paretic or restrictive strabismus usually had the onset of strabismus after age 9 and was termed the after visual maturity (AVM) group.

Results: Patients with adult strabismus can gain restoration of alignment, as well as binocular function. At the last postoperative visit, 74% of the BVM group were aligned within 15 prism diopters. Not only was restoration of alignment accomplished, many of them gained some degree of sensory fusion as measured by the Worth 4-Dot (W4D) or Titmus stereoacuity. Twenty-nine percent of patients with congenital esotropia had some sensory fusion. The other subtypes in the BVM group had even higher percentages of patients with postoperative stereoacuity. In the AVM group, 92% had fusion at the last postoperative visit.

Conclusions: The outcomes of adult strabismics in our study show that certain benefits can be gained from correction of ocular alignment. Restoration of alignment, elimination of diplopia and sensory fusion are functional benefits that can be obtained through strabismus surgery in the adult patient. It is clear that adult strabismus is more than just a cosmetic problem and treatment is worthwhile.
The Long-term Use of Botulinum Toxin for Adult Strabismus
Authors: Horgan Simon E , Lee John P , Bunce Catey
Published: April 2021

ABSTRACT

Purpose: To characterize patients choosing repeated botulinurn toxin injection as a treatment for their strabismus, and assess their demand for it over time (up to 8 years ).

Method: Patients who had undergone at least eight injections were identified and their clinical records analyzed for diagnosis, demographic details, and demand for toxin injections with time. To establish any predictive variables, the details for these cases were compared with those of matched controls who had undergone fewer injections. Lastly, a questionnaire was mailed to research patients' views as to the indications and preferences for regular toxin injection as a method of treatment.

Results: Ninety-five patients were identified (34 men, 61 women; median age 37 years), of whom 35 had consecutive exotropia and 16 had secondary exotropia. Other diagnoses represented were residual and primary deviations, restrictive exotropias, and oscillopsias.

A trend of fewer injections over the attendance period was seen, and the only complication observed was upper lid ptosis in 1% of injections. Cases exhibited similar demographic composition to matched controls, but were more likely to have consecutive exotropia or secondary esotropia as a diagnosis. Univariate analysis showed evidence (p<0.001) of an association between the number of previous operations and the odds of being a case. No evidence was found that cases and controls lived at differing distances from our hospital.

The questionnaire found that 71% of patients stated appearance as the prime reason for seeking treatment, and 37% stated simplicity of toxin therapy as their reason for reattendance. Twenty-six percent of the patients were disillusioned with the resurts of previous surgery and preferred toxin therapy as a means of controlling their symptoms.

Conclusion: Botulinum toxin injection is an appropriate long-term treatment for some strabismus patients who choose not to undergo further surgery. A trend toward fewer injections with time was observed, and no adverse effects were associated with long-term treatment.
Lacrimal-duct-probing-induced Bacteremia; Should Children With Congenital Heart Defects Receive Antibiotic Prophylaxis?
Authors: Eippert Gregory A , Burnstine Robert A , Bates James H
Published: April 2021

ABSTRACT

Purpose: To determine the Incidence of bacteremla following lacrimal-duct probing in children, and to evaluate the potential need for antibiotic prophylaxis in children who are at an increased risk of infectious endocarditis (IE).

Methods: In a prospective study beginning in October 1994, 40 consecutive children requiring lacrimal-duct probing performed by a single pediatrie ophthalmologist received preoperative lacrimai and blood cultures followed by postoperative probe-induced transient bacteremia that was defined as a negative preoperative blood culture, followed by a positive postoperative blood culture of the same bacteria identified in the positive lacrimal culture.

Results: The overall infection rate as described above was 7 of 40 children (17.5%) with a 95% confidence interval of 7.3% to 32.8%. Of these, four children had positive postoperative cultures for Haemophilus influenzae (10.0%) and 3 were positive for Streptococcus pneumoniae (7.5%) One child had a negative preoperative blood and lacrimal culture with a postoperative blood culture positive for Streptococcus viridans.

Conclusions: This study shows a significant Incidence of I ac r I ma l-p robe-Induced bacteremla with organisms that have been documented as etiologlcal agents for IE in children. IE, although less common in children, remains a serious, potentially life threatening infection with high mortality. Although lacrimal-duct probing has never been clearly associated with documented endocarditis, it is the authors' recommendation that it be prudent for patients who are at known high risk for endocarditis to receive SBE prophylaxis considering the low cost/benefit ratio.
Clinical Characteristics of Surgically Treated Adult Strabismus
Authors: Hertle Richard W
Published: April 2021

ABSTRACT

Background: Strabismus is present in approximately 4% of the population with most forms becoming clinically evident in infancy and childhood. Adult strabismus, including that resulting from recurrent childhood deviations, varies in etiology, presentation, symptomatology, and response to treatment. This report is intended to prospectively characterize adults who required surgical correction of their strabismic deviation.

Methods: Beginning in 1991, a prospective computerized database was collected that contained all clinical, laboratory, and surgical information on the adult ocular motility service at the Scheie Eye Institute and The Children's Hospital of Philadelphia (Philadelphia, Pa). Analysis of those patients who underwent surgical correction of their strabismus is included in this report. Demography, clinical characteristics, and surgical procedures including results were analyzed separately in adults with their strabismus beginning before visual maturation (BVM) (9 years of age) and after visual maturation (AVM).

Results: A minimum of 6 months and average of 1.8 years follow up is reported on 262 procedures in 255 patients with an average age of 37 between January 1991 and January 1996. Sixty-two percent of patients had their strabismus onset BVM. Fifty-one percent of BVM patients and 80% of AVM patients had incomitant deviations. Adjustable suture surgery was performed on 97% of all patients, with 28% of BVM and 57% of AVM patients having multiplanar surgery. Successful motor alignment was achieved in 85% of all patients after one surgical procedure. Sensory success was achieved in 81% of all AVM patients and 25% of all BVM patients. Subjective success was 94% in both groups of patients.

Conclusions: Numerous differences exist between childhood and adult strabismus characteristics and response to surgery. Although strabismus surgery is effective, differences in results reflect the varied physiology regarding etiology, pathophysiology, and symptomology. Classification into AVM and BVM groups will provide continued clarity for future studies.
Clinical Features of Pediatric Behçet's Disease
Authors: Eldem Bora , Onur Cengiz , Özen Seza
Published: April 2021

ABSTRACT

Objective: The aim of this study is to determine the clinical features and outcome of Behcet's disease in the pediatric age group.

Method: Twenty cases within a pediatric age group whose ages differ from 5 to 1 5 years were studied retrospectively to determine the age of onset, the initial signs, and the progress of the disease.

Results: In 18 of the patients whose average age were 13.3 years (5 to 18 years), the initial symptoms associated with Behcet's disease were oral aphtous lesions or genital ulcers. Among them, 16 developed ocular symptoms in a later stage, at an average of 15.5 years of age (11 to 18 years). Posterior uveitis was the most common manifestation, detected in 75% of the cases. Three patients had neurobehçet's disease, and the neurologic manifestations were dural thrombosis, pseudotumor cerebri, and quadriparesis.

Conclusions: In this study, after an average 4 years' follow up (6 months to 13 years) the clinical progress of Behcet's disease in the pediatric age group was similar to that found in adult disease. Both the ocular signs (ie, cataracts and glaucoma) and the systemic features (ie, aphtous stomatitis, genital ulcers, erythema nodosum, arthritis, and neurologic signs) were manifested at the onset or during the progress of the disease.
Characteristics of a Pediatric Low-vision Population
Authors: de Carvalho Keila Monteiro , Minguini Nilza , Filho Djalma C Moreira , Kara-José Newton
Published: April 2021

ABSTRACT

Background: Assessment of the causes of childhood blindness is important to develop preventive and therapeutic strategies that can reduce the incidence of visual impairment.

Methods: A retrospective survey of the clinical records of 395 consecutive children younger than 14 years of age who were attended by the Low Vision Service of State University of Campinas (UNICAMP) was conducted. Data on the age distribution, the causes of low vision, the types of low vision aids prescribed, the follow up of their use, and improvement in visual acuity were obtained.

Results: Congenital bilateral toxoplasmic macular scars, optic atrophy, and congenital cataracts were the major causes of (ow vision in this population. The optical aid most frequently prescribed was a telescope. The improvement of visual acuity with the use of aids was highly significant.
Inherited Retinal Telangiectasia With Glial Proliferation
Authors: McKibbin Martin , Amoaku Winfred , Bradbury John A
Published: April 2021

ABSTRACT

We describe five patients from a family of Pakistani origin with inherited retinal telangiectasia and glial proliferation. Characteristics of this condition include: variable visual loss; peripapillary retinal telangiectasia with vascular incompetence on fluorescein angiography; glial proliferation; cystoid macular edema or altered macular pigment; retinal hemorrhage; and abnormal electroretinopathy. We discuss the similarities with and distinguishing features from other documented conditions and the mode of inheritance.
Recent Developments in the Management of Retinoblastoma
Authors: Shields Carol L , Shields Jerry A
Published: April 2021

ABSTRACT

The management of retinoblastoma has gradually changed over the past few decades. There is a trend away from enucleation and external beam radiotherapy toward focal conservative treatments. This is primarily because of earlier detection of the disease and more focused treatment modalities. Enucleation is still employed for retinoblastoma that fills most of the eye, especially when there is a concern for tumor invasion into the optic nerve or choroid. After enucleation, an integrated orbital implant, provides improved motility and appearance of the prosthesis.

External beam radiotherapy continues to be an important method of treating less advanced retinoblastoma, especially when there is diffuse vitreous or subretinal seeding. Plaque radiotherapy is useful for controlling small- to medium-sized retinoblastomas, even those with focal vitreous seeds.

Tumors that recur after failure of other methods are often suitable for plaque treatment. When plaque radiotherapy is employed in a child receiving chemotherapy, eventual radiation retinopathy can occur.

Cryotherapy and photocoagulation provide excellent control of selected small tumors. Advanced laser delivery systems, particularly those that have been adapted to the indirect ophthalmoscope, have facilitated the visualization for treatment of tumors. Thermotherapy is the newest focal method for retinoblastoma. When combined with chemotherapy, thermotherapy provides satisfactory tumor control, leaving the child with a reasonably small scar, thus preserving more vision. Chemoreduction, using intravenous or subconjunctival routes, is often employed to reduce initial tumor volume and thus allow for focal treatment to eradicate the residual smaller tumor.

Many children with advanced retinoblastoma can be spared external beam radiotherapy and enucleation mostly as a result of chemoreduction and focal methods. Chemoreduction combined with cryotherapy, thermotherapy, and plaque radiotherapy plays an important role in the current management of many children with retinoblastoma.
Comparison of Visual Evoked Potentials in Patients With Psychogenic Visual Disturbance and Malingering
Authors: Saitoh Eiko , Adachi-Usami Emiko , Mizota Atsushi , Fujimoto Naoya
Published: April 2021

ABSTRACT

Purpose: To verify the efficiency and objectivity of the pattern visual evoked potential (VEP) for organic disorders oí the cortical visual system.

Methods: This retrospective study evaluated VEP in 19 patients diagnosed with psychogenic visual disturbance, 7 patients with malingering, and 37 age-matched normal volunteers. Transient (3 reversals per second) and steady-state (12 reversals per second) pattern VEPs for check sizes 1 5' and 30', with a contrast of 80%, were recorded.

Results: The amplitudes of both transient and steady-state pattern VEPs were significantly increased in patients with psychogenic visual disturbance, while patients with malingering had significantly lower amplitudes. P100 peak latency was prolonged in both groups of patients.

Conclusion: Monitoring of patients' fixation on the stimulus showed those with psychogenic visual disturbance fixated well on the stimulus, while those with malingering did not. This finding produced a VEP amplitude reduction in patients with malingering. The reason for the VEP amplitude in patients with psychogenic visual disturbance is unclear.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:21-26.
Effects of Anisometropia on Binocularity
Authors: Tomaç Sühan , Birdal Esmahan
Published: April 2021

ABSTRACT

Purpose: To investigate the effects of anisometropia on binocular function and the relationship between stereopsis and fusion in anisometropia.

Methods: Twenty-five patients with anisometropia were studied. The manifest refraction and bestcorrected Snellen visual acuity of each patient was recorded. Patients, corrected with spectacles, were evaluated using Bagolini glasses, the 4diopter (D) prism test, Worth four-dot test, and TNO stereotest.

Results: All patients indicated fusion by the Bagolini glasses. Although the 4-D prism test was positive in the anisometropic eye of all 25 patients, it was slower than the response of the other eye in 1 9 patients with reduced stereoacuity. On the distant Worth four-dot test, fusion response was positive in 1 5 patients. On the TNO test, stereoacuity levels were reduced or absent in 19 patients.

Conclusion: The depth of amblyopia is more effective than the amount of anisometropia in causing a deterioration in binocularity. Even if fusion is weak, almost all patients with anisometropia have bifoveal fusion. Fusion becomes weak and stereoacuity decreases in proportion to the anisometropic amblyopia. Stereoacuity is related to the strength of fusion, and the TNO stereotest effectively detects those patients with significant anisometropic amblyopia.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:27-33.
Echography of Retinoblastoma: Histopathologic Correlation and Serial Evaluation After Globe-Conserving Radiotherapy or Chemotherapy
Authors: Roth Daniel B , Scott Ingrid U , Murray Timothy G , Kaiser Peter K , Feuer William J , Hughes J Randall , Rosa Rubert H
Published: April 2021

ABSTRACT

Purpose: To assess the sensitivity of echography in detecting retinoblastoma, compare tumor features observed by echography with histopathology data, and assess the usefulness of echography in serially following retinoblastoma tumors after globe-conserving treatments.

Methods: The medical and echography records of all patients treated for retinoblastoma at the Bascom Ralmer Eye Institute between 1991 and 1997 were reviewed. All eyes underwent pretreatment echographic evaluation, and eyes treated with external beam radiotherapy, brachytherapy, or chemotherapy underwent serial follow-up echography.

Results: Sixty-nine eyes of 48 patients were identified. Echography demonstrated evidence of retinoblastoma in 69 of 69 (100%) eyes and calcification in 63 (91 .3%) eyes. Histopathology was superior to echography in detecting optic nerve invasion, extraocular extension, and presence of calcification.

Conclusion: Echography is a useful adjunct to indirect ophthalmoscopy in establishing the diagnosis of retinoblastoma. While not as specific as histopathology, echographic evaluation before and after treatment of retinoblastoma permits monitoring of treatment response and may aid in detecting recurrent tumor growth or failure to respond to treatment.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:136-143.
Comparison of Hang-Back and Conventional Recession Surgery for Horizontal Strabismus
Authors: Rajavi Zhale , Ghadim Hashem Moezzi , Nikkhoo Mehran , Dehsarvi Babak
Published: April 2021

ABSTRACT

Purpose: To compare the results of hang-back and conventional recession surgery.

Methods: This randomized, double-blind, matched clinical trial comprised 30 patients with esotropia and 24 with exotropia. All ocular examinations before and at least 1.5 months after surgery were performed by an orthoptist who was unaware of the method of recession. All surgeries were performed by the same surgeon.

Results: In patients with esotropia, deviation improved from 31 ±9 prism diopters (Δ) preoperatively to 7±6 Δ postoperatively for hang-back recession (n=1 5) and from 41 ±14 Δ to 6±6 Δ for conventional recession (n=1 5). Postoperative horizontal deviation was >10 Δ in 40% of patients who underwent hang-back recession and 20% of patients who underwent conventional recession (P<.8). In patients with exotropia, deviation improved from 28.9±9 Δ preoperatively to 0.5±11 Δ postoperatively for hang-back recession (n=12) and from 29±8 Δ to 6±6 Δ for conventional recession (n=12). Postoperative horizontal deviation was >10 Δ in 24% of patients who underwent hang-back recession and 17% of patients who underwent conventional recession (P<.2). Mean follow-up was 7 months.

Conclusion: Hang-back recession is an alternative to conventional rectus muscle recession, especially in children who have smaller globes and patients with myopia or collagen vascular diseases.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:273-277.
Family Environments and the Young Chronically Mentally Ill
Authors: Wilk Joan
Published: April 2021

Because there is no "typical" behavior among families providing primary care to a chronically mentally ill family member, research must focus on deficits in the health care system that hinder treatment.
Incorporating Psychiatric Rehabilitation Principles into Mental Health Nursing
Authors: Palmer-Erbs Victoria K , Anthony William A
Published: April 2021

An Opportunity to Develop a Full Partnership Among Nurses, Consumers, and Families
SCREENING for Postpartum Depression
Authors: Ugarriza Doris Noel
Published: April 2021

ABSTRACT

A prospective time-series descriptive design was used to screen for depression in puerperal women. Two measures of depression, the Beck Depression Inventory (BDI) and the Atypical Depression Diagnostic Scale (ADDS), were selected to measure different aspects of depression. The measures were administered to 124 mothers twice in the prepartum period, with a 2-week intervening period, and twice in the postpartum period, with a 2-week intervening period. Results indicated that these instruments may not be effective to screen for postpartum depression. The ADDS overestimates the number of depressed women by counting as symptoms the normal changes of pregnancy and parturition. The BDI does the same and does not focusing on the primary symptoms of postpartum depression, such as being overwhelmed by motherhood and having thoughts of harming the baby. The need for a screening tool that measures the specific symptoms of postpartum depression as well as the severity of those symptoms is determined.
The Four S Model in Action for De-escalation
Authors: Chabora Nidhi , Judge-Gorny Margaret , Grogan Kim
Published: April 2021

An Innovative State Hospital-University Collaborative Endeavor
The Latex Allergic Psychiatric Patient
Authors: Scholler-Jaquish Alwilda , Weiss-Kaffie Cynthia J , Ashcraft Alyce , Diaz Shelly
Published: April 2021

ABSTRACT

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.
Positive Attitude: An Essential Element for Effective Care of People with Mental Illnesses
Authors: Emrich Kathleen , Thompson Teresa Cervantez , Moore Gary
Published: April 2021

ABSTRACT

It is well known that attitudes influence behavior, and attitudes toward people with mental illnesses have been described as negative, stigmatizing, uninformed, and fearful. The general public view people with mental illnesses as dangerous, prone to violence, unpredictable, and in some measure responsible for their illnesses. Health care professionals share these attitudes to a surprising extent, which compromises their ability to deliver competent, compassionate care. Nursing students' perceptions of people with mental illnesses are reflective of those held by the general public.

The purpose of this descriptive study was to determine whether a curriculum that embeds psychiatric nursing principles in a course focused on care of people with chronic illnesses and uses specific fear-reduction teaching strategies, would have a positive effect on students' attitudes toward people with mental illnesses. Using an adaptation of Yucker's attitude scale, a test of nursing students' (n = 38) attitudes before and after completion of the course was conducted. Students' attitudes were significantly more positive at the completion of the course. The findings suggest that exposure to factual information about mental illnesses, the opportunity to interact with people with mental illnesses, emphasis on treatment options, and use of fear-reduction strategies positively affected students' attitudes toward people with mental illnesses.
Providers' Perceptions of How Rural Consumers Access and Use Mental Health Services
Authors: Ryan-Nicholls Kimberley D , Racher Frances E , Robinson J Renée
Published: April 2021

ABSTRACT

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.
Forward Light Scatter at One Month After Photorefractive Keratectomy
Authors: Harrison Joseph M , Tennant Thomas B , Gwin Marc C , Applegate Raymond A , Tennant Jerald L , van den Berg Thomas J T P , Lohmann Chris P
Published: April 2021

ABSTRACT

BACKGROUND: Although it is known that backward light scatter increases transiently following most excimer laser photorefractive keratectomies (PRKs), it is not clear that there is a significant increase in forward light scatter, which is of primary concern for the patient. The object of this study was to determine if there is a significant change of forward light scatter at 1 month after (PRK) with an ablation zone diameter of 6 mm.

METHODS: Overlapping subsets of 24 normal myopic eyes were tested before (on the day of surgery) and 1 month after PRK, using three instruments: a Stray Light Meter (16 eyes); a Computerized Stray Light Meter (14 eyes); and a mesopic Increment Threshold-Glare Paradigm (six eyes). Differences between the two eyes before PRK were compared with the differences between the same eye before and after PRK, using repeated measured analysis of variance. In addition, increment threshold data obtained from 22 eyes after PRK were compared with those of 60 controls of the same age range and distribution by a t test.

RESULTS: None of the statistical comparisons

approached significance at the a =0.05 level. Changes in light scatter as small as a factor of 1.95 (Stray Light Meter) and 1.55 (Increment ThresholdGlare Paradigm) could be detected as significant with a high power (0.8). Changes larger than a factor of 21 could be detected with a power of 0.8 for the Computerized Stray Light Meter.

CONCLUSIONS: In these data, there is no support for the hypothesis that forward light scatter increases significantly 1 month after PRK with an ablation zone of 6 mm. Any increases in forward light scatter are unlikely to he greater than a factor of 1.5 to 2 under daytime or nighttime illumination conditions. [J Refract Surg. 1995;11:83-88.]
Classification of Variable Clinical Response After Photorefractive Keratectomy for Myopia
Authors: Durrie Daniel S , Lesher Mark P , Cavanaugh Timothy B
Published: April 2021

ABSTRACT

BACKGROUND: Variation in healing response has been noted after excimer laser photorefractive keratectomy (PRK).

METHODS: A retrospective analysis of 116 eyes that underwent PRK for myopia was performed. Standard surgical protocol and postoperative corticosteroid treatment were followed for all eyes. Scattergrams of achieved correction versus attempted correction at 6 months after surgery were analyzed. Subepithelial corneal haze was compared with refractive outcome.

RESULTS: Three healing responses were observed. Normal responders (84.5%) showed a hyperopic overcorrection at 1 month with a gradual regression toward plano and good refractive outcome. Inadequate responders (11.2%) showed a pronounced early hyperopic overcorrection (greater than 1.50 diopters [D]) with minimal regression at 6 months. Aggressive responders (4.3%) displayed an early overcorrection with rapid regression toward myopia. Clear to trace subepithelial corneal haze was present at 6 months in 96% of normal and inadequate responders. Aggressive responders had more pronounced subepithelial haze at 6 months.

CONCLUSION: Variation in the amount of subepithelial healing response occurs after excimer laser PRK. Abnormal healing responses may be detected early in the postoperative period by correlation of refractive error with the amount of subepithelial haze. [J Refract Surg. 1995;11:341-347.]
Bilateral Penetrating Autokeratoplasty
Authors: Price Francis W , Ranna Sherif I
Published: April 2021

ABSTRACT

BACKGROUND: Corneal transplantation is an important modality for treatment of a variety of degenerative, congenital, and traumatic disorders. Despite great advances in surgical techniques, postoperative care, and eye banking over the past 20 years, corneal graft rejection continues to be a substantial risk to successful outcome.

METHODS: We describe a series of three cases in which the clear cornea from a blind eye was used to replace an opaque cornea on a fellow eye with known visual potential and the abnormal cornea was transplanted on the blind eye. Mean follow up was 74 months (range, 66 to 84 months). All three patients had concurrent glaucoma at presentation, and one had a highly vascularized cornea.

RESULTS: Spectacle-corrected vision improved in all cases postoperatively. However, one patient had a non-immune graft failure 58 months after surgery.

CONCLUSIONS: The use of autologous tissue avoids the risk of allograft rejection after penetrating keratoplasty and eliminates the need for long-term postoperative corticosteroids which may exacerbate pre-existing glaucoma. In selected patients, autokeratoplasty can be a useful technique, especially if heavy corneal vascularization or pre-existing glaucoma is present. [J Refract Surg. 1995;11:494-496.]
Topical Tetracaine With Bandage Soft Contact Lens Pain Control After Photorefractive Keratectomy
Authors: Brilakis Harilaos S , Deutsch Thomas A
Published: April 2021

ABSTRACT

PURPOSE: A major disadvantage of photorefractive keratectomy (PRK) is pain and discomfort in the first three postoperative days. We tried to assess the efficacy and safety to the cornea of a limited amount of topical tetracaine given to patients for use when needed to manage severe pain.

METHODS: Sixty-nine eyes of 49 patients who underwent PRK between June 21, 1996 and June 15, 1998 by a single surgeon were prospectively included. Approximately 10 drops of commercial, non-preserved 0.5% tetracaine were given to patients to use when needed to control severe pain. A bandage soft contact lens was applied. Patients were examined at 1 and 3 days after surgery, at which time corneal re-epithelization was assessed and the number of tetracaine drops used was noted. No systemic analgesic or topical non-steroidal antiinflammatory was prescribed.

RESULTS: All eyes healed within 3 days. The mean number of drops of tetracaine used was 2.3 drops over 3 days, although in 33 eyes (48%) the patient did not use any tetracaine. There was no correlation between the attempted correction in diopters and the number of drops used. No significant difference was found in the number of drops used in the second eye of patients who had both eyes treated.

CONCLUSIONS: Limited use of topical anesthetics is an effective and safe analgesic option after PRK. Use of tetracaine in this protocol did not prolong the time to re-epithelialization. Giving only a limited amount of tetracaine to patients prevents abuse and toxicity to the cornea while managing severe pain. [J Refract Surg 2000;16:444-447]
Microbial Keratitis After Laser in situ Keratomileusis
Authors: Pushker Neelam , Dada Tanuj , Sony Parul , Ray Manotosh , Agarwal Tushar , Vajpayee Rasik B
Published: April 2021

ABSTRACT

PURPOSE AND METHOD: To review the literature on microbial keratitis reported after laser in situ keratomileusis (LASIK).

RESULTS: Forty-one eyes have been reported to have microbial keratitis after LASIK. The causative organisms vary from gram positive bacteria to atypical mycobacteria, fungal, and viral pathogens. The infection is usually acquired intraoperatively, but may also be caused by postoperative contamination. A majority of the patients present within 72 hours of the surgery with an acute onset of symptoms. Management of microbial keratitis after LASIK includes aggressive topical fortified antibiotic therapy, irrigation of stromal bed with antibiotic solution after lifting the flap, and sending the scraping of the infiltrate for microbiological evaluation. The keratitis heals with scarring and a best spectacle-corrected visual acuity of 20/40 or better can be obtained in the majority of the patients.

CONCLUSION: Microbial keratitis is a sightthreatening complication of LASIK [J Refract Surg 2002;18:280-286]
Adaptive Optics Visual Simulator
Authors: Fernández Enrique J , Manzanera Silvestre , Piers Patricia , Artal Pablo
Published: April 2021

ABSTRACT

PURPOSE: To develop a prototype instrument that uses adaptive optics to introduce virtually any desired aberration profile in a subject's eye. At the same time, the instrument could be used to evaluate the subject's spatial vision for each controlled aberration profile. This "aberration testing station" or "visual simulator" allows us to study the relationship between specific aberrations and visual quality.

METHODS: The apparatus uses infrared light to measure the wavefront aberration of the system plus the eye with a Hartmann-Shack wavefront sensor. Defocus is added (or removed) with a computer-controlled, motorized optometer, while higher order aberrations are introduced by a 37-channel membrane deformante mirror. A parallel viewing channel is used for visual testing with the instrument. Visual acuity, contrast sensitivity, and other visual tests are performed under normal viewing for each desired aberration profile.

RESULTS: The range of defocus that can be added is nearly unlimited, while the maximum amount of other aberration modes is restricted to approximately 0.5 µ?a., depending on mode. Pure modes or any selected combination of modes can be produced with high repeatability and precision (usually better than 0.05 /<m), and the system works for pupil diameters up to 6 mm (with a natural pupil).

CONCLUSIONS: The adaptive optics visual simulator is a powerful, non-invasive tool to evaluate how aberrations affect vision. In addition, it can be used for the interactive design and testing of new ophthalmic devices, and for the simulation of visual outcomes in customized refractive surgery. [J Refract Surg 2002;18:S634-S638]
Epiphora Following Rhinoplasty and Caldwell-Luc Procedures
Authors: Cies William A , Baylis Henry I
Published: April 2021

SUMMARY

Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of persistent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.
An Evaluation of 8-0 Polyglactin 910 Synthetic Absorbable Suture in Cataract Surgery
Authors: Blaydes J Elliott
Published: April 2021

SUMMARY

This study describes the operative and postoperative performance of 8-0 Polyglactin 910 in cataract surgery. The evaluation represents a clinical comparison of 7-0 Polyglactin 910 to the same suture in 8-0 size in 155 cataract surgical procedures. In 45 cases, 8-0 Polyglactin 910 was the sole wound closure material used.

8-0 Polyglactin 910 provided high tensile strength, good knot security, batch-to-batch uniformity, ease of handling, minimal reaction, and a predictable absorption rate that was virtually completed in 33 days. When compared to 7-0 Polyglactin 910, 8-0 produced less tissue drag, fibrillation, and reaction.

Early in our series, three cases of wound dehiscence occurred. One was caused by trauma and the other two by 8-0 Polyglactin 910 cutting through tissue. This study's conclusion stresses avoiding the tendency of tying the knot too tightly to prevent suture pull-out
Experience with Donor Sclera for Extruding Orbital Implants
Authors: Zolli Christine , Shannon Gerard M
Published: April 2021

SUMMARY

Accumulated clinical evidence has confirmed the suitability of eye bank sclera as a structural and reconstructive material for lid and orbital surgery.

Since 1970 we have been using fresh donor sclera. In our series of sixty-four cases, seventeen were for extruding or extruded orbital implants. Of these seventeen only two had any sort of complication, and these were easily corrected.

This technique has permitted a successful prosthetic fitting within six weeks following surgery, with good cosmesis in all cases.
Surgical Management of Cataract Associated with Chronic Uveitis
Authors: Dangel Matthew E , Stark Walter J , Michels Ronald G
Published: April 2021

SUMMARY

Eight eyes in five patients with cataracts associated with chronic uveitis were operated upon with instrumentation designed for vitreous surgery. A clear visual axis with improvement in visual acuity was achieved in all cases. There were no major operative complications. Vitrectomy instrumentation provides improvements over conventional techniques in the management of these difficult surgical cases.
Dacryocystorhinostomy With Silicone Tubes: Evaluation of 253 Cases
Authors: Rosen Nachum , Shark Mordechai , Moverman David C , Rosner Mordechai
Published: April 2021

ABSTRACT

Two hundred fifty-three patients with chronic epiphora underwent dacryocystorhinostomy combined with silicone intubation of the lacrimal drainage system. An overall success rate of 91.3% was achieved. Since the tubes were well-tolerated posto peratively, complications were rare and benign. Although our success rate is similar to those reported for similar cases using other techniques, we find that silicone intubation facilitates surgery in cases with excessive intraoperative bleeding or nasal mucosal tears, and simplifies postoperative follow-up.
Anterior Chamber Depth Following Filtration Surgery
Authors: Kao Sue F , Lichter Paul R , Musch David C
Published: April 2021

ABSTRACT

We measured the anterior chamber depth in 20 consecutive phakic glaucoma patients undergoing thermal sclerostomy (n = 12) or trabeculectomy (n = 8). Using the Haag-Streit pachymeter, measurements were taken preoperatively and at postoperative days 1, 2, 3, 6, 15, and 42. In all eyes, shallowing of the anterior chamber was observed following surgery. It was greatest by postoperative day 2 or 3, with maximum mean decreases from preoperative anterior chamber depths of 70.9% for thermal sclerostomy and 54.0% for trabeculectomy. In 18 patients, the anterior chamber depth gradually deepened over the course of postoperative days 4 through 15, so that by 15 days after surgery, the average anterior chamber depth was 87.6% of the preoperative level. In two patients who ultimately required surgical reformation on their anterior chamber, however, only a minimal deepening occurred over this interval. At 15 days after surgery, the average anterior chamber of these two patients was significantly more shallow (37.5% of the preoperative anterior chamber depth, p = 0.003) than the mean of the other 18 patients (87.6% of the preoperative anterior chamber depth). These observations suggest that if the anterior chamber has not reformed by postoperative day 15, spontaneous reformation of the anterior chamber is unlikely and surgical intervention may be required.