bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudo Oculomotor Palsy as the Presenting Sign of Linear Scleroderma
Authors: Tang Rosa A , Mewis-Christmann Linda , Wolf John , Wilkins Robert B
Published: April 2021

ABSTRACT

A case of linear scleroderma presenting as a pseudo oculomotor palsy is reviewed. The patient's facial skin abnormalities suggested the underlying etiology. This case illustrates a previously unreported finding in linear scleroderma, mydriasis without atrophy, reminding the clinician to look at the skin in patients with unexplained unilateral pupillary disturbances.
The Variable Clinical Characteristics and Course of Early Infantile Esotropia
Authors: Robb Richard M , Rodier Dorothy W
Published: April 2021

ABSTRACT

A study of 75 patients with early infantile esotropia treated by one of the authors (RMR) between 1965 and 1980 revealed a broad range of clinical findings and treatment modalities. The study group included nine children born prematurely and 16 with neurologic impairment; the balance had no apparent illness other than strabismus. Only 21 patients had spontaneously alternating fixation; the rest required some form of occlusion therapy. Glasses were prescribed for 75% of the patients sometime during their management, and changes in refractive error were common. One or more operations were performed on 56 patients, but 19 patients required no surgical intervention because of a spontaneous decrease in their deviation. Binocularity was found more frequently in patients straightened surgically before 2 years (50%) than in those straightened after that time (14%), but it was also present in five of the 19 patients who required no surgery. The presence of binocularity during the course of treatment did not insure stability of alignment.
Cyclotorsional Diplopia Following Retinal Detachment Surgery
Authors: Metz Henry S , Norris Andrew
Published: April 2021

ABSTRACT

Four patients reporting symptoms of torsional diplopia following retinal detachment repair were seen. One patient most likely had a pre-existing, partially compensated superior oblique palsy as the cause of her vertical deviation and excyciotorsion. A second was found to have the superior oblique tendon adherent anteriorly to the encircling band and buckle just behind the superior rectus insertion, resulting in incyclotorsion. Release of these restrictions reduced the torsion to a small, asymptomatic degree. The third and fourth patients had excyciotorsion for unexplained reasons. Removing the scleral exoplant and Harada-Ito type surgery on the superior oblique tendon did not relieve the symptoms and only minimally reduced the excyciotorsion in one patient. A second procedure, with advancement of the anterior portion of the superior oblique tendon, successfully eliminated cyclotorsional symptoms.
Retinoblastoma
Authors: Helveston Eugene M , Knuth Keith R , Ellis Forrest D
Published: April 2021

ABSTRACT

Retinoblastoma was diagnosed in 74 patients between July 1967 and February 1987. Thirty cases (40%) were bilateral; 39 were female and 35 were male. Treatment in bilateral cases consisted of enucleation of the more involved eye and a combined approach of supervoltage irradiation, cryocoagulation, and photocoagulation to the remaining eye. In unilateral cases the involved eye was enucleated and the uninvolved eye observed. Four patients had bilateral enucleation at their initial presentation and four others had the second eye enucleated after unsuccessful tumor treatment. One patient died from metastatic retinoblastoma, one patient died after intrathecal chemotherapy without the evidence of tumor, and one patient died with trilateral retinoblastoma. Seventy-one of 74 patients (96%) currently survive with a follow-up of 1 month to 19 years. Two-year survival is 65 of 68 (95.5%).
Congenital Iris Ectropion and a New Classification for Anterior Segment Dysgenesis
Authors: Wilson M Edward
Published: April 2021

ABSTRACT

Congenital iris ectropion has recently been added to the spectrum of neural-crest-derived anterior segment dysgenesis syndromes. Major features include a nonprogressive ectropion of the iris pigment epithelium, a glassy smooth cryptless iris surface, a high iris insertion, dysgenesis of the drainage angle, glaucoma, and in many cases, ipsilateral ptosis. Anterior segment dysgenesis syndromes have been subdivided into disorders of neural crest cell migration, proliferation, or differentiation. The congenital iris ectropion syndrome does not clearly fit into this classification. A new classification based on a theory of developmental arrest is presented which is more consistent with current knowledge of embryologie development and with recent clinical and histopathologic findings. The new classification links the congenital iris ectropion syndrome with the Axenfeld-Rieger spectrum but separates it from classic congenital glaucoma and the irido-corneal endothelial (ICE) syndromes. In addition, a histopathologically-supported etiologic theory for congenital iris ectropion is presented that supports the new classification.
Response of Coexisting Underacting Superior Oblique and Overacting Inferior Oblique Muscles to Inferior Oblique Weakening
Authors: Hunter Lee R , Parks Marshall M
Published: April 2021

ABSTRACT

One hundred twenty-six eyes with inferior oblique overaction and coexisting superior oblique underaction were retrospectively studied pre- and postoperatively. The data show that weakening the inferior oblique corrected the underaction of the superior oblique, and that overcorrection of the underacting superior oblique was unusual. Eyes were selected for study if superior oblique underaction coexisted with inferior oblique overaction preoperatively. The operation chosen for the inferior oblique in every case was determined by the quantity of inferior oblique overaction and whether prior surgery on the inferior oblique had been performed. A denervation and extirpation was the final inferior oblique weakening procedure in all except three of these eyes. Congenital or acquired superior oblique palsy cases were not included in this study. To eliminate eyes with superior oblique palsy, we excluded any patient with a history of serious head trauma; a vertical deviation in the primary position greater than 5 prism diopters except if caused by dissociated vertical deviation; the complaint of torsional diplopia controlled by an anomalous head posture; or a positive Bielschowsky head tilt test. The mean preoperative superior oblique action was - 2.4 on a scale of 0 to 4, and this corrected to a mean postoperative action of -0.2, (P < .001). This was accompanied by a change in the mean inferior oblique action of +3.8 to -0.2, (P < .001). These same results were found regardless of the preoperative action of either the inferior or superior oblique. With regard to the postoperative superior oblique action, 22 cases were undercorrected, 2 were overcorrected, and 102 were normal.
Detachment of Intact Posterior Lens Capsule: Secondary to Contusion in Penetrating Ocular Trauma
Authors: Wolter J Reimer
Published: April 2021

ABSTRACT

Severe contusion of the lens in a penetrating scleral injury of the eye of a young patient resulted in separation and bleb-like detachment of the posterior lens capsule with subcapsular accumulation of a fibrin-containing exudate. This separation of the posterior lens capsule resulting from increase of permeability with subcapsular fluid accumulation is believed to represent a possible basic mechanism of posterior lens involvement without capsule rupture secondary to ocular trauma.
An Unusual Case of Cellulitis Associated With a Molteno Implant in a 1-Year-Old Child
Authors: Karr Daniel J , Weinberger Edward , Mills Richard P
Published: April 2021

ABSTRACT

The Molteno seton implant has recently been used in pediatric patients with advanced childhood glaucoma, who would otherwise have been treated with cyclodestructive surgery. We report a case of Molteno implant (first stage) associated with orbital cellulitis in a 1-year-old child. The presence of the implant was initially unrecognized until, in the course of evaluation for orbital cellulitis, computerized tomography of the orbit suggested a foreign body. We believe this is the first report of a complication associated with the first stage of this procedure.
A Diagnostic Ruler for Strabismus and Amblyopia
Authors: Wang Guang-Ji , Pomerantzeff Oleg
Published: April 2021

ABSTRACT

We designed a diagnostic slide ruler for easier detection of strabismus and amblyopia, both of which begin in childhood. This new instrument makes the Parks threestep test easier to use and faster than other methods in diagnosing isolated cyclovertical muscle paralysis. Furthermore, the slide ruler tests visual acuity with both series letters and single letters. Incorporated into the instrument are Laurence's strabismometer, Haab's pupillometer, occluder, pinhole, and millimeter ruler. A laboratory model is now available, and this slide ruler can assist the ophthalmological practitioner in analyzing three-step test data more rapidly than graphs and computer programs can. This instrument can also diagnose pediatric patients in the early stages of microstrabismus and amblyopia to obtain the best therapeutic results.
Postoperative Endophthalmitis in Children Following Cataract Surgery
Authors: Good William V , Hing Stephen , Irvine Alexander R , Hoyt Creig S , Taylor David S I
Published: April 2021

ABSTRACT

Three children developed endophthalmitis after cataract surgery. Each had signs and symptoms of either nasolacrimal duct obstruction or upper respiratory infection at the time of surgery. The causative organisms were Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. Final visual acuities were 6/24, LP, and NLP, respectively.

Endophthalmitis after cataract surgery in intents has never been reported. These three cases drawn from two pediatrie ophthalmology practices represent an incidence of postoperative endophthalmitis of 0.45%. Although this incidence report is potentially spurious, it indicates that postoperative endophthalmitis is a very real threat in infants. We recommend a thorough systems review and exam of upper airways and lacrimal system before undertaking intraocular surgery in young children. We also caution against simultaneous bilateral surgery.
Visual Acuity in Monocular Pediatric Aphakia: Does Epikeratophakia Facilitate Occlusion Therapy in Children Intolerant of Contact Lens or Spectacle Wear?
Authors: Elsas Frederick J
Published: April 2021

ABSTRACT

Twenty-two children had a monocular cataract extracted between 1981 and 1986. Twelve of these patients eventually tolerated a monocular contact lens or anisometropic spectacle wear. Eleven patients initially would not tolerate conventional therapy, and epikeratophakia was performed. Of the 12 patients tolerating a contact lens or spectacles, eight (67%) now see 20/60 or better, and six (50%) see 20/40 or better. Only one (10%) of the patients maintaining the epikeratophakia graft developed vision as good as 20/70. Epikeratophakia did not facilitate occlusion therapy for amblyopia. The critical factor in the development of good vision following monocular cataract extraction was the patient's willingness to patch the better eye, not the method of correcting the refractive error.
Excessive Single Lateral Rectus Muscle Recession in the Treatment of Intermittent Exotropia
Authors: Feretis D , Mela K , Vasilopoulos G
Published: April 2021

ABSTRACT

Ten patients with small angle intermittent exotropia of 14 to 16 prism diopters were treated by unilateral lateral rectus muscle recession of 11.5 to 12 mm on the nondominant eye.

In the immediate postoperative phase, overcorrection of 4 to 6 Δ gave a very good functional result. Abduction deficiency was minimal for recession up to 12 mm.

This procedure should be considered as an alternative approach in the treatment of small angle intermittent exotropia showing a "basic" pattern.
Changing Trends in the Management of Retinoblastoma: 1951-1965 vs 1966-1980
Authors: Abramson David H , Niksarli Kevork , Ellsworth Robert M , Servodidio Camille A
Published: April 2021

ABSTRACT

A retrospective analysis of the records of 1253 retinoblastoma patients (567 females, 665 males, and sex of one unknown) seen in the years 1951-1965 (575 patients, Interval I) and 1966-1980 (678 patients, Interval II) was conducted to determine changes in the manner of presentation of the disease, the treatment modalities employed, and their subsequent outcomes following treatment. There was no significant difference between the two 15-year time intervals in the age at presentation (mean, range), laterality, gender, family history, laterality vs gender distribution, family history vs laterality, employment of chemotherapy in unilateral cases or the use of external beam radiation (EBR) in bilateral cases. Changing trends in the management of retinoblastoma were observed as a result of the introduction of new treatment modalities, such as cryotherapy, light coagulation, and radioactive plaque therapy. Bilateral patients have received chemotherapy less frequently in Interval II. The use of photocoagulation, cryotherapy, and brachytherapy for bilaterals, and cryotherapy for unilaterals increased significantly during Interval II. During both time intervals, a significantly higher percentage of unilaterally affected eyes were enucleated compared with bilaterally affected eyes; in addition, there was a decrease in the percentage of enucleations performed on both unilaterally and bilaterally affected eyes. In Interval II, 87% of unilateral patients and 91% of the bilateral patients had an enucleation performed.
Delayed Consecutive Exotropia Following 7-Millimeter Bilateral Medial Rectus Recession for Congenital Esotropia
Authors: Stager David R , Weakley David R , Everett Mary , Birch Eileen E
Published: April 2021

ABSTRACT

The rate of delayed consecutive exotropia after bilateral 7-millimeter medial rectus recession for large angle congenital esotropia in 88 patients was 27% (24/88), larger than previously reported. The rate was 38% (8/21) in infants having surgery prior to 7 months of age, 20% (1 0/49) In infants undergoing surgery at 7 to 1 2 months of age, and 33% (6/18) in patients undergoing surgery at 13 months of age or later. The onset of consecutive exotropia averaged 26.8 months postoperatively, allowing a long period of good alignment for binocular vision to develop before exotropia surgery was required.

Physicians and parents should be aware that delayed consecutive exotropia may develop several years postoperatively. Since delayed consecutive exotropia may be characteristic of the 7-millimeter recession procedure or characteristic ol all patients who have had surgery lor congenital esotropia, a prospective long-term study to compare the 7-millimeter procedure with the three- and four-muscle procedure would be helpful.
Bovine Surfactant Therapy and Retinopathy of Prematurity
Authors: McGinnity F Gerry , Girschek Peter K , Morin J Donald , O'Donoghue Eamon P , Dunn Michael S
Published: April 2021

ABSTRACT

We reviewed the results of three randomized clinical trials of prophylactic bovine surfactant therapy on babies under 30 weeks gestational age to assess the effects of this treatment on the frequency and severity of retinopathy of prematurity (ROP). Of the 119 babies who received surfactant treatment, 54 (45.4%) had ROP compared to 33 (47.1%) of the 70 babies in the control group. Stage 2 ROP or greater was noted in 10 (8.4%) babies in the treatment group and in 10 (14.3%) of the untreated group. Prophylactic bovine surfactant replacement therapy does not have a significant effect on the frequency of ROP in preterm babies. The severity of ROP also appears to be unaffected by surfactant.
Value of Bacterial Culturing in the Course of Congenital Nasolacrimal Duct (NLD) Obstruction
Authors: MacEwen Caroline J , Phillips M Gabby , Young James D H
Published: April 2021

ABSTRACT

The role of infection in the etiology and persistence of congenital nasolacrimal duct (NLD) obstruction is examined in a group of 334 infants who had conjunctival swabs cultured. One hundred and fifty eight (47%) of these had evidence of NLD obstruction and 176 (53%) did not. The types of organism grown from those with and without NLD obstruction were similar and occurred in almost equal proportions in each group. In addition, the rate of spontaneous resolution in those with NLD obstruction was the same, whether pathogenic bacteria were grown or not. There were no cases of orbital cellulitis, dacryocystitis, or ocular infection in those with NLD obstruction and no suggestion that secondary infection was more common in this group.
A New Scleral Depressor for Extremely Premature Infants
Authors: Karaki Takeshi
Published: April 2021

ABSTRACT

A new scleral depressor has been designed that enables easy insertion into a small conjunctival sac, facilitating examination of the ocular fundus in extremely premature infants with retinopathy of prematurity. This new scleral depressor is also useful in mature infants and children.
Magnetic Resonance Imaging of the Superior Oblique Muscle in Superior Oblique Myokymia
Authors: Mehta Ashish M , Demer Joseph L
Published: April 2021

ABSTRACT

High resolution, magnetic resonance imaging was used to quantitatively study the morphometry of the superior oblique muscles of two patients with superior oblique myokymia, as well as 18 superior oblique muscles of 14 patients with normal superior oblique function. The cross sectional area of each superior oblique muscle was measured at 3-millimeter intervals along the entire muscle length. In both cases of myokymia, the affected superior oblique muscles were significantly smaller than normal (P < .05).

These anatomical changes in the superior oblique muscle of patients with myokymia suggest that an antecedent injury to the trochlear nerve has occurred. This injury, even if clinically unapparent, may be the initial event which leads to subsequent development of superior oblique myokymia.
Ophthalmoscopic Evolution of Papillary Colobomatous Malformations
Authors: Gornés Pedro A Villalonga , Terraza Alicia Galan , Gil-Gibernau Juan J
Published: April 2021

ABSTRACT

We describe congenital colobomatous malformations of the optic nerve and the clinical variations and complications that may appear eventually in them. We also present two clinical cases of patients with papillary colobomatous defects where spontaneous variations have been observed throughout their evolution and where the current Ophthalmoscopic aspect is completely different from the initial one. Finally, bearing in mind the embryologie origin and histologie structure of these anomalies, we develop a hypothesis that explains the physiopathologic mechanism that causes the clinical changes described in each case.
Steroid Injection Versus Conservative Treatment of Anisometropia Amblyopia in Juvenile Adnexal Hemangioma
Authors: Motwani Manoj V , Simon John W , Pickering J Dawn , Catalano Robert A , Jenkins Paul L
Published: April 2021

ABSTRACT

Because of serious side effects, the indications for intralesional steroid injection of adnexal hemangiomas are unclear. Of 23 children with such lesions who were examined over a period of 9 years, 9 had no evidence of amblyopia and needed no intervention. Five required steroids intralesionally and/or systemically because of threatened occlusion of the pupillary axis. The remaining 9 were considered at risk of anisometropic amblyopia because of induced astigmatism: 5 received injections and 4 were treated with glasses and/or patching alone. The visual, refractive, and cosmetic results of the injected and conservatively managed anisometropes were simitar. We recommend that steroid injection be reserved for patients with threatened occlusion of the visual axis and for those with severe astigmatism or amblyopia refractory to conservative management.
The Predictive Value of Posterior Pole Vessels in Retinopathy of Prematurity
Authors: Saunders Richard A , Bluestein Ettaleah C , Sinatra Robbin B , Wilson M Edward , O'Neil James W , Rust Phillip F
Published: April 2021

ABSTRACT

Dilation and tortuosity of the posterior pole vessels "(plus disease)" is a sign of poor prognosis and may be associated with threshold or prethreshold retinopathy of prematurity (ROP). We have found that normal posterior pole vessels are a reliable marker for the absence of stage 3 ROP. One hundred thirty-two consecutive premature infants weighing less than 1600 g at birth underwent ROP examinations between 32 and 40 weeks' postconceptional age. The status of the posterior pole vessels was compared to peripheral retinal pathology. Vascular findings in the posterior pole were graded 0, 1, 2, or 3, with 0 representing normal arterioles and venules and 3 representing plus disease. The remainder of the fundus examination was recorded using the International Classification of ROP, then converted to a severity scale based on zone and stage of ROP. For each infant, only one examination representing the most severe stage of ROP reached prior to treatment or spontaneous regression was used for data analysis. There was a highly significant Spearman's rank correlation (r^sub s^ = 0.65) between the posterior pole vascular abnormalities and the severity of ROP in the retinal periphery. Clinically important ROP was not found in any patient with normal posterior pole vessels (grade Q) and stage 3 disease was usually associated with both venous and arterial vascular abnormalities (grades 2 or 3). When ocular examination of premature infants is difficult because of poor dilation of the pupil, hazy media, or medical instability, normal appearance of the posterior pole vessels can be a reassuring finding if it is necessary to postpone complete fundus examination in infants at risk for ROP.
Upper Age Limit for the Development of Amblyopia
Authors: Keech Ronald V , Kutschke Pamela J
Published: April 2021

ABSTRACT

The medical records of 64 patients between 1 and 11 years old with known onset of an amblyopia-induclng condition were retrospectively reviewed to determine the upper age limit for the development of amblyopia. Thirty seven patients (group 1) developed amblyopia and 27 patients (group 2) did not. The mean patient age at the onset of the amblyopia-inducing condition was 41.0 months (2.90 SE) for group 1 and 92.3 months (4.02 SE) for group 2. The difference was statistically significant (P=. 0001). No patient developed amblyopia after 73 months of age. The duration of the amblyopia-inducing condition and the type of amblyopia-inducing condition were not significantly different between the two groups.

The age of the patient when exposed to an amblyopiainducing condition is the most important determinant for the development of amblyopia. Patients 6 years or older with a normal visual system have a low probability of developing amblyopia following the onset of an amblyopia-inducing condition.
Unusual Presentation of Advanced Coats' Disease
Authors: Patel Hitesh K , Augsburger James J , Eagle Ralph C
Published: April 2021

ABSTRACT

The authors report the case of a 19-month-old boy with advanced Coats' disease whose presenting manifestation was turbid, lipoproteinaceous fluid filling the anterior chamber. The possible sites of origin and routes of migration of the turbid fluid into the anterior chamber are discussed.
Subretinal Neovascularization in Children and Adolescents
Authors: Goshorn Erin Booher , Hoover Darren L , Eller Andrew W , Friberg Thomas R , Jarrett William H , Sorr Edward M
Published: April 2021

ABSTRACT

Subretinal neovascular membranes (SRNVM) in the pediatric population are rare. The clinical presentation, etiology, course, and management of SRNVM in 25 children (27 eyes) were studied retrospectively. Inflammatory or infectious conditions predominated (10 of 25). Eleven of 19 untreated SRNVM (58%) spontaneously involuted, with 9 of these 11 achieving a final visual acuity of 20/50 or better. A hyperpigmented ring on fluorescein angiography was associated with 9 of the 1 1 involuted SRNVM. The presence of this pigmented ring may help to identify those cases with a better visual prognosis.
Results of Treatment of Superior Oblique Overaction by Silicone Tendon-Expander Technique
Authors: Seawright Ashley A , Gole Glen A
Published: April 2021

ABSTRACT

Purpose: To report the results of treatment of a series of patients with superior oblique overaction using the superior oblique silicone tendon-expander technique.

Methods: A chart review of 17 patients with superior oblique overaction who had a total of 26 silicone tendonexpander procedures was conducted.

Results: Mean preoperative degree of superior oblique overaction was +2.7. 92% of eyes had mild (+1) or no residual overaction at last postoperative assessment (follow-up range: 6 to 59 months). Of 15 patients with preoperative ?-pattern of 10 prism diopter (A) or more, only two patients (1 3%) had ?-pattern of 1 0 ? or more at last assessment. Of 13 patients with preoperative hypotropia in primary position, five patients (38%) had no vertical deviation in primary position, and seven patients (54%) had persistent, but less vertical deviation in primary position at last assessment (mean reduced from 11Δ to 4Δ). No patient manifested superior oblique palsy at their last postoperative assessment.

Conclusions: We believe that the superior oblique tendon-expander technique should be strongly considered for the treatment of superior oblique overaction associated with ?-pattern or hypotropia In primary position, because it has a high success rate and a low incidence of postoperative complications. Consecutive superior oblique underaction did not occur In this series.
Clinicopathologic Factors Related to Metastasis in Retinoblastoma
Authors: Wang An-Guor , Hsu Wen-Ming , Hsia Wei-Wei , Liu Jorn-Hon , Yen May-Yung
Published: April 2021

ABSTRACT

Purpose: To investigate the orbital invasion and metastatic pattern in retinoblastoma, and to analyze the correlation with other pathologic and prognostic factors.

Methods: Pathologic and admission records of 45 patients with a pathologically confirmed diagnosis of retinoblastoma during the past 20 years were reviewed. Clinical risk factors and pathologic findings were analyzed for association with tumor invasion/metastasis using chi-square, Fisher's exact, and Student's t tests.

Results: Clinical risk factors such as exophthalmos, cataract, and pseudohypopyon were significantly correlated with tumor invasion/metastasis. The pathologic finding of choroid involvement was highly predictive of tumor invasion/metastasis. Delayed enucleation (>3 months) also was significantly correlated with tumor invasion/metastasis.

Conclusion: Tumor invasion/metastasis is strongly associated with various ocular, pathologic, and treatment outcome factors. Identification of these risk factors may help plan treatment regimens.

Journal of Pediatric Ophthalmology and Strabismus 2001 ;38:1 66-171.
Iris Neovascularization in Children as a Manifestation of Underlying Medulloepithelioma
Authors: Singh Annapurna , Singh Arun D , Shields Carol L , Shields Jerry A
Published: April 2021

ABSTRACT

Purpose: To report the occurrence of unilateral iris neovascularization in children secondary to medulloepithelioma.

Methods: Presenting features and the clinical course of patients confirmed to have medulloepithelioma were reviewed.

Results: Seven patients with medulloepithelioma had iris neovascularization during the clinical course. Associated cataract and lens coloboma occurred in two and three cases, respectively. In six (86%) cases, no apparent cause for iris neovascularization could be detected at presentation. Two cases had tube shunts for management of neovascular glaucoma before medulloepithelioma was recognized. All cases eventually required enucleation.

Conclusion: Presence of iris neovascularization is an early manifestation of medulloepithelioma. Children with iris neovascularization of unknown cause should be evaluated to exclude underlying medulloepithelioma.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:224-228.
Clinicopathologic Factors Related to Apoptosis in Retinoblastoma
Authors: Wang An-Guor , Lai Chiung-Ru , Hsu Wen-Ming , Liu Jorn-Hon , Yen May-Yung
Published: April 2021

ABSTRACT

Purpose: To investigate the presence of apoptosis in retinoblastoma and its correlation with other pathologic and prognostic factors.

Methods: The pathologic and admission records of 25 patients with a pathologically confirmed diagnosis of retinoblastoma were reviewed. TUNEL (TdT dUTP nick end labeling) staining was used to examine apoptosis in the pathologic slides of these 25 patients. The association between apoptosis and clinicopathologic factors was examined with chi-square, Fisher's exact, and Student's t tests.

Results: Of the 25 specimens tested, 11 were TUNEL stain-positive for the presence of apoptotic cells. Apoptosis was found more frequently in younger patients and within rosettes, although these associations were not statistically significant. Apoptosis was not associated with tumor invasion or metastasis.

Conclusion: Apoptotic cells were found in 11 of 25 retinoblastoma specimens. Apoptosis tends to occur in young patients and be distributed within rosettes.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:295-301.
Digital Values for Alpha Acuities
Authors: Arnold Robert W.
Published: April 2021

Purpose:

The lack of consistent data formatting for visual acuity in electronic medical records has led to inefficient data extraction and analysis.

Methods:

Prior acuity efforts were reviewed and analyzed relative to alpha-designated visual acuity. Prominent electronic medical record formatting was reviewed.

Results:

A table was generated facilitating the assignment of digital values to alpha acuities for metric and United States designation including centered steady maintained for infants and counting fingers, hand motions, light perception, and no light perception for patients with low vision.

Discussion:

Consistent and usable visual acuity data should lead to better research and eventually improve physician burn-out.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(2):132–135.]
Nursing Education and Nursing Service
Authors: Smith Dorothy M
Published: April 2021

A merging of nursing education and service, analogous to that of medicine, holds promise for the improvement of patient care and the development of niwse-clinicians.

A Dual or Separate Administrative Responsibility?
The Senior Club-A Community Link
Authors: Adkins JoAnn
Published: April 2021

One Method of Mobilizing Geriatric Patients
Light at the Top: PSYCHIATRIC NURSING STOCKTON STATE HOSPITAL
Authors: Thompson Faith Elise
Published: April 2021

It is exceedingly difficult to capture on paper tlie schizophrenic. We are accustomed to relating in a structured way, with paragraphs, sentences, and headings. The schizophrenic is unable to put structure to his thoughts. The line between the light of reality and the darkness of fabrication, within his own mind, is only a thin fiber. Words become intensities of light and dark and hot and cold; leaves, chairs and cars become animated. The impossible is no more - life is a cartoon.

The schizophrenic struggles constantly to recognize, accept and function within the limits of reality - this is the light at the top.
Bibliotheraphy
Authors: Cohen Laura J
Published: April 2021

Using Literature to Help Children Deal with Difficult Problems
Children of Affectively Ill Parents
Authors: Buckwalter Kathleen C , Kerfoot Karlene M , Stolley Jacqueline M
Published: April 2021

When a child needs psychiatric treatment, a special effort is made to involve the parents. However, the children of parents with psychiatric disorders have been largely ignored by mental health professionals. This neglect and its consequences has been addressed by KATHLEEN C. BUCKWALTER, PhD, RN, KARLENE M. KERFOOT, PhD, RN, and JACQUELINE M. STOLLEY, BA, RN.
Psychiatric Inpatients' Experience of Nursing Observation
Authors: Jones Julia , Ward Martin , Wellman Nigel , Hall John , Lowe Trevor
Published: April 2021

A United Kingdom Perspective
Eye Movement Desensitization & Reprocessing
Authors: Lee Gale K , Beaton Randal D , Ensign Josephine
Published: April 2021

A Brief and Effective Treatment for Stress
Deepening of Incisions After Radial Keratotomy Using the "Tickle" Technique
Authors: Buzard Kurt A
Published: April 2021

ABSTRACT: Since the introduction of radial keratotomy, accurate incision depth has been difficult to achieve with any corneal knife. To assure repeatable depth of incisions and to adjust the refractive effect of these incisions after the surgery, I have developed a series of techniques that are described in this article and that I refer to as "tickles" in discussion with the patients. Seventeen eyes, from a consecutive series of 102 operations (reoperation rate of 17%), underwent complete opening and/or deepening of undercorrected eight-incision radial keratotomy. This was performed in the immediate postoperative period (3.0 ± 4.2 months), at the slit-lamp microscope, without peripheral deepening or extension of the optical zone. After the initial radial keratotomy, the average spherical equivalent refraction was - 2.04 ± 0.68 D; after opening and/or deepening the incisions, the average spherical equivalent refraction was -0.53 ± 0.24 D. The average effect of this procedure was a reduction in myopia of 1.51 D. All 17 eyes had a final refraction between -0.25 and -1.00. [Refract Corneal Surg 1991;7:348-355.)
Radial Keratotomy in a Patient With Keratoconus
Authors: Mamalis Nick , Montgomery Steven , Anderson Chad , Miller Corey
Published: April 2021

ABSTRACT: A 33-year-old patient had radial keratotomy performed on both eyes for relief of longstanding myopia. Minimal reduction of myopia was obtained, and the patient underwent a second radial keratotomy in both eyes. Best corrected visual acuity decreased, and the patient had a marked, irregular astigmatism postoperatively. Careful ophthalmologic evaluation revealed that the patient had keratoconus bilaterally. Following a failed trial of contact lens wear, the patient underwent a penetrating keratoplasty of the right eye. Pathologic evaluation revealed findings of keratoconus, as well as radial keratotomy scars. This case report illustrates the importance of a complete ophthalmologic examination possibly including videokeratography, prior to keratorefractive surgery. [Refract Corneal Surg 1991;7:374-376.)
Corneal Lathing Using the Excimer Laser and a ComputerControlled Positioning System: Part I-Lathing of Epikeratoplasty Lenticules
Authors: Altmann Johann , Grabner Günther , Husinsky Wolfgang , Mitterer Sabine , Baumgartner Isabella , Skorpik Florian , Asenbauer Talin
Published: April 2021

ABSTRACT: Precise lathing of epikeratoplasty lenticules is difficult to achieve with the cryolathe due to unpredictable expansion of the lathing tools and the corneal tissue during the freezing process. In addition, the procedure destroys all viable cells in the transplant thereby possibly contributing to the prolonged period of visual rehabilitation. Nonfreezing techniques using the microkeratome or the rotor-trephine, on the other hand, are technically demanding, can cause mechanical damage during cutting or fixation, and, have not given consistently reproducible refractive results.

A new system is presented that allows a variable laser ablation of donor corneas into lenticules for aphakic and myopic epikeratoplasty, as well as for lamellar keratoplasty. With the help of a computer-controlled positioning system that uses high-precision micropositioning elements (both translation and rotational stages) the donor cornea is moved, epithelial side down, in a holding device in front of a focused excimer laser beam (ArF, λ = 193 nm). This photoablation lathing process assures the viability of the stromal cells in the lenticule in close approximation to the treated surface.

The user friendly computer software allows the fast and convenient selection of a variety of parameters, such as the diameter of the optical zone, the shape of the wing zone, the refractive power, the central thickness of the lenticule and the overall contour of the transplant. The first laboratory data of lenticules prepared from human corneas with this "Excimer Laser Corneal Shaping System" are presented. [Refract Corneal Surg 1991;7:377-384.)
Photorefractive Keratectomy With an Argon Fluoride Excimer Laser: A Clinical Study
Authors: Gartry David S , Muir Malcolm G Kerr , Marshall John
Published: April 2021

ABSTRACT: The results of excimer laser photorefractive keratectomy (PRK) in 16 blind and 120 sighted eyes (136 patients) are presented. Follow up for the blind eyes was 22 months and for the sighted eyes 8 to 18 months (mean, 1 year). A Summit Technology UV200 excimer laser with fluence fixed at 180 mJ/cm
p 2
, beam diameter 4 mm, a frequency of 10 Hz, and ablation rate of 0.22 µ per pulse was used. The range of preoperative myopia was - 1 .50 diopters to - 1 7.50 D (spherical equivalent). Ninety percent of patients undergoing a -2.00 D correction and 75% of patients undergoing a -3.00-diopter correction were within ± 1 .00 D of intended refraction at 6 months. This figure fell to 40% and 20% for the groups undergoing -6.00 D and -7.00 D corrections, respectively. While the trend is toward undercorrection, around 70% of patients in all groups have benefited from a reduction of their myopia by at least half that intended. A variable degree of anterior stromal "haze" was detected in 110 patients (92%) despite a rigid high dose topical corticosteroid regime over 3 months. Best spectacle corrected visual acuity, however, was greater than or equal to preoperative levels in 111 patients (93%). Six patients experienced a reduction of one line of Snellen acuity at 6 months and three of the high myopes lost two lines. No patienfs lost more than two lines of Snellen acuity.

Ninety-four patients (78%) noticed a "halo" around lights at night, more marked in the early postoperative period, which we attribute to the 4-millimeter diameter ablation zone. With a large pupil, both central and paracentral cornea can contribute simultaneously to the retinal image.

We have demonstrated considerable individual variation in response to this surgery, which is more marked in high myopia. Although follow up at the present time is limited, to date PRK appears to be a safe procedure that holds considerable promise for refractive surgery in the future. (Refract Corneal Surg 1991;7:420-435.)
Excimer Laser Phototherapeutic Keratectomy for Shield Ulcers and Corneal Plaques in Vernal Keratoconjunctivitis
Authors: Cameron James A , Antonios Sobhi R , Badr Ihsan A
Published: April 2021

ABSTRACT

BACKGROUND: Shield-shaped corneal ulcers and corneal plaques in vernal keratoconjunctivitis are associated with delayed epithelial healing, as well as the risks of infectious keratitis and sterile stromal ulceration. Significant visual impairment due to scarring and irregular astigmatism may result from central corneal lesions.

METHODS: Three eyes with central corneal lesions resulting from vernal keratoconjunctivitis were treated by excimer laser after active vernal keratoconjunctivitis was controlled and inflammatory plaque overlying the shield ulcers was removed.

RESULTS: All three eyes showed rapid reepithelialization within 1 week. Spectacle-corrected visual acuity of 20/30 or better was obtained in each eye.

CONCLUSIONS: In selected patients, excimer laser phototherapeutic keratectomy may be a useful adjunct in the treatment of shield-shaped corneal ulcers and plaques in vernal keratoconjunctivitis. [J Refract Surg. 1995;11:31-35.]
Thermal Collateral Damage in Porcine Corneas After Photoablation With Free Electron Laser
Authors: Bende Thomas , Walker R , Jean B
Published: April 2021

ABSTRACT

BACKGROUND: The study describes a quantitative and systematic investigation of the collateral thermal damage during infrared photoablation as a function of wavelength between 2.7 and 6.7 µm.

METHODS: Using the tunable Free Electron Laser at Vanderbilt University, Nashville, Tenn, 60 freshly removed porcine cadaver eyes were irradiated at wavelengths between 2.7 and 6.7 µm, at a fluence of 1.3 J/cm
p 2
. For wavelengths where no photoablation occurred, fluence was increased to 3.5 J/cm
p 2
; pulse length (macropulse) was 4 µs, consisting of a train of micropulses (pulse duration 2 ps at a 2.9 GHz repetition rate). The corneal buttons were removed and stained with hematoxylin and eosin (H&E) and analyzed by histologic micrometry.

RESULTS: Two thermal damage zones in the remaining tissue were observed: zone 1 showed superficial carbonization and measured between 2 and 4 µm; beyond, the eosinophilic zone 2 measured between 10 and 100 µm. The extent of zone 2 was inversely related to the absorption spectra of the cornea; it was minimal at the 3- and 6-micrometer water absorption bands and maximal at minimal target absorption.

CONCLUSION: The results correlated well with a model of the ablation process. The study provides a systematic and predictive element for the determination of collateral thermal adverse effects; it does not yet include pulse length variation as a determining factor. [J Refract Surg. 1995;11:129-136.]
Excimer Laser In Situ Keratomileusis
Authors: Kremer Frederic B , Dufek Michael
Published: April 2021

ABSTRACT

We have been using a 193-nm excimer laser under protocol to ablate the corneal stromal bed after creating a hinged corneal flap with a microkeratome in order to reduce or eliminate refractive error. Thirty-one consecutive eyes are reviewed with a preoperative mean spherical equivalent refraction of -6.25 diopters (D) (range -3.50 to -11.75 D). Preoperative mean astigmatism was +0.87 D (range +0.25 to +2.75 D). At 6 months postoperatively, the mean spherical equivalent refraction was -0.50 D (range -3.50 to +2.00 D). Mean postoperative astigmatism was 0.64 D (range 0.25 to 3.50 D). A result within 1.00 D of attempted correction was achieved in 74.2% of eyes. Uncorrected visual acuity after a single procedure was 20/40 or better in 81% of eyes. Spectacle corrected visual acuity was unchanged in 26 (84%), decreased 1/2 line in 2 (6%), and increased 2 lines in 1 (3%). The incidence of postoperative complications was minimal. Excimer laser ablation in the stromal bed in combination with a hinged corneal flap seems to offer many advantages over excimer laser surface ablation with fewer complications. [J Refract Surg. 1995;11(suppl.):S244-S247.]
Photorefractive Keratectomy for Myopia of 6 to 12 Diopters
Authors: Chan Wing-Kwong , Heng Wee Jin , Tseng Peter , Balakrishnan Vivian , Chan Tat Keong , Low Cze Hong
Published: April 2021

ABSTRACT

To conduct a prospective, nonrandomized clinical trial to assess the efficacy, stability and safety of the use of excimer laser photorefractive keratectomy (PRK) to correct myopia of greater than -6.00 diopters (D) in Singapore.

Two hundred thirty-three eyes of 176 patients with a mean preoperative spherical equivalent refraction of -8.70 ± 2.30 D (range, -5.75 D to -18.13 D) underwent PRK with a 193nm ArF excimer laser (ExciMed, Summit) for myopic corrections of between -6.20 D and -11.90 D. The first 66 of 233 eyes that reached at least 1 year of postoperative follow up are reported.

One year postoperatively, the mean manifest spherical equivalent refraction was -1.50 D ± 1.90 D (range -6.25 D to +3.25 D); 34% of eyes were within ± 1.00 D of attempted correction; uncorrected visual acuity was 20/40 or better in 75% of eyes. No eyes lost two or more Snellen lines of spectacle corrected visual acuity. Central corneal haze was mild in 20% of eyes and moderate in 3% of eyes. Five eyes developed ocular hypertension that subsequently resolved with treatment.

Excimer laser PRK is reasonably effective and safe in the treatment of -6.00 D to -12.00 D of myopia. However, it is less accurate than PRK in eyes with low to moderate myopia and is more likely to result in significant corneal haze. [J Refract Surg. 1995;11(suppl.):S286-S292.]
Automatic Eye Tracker for Excimer Laser Photorefractive Keratectomy
Authors: Gobbi Pier Giorgio , Carones Francesco , Brancato Rosario , Carena Marco , Fortini Alberto , Scagliotti Franco , Morico Alessandro , Venturi Elisabetta
Published: April 2021

ABSTRACT

Acute overlapping of successive laser pulses onto the cornea during photorefractive keratectomy (PRK) is important to avoid refractive distortions. Most excimer laser systems performing corneal ablation lack control of the patient's eye movements and they cannot track the target corneal zone.

We developed an eye-tracker based on television monitoring of the pupil and on automatic electromechanical deflection of the laser turning mirror, and we applied it to the ExciMed UV200 ArF work station (Summit Technology, Inc., Waltham, Mass.). Basic components are a black and white CCD camera and two fast stepping motors. The circuitry for target discrimination and tracking, and the optical imaging system are designed specifically. The tracker assembly does not interfere with the laser beam path nor with the operator's observation.

Tracking of the pupil has been successfully achieved on different color irides, with an accuracy better than 0.1 mm in a 6 × 6 mm
p 2
tracking field. Response time is less than 100 me. Recordings of eye movements during PRK are presented. Tracking ablations have been performed on moving test eyeballs with plastic corneas.

The proposed automatic system appears to be a reliable and effective method for the compensation of patient eye movements appears to be a reliable and effective method during PRK procedures. [J Refract Surg.1995; 11 (suppl.):S337-S342.]
Holmium: YAG Laser to Treat Astigmatism Associated With Myopia or Hyperopia
Authors: Cherry Paul M H
Published: April 2021

ABSTRACT

The Summit Technology, Inc. (Waltham, Mass.) holmium:YAG laser was used to treat astigmatism in 31 myopic and 8 hyperopic eyes. There was slow but continuing regression of effect even 1 year after treatment. This regression was particularly seen in hyperopic astigmatism, larger amounts of myopic astigmatism, and younger patients. In some cases keratometry readings returned to their pretreatment values. Males and females had similar results. The mean myopic shift in 9 myopic astigmatism eyes at 9-month follow up was 1 D. [J Refract Surg. 1995;11(suppl.):S349-S357.]
Corticosteroid Suppression of TraumaInduced Hyaluronan in Rabbit Cornea and Aqueous
Authors: Molander Nils , Ehinger Berndt , Stenevi Ulf , Lindquist Ulf , Lind Maj-Lis
Published: April 2021

ABSTRACT

BACKGROUND: Corneal and aqueous hyaluronan have recently been shown to react in response to several different types of trauma, including cataract surgery. In order to find ways to influence the reaction, we have evaluated the effect of topical dexamethasone (Isopto-Maxidex®, Alcon Universal Ltd, Fort Worth, Tex) or indomethacin (Confortid®, Dumex Ltd, Copenhagen, Denmark) on the postoperative hyaluronan concentration in rabbit cornea and aqueous after extracapsular lens extraction.

METHODS: The drugs were administered as topical eye drops three times daily. The hyaluronan concentration in rabbit cornea and aqueous after extracapsular lens extraction was measured with a radioligand assay.

RESULTS: Dexamethasone treatment (1 mg/mL) significantly suppressed the increase in corneal hyaluronan seen after extracapsular lens extraction, 2 (p≤0.0022) and 3 weeks (p≤0.0002) after surgery, while indomethacin did not induce any significant difference at 2 weeks. When the dexamethasone concentration was lowered to 0.1 and 0.2 mg/mL, there was still a significant decrease (p≤0.009) in hyaluronan concentration, but at lower concentrations of dexamethasone (0.01 and 0.02 mg/ mL), no significant decrease was seen. The increase in aqueous hyaluronan concentration seen 2 days after surgery in untreated eyes was significantly lowered by both dexamethasone (p≤O.0076) and indomethacin (p≤0.036).

CONCLUSIONS: Dexamethasone lowers reactive corneal and aqueous hyaluronan concentration in vivo after extracapsular lens extraction. [J Refract Surg. 1995;11:260-266.]