bluuebunny/crossref_metadata_2025 huggingface dataset:
Initiation Into Qualitative Data Analysis
Authors: Beck Cheryl Tatano
Published: April 2021

ABSTRACT

Qualitative data analysis may be daunting to nursing graduate students and other novice qualitative researchers. This article describes a qualitative research project required in a graduate nursing research couree that was designed to guide students through their first qualitative data analysis. Common pitfalls novice researchers may encounter, such as data shuffling, premature closure, and overly delayed closure, also are discussed. The project reported in this article not only decreased students' anxiety concerning qualitative data analysis but also helped students gain respect for the amount of time, effort, and creativity this process entails.
Public Health Nursing Education in Russia
Authors: Ivanov L Louise , Paganpegara Galina
Published: April 2021

ABSTRACT

The collapse of the Soviet Union in 1990 brought many changes to Russia, including changes in nursing education. However, the changes did not include content in public health nursing. Most health care in Russia is provided at the tertiary level in hospitals. Health promotion and health education are new concepts in Russia and are not well understood. When health education does occur, it is at the individual level, taught by physicians, and in response to new diagnoses. Health promotion at the primary level and with aggregates is not often practiced. Russia currently is in a demographic crisis where health indicators continue to decline. Russian nurses trained in public health principles, such as health promotion, health education, and providing primary and secondary prevention services at the population and aggregate level, can positively affect the current demographic crisis.
Blackbirds Singing in the Dead of Night?: Advancing the Craft of Teaching Qualitative Research
Authors: McAllister Margaret , Rowe Jennifer
Published: April 2021

ABSTRACT

Qualitative research education, which is overly concerned with teaching content, can reduce knowledge to the technical-rational domain, and in this process, opportunities for students to be inspired and passionately engaged with the art of qualitative research are lost. Although students may acquire the characteristics of qualitative researchers by observing role models, there is much skilled teachers can do to teach students not only how to conduct research, but also how to be committed qualitative researchers. The craft knowledge of skilled teachers in facilitating these understandings, techniques, and attributes in students must be shared and discussed in meaningful ways to advance quality education and, in turn, quality nursing research. If unshared, teachers' knowledge may go unheard, and they may be left isolated, like blackbirds singing in the dead of night. In this article, the skills of "doing and being" in qualitative research are emphasized by sharing strategies the authors have used in research education. The aim is to discuss creative aspects of teaching practice that are helpful in understanding and advancing rigorous qualitative research.
Blood Oxygen, Carbon Dioxide and pH Levels Prior to Diagnosis of Retinopathy of Prematurity
Authors: Biglan Albert W , Milley J Ross , Brown David R , Reynolds James D
Published: April 2021

ABSTRACT

We examined the eyes of all infants in our Neonatal Intensive Care Unit from 1979 to 1981 who were premature and/or had exposure to increased ambient oxygen. From these 1,012 neonates, 19 were found to have Grade III or worse acute retinopathy of prematurity (ROP) in at least one eye. We studied the graphic relationship of the mean daily values for blood Pc0
2
, Pa0
2
, PC0
2
, and pH and the production of retinopathy of prematurity in these infants and compared the results with a similar group of infants who had similar birthweight, gestational age and Vitamin E administration. The comparison group patients were in the hospital during this same period of time and did not have Grade III ROP. There was no characteristic level, peak or pattern of these values that could identify or predict which infants would develop ROP.
Near-Evoked Nystagmus in Spasmus Nutans
Authors: Chrousos Georgia Antonakou , Matsuo Victor , Ballen Ann K , Cogan David G
Published: April 2021

ABSTRACT

Near-evoked nystagmus was evident in two children with spasmus nutans by clinical observation and electrooculographic recording. In one child the nystagmus appeared to be evoked by fusional convergence and in the other by convergence-accommodation. These cases represent an atypical form of spasmus nutans in which the nystagmus is modulated by centers controlling visuomotor changes with near viewing.
Preferential-Looking Acuity and Stereopsis in Infantile Esotropia
Authors: Stager David R , Birch Eileen E
Published: April 2021

ABSTRACT

One hundred esotropie infants were assessed by preferential-looking (PL) for monocular acuity and stereopsis before the initiation of treatment. PL acuity of infantile esotropes who freely alternated fixation and of preferred eyes of unilateral esotropes was not significantly different from monocular acuity of age-matched normal infants. PL acuity of non-preferred eyes was normal during months three to five, but frequently below normal during months six to 14. Approximately the same percentage of normal and esotropie infants aged three to four months demonstrated stereopsis, but fewer esotropes than normals demonstrated stereopsis during months five to 14. Ninety-five percent of infants judged non-amblyopic by the cover-uncover test also showed no evidence of amblyopia in the PL test. Overall, 42% of esotropie infants judged amblyopic by the cover-uncover test were found amblyopic by PL. Most discrepancies between PL and fixation preference (73%) occurred when clinically amblyopic infants under eight months of age were found non-amblyopic by PL. These findings suggest that fixation preference develops prior to the onset of amblyopia detectable by PL. The results of PL stereopsis testing suggest that stereoscopic pathways are present and potentially functional in at least some esotropie infants.
The Relationship of Rectus Muscles to the Globe: A Study With Coronal CT Scanning
Authors: Saunders Richard A , Croley Thomas L , Croley Marilyn R , Holgate Richard C
Published: April 2021

ABSTRACT

Coronal computerized tomographic scans of 25 patients were reviewed in order to determine the normal relationship of rectus muscles to the globe. Using a horizontal reference line constructed along the anterior cranial fossa, the mean horizontal rectus muscle axis was found to be slightly excyclotorted in both eyes, and the mean vertical rectus muscle axis slightly incyclotorted in both eyes. In addition, the mean superior temporal quadrant angle formed by the intersection of the horizontal and vertical rectus muscle axis was significantly greater than the mean superior nasal quadrant angle in the same eye. The presence of large anatomical variations in individual patients may make it difficult to implicate rectus muscle malposition as an important etiology of A- and V-pattern strabismus.
Suppression and the Pattern Visual Evoked Potential
Authors: Wright Kenneth Weston , Ary James P , Shors Tracey J , Eriksen K Jeffrey
Published: April 2021

ABSTRACT

We assessed the effect of amblyopic suppression on the pattern visual evoked potential (P-VEP). Since anisometropic amblyopia is associated with the monofixation syndrome and a central suppression scotoma in the amblyopic eye, patients with this functional defect were used for the study.

Five anisometropic amblyopes and four normal subjects were studied using the P-VEP test. A modified haploscope was used to present a pattern stimulus to the area of suppression. By comparing responses generated under monocular conditions (non-suppression) with monocular responses under binocular viewing conditions (suppression), we measured the effect of suppression on the P-VEP.

Our results show that amblyopic suppression completely abolishes P-I amplitudes in patients with large suppression scotomas; in patients with small suppression scotomas the P-I amplitudes were greatly reduced. Rivalry in normals also caused a reduction in P-I amplitudes, but to a much lesser degree than that associated with anisometropic suppression. Patients with significant amblyopia did not show a rivalry effect on the P-VEP.

Because the P-I wave of the transient P-VEP is thought to represent activity at the level of the striate cortex, our results indicate that suppression probably occurs at the striate cortex or lateral geniculate nucleus.
Results of Overminus Lens Therapy on Postoperative Exodeviations
Authors: Iacobucci Ida L , Martonyi E Jean , Giles Conrad L
Published: April 2021

ABSTRACT

This paper is a study in the use of overminus lenses for 37 patients with postoperative exodeviations. These patients have been observed for a period ranging from three to nine years following their surgery. This study includes: (1) the immediate response to overminus treatment, (2) results at the time of cessation of overminus therapy, and (3) the followup results. The results are evaluated with an average followup of 24 months after termination of treatment and sequentially at one-year intervals following overminus therapy.
Acquired Esotropia as Initial Manifestation of Arnold-Chiari Malformation
Authors: Bixenman Wayne W , Laguna Jose F
Published: April 2021

ABSTRACT

A 13-year-old patient originally presented with a divergence palsy and gaze-evoked nystagmus. Over a short period of time, the esotropia became increasingly comitant and was successfully treated with strabismus surgery. Three years later, she developed downbeat nystagmus. An Arnold-Chiari Malformation could only be demonstrated using nuclear magnetic resonance imaging (MRI). Subsequent neurosurgical decompression resulted in resolution of the downbeat nystagmus with maintenance of single binocularity.
Histologic Consequences of Inferior Oblique Anastomosis to Denervated Lateral Rectus Muscle
Authors: Christiansen Stephen , Madhat Maher , Baker Robert S
Published: April 2021

ABSTRACT

Secondary muscular neurotization has been proposed as a means of restoring contractility to paretic extraocular muscle. We studied this technique by anastomosing healthy inferior oblique muscle to lateral rectus muscle that had been denervated either orbitally or intracranially in 20 dogs. Nerve and muscle fiber growth from the inferior oblique to the lateral rectus was demonstrated but no new neuromuscular junctions were formed. Regeneration of the lesioned sixth nerve occurred frequently and may explain the restoration of function claimed after this procedure.
Corneal Crystals, Myopathy and Nephropathy: A New Syndrome?
Authors: Arnold Robert W , Stickler Gunnar B , Bourne William M , Mellinger James F
Published: April 2021

ABSTRACT A case with ocular (corneal crystals and retinal pigment epithelial mottling), muscle (oropharyngeal and hand weakness and atrophy), and renal (proteinuria and hyper- tension) abnormalities is described. We believe that this represents a previously unrecognized syndrome.
Epikeratophakia on Pediatric Traumatized Corneas
Authors: Vila-Coro A Aguirre , Goosey John D , Mazow Malcolm L , Martin David I
Published: April 2021

ABSTRACT

Four children ranging from 4 to 6 years of age with unilateral aphakia and corneal scarring secondary to penetrating injuries were treated with epikeratophakia. One child had undergone a rotational penetrating keratoplasty to displace the corneal scar from the visual axis prior to the epikeratophakia procedure. In all of the cases, nonlyophilized donor tissue was utilized. The procedure was successful in all four cases. The average best corrected postoperative visual acuity was 20/45. These results confirm prior studies suggesting that epikeratophakia can be performed successfully on partially opaque and scarred corneas in pediatric aphakic eyes.
Bradycardia With Traumatic Hyphema in Children
Authors: Cohn James N , Scagliotti Daniel , Deutsch Thomas A
Published: April 2021

ABSTRACT

Eleven patients, aged 4 to 18 years, who were admitted to the hospital with the diagnosis of traumatic hyphema were placed on 24-hour cardiac (Holter) monitors. Ten of the 11 patients had episodes of bradycardia and bradyarrhythmias. Blood pressures monitored during the same period showed that the bradycardia was not hemodynamically significant. Cardiac monitoring was repeated on six patients 3 months later, and nocturnal cardiac rhythms were compared; the minimum heart rates immediately following the eye injury were significantly lower (p=.03) than those measured 3 months later. While these data do not establish a relationship between bradyarrhythmias and the frequently-observed occurrence of somnolence, it does appear that episodes of bradyarrhythmias represent a common physiologic response to traumatic hyphema, and they can be expected to resolve spontaneously.
Lamellar Sclerokeratoplasty of Epibulbar Tumor in Xeroderma Pigmentosum
Authors: Arora Ritu , Panda Anita , Kumar Harsh
Published: April 2021

ABSTRACT

A 10-year-old boy was followed up from the stage of biopsy-proven dysplastic conjunctival mass to carcinoma in situ. This carcinoma was managed by radical excision and lamellar sclerokeratoplasty. To our knowledge, this case represents the first reported successful management of conjunctival carcinoma in xeroderma pigmentosum.
Abortive Cryptophthalmos: A Case Report and a Review of Cryptophthalmos
Authors: Walton William T , Enzenauer Robert W , Cornell F Michael
Published: April 2021

ABSTRACT

Cryptophthalmos is a rare, probably autosomal recessive condition in which the lid folds fail to separate in the embryo resulting in a continuous sheet of skin from the forehead to the cheeks covering the eyes. Cryptophthalmos has many variants and is usually associated with multiple other congenital anomalies.

This article reports on an isolated case of "abortive cryptophthalmos" with multiple systemic anomalies. The surgical treatment is described and the general features of the cryptophthalmos syndrome and its variants are reviewed.
PVEP Evidence of True Suppression in Adult Onset Strabismus
Authors: Wright Kenneth W , Fox Barbara E S , Eriksen K Jeffrey
Published: April 2021

ABSTRACT

Customarily, it is taught that strabismus acquired in childhood results in suppression of the diplopic image, whereas strabismus acquired in adulthood causes diplopia or conscious image ignoring, but not true cortical suppression. The pattern visual evoked potential (PVEP) was recorded from strabismic patients, three with childhood onset, two adult onset with diplopia, and three with longstanding adult onset strabismus "ignored" diplopia. Patients with childhood onset and adult onset "ignored" diplopia similarly showed essentially no response under haploscopic stimulation, whereas patients with diplopia and normal control subjects showed a 50% decrease (rivalry). These results suggest that adults with acquired strabismus who "ignore" the diplopic image actually have a suppressed cortical visual activity, as evidenced by the pattern visual evoked potential.
Iritis in Children With Varicella
Authors: Kachmer M L , Annable W L , DiMarco M
Published: April 2021

ABSTRACT

A prospective study that included 82 consecutive children seen over 2 years by five pediatricians was undertaken to determine the incidence of iritis in children with chickenpox. Twenty-one (25%) children without pox on their lids were found to have iritis. Follow-up of children with objective evidence of iritis revealed no long-term sequelae.
The Effect of Topical Cysteamine Drops on Reducing Crystal Formation Within the Cornea of Patients Affected by Nephropathic Cystinosis
Authors: MacDonald Ian M , Noel Léon P , Mintsioulis George , Clarke William N
Published: April 2021

ABSTRACT

We studied the usefulness of topical cysteamine ophthalmic drops in reducing crystal formation within the corneas of patients affected by nephropathic cystinosis. A dosage of 0.3% cysteamine given four times daily was chosen as a more manageable method than a previously reported protocol of hourly administration of 0.11% drops. No reduction in crystal formation was observed in our patients; they were followed for seven months.
Microphthalmos With Cyst in Monozygous Twins
Authors: Leatherbarrow Brian , Kwartz Jeffrey , Noble Joan Laura
Published: April 2021

ABSTRACT

We present two cases of microphthalmos with cyst affecting monozygotic twins. The etiology and pathogenesis of this developmental anomaly are discussed. The diagnostic evaluation, differentia) diagnoses, and management options of this unique disorder are also considered.
Adjustable Vertical Rectus Muscle Transposition Surgery
Authors: Laby Daniel M , Rosenbaum Arthur L
Published: April 2021

ABSTRACT

Transposition of the vertical rectus muscle to the insertion of a paralytic or aberrantly innervated lateral rectus muscle is useful in treating esotropia associated with abducens palsy and Duane syndrome. However, this procedure may cause a manifest vertical deviation, requiring either prismatic or additional surgical correction. In an attempt to reduce the incidence of this surgical complication, we performed vertical rectus muscle transposition surgery, using an adjustable suture technique on each muscle, in 10 consecutive patients with abnormal lateral rectus function. Preoperative diagnoses included abducens palsy (70%) and Duane syndrome (30%). Preoperative deviations ranged from 14 to 85 prism diopters esotropia (mean, 39 δ) in the primary position. No vertical deviation was present preoperatively. Following transposition surgery, 8 of 10 patients were esotropic, 1 of 10 patients was exotropic, and 4 of 10 patients had a manifest vertical deviation. At the time of adjustment, all vertical deviations were corrected by "recessing" the appropriate vertical rectus muscle. Additionally, exotropia was lessened by "recessing" both vertical muscles in one patient.
Bilateral Lateral Rectus Recession for Exotropia: A Survival Analysis
Authors: Stoller Scott H , Simon John W , Lininger Lloyd L
Published: April 2021

ABSTRACT

Exotropia may progress during the childhood years, and the ideal time for surgical intervention remains uncertain. We reviewed our results following bilateral lateral rectus recession in 57 consecutive patients. In order to identify possible predictive covariates, we performed survival analysis using survival time as the time from surgery to failure. The patients' age at the time of surgery ranged from 11 months to 50 years (mean, 68 months). Follow up after surgery ranged from 1 to 105 months (mean, 47 months).

Outcomes were considered failures if there was (1) a distance exodeviation greater than 10 prism diopters at any time after surgery, (2) a distance esodeviation greater than 10 δ more than 6 months postoperatively, or (3) further surgery for exotropia or esotropia. By these criteria, surgery was successful in 58% of cases.

Results of the survival analysis indicated an estimated mean time to failure of 68 months. Patients with intermittent exotropia were more likely to remain aligned postoperatively than were those with constant deviations. The age at onset of exotropia, age at surgery, angle of deviation at different fixation distances, early postoperative alignment, and presence of symptoms, amblyopia, anisometropia, or incomitance before surgery were not predictive of success. We conclude that exotropia surgery may be performed with the same likelihood of success at any age, but patients with intermittent deviations do better.
Mitomycin in the Treatment of Hypertrophic Conjunctival Scars After Strabismus Surgery
Authors: Urban Robert C , Kaufman Lawrence M
Published: April 2021

ABSTRACT

A recognized complication of strabismus surgery is the development of hypertrophic conjunctival scars over the operated-on muscle. Our standard treatment of these scars has been excision followed by corticosteroid eye drops, which results in a scar recurrence rate of 33%. Antimetabolic chemotherapeutic agents, such as mitomycin, can reduce posttraumatic scarring and vascularization of the ocular surface. We studied the use of mitomycin eye drops as an adjunct to standard treatment of hypertrophic conjunctival scars after strabismus surgery. Four patients were treated with adjunct mitomycin eye drops (0.2 to 0.4 mg/ml). Postoperative follow up ranged from 16 to 56 weeks. None of these cases showed significant scar recurrence. Mitomycin in the higher dosage caused mild superficial punctate keratitis after 8 days of use. Despite a lamellar sclerectomy in a patient treated with 0.2 mg/ml of mitomycin, there was no further clinically apparent loss of scleral tissue. The results of this pilot study suggest that topical mitomycin is a safe and effective adjunct to excision and corticosteroid eyedrops in the treatment of hypertrophic conjunctival scars after strabismus surgery.
How Far Can a Medial Rectus Safely Be Recessed?
Authors: Kushner Burton J , Fisher Marian R , Lucchese Neil J , Morton Gail V
Published: April 2021

ABSTRACT

Previous studies have suggested that the location of the equator should be important in determining the site of a "safe maximum recession" of a rectus muscle, and that the location of the equator should be a function of axial length. Exactly where in relationship to the equator a muscle can be safely recessed has never been scientifically determined. Over a 4-year period, we measured axial length on all patients we operated on for strabismus. Using a previously derived formula, we were able to calculate the limbus-to-equator distance, given axial length. Based on our analysis of 28 patients in whom we recessed one or both medial recti posterior to the equator, we believe that recessions of the medial recti up to 1.5 mm posterior to the equator should not produce postoperative medial rectus underaction associated with an overcorrection, but recessions that are further than 1.5 mm posterior to the equator may do so. Recessions to a point greater than 11 mm from the limbus do not appear to be associated with late progressive overcorrection provided that the site of recession is not greater than 1 .5 mm posterior to the equator. Using our previously determined formula for estimating the location of the equator, given axial length, we have generated easy-to-use reference tables for determining the location of the equator in terms of millimeters posterior to the limbus. Also, based on axial length data from 180 strabismus patients, we have generated an algorithm for predicting axial length, given age, and refractive error, which may be useful to the strabismus surgeon in predicting the location of the equator when A-scan ultrasonography is not available.
Congenital Nasolacrimal Duct Obstruction: Natural History and the Timing of Optimal Intervention
Authors: Paul T Otis , Shepherd Rodger
Published: April 2021

ABSTRACT

Nasolacrimal duct obstruction (NLDO) is a relatively common clinical problem. Debate continues about optimal management. Intervening early and intervening late each have advantages and disadvantages.

We reviewed the world literature on NLDO. We assembled information on occurrence, natural history, and results of treatment. Spontaneous remission data were used to derive the probability of continued obstruction versus age. The prevalence a hypothesized treatmentresistant form of NLDO was estimated.

Symptomatic NLDO probably occurs in 5 to 6% of infants. Given a symptomatic case under the age of 14 months, the probability of spontaneous remission within the following month appears to be approximately one of three. Probe failure risk increases with age, doubling every 6 months.

Increasing probe failure risk may be due to selfselection. Preliminary analysis of management strategies suggests that lacrimal duct probing at age 4 months in the office is the most cost-effective strategy. Further descriptive studies of NLDO remission and treatment are indicated.
Neonatal Dacryocystitis Associated With Nasolacrimal Duct Cysts
Authors: Lueder Gregg T
Published: April 2021

ABSTRACT

Neonatal dacryocystitis is a rare complication of congenital nasolacrimal duct (NLD) obstruction. Recent reports suggest that the association of neonatal dacryocystitis and NLD cysts may be more common than previously believed. The purpose of this study is to describe the nasal endoscopic findings and treatment of three patients with this disorder. In this prospective study, three consecutive patients who presented at 2 weeks of age or less with dacryocystitis were treated with NLD probing and rigid nasal endoscopy. All patients were found to have congenital NLD cysts at the time of NLD probing. The cysts were marsupialized under endoscopic visualization. The treatment was successful in all patients. Dacryocystitis in the early newborn period is commonly associated with NLD cysts. Nasal endoscopic marsupialization of the cysts is an effective adjunct to treatment of these patients.
Facial Asymmetry and Tendon Laxity in Superior Oblique Palsy
Authors: Paysee Evelyn A , Coats David K , Plager David A
Published: April 2021

ABSTRACT

Both facial asymmetry and superior oblique tendon laxity are associated with congenital superior oblique muscle palsy (SOP). It is unknown whether facial asymmetry and tendon laxity are related to each other, perhaps even causally. We evaluated 29 patients with SOP for presence of facial symmetry, tendon laxity, or both, and correlated these findings with presence or absence of chronic head tilt. Sixteen of 21 (76%) unilateral congenital SOP patients had facial asymmetry and 17 (81%) had tendon asymmetry. Ninety-four percent had either or both abnormalities, but only 57% had tendon laxity (palsy) on the side opposite the facial hypoplasia. All patients with facial hypoplasia had a head tilt toward the hypoplastic side of the face, regardless of which side the palsy was on.

These findings, along with previous studies of congenital muscular torticollis, infer that the two anatomic abnormalities associated with congenital SOP (facial asymmetry and tendon asymmetry) do not occur as part of the same developmental sequence, but the facial asymmetry develops as a consequence of a chronic head tilt from a young age.
Dissociated Horizontal Deviation and Accommodative Esotropia: Treatment Options When an Eso- and an Exodeviation Co-exist
Authors: Wilson M Edward , Saunders Richard A , Berland Jerry E
Published: April 2021

ABSTRACT

Dissociated strabismus includes movements in the vertical, horizontal, and torsional axes. Dissociated vertical deviation (DVD) is an oversimplified label because it implies a purely vertical deviation. When the abducting component of the dissociated strabismus complex is prominent, the term dissociated horizontal deviation (DHD) is used. We present six patients with accommodative esotropia who developed prominent DHD. Only two patients have a prior history of congenital esotropia. Latent nystagmus was observed in five of the patients. With the combination of DHD and esotropia, an esodeviation during active fixation may become an exodeviation when the patient is visually inattentive.

Five patients required surgery for DHD. Four options are used and discussed. DHD can be treated alone with lateral reclus muscle recession. DHD can be treated as above, but combined with medial rectus muscle recessions or posterior fixation sutures to simultaneously treat the esotropia. The esotropia can be treated alone, possibly with a reduced surgical dosage. If the patient varies from an esodeviation to an exodeviation, but is straight much of the day, observation without surgical therapy may be advisable. Just as a hypotropia can have an overlying DVD, an esotropia can have an overlying DHD. This combination may masquerade as variable angle esotropia or may present as an esodeviation when the patient is visually attentive and an exodeviation when the patient is visually inattentive.
The Treatment of Congenital Nystagmus With Botox
Authors: Carruthers Jean
Published: April 2021

ABSTRACT

Clostridium botulinum A exotoxin (Botox) is the most potent toxin known to man. It produces a reversible paralysis of cholinergically innervated muscle, an effect useful in the management of non-accommodative strabismus and various disabling focal dystonias.

In the present study, botulinum toxin (Botox) was used to treat congenital nystagmus, injecting the toxin into multiple horizontal rectus muscles at the same treatment session. Three of four patients achieved a significant enough change in acuity to receive daytime-restricted driver's licenses. No treatment was complicated by retrobulbar hemorrhage, ocular perforation, or ptosis. Two patients are continuing the Botox treatments every 3 to 4 months.
Neuroanatomic Abnormalities of Primary Visual Cortex in Macaque Monkeys With Infantile Esotropia: Preliminary Results
Authors: Tychsen Lawrence , Burkhalter Andreas
Published: April 2021

ABSTRACT

To explore the structural basis for visuomotor deficits in infantile esotropia, we examined binocular connections and metabolic activity in the primary visual cortex of two strabismic macaque monkeys. The animals were documented to have onset of natural esotropia in early infancy. Behavioral testing showed that the animals had normal visual acuity in both eyes and the ocular motor deficits that characterize strabismus with onset in infancy. The neuronal tracer substance biotinylated-dextran-amine was injected into ocular dominance columns (ODC) in area V-1 (striate cortex), revealing a paucity of binocular connections between right-eye and left-eye ODCs. The metabolic label cytochrome-oxidase was used to stain neighboring right-eye and left-eye ODCs, revealing inequalities in metabolic activity compatible with interocular suppression. These results show that infantile esotropes have abnormalities of visual cortex structure that correlate with abnormalities in binocular behaviors.
CHARGE Association: Histopathological Report of Two Cases and a Review
Authors: Hayashi Nobutsugu , Valdes-Dapena Marie , Green W Richard
Published: April 2021

ABSTRACT

Background: The CHARGE association (C=coloboma, H= heart disease, A=atresla or stenosis of the choanae, R=retarded growth and development or CNS anomalies, G=genital hypoplasia, and E=ear anomalies or deafness) is a rare, recently well-recognized clinical study. The ophthalmic abnormalities have been described in numerous reports, but the ocular histopathologic findings have not been presented in detail.

Methods: We conducted gross and microscopic studies of eyes of two patients with the CHARGE association obtained postmortem.

Results: The eyes in one case had a small, symmetrical, inferior nasal coloboma of the choroid. In the other case, extensive inferior nasal colobomas of the iris, ciliary body, and choroid with retinal dysplasia, ectopie retinal/glial tissue in the sclera and hypoplasia of the optic nerve head were present.

Conclusion: We document the h i sto pathological features of eyes of two subjects with the CHARGE association. The abnormalities of these eyes were typical ocular colobomas presumably resulting from the failure of complete closure of the optic fissure.
An XX Male With Microphthalmos and Sclerocornea
Authors: Kobayashi Miwako , Kiyosawa Motohiro , Toyoura Takio , Tokoro Takashi
Published: April 2021

INTRODUCTION

Microphthalmos is a severe congenital ophthalmic disease. As knowledge of gene locus for hereditary ocular diseases expands, so does the number of the Xp-Jinked ophthalmic disease (Table).1 A percentage of microphthalmos appears to be caused by the abnormal X chromosome. Microphthalmos and linear skin defects (MLS) syndrome (MIM309801) is a good illustration. This syndrome is a developmental disorder observed in XX individuals with distal Xp segmentai monosomy, or deletions and unbalanced translocations involved in the Xp22.3 region.2-6

Al Gazali2 described a Caucasian XX male with bilateral microphthalmos. This case was further described by Lindsay3 as MLS syndrome. Al Gazali4 reported two MLS syndrome female with de novo X;Y translocations. Their eye findings included microphthalmos, corneal opacities, and orbital cysts on the left side. Temple5 reported a Xp22.2-pter MLS syndrome female with left side microphthalmos. Lindor6 reported a MLS syndrome female with an Xp22.3 microdeletion and a chromosome satellite on the abnormal Xp-arm. Her eye findings were bilateral microphthalmos, sclerocornea, and cataracts. The phenotype of MLS syndrome is various. The dermal lesions of the patients are limited to the face and neck, and varies from slight to severe. MLS syndrome is recognized to be contiguous gene syndrome.3
Migraine in a Pediatric Ophthalmology Practice
Authors: O'Hara Mary A , Koller Harold P
Published: April 2021

ABSTRACT

Purpose: A prospective study of children between the ages of 2 and 15 years was conducted to investigate the prevalence and characteristics of migraine in children seeking ophthalmic care.

Methods: A questionnaire, based on established criteria for the diagnosis of migraine, was administered to 1479 consecutive children presenting to a single pediatric ophthalmologist (H.P.K.). Over 25% of all respondents reported headaches that met the criteria for migraine. In general, these individuals were older than non-migraine sufferers (mean age of 8.3 years vs. 6.6 years). There were no significant sex differences.

Results: Headache was the chief complaint for 8.9% of all patients seeking ophthalmic care in this study population. Eighty percent of this subpopulation described headaches that met the diagnostic criteria for migraine. This study found childhood migraine symptoms to be present in a significant proportion of the patient population of a pediatric ophthalmologist.
Refractive Status in Children After LongTerm Follow up of Cataract Surgery With Intraocular Lens Implantation
Authors: Spierer Abraham , Desatnik Howard , Blumenthal Michael
Published: April 2021

Abstract

Purpose: To evaluate the resultant refractive status In children 5 to 11 years after cataract surgery with a high power Intraocular lens (IOL) Implantation.

Methods: Charts of eight patients (10 eyes) who underwent cataract surgery with IOL implantation by the same technique were reviewed. Age at surgery was 2 months to 3 years. High-power IOL of 27.0 to 30.0 diopters (D) was implanted In seven eyes and lower IOL (between 19.0 D to 23.0 D) in three eyes. Follow-up period was between 5 and 1 1 years.

Results: In children who received a high-power IOL, the resultant refraction after 5 to 7 years was found to be between -5.50 and -12.00 D. In the group that had a lower power IOL implanted, the refraction was between -2.50 and +9.00 after 6 to 11 years. The results were plotted on a graph of refraction vs. IOL power and showed that the IOL power that may result in emmetropia in an older child is 23.2D.

Conclusions: The Implantation of a high-power IOL (27 D to 30 D) in eight young children resulted In refractive status within 3 D of emmetropia during the first year or two of life and in high myopia at age 5 to 12 years.
Unilateral or Asymmetric Congenital Ptosis, Head Posturing, and Amblyopia
Authors: Fiergang Dean L , Wright Kenneth W , Foster Jill A
Published: April 2021

ABSTRACT

Purpose: To determine the prognostic implication of compensatory head posturing in patients with unilateral or asymmetric congenital ptosis.

Methods: A retrospective review of 80 consecutive patients with unilateral or asymmetric congenital ptosis was performed. The presence of documented compensatory head posturing, age of onset, age of presentation, visual acuity, refraction, and amblyopia were recorded, and binocularity was tested.

Results: Five of seven (71%), patients with unilateral or asymmetric congenital ptosis and compensatory head posturing had amblyopia. All of these patients had straight eyes and four of the five amblyopic patients had anisometropia of less than 2 diopters (D).

Conclusion: The high incidence of amblyopia in this group can occur in the absence of significant anisometropia and strabismus. This unusually high incidence of amblyopia in this subgroup of patients with unilateral or asymmetric congenital ptosis and compensatory head posturing warrants compulsive examination and prophylactic part-time occlusion therapy of the nonptotic eye until reliable vision testing can be performed.

Journal of Pediatric Ophthalmology & Strabismus 1999; 36:74-77.
e-Consults
Authors: Ruttum Mark , Alcorn Deborah
Published: April 2021

In this new feature, our Column Editors prepare a patient case for virtual consultation - the patient's history, physical examination, and pertinent photos are e-mailed to colleagues for a discussion of their individual treatment choices.

For the inaugural column, Mark Ruttum presents a case of complicated strabismus In a child with an orbital floor fracture. Miles J. Burke, William N. Clarke, and Scott E. Olitsky, who served as "consultants," present management options.
Palpebral Fissure Changes in Early Childhood
Authors: Paiva Raquel S N , Minare-Filho Abenor M , Cruz Antonio A V
Published: April 2021

ABSTRACT

Purpose: To describe palpebral fissure changes during early childhood.

Methods: Digital imaging was used to analyze the monocular palpebral fissure images of 185 children and 35 adults. Six variables were quantified for each eye: the distance between the pupil center and the upper and lower eyelid margin, the palpebral fissure area, and the obliquity and length of the fissure. The lower eyelid crease pattern also was evaluated qualitatively.

Results: The upper eyelid was at its lowest position after birth, and the lower eyelid margin was close to the pupil center. Between ages 3 and 6 months, the position of the upper eyelid reached its maximum and then declined linearly. At the same time, the distance between the pupil center and the lower eyelid margin increased linearly until age 18 months when its position stabilized. Both the horizontal palpebral fissure length and the fissure area followed a logarithmic pattern of growth and were strongly correlated. The obliquity of the fissure was evident at an early age and did not change until adulthood. At birth, the most common pattern of the lower eyelid crease was a single crease. The number of individuals showing a double crease increased with age, and at approximately age 36 months, a double crease became the most common pattern.

Conclusion: The palpebral fissure undergoes complex changes during infancy. An accurate knowledge of these changes is important for evaluating eyelid disorders in children.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:219-223.
Neuro-Ophthalmic Features in Pediatric Tubercular Meningoencephalitis
Authors: Amitava Abadan K , Alam Seema , Hussain Rashid
Published: April 2021

ABSTRACT

Purpose: To examine the neuro-ophthalmic profile in childhood tubercular meningoencephalitis and assess its prognostic importance.

Methods: One hundred consecutive patients with tubercular meningoencephalitis underwent evaluation for optic nerve functions, supra- and infranuclear oculomotor involvement, and raised intracranial tension, Patients underwent follow-up for 9 months.

Results: In 100 patients with tubercular meningoencephalitis, 67 had neuro-ophthalmic features. Common findings were retrobulbar neuritis (32) and gaze palsy (20). Others, in decreasing prevalence, were third and sixth nerve palsy, conjugate deviation, primary optic atrophy, and complete ophthalmoplegia. Raised intracranial tension was associated with neuro-ophthalmic features in 53 of 67 patients (P<.05). Complete ophthalmoplegia was significantly associated with mortality on logistic regression analysis (relative risk, 6.35; P=.012). By 6 months, 56% of patients with retrobulbar neuritis progressed to optic atrophy.

Conclusion: Neuro-ophthalmic features, in association with raised intracranial tension, often are a part of pediatric tubercular meningoencephalitis presentation. The type of neuro-ophthalmic features may have prognostic value. Optic nerve involvement is the most common finding in tubercular meningoencephalitis.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:229-234.
Characteristics of Okihiro Syndrome
Authors: Chun Benjamin B , Mazzoli Robert A , Raymond William R
Published: April 2021

ABSTRACT

Purpose: To describe Okihiro syndrome, a syndrome consisting of Duane's syndrome, radial ray anomaly, and sensorineural deafness.

Methods: The incidence of anomalies in 41 individuals from 9 affected families was assessed by literature review and patient examination, and the frequency of the characteristics occurring together was determined.

Results: Of all the individuals with at least one of the above characteristics, only 12% had all three characteristics. However, 44% had both Duane's syndrome and radial ray anomaly, whereas sensorineural deafness alone occurred in only 17% of patients.

Conclusion: Okihiro syndrome is consistent with autosomal dominance with variable penetrance, manifesting primarily with Duane's syndrome and radial ray anomaly, and less frequently, sensorineural deafness.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:235-239.
Stimulus Deprivation Myopia in Human Congenital Ptosis: A Study of 95 Patients
Authors: Gusek-Schneider Gabriele-Ch , Martus Peter
Published: April 2021

ABSTRACT

Purpose: To establish differences between the frequency of suspected deprivation myopia in unilateral and bilateral congenital ptosis with and without covered optical axis.

Methods: Ametropia was evaluated in both eyes of 95 patients with congenital ptosis. The amount of refraction was documented as spherical equivalent (100% cycloplegia). Statistical analysis was performed using the chi-square and sign tests.

Results: In unilateral ptosis, the frequency of myopia was lower (10/68: 15%) than that of hyperopia (58/68: 85%) in the ptotic eye (P <0.001). However, myopia occurred more often in the ptotic eye (10/68: 15%) than in the fellow eye (3/68: 4.4%). Myopic anisometropia was found only in the ptotic eye (5/68 vs 0/68), but was less frequent than hyperopic anisometropia (6/68 vs 8/68). In bilateral ptosis 7/54 myopia as compared with 47/54 hyperopia were observed and 1/27 myopic anisometropia vs 6/27 hyperopic anisometropia. Covered center of the pupil, in children ≤8 years of age, was associated with myopia more frequently in bilateral than in unilateral ptosis (6/30 vs 1/27). We found a significantly higher rate of myopia <-1 diopter and hyperopia >2 diopter in comparison of children 5 to 7 years old with first-grade school children.

Conclusions: Two expected results were (1) compared with the normal population, an overall higher frequency of myopia in human congenital ptosis; (2) in unilateral ptosis, a higher frequency of myopia in the ptotic, than in the fellow eye.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:340-348.
Unilateral Rectus Resection in the Treatment of Undercorrected or Recurrent Strabismus
Authors: Olitsky Scott E , Kelley Christopher J , Lee Henry , Nelson Leonard B
Published: April 2021

ABSTRACT

Background: When surgery is required for an undercorrection or for a recurrent strabismus that is in the same direction as the previous deviation, traditional options have included a rerecession of the previously operated muscle(s), a marginal myotomy of the previously operated muscle(s) with or without a resection of the direct antagonist, or a bilateral resection of the antagonist muscles. While many surgeons prefer to perform a bilateral resection for these reasons, a unilateral resection would be a useful approach for small to moderate deviations.

Methods: Data were collected for patients who had undergone a unilateral rectus resection: age, number of prior surgeries, the preoperative deviation, the postoperative deviation at 1 week, 6 weeks, and 6 months, and the amount of surgery performed. An acceptable postoperative result was considered to be any deviation ≤8 pd.

Results: A resection of a single rectus muscle was undergone by 113 patients. Complete data were available on 81 of these patients: 60 underwent a unilateral resection of the lateral rectus and 21 underwent a unilateral resection of the medial rectus. Of those patients undergoing a unilateral lateral rectus resection, 90% were acceptably aligned at the 6-month postoperative exam. Among those patients undergoing a medial rectus resection, 95.2% obtained a successful result.

Conclusions: A unilateral resection of the medial or lateral rectus is an effective tool in the treatment of undercorrected or recurrent strabismus. It is predictable, stable in the immediate postoperative period, and limits surgery to 1 eye.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:349-353.
Brain Bank Seeks Donors
Authors: Anonymous
Published: April 2021

Brain tissue of schizophrenics in short supply
Rapidly Polymerized Collagen Gel as a Smoothing Agent in Excimer Laser Photoablation
Authors: DeVore D P , Scott J B , Nordquist R E , Hoffman R S , Nguyen H , Eiferman R A
Published: April 2021

ABSTRACT

BACKGROUND: Excimer laser photoablation effectively and precisely removes corneal tissue but may not smooth irregularities on the anterior corneal surface. An even surface might be obtained by applying a smoothing substance that fills in irregularities and ablates at the same rate as corneal tissue. Evaluation of collagen gel as a smoothing agent is reported.

METHODS: Pure, type I collagen solutions were prepared to remain soluble at physiological pH and to spontaneously gel when exposed to cationic buffers. Collagen gels were formed on the surface of enucleated porcine corneas and on human donor corneas and exposed to varying pulses of 193nanometer excimer laser energy. Effects of collagen gel on ablation depth, corneal surface smoothness, and smoothing of roughened cornea were evaluated by examining scanning electron micrographs of control and treated specimens.

RESULTS: Collagen gels formed from 5 mg/ml collagen solutions dramatically altered the depth of photoablation. Photoablation of roughened cornea with collagen gels produced smooth corneal surfaces, whereas control eyes remained roughened and irregular. The smoothness of photoablated cornea surfaces improved when collagen gels were applied prior to photoablation.

CONCLUSIONS: The rapidly gelling collagen solution appears to exhibit the functional properties required for an effective smoothing agent for excimer laser photoablation. The substance has low viscosity when applied to the corneal surface and forms a rigid gel when exposed to cationic buffer solution. In addition, the concentration of the collagen gel can be adjusted to provide different ablation rates. [J Refract Surg. 1995;11:50-55.]
Model for Deriving the Optical Performance of the Myopic Eye Corrected With An Intracorneal Ring
Authors: Patel Sudi , Marshall John , Fitzke Frederick W
Published: April 2021

ABSTRACT

BACKGROUND: The intracorneal ring has been advanced as a mechanical device for the correction of myopia. The device may reduce refractive error, but the effect on the overall optical performance of the eye has been neglected. This paper addresses this issue by presenting mathematical models that will predict the effect of the intracorneal ring on refractive error, corneal asphericity, and the spherical aberration of the eye.

MATERIALS AND METHODS: Algorithms are derived for predicting the corneal apical radius, asphericity, and the change in myopia after inserting intracorneal rings of any thickness and diameter.

RESULTS: The model predicts that the magnitude of myopia reduction is a function of both ring thickness and diameter. The large diameter (9 to 10 mm), thin (0.1 to 0.2 mm) intracorneal ring is less likely to adversely affect corneal asphericity and therefore not significantly enhance the spherical aberration of the eye.

CONCLUSIONS: An intracorneal ring cannot correct more than 4.00 diopters (D) of myopia without significantly increasing ocular spherical aberration, which, in turn, will compromise the final visual outcome. [J Refract Surg. 1995;11:248-252.]