bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Absence of the Superior Rectus Muscle: A Case Report
Authors: Mather Thomas R , Saunders Richard A
Published: April 2021

ABSTRACT

We report a case of bilaterally absent superior rectus muscles presenting clinically as a double elevator palsy. This patient is unique due to paradoxical ocular movements on attempted upgaze and the absence of other major craniofacial anomalies. Successful surgical correction was accomplished using a modified Jensen procedure where the superior halves of the horizontal rectus muscles were united using synthetic absorbable sutures. Congenital absence of the superior rectus muscles should be suspected in patients with severe elevation deficiency associated with paradoxical ocular movements.
Thyroid Eye Disease Presenting After Cataract Surgery
Authors: Hamed Latif M , Lingua Robert W
Published: April 2021

ABSTRACT

Strabismus presenting after cataract surgery has been attributed to a variety of disorders, some of which are unrelated to the surgery. When thorough ophthalmologic and neurologic examinations fail to elucidate a definitive etiology, the motility disturbance is often ascribed to operative trauma to the orbital soft tissues. In a series of 58 patients with strabismus presenting after cataract surgery, eight (14%) were found to have previously unsuspected thyroid eye disease. Three of the eight patients had past histories of systemic dysthyroidism, but none reported diplopia prior to cataract extraction. Three of the remaining five patients showed normal thyroid function tests. Absence of diplopia prior to cataract extraction in these patients may be due to: 1) poor vision precluding diplopia until surgical restoration of sight; 2) intraoperative aggravation of the inflammatory process in otherwise subclinical thyroid eye disease; or 3) onset of clinical thyroid eye disease that was temporally associated with cataract surgery by chance. Thyroid eye disease should be included in the differential diagnosis of all patients presenting with binocular diplopia following cataract surgery. Suitable neuroimaging studies may be needed to confirm the diagnosis.
Idiopathic Superior Oblique Palsies in Children
Authors: Robb Richard M
Published: April 2021

ABSTRACT

The records of 110 patients with superior oblique palsy seen at the Boston Children's Hospital between 1966 and 1988 were reviewed. Patients with identifiable orbital or neurological disorders affecting the fourth cranial nerve or with a history of head trauma preceding their superior oblique palsy were excluded from analysis. Patients were also excluded because of prior surgery elsewhere or insufficient diagnostic information. The remaining 63 patients were considered to have idiopathic superior oblique palsies. All 63 patients presented with unilateral palsies. All had incomitant hypertropia of the affected eye, greater on gaze to the contralateral side and increased by ipsilateral head tilt. Left eyes were affected in 41 patients. The age at first ophthalmological examination was spread over the first 20 years, with heavier representation in the first 5 years and decreasing numbers in each succeeding 5-year interval. Only one patient was found to have a masked bilateral superior oblique palsy following surgery for an apparent unilateral palsy. A distinction is made between unmasking a bilateral superior oblique palsy and surgical overcorrection of a unilateral palsy. The predominant unilaterality of idiopathic superior oblique palsies is in contrast to the reported frequency of bilaterality in traumatic cases.
Nodular Fasciitis Presenting as a Rapidly Enlarging Episcleral Mass in a 3-Year-Old
Authors: Holds John B , Mamalis Nick , Anderson Richard L
Published: April 2021

ABSTRACT

A rapidly enlarging periocular mass in a child obligates the treating physician to rule out a malignancy, especially a rhabdomyosarcoma. A 3-year-old girl presented with a 5-day history of a rapidly growing episcleral mass superonasal to the globe, adjacent to the superior rectus muscle insertion. The lesion was locally excised. A sarcoma could not be excluded on frozen sections. Permanent sections and electron microscopy revealed nodular fasciitis, a benign lesion with a pseudosarcomatous histologic appearance. No recurrence has been noted at 9 months follow-up. Nodular fasciitis is a benign proliferation which should be considered in the differential diagnosis of a rapidly enlarging subconjunctival or orbital mass in a child.
Stereoacuity Testing in the Monofixation Syndrome
Authors: Clarke William N , Noel L P
Published: April 2021

ABSTRACT

A group of patients with the monofixation syndrome were assessed prospectively to compare performance on Titmus and Randot stereograms under monocular and binocular conditions. These patients achieved monofixation either as a result of surgery for infantile esotropia, or because of a partially accommodative esotropia or significant anisometropia. Their ability to detect elevation of the Titmus circles was not significantly better with two eyes as compared to that level achieved using only their monofixating eye. However, performance on the Titmus animals and on Randot circles or animals showed better discrimination. These data would suggest that the monocular clues available in determining elevation of the Titmus circles would invalidate establishing a diagnosis of monofixation.
Vertical Rectus Muscle Transposition Surgery for Duane's Syndrome
Authors: Molarte Althea B , Rosenbaum Arthur L
Published: April 2021

ABSTRACT

Thirteen patients with Duane's syndrome, Type I, underwent full vertical rectus muscle transposition. Prior to surgery, all patients had esotropia in the primary position and 11 patients had a face turn. Postoperatively, esotropia was improved in 77%. The face turn was improved in 100% and eliminated in 69%. Abduction ability was increased and binocular diplopia-free field size enlarged to a mean of 60°. Seven patients (54%) with a mean preoperative deviation of 17 prism diopters required only vertical rectus muscle transposition to improve their face turn and strabismus. Six patients (46%) with a mean preoperative deviation of 30 Δ required an additional medial rectus recession several months later. Two patients (15%) developed a vertical deviation following vertical rectus muscle transposition.
Preoperative Alternate Occlusion Decreases Motion Processing Abnormalities in Infantile Esotropia
Authors: Jampolsky Arthur , Norcia Anthony M , Hamer Russell B
Published: April 2021

ABSTRACT

We have examined the effects of preoperative, full-time alternate occlusion on the development of visual motion processing mechanisms. Motion visual evoked potentials (MVEPs) were recorded longitudinally in 14 infantile esotropia patients during the course of standard preoperative occlusion therapy. The MVEP in these patients was initially asymmetric in a fashion consistent with a nasalward/temporalward response bias, with a motion asymmetry significantly higher than that of agematched normals. The magnitude of the developmental motion asymmetry declined significantly after an average of 24 weeks of alternate occlusion. This result implies that the binocular motion-sensitive cells underlying the MVEP retain some degree of plasticity up to at least 1 year of age. Our data suggest further that the persistence of motion asymmetries in untreated infantile esotropia patients is maintained by an active process that can be disrupted by alternate occlusion. Alternate occlusion apparently eliminates a form of abnormal binocular interaction that supports the persistence of the motion asymmetry. We propose that one of the necessary pre-conditions for symmetricization of motion processing in infantile esotropia is the absence of abnormal competitive binocular interactions.
Change of Eye Muscle Sarcomeres According to Eye Position
Authors: Scott Alan B
Published: April 2021

ABSTRACT

In three monkeys, the right eye was moved from the primary position to a position of 30° to 45° exotropia by suturing the globe to the orbital wall. In two animals perfused immediately following suturing, histological examination showed the medial rectus and its sarcomeres to be lengthened and the lateral rectus and its sarcomeres to be shortened as compared to those of the unoperated control eye. In the third monkey, after exotropia was maintained for 2 months, the muscle lengths changed but the sarcomere lengths were similar to those of the control eye. We interpret this to indicate addition of sarcomeres to the lengthened medial rectus and removal of sarcomeres from the shortened lateral rectus. This adaptation to conform muscle length to eye position may explain the altered eye position which persists following periods of eye deviation due to muscle paralysis, prior surgery, injury, or botulinum toxin treatment.
Observations on Bilateral Simultaneous Botulinum Toxin Injection in Infantile Esotropia
Authors: McNeer Keith W , Spencer R F , Tucker Mary G
Published: April 2021

ABSTRACT

Botulinum toxin (BoTX) is an effective pharmacological alternative to the surgical management of strabismus in adults. In a previous study, we found that concurrent bilateral medial rectus muscle BoTX injections for infantile esotropia could produce stable ocular realignment without significant risk. No other investigators have used bilateral simultaneous BoTX injection. We report the results of bilateral simultaneous medial rectus BoTX injection in 57 infantile esotropia patients followed for a minimum of 12 months. The esotropic angle in 27 infantile esotropia patients under 12 months of age was reduced from 43 ± 12 to 1 ± 2 prism diopters. The esotropic angle in 30 infantile esotropia patients at a mean age of 24 months was reduced from 31 ± 12 to 2 ± 3 Δ. Other variables including late onset of hyperopic refractive errors, dissociated vertical deviations, overacting oblique muscles, and consecutive exodeviations are evaluated. We regard BoTX as reliable therapy in infantile esotropia.
A Comparison of Surgical Techniques for the Treatment of Acquired Esotropia With Increased Accommodative Convergence/ Accommodation Ratio
Authors: West Constance E , Repka Michael X
Published: April 2021

ABSTRACT

The conventional surgical treatment for acquired esotro pia with increased accommodative convergence/ accommodation ratio consists of bilateral medial rectus recessions of graded amounts based on the distance deviation while wearing full hyperopic correction. This retrospective study was undertaken to determine whether surgery was more successful when performed for the distance or near deviation measured through the distance correction. Surgical success was evaluated by 1) long-term motor alignment of ≤ 10 prism diopters of esoor exotropia at distance and near, 2) sensory fusion as determined by Worth 4-Dot at 33 cm and Randot II stereo acuity testing, and 3) the continued need for bifocal or spectacle correction.

Nine patients underwent surgery for their distance deviation measured with full hyperopic correction; all (100%) were successful by alignment and eight of nine (89%) by sensory criteria. Twenty-five patients underwent surgery enhanced by 1.0 to 6.5 mm per eye over the dose of surgery for the distance angle (average 3.1 mm); 20 of 25 (80%) were successful by alignment criteria and 21 of 25 (84%) were successful by sensory criteria. Two of nine patients (22%) in the distance target angle group and 13 of 25 patients (52%) in the near target angle group were able to discontinue spectacles and maintain satisfactory alignment. Six of nine (67%) patients in the distance angle group were able to discontinue bifocals, while every patient in the near angle group was so benefited. No patient in the distance target angle group, but two patients in the near target angle group, required a second operation.

The near angle measured through the distance correction may be used to determine the target angle for acquired esotropia surgery. Use of this angle reduces the need for continued spectacle use, but with a risk of overcorrection.
SKILL Card Results in Amblyopic Children
Authors: Leguire Lawrence E , Suh Steven , Rogers Gary L , Bremer Don L
Published: April 2021

ABSTRACT

Two experiments were undertaken to assess high contrast-high luminance (HCHL) and low contrast-tow luminance (LCLL) visual acuity as measured with the Smith-Kettlewell Institute Low Luminance (SKILL) card, in childhood amblyopia. In experiment 1, HCHL and LCLL visual acuity was measured in 11 amblyopic children and in 12 normal children of similar age. The results revealed that HCHL visual acuity was similar in the normal eyes and in the amblyopes' dominant eyes, and was abnormal in 91% of the amblyopic eyes. LCLL visual acuity was significantly worse in normal eyes compared to the amblyopes' dominant eyes, and was abnormal in only 64% of the amblyopic eyes. In experiment 2, HCHL and LCLL visual acuity was measured in seven previously tested amblyopic children, after a 5-month interval, and in six additional amblyopic children. In the amblyopic children who were tested twice, significant test-retest reliability for HCHL and LCLL visual acuity was found and visual acuity varied by 3.6%. The results of experiment 2 corroborated the results of experiment 1 from the amblyopic children. It is concluded that visual acuity in the amblyopic eye tends to normalize under low contrast-low luminance conditions. In addition, the mechanism(s) underlying amblyopia appear also to influence the dominant eye, resulting in superior visual acuity under low contrast-low luminance conditions.
Treatment of Residual Dissociated Vertical Deviation With Inferior Rectus Resection
Authors: Kapp Mary Beth Esswein , von Noorden Gunter K
Published: April 2021

ABSTRACT

The effectiveness of an ipsilateral 4-millimeter resection of the inferior rectus muscle was evaluated as a treatment of recurrent dissociated vertical deviation. Thirty-six patients who had an unsatisfactory outcome after 7- to 9-millimeter recession of the superior rectus muscle had an ipsilateral inferior rectus muscle resection. The dissociated vertical deviation was fully corrected in 18 patients and improved in 15 patients. Only three patients (8%) had an unsatisfactory result. Multivariate analysis of four preoperative features including the amplitude of the dissociated deviation, the age at diagnosis, the age at surgery, and the degree of amblyopia failed to define any factors that could predict surgical success.
Persistent Tunica Vasculosa Lentis as a Sign of Congenital Myotonic Dystrophy
Authors: Blayney Marc , Clarke William N
Published: April 2021

ABSTRACT

We describe the ocular findings in eight patients with congenital myotonic dystrophy in the newborn period. While three infants had normal findings, five infants had evidence of persistent tunica vasculosa lentis (TVL) at gestational ages ranging from 34 to 40 weeks. Atrophy of vessels on the anterior lens capsule is normally complete by 34 weeks gestation and its persistence should suggest congenital infection or congenital myotonic dystrophy. Diagnosis of myotonic dystrophy has serious implications for the baby and the mother, in whom the condition may have not been recognized earlier.
Reappraisal of Occlusion Therapy for Severe Structural Abnormalities of the Optic Disc and Macula
Authors: Yang Lucy L H , Lambert Scott R
Published: April 2021

ABSTRACT

The visual function of some children with structural defects of the macula or optic nerve has previously been shown to improve with occlusion therapy. The charts of five children, ages 4 to 8 years, who had various types of severe structural abnormalities were reviewed. Two patients had optic nerve hypoplasia; there was one case each of foveal hypoplasia, posterior persistent hyperplastic primary vitreous, and retinopathy of prematurity. All the patients had undergone extensive amblyopia therapy prior to referral.

In three children, occlusion therapy had been initiated and continued intensively for several months or longer without recognizing the presence of a severe, underlying structural abnormality. In none of the five children was there any clear-cut evidence of visual improvement. In some cases, the long period of enforced iatrogenic vision impairment resulted in significant psychosocial harm and developmental delay. In all five cases, it was structural changes rather than amblyopia that ultimately accounted for visual loss.

The authors stress the importance of a meticulous fundus examination directed at finding organic defects prior to patching. Close, periodic monitoring of visual function should then follow. To spare the child unnecessary psychosocial impairment, it is advisable to follow established recommended thresholds for terminating occlusion therapy.
Periocular Infection After Strabismus Surgery
Authors: Kivlin Jane D , Wilson M Edward
Published: April 2021

ABSTRACT

Fewer than 15 cases of cell ulitis and subconjunctival abscess after extraocular muscle surgery have been reported in detail. In an effort to provide greater information about this serious complication, the members of the American Association for Pediatric Ophthalmology and Strabismus (AAPO&S) were surveyed and contributed cases were analyzed.

Among the 25 cases of cellulitis, there was a predominance of preschool age patients and Staphylococcus aureus cultures. Many cases presented after a normal initial postoperative visit. The most common symptoms were marked swelling and pain. Possible predisposing factors included unsuspected sinusitis, eye rubbing, and poor hygiene. Two patients had documented bacteremia, but no patient developed endophthalmitis. All cases resolved on antibiotics, but only five patients were successfully treated with oral antibiotics alone.

Periocular Infections after extraocular muscle surgery can present after a normal initial postoperative visit. Symptoms of marked swelling and pain are cause for closer inspection. S. aureus is the most common organism and oral antibiotics alone can fail to halt the infection.
Retinopathy of Prematurity in Discordant Twins
Authors: Fellows Rae R , McGregor Mary Lou , Bremer Don L , Rogers Gary L , Miller Dennis
Published: April 2021

ABSTRACT

Discordant twins may be at increased risk for retinopathy of prematurity (ROP) because of factors related to their unequal growth. Discordancy is defined as a difference of 15% or more in the birth weights of the two infants. We examined the data in 26 sets of discordant twins from six NICUs, including birth weight, gestational age, sex, and highest grade of ROP. Thirty-eight percent (10) of the lower birth weight infants had higher grades of ROP than their twin. Twenty-three percent (6) of the heavier birth weight twins had higher grades of ROP than their smaller siblings. Three infants reached threshold, and five were prethreshold. In every case, their twin siblings had mild or no ROP. Thirty-eight percent of the twins (10) had the same ROP outcome.
Levodopa/Carbidopa Treatment for Amblyopia in Older Children
Authors: Leguire Lawrence E , Walson Philip D , Rogers Gary L , Bremer Don L , McGregor Mary Lou
Published: April 2021

ABSTRACT

The purpose of the present study is to determine how long visual function improves during levodopa/ carbidopa with part-time occlusion treatment in older amblyopic children.

A 7-week open clinical trial of levodopa (0.55 mg/kg, three times daily) with 25% carbidopa combined with part-time occlusion (3 hours/day), was undertaken in 15 older (mean age, 8.87 years) amblyopic children. Visual acuity, fusion, and stereo acuity were measured at baseline, at weeks 1, 3, 5, and 7 during treatment, and 6 weeks following the end of all treatment. Health status was assessed by physical examination, questionnaire, and standard laboratory tests (CHEM 20, complete blood cell count [CBC], and differential). The results revealed that visual acuity in the amblyopic eye improved for 5 weeks, from 20/170 at baseline to 20/107, then stabilized for the last 2 weeks. Visual acuity also improved in the dominant eye by 0.6 lines, from 20/19 to 20/16. At the 6-week follow up, visual acuity in the amblyopic eye remained at 20/107 (paired t=4.78, df= 14, P<.001), a 37% improvement. Thirty-three percent of the subjects demonstrated improved fusion from baseline to the 7-week trial that was maintained at follow up (χ
p 2
= 3.97, P<.05). Stereo acuity did not significantly change. Physical exam (blood pressure, body temperature, respiration, heart rate) and standard laboratory tests remained normal and side effects were minimal.

It is concluded that levodopa/carbidopa combined with part-time occlusion in older amblyopic children improves visual acuity for 5 weeks then stabilizes, and can lead to improvements in visual acuity and in fusion over a period of at least 6 weeks following cessation of treatment, with minimal side effects.
Interstitial Keratitis as Presenting Ophthalmic Sign of Sarcoidosis in a Child
Authors: Lennarson Peter , Barney Neal P
Published: April 2021

ABSTRACT

Interstitial keratitis is a rarely occurring sign in sarcoidosis. We report a case of childhood sarcoidosis with initial ocular presentation as interstitial keratitis. Erythema nodosum preceded the ocular findings by 4 years and arthritis developed 1 year after ocular findings developed. Although no history of intraocular inflammation was present, there was evidence of inactive chorioretinitis and vitritis found at initial presentation. Systemic steroids were used to treat the patient's skin lesions and topical steroids to treat his corneal inflammation. He developed posterior uveitis and optic nerve edema both of which were responsive to oral steroids. Two years after the presentation of his ocular findings, the onset of pulmonary symptoms and resultant transbronchial biopsy confirmed his diagnosis of sarcoidosis.
Hydroxypropylmethylcellulose and Sodium Hyalorunate in Adjustable Strabismus Surgery
Authors: Ferreira Rosane C , Lamberts Marianne , Moreira José Belmiro C , Campos Mauro S Q
Published: April 2021

ABSTRACT

The efficacy of hydroxypropylmethylcellulose and sodium hyaluronate as adjuncts during adjustable strabismus surgery was evaluated experimentally. Fifteen randomized NZA rabbits underwent a bilateral 4-mm recession of the superior rectus followed by a 0.05 mL injection of submuscular hydroxypropylmethylcellulose 2% (HPMC) in one eye and sodium hyaluronate 1% (Healon) in the other eye. Five additional rabbits (10 eyes), used as controls, underwent the same procedure, but no viscoelastic was injected after surgery. The force needed to move the muscle 4 mm toward its original insertion was measured immediatety and 24 hours after the operation, using a force gauge. The force needed to adjust the muscles increased 326.0%, 98%, and 124.7%, respectively in the control, Healon and HPMC groups (p<0.001). No significant difference was found between the two viscoelastic substances. Histologic evaluation of the operation sites disclosed similar inflammation in both controls and viscoelastic groups (p=.5960).
Glaucoma and Findings Simulating Glaucoma in the Rubinstein-Taybi Syndrome
Authors: Brei Timothy J , Burke Miles J , Rubinstein Jack H
Published: April 2021

ABSTRACT

Information is reviewed on the ophthalmologic findings in 614 individuals with Rubinstein-Taybi syndrome (RTS): The data were collected from the world literature, from communication with colleagues and with families of individuals with RTS, and from personal observations. Particular emphasis is given in this article to the association of RTS with glaucoma and five other findings that may be confused with glaucoma (corneal lesions, megalocomea, colobomatous or cystic optic nerve, excavation of papilla, and large cup-to-disc ratio). A case report is presented including autopsy results on a 5-year- old black female with RTS, corneal lesions, colobomas of the optic nerves, and normal intraocular pressure.
Tonometry in Pediatric Patients: A Comparative Study Among Tono-pen, Perkins, and Schiötz Tonometers
Authors: Bordon Arnaldo F , Katsumi Osamu , Hirose Tatsuo
Published: April 2021

ABSTRACT

Measuring the intraocular pressure (IOP) in children can be difficult. We compared the accuracy of IOP measurements in pediatrie patients using three tonometers: Perkins, Schiötz, and Tono-pen. Seventy-seven children (132 eyes; average age, 1 year, 7 months; range, 1 month to 60 months), mainly afflicted with retinopathy of prematurity (107 eyes), were evaluated. A good correlation (r=0.867) was found between the Tono-pen and the Perkins tonometers. No statistical difference was found between the mean difference of IOP values obtained with the Tonopen and the Perkins (P>.05). The Schiötz measurements were significantly higher than those obtained with the Perkins and the Tono-pen tonometers (P<.05).We concluded that the Tono-pen tonometer has a higher correlation coefficient, comparable to the Perkins tonometer, and can be used reliably to assess IOP in pediatrie patients.
Treatment of Congenital Adduction Palsy With Synergistic Divergence
Authors: Mohan Kanwar , Gupta Rajeev , Sharma Ashok , Gupta Amod
Published: April 2021

ABSTRACT

Objective: To report on successful management of congenital adduction palsy with synergistic divergence by performing weakening surgery on the superior and inferior oblique muscles.

Methods: We performed a total tenotomy of the lateral rectus muscle, followed by resection of the medial rectus muscle and tenotomy of the superior oblique and myectomy of the inferior oblique muscles in a patient who had congenital adduction palsy with synergistic divergence.

Results: Total tenotomy of the lateral rectus muscle had no effect on synergistic divergence, resection of the medial rectus muscle reduced it to some extent and tenotomy of the superior oblique and myectomy of the inferior oblique muscles further reduced this phenomenon. The improvement in synergistic divergence was maintained at 2Va years later at follow up.

Conclusions: Weakening surgery on the superior and inferior oblique muscles should be considered in the management of synergistic divergence.
Reduction in Binocular Enhancement of the Visual-evoked Potential During Development Accompanies Increasing Stereoacuity
Authors: Sloper John J , Collins Alan D
Published: April 2021

ABSTRACT

Purpose: To study the maturation of normal binocular vision.

Methods: Binocular visual function has been studied and monocular and binocular pattern reversal visualevoked potentials (VEP) recorded in 20 normal subjects aged 5 to 43 years.

Results: Stereoacuity improved significantly between the age of 5 and adulthood. Mean stereoacuity for eight children measured by theTitmus test was 61 seconds of arc and 56 seconds of arc by the TNO test. For the 12 adults in the study, corresponding mean stereoacuities were 45 and 31 seconds of arc. Over the same timespan, binocular enhancement of the VEP P100 amplitude decreased. For the children aged 5 to 10 years, the mean binocular VEP enhancement to 20' checks was 1.60, whereas for young adults it was 1.1 9. There was no comparable change in the binocular enhancement to 40' checks, with mean binocular enhancement of 1.31 in the children and 1 .26 in the young adults. Over the same age range, VEP latency also decreased.

Conclusion: During visual maturation, improvement in stereoacuity is accompanied by a fall in binocular enhancement of the P100 amplitude of the VEP to small checks and a reduction in the P100 latency.
Outcome of Occlusion Treatment for Amblyopia
Authors: Beardsell Ruth , Clarke Suzanne , Hill Mary
Published: April 2021

ABSTRACT

Background The purpose of this study was to determine the level of visual acuity following occlusion treatment for strabismic and anlsometropic amblyopia and to analyze the factors that influence the outcome.

Methods: In this observational study, we examined the medical records of 246 patients discharged between April 1991 and March 1996, including those who failed to complete treatment. Two groups were identified: Group 1 esotropia (n=151); and Group 2 anlsometropic amblyopia with or without microtropia (n=79). Factors influencing outcome of treatment were analyzed, success being defined as 6/12 or better in the amblyopic eye.

Results: In Group 1, 85% achieved 6/12 or better in the worst eye (linear acuity test), 15% achieved less than 6/12. (73% achieved 6/9 or better, 16% achieved 6/12 or 6/18, and 11% achieved less than 6/18). In Group 2, 95% achieved 6/9 or better in the worst eye (linear acuity test); 5% achieved 6/1 2.

Conclusion: Outcome was better than other full population studies to date. A good visual outcome was achieved in all cases of pure anisometropic amblyopia. Significant factors Influencing outcome in the esotropie group were compliance, anisometropia, and visual acuity at start of treatment An occlusion protocol is suggested aimed at further improving compliance and outcome.
Visual Acuities After Levodopa Administration in Amblyopia
Authors: Mohan Kanwar , Dhankar Vandana , Sharma Ashok
Published: April 2021

Abstract

Purpose: To investigate the effect of the augmentation of levodopa with part-time and full-time occlusion on visual acuity and to determine its late results in amblyopia.

Methods: Seventy-two patients with amblyopia were prospectively studied and randomly distributed into groups A, B, and C consisting of 24 patients each. Group A patients received levodopa alone, group B received levodopa and part-time (3 hours/day) occlusion, and group C received levodopa and full-time (during all waking hours) occlusion of the dominant eye. Levodopa 0.50 mg/kg body weight, with a 25% fixed dose combination of carbidopa, was administered orally three times a day for 7 weeks. Snellen visual acuity and its logMAR equivalent were recorded before treatment, at weeks 1,3, 5, and 7 after starting treatment, and every 6 weeks for 1 year after the completion of treatment.

Results: Fifty-three (74%) of the 72 patients had an improvement in visual acuity after treatment. Forty-four of the 53 patients with improved visual acuities completed 1-year post-treatment follow-up. Twenty-three (52%) of the 44 patients had a regression in visual acuity.

Conclusion: The augmentation of levodopa with parttime or full-time occlusion does not enhance the recovery of vision in amblyopia. Improved visual acuity after levodopa administration persists at least 1 year in almost half of patients after cessation of treatment. Addition of full-time occlusion to levodopa helps maintain improved visual acuity for a longer duration compared to levodopa afone or combined with part-time occlusion.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:62-67.
Effect of Botulinum Toxin A Chemodenervation in Sensory Strabismus
Authors: Han Sueng Han , Lew Helen , Jeong Chang Woog , Lee Jong Bok
Published: April 2021

ABSTRACT

Purpose: To study the effect of botulinum toxin type A chemodenervation in sensory strabismus.

Methods: Twelve patients with sensory strabismus were treated with an injection of botulinum toxin type A (Botox; Allergan, Irvine, Calif). Botulinum toxin type A was diluted with 0.9% sodium chloride without preservative at a dose that ranged from 1 .25-5 U. A Teflon-coated needle electrode was inserted into the medial reclus muscle in cases of esotropia and into the lateral rectus muscle in cases of exotropia. Four patients were treated with 5=2 injections of botulinum toxin type A. Changes in the angle of strabismus and related complications were followed for >6 months postinjection.

Results: The mean deviation before injection was 33.8 prism diopters (?) and the mean corrective effect on the deviation was 72.8% after injection in patients with sensory strabismus. The final deviation in 9 patients was <10?. Complications were hypertropia in 3 (25%) patients and conjunctival hemorrhage in 1 (8.3%) patient.

Conclusion: Botulinum toxin type A is likely to prevent muscle contracture and affect muscle and neuronal tissues. This study on the effects of sensory strabismus with botulinum toxin type A injection suggests it has the potential to replace surgery or be used as an adjuvant therapy.

Journal of Pediatrie Ophthalmology and Strabismus 2001:38:68-71.
Open Globe Injuries in Children: A Retrospective Analysis
Authors: Farr Arman K , Hairston Richard J , Humayun Michael U , Marsh Marta J , Pieramici Dante J , Maccumber Mathew W , de Juan Eugene
Published: April 2021

Abstract

Purpose: To study the outcome of open globe injuries In patients aged <14 years and compare the results between patients who presented approximately 30 years ago and a recent series.

Methods: Between January 1970 and January 1993, 180 eyes of children who presented with an open globe injury were retrospectively analyzed. Patients were divided into two groups. One group of children underwent treatment of an open globe injury between January 1970 and December 1981 (group A) and another between December 1985 and January 1993 (group B). Main outcome measures studied were final visual acuity and enucleation rates. Risk factors studied included age, race, sex, visual acuity, type of trauma, and various injury characteristics at presentation.

Results: The factors associated with visual outcomes included: age, type of injury, wound size, initial visual acuity, and retinal detachment. Final visual outcome and enucleation rates were not significantly different between the older series (group A) and the recent series (group B). Lenticular damage, location, posterior extent of the injury, and presence of an intraocular foreign body had been significant prognostic factors in the older series, but were not statistically associated with the prognosis in the recent series.

Conclusion: The nature of the injury and the patient's age are the main determining factors in the outcome of open globe injuries in children.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:72-77.
Effect of Late Surgery for Acquired Esotropia on Visual Evoked Potential
Authors: Kozma Petra , Deák Andrea , Janáky Márta , Benedek György
Published: April 2021

ABSTRACT

Purpose: To asses the effect of strabismus surgery on visual evoked potential (VEP) amplitude after age 5 years in children with acquired esotropia.

Methods: Visual evoked potentials to binocular and monocular pattern reversal stimulation were recorded in 10 children aged 5 to 6 years before and 3 months after surgical correction of their esotropia. Visual function (fusion) was tested by synoptophore after strabismus surgery. Electrophysiological and clinical data were correlated following surgical intervention.

Results: A significant increase in pattern VEP amplitudes was noted following strabismus surgery. Visual evoked potential changes were most prominent on binocular stimulation. Binocuiar fusion showed similarly significant improvement after intervention. Postoperative VEP data, however, were not consistently correlated with functional improvement.

Conclusion: Surgical intervention in esotropia, even if performed years beyond the end of the classical critical period, can have a strong effect on binocular VEPs and a beneficial effect on the development of binocular fusion.

Journal of Pediatric Ophthalmology and Strabismus 2001 ;38:83-88.
Effectiveness of Mitomycin C in Reducing Reformation of Adhesions Following Surgery for Restrictive Strabismus
Authors: Mahindrakar Avinash , Tandon Radhika , Menon V , Sharma Pradeep , Khokhar Sudershan
Published: April 2021

ABSTRACT

Purpose: To evaluate the efficacy of mitomycin C in reducing reformation of adhesions following surgery for restrictive strabismus.

Methods: Sixteen patients with restrictive strabismus resulting from trauma, retinal detachment surgery, and multiple squint surgeries were randomized to either a mitomycin group (8 patients) or a control group (8 patients). Mitomycin C (0.2 mg/mL) was applied intraoperatively for 5 minutes after release of adhesions. Range of passive ductions was scored for comparison. Postoperative follow-up ranged from 3-18 months.

Results: Compared to controls, the mitomycin C group had better range of passive ductions. There were no complications related to the cornea, intraocular pressure, uveitis, or muscle disinsertion in the mitomycin C group.

Conclusion: Intraoperative application of mitomycin C (0.2 mg/mL for 5 minutes) is a safe and effective adjunct to surgery in the treatment of restrictive strabismus.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:131-135.
Cross Polarized Spectacles in Photosensitive Epilepsy
Authors: Jain Sunila , Woodruff Geoffrey , Bissessar E A
Published: April 2021

ABSTRACT

Purpose: To investigate the role of cross polarized spectacles in the treatment of photosensitivity demonstrable by EEG.

Method: Patients receiving an EEG who tested positive for photosensitivity were invited to participate in the study. The most sensitive light flicker frequency causing a photic response was determined for each patient. Stimulation was repeated with 2 different pairs of spectacles-1 conventionally polarized and the other cross polarized. An EEG was obtained in each case and reported by a neurophysiologist who was unaware of the identity of the 2 types of spectacles.

Results: We tested 19 patients, 8 to 18 years of age. Two patients did not benefit from either pair of glasses. In 17 patients, the photic response was greatly diminished or eliminated by polarizing spectacles. In 1 patient, conventional polarized glasses helped, but the cross polarized spectacles did not. In 6 patients, both types of spectacles were equally effective; in 10 patients, cross polarized spectacles were more effective than conventionally polarized spectacles.

Conclusion: The role of cross polarized spectacles in the management of photosensitivity in a clinical situation merits further investigation.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:331-334.
Subcutaneous Dirofilariasis of the Eyelid in a 7-Month-Old Infant
Authors: Pai Vijaya H. , Kusumgar Pallak , Pai Kanthilatha
Published: April 2021

Human dirofilariasis is an unusual zoonotic infection (transmitted from animals to humans) presenting as a subcutaneous nodule. Occasionally it involves the eye. The parasite is transmitted to humans by mosquitoes. Presentation in infants is extremely rare. A rare case of subcutaneous dirofilariasis of the eyelid in a 7-month-old infant is reported.

[
J Pediatric Ophthalmol Strabismus.
2015;52:e14–e16.]
Pattern-Reversal Visual Evoked Potential in Children With Congenital Zika Syndrome
Authors: Almeida Luan F. B. , Kattah Marisa , Ventura Liana O. , Gois Adriana L. , Rocha Camilla , Andrade Camila G. , Mendonza-Santiesteban Carlos , Ventura Camila V.
Published: April 2021

Purpose:

To objectively evaluate the visual function in children with congenital Zika syndrome using pattern-reversal visual evoked potential (PR-VEP).

Methods:

This was a cross-sectional study composed of two patient groups: children aged between 18 and 24 months who were positive for the Zika virus (congenital Zika syndrome group) and age-matched healthy children (control group). All patients underwent a comprehensive ophthalmologic examination and PR-VEP was performed binocularly in a room with constant dim illumination. The P100 peak time in the 60' arc stimuli was used, and the results were correlated with visual acuity, cephalic perimeter at birth, and funduscopic findings.

Results:

Thirty-seven children were included in the congenital Zika syndrome group and 15 in the control group. The mean age was 18.5 ± 0.9 months (range: 17 to 20 months) in the congenital Zika syndrome group and 24.3 ± 1.6 months (range: 21 to 28 months) in the control group. The P100 response was normal in 7 patients (18.9%) with congenital Zika syndrome, borderline in 2 (5.4%), abnormal with prolonged latency in 18 (48.6%), and abnormal with no response in 10 (27.0%). A significant correlation between the visual acuity and P100 peak time was observed (
P
< .001). The P100 values were not correlated significantly with the cephalic perimeter at birth (
P
= .412) or the funduscopic findings (
P
= .510). PR-VEP in children with congenital Zika syndrome and no funduscopic findings was significantly worse than in the control group (
P
= .001).

Conclusions:

Children with congenital Zika syndrome have characteristically abnormal PR-VEPs regardless of the funduscopic findings and severe microcephaly. The PR-VEP findings supported the diagnosis of cortical visual impairment in these children.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(2):78–83.]
Accuracy of Intraocular Lens Power Calculation in Children With Vitrectomized Eyes Undergoing Cataract Surgery
Authors: Agarkar Sumita , Mailankody Swathi , Srinivasan Ramyaa , Raman Rajiv
Published: April 2021

Purpose:

To assess the predictability of desired postoperative refractive outcomes using the SRK-II formula for intraocular lens (IOL) power calculation in children undergoing cataract surgery in eyes with a previous pars plana vitrectomy (PPV).

Methods:

In this retrospective study, 68 eyes of 66 children who underwent cataract surgery and IOL implantation in eyes that had previous vitrectomy between January 2008 and December 2017 were included. Data were collected on preoperative and postoperative characteristics. The Mann-Whitney test, Kruskal-Wallis test, and multinominal logistic regression were used for comparing the results.

Results:

Absolute prediction error (APE) in the cohort was 1.29 ± 1.13. Desirable refractive outcome with insignificant prediction error of less than 0.50 diopters (D) was found in approximately one-third of the children. Patients were further subdivided by magnitude of APE as ≥ 0.50 to ≤ 1.00 D and > 1.00 D. Age at the time of surgery, axial length, mean keratometry, silicone oil removal, IOL position, scleral buckle, and corneal suture did not affect APE and there was no significant difference between the groups (
P
> .05).

Conclusions:

The mean APE of the SRK-II formula for IOL power calculation in pediatric eyes that had vitrectomy is comparable to that reported in the literature for routine pediatric cataract surgeries. Factors such as age, axial length, corneal power, IOL position (bag/sulcus), scleral buckle, corneal suture, and silicone oil removal done prior to surgery or along with cataract surgery did not affect the APE.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(2):126–131.]
Anger in Group Therapy
Authors: Baker Joan M , Estes Nada J
Published: April 2021

Whether they work with patients singly or in groups, and in no matter which setting, all nurses deal with anger, short-lived or smoldering. Psychiatric nurses deal with this symptom most knowingly. Two psychiatric nurses, who describe their experiences in handling anger in group therapy, point out how necessary it is to understand the dynamics, manifestations, and appropriate methods of handling anger in order to be of most benefit to patients.
PILOT STUDY RESULTS: The Psychiatric RN Case Manager
Authors: Van Dongen Carol J , Jambunathan Jaya
Published: April 2021

"The common measure of health care delivery services today from a clinical perspective is the quality of care provided. . . quality provides stability. . . quality serves as the balancé that demonstrates professional commitment to patient care" (Beyers, 1988). There is also a growing consensus that the quality of care be defined by the recipient of that care (Hölzerner, 1990).

Providing quality health care is one of the goals of nursing case management, in addition to enhancing clients' quality of life and cost containment (American Nurses Association, 1988). The American Nurses Association (ANA) states that "case management optimizes clients' self-care capability and promotes efficient use of resources. . . and the goals of case management are the provision of quality health care" (1988).

Although a number of outcome studies have been done on the cost effectiveness of case management for psychiatric clients, few have been done on client satisfaction and quality; of care (Bond, 1988; Borland, 1989; Goering, 1988). Hence, it is especially important to examine client satisfaction with the RN case management model to enhance the quality of care.

In this article, the results of a recently conducted pUot study related to the role of the registered nurse case manager (RNCM) and quality of care as perceived by clients, psychiatrists, and the RNCM will be reported.
A Target Weight Procedure for Disordered Water Balance in Long-Term Care Facilities
Authors: Boyd Mary Ann , Williams Lorraine , Evenson Richard , Eckert Anne , Beaman Margaret , Carr T R
Published: April 2021

Strategies that help patients identify and monitor disordered water balance, as well as develop control over fluid balance, are needed.
It Takes a Village and Time . . . A Collaborative Case Study
Authors: Dunbar Berthenya , Argenbright Sandra , Griffiths Carol
Published: April 2021

Today's approach to health care presents a challenge to those providers who work with patients with multifaceted complex issues that require the time and the efforts of several clinicians. These patients do not easily fit into a short-term, predetermined mold of care. This is an ongoing issue that warrants further investigation. This article presents a collaborative case study that chronicles the case of a patient who had multiple problems, such as homelessness, depression, substance abuse, anger, and serious emotional and physical scars contributing to a damaged self-image. In this case, three clinicians in three programs collaboratively assisted the patient in his complicated trek toward an improved quality of life.
Current Understanding of Violence and Aggression: Assessment and Treatment
Authors: Littrell Kimberly H , Littrell Steven H
Published: April 2021

Links between violence, aggression, and mental illness are well documented. Despite this association, our current understanding of the causation and optimal treatment of aggression remains limited. This lack of knowledge is alarming because nurses treating patients with mentally illness are frequent targets of patient aggression. Consequently, the aim of this article is to provide contemporary information regarding the concept of patient aggression, assessment of violent behavior, and implementation of treatment interventions. A review of pharmacological and psychosocial strategies are presented as well. These findings provide psychiatric nurses with a conceptual model as well as practical interventions for patient aggression.
Caring in forensic nursing: Expanding the holistic model
Authors: Hammer Rita
Published: April 2021

ABSTRACT

Nurses have practiced forensic nursing for many years without formal recognition of the domain as a discipline for specialized study. Forensic nursing expands the traditional concept of holism to include the medical-legal aspects of potential or actual client problems. The American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) recently have designated forensic nursing as a unique specialty. Recognition of forensic nursing as a specialty area of practice within nursing mandates that the specialty define and explicate its major conceptual base. A concept germane to the practice of forensic nursing is that of caring. Caring as a central concept to the role of this specialty is discussed, and the implications for its inclusion in a curriculum preparing forensic nurses are explored.
A Troubling Triangle
Authors: Slama Carol A , Bergman-Evans Brenda
Published: April 2021

An Exploration of Loneliness, Helplessness, and Boredom of Residents of a Veterans Home
Learning From Extremism in the History of Mental Health
Authors: Mohr Wanda K
Published: April 2021

The Example of Multiple Personality Disorder

ABSTRACT

This article reviews some of the history of the cultural forces that shaped the diagnosis of multiple personality disorder/dissociative identity disorder and the subsequent abuses that occurred at the time of its popularization. Some of the implications that can be drawn from these kinds of historical excesses in the field of mental health will be discussed. The article concludes by underscoring the ethical obligation inherent in maintaining healthy professional skepticism toward ideas driven by ideology and fad, rather than scientific empiricism.
The Tidal Model
Authors: Barker Phil
Published: April 2021

The Healing Potential of Metaphor Within a Patient's Narrative