bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Antiocular Antibodies in Patients With Juvenile Rheumatoid Arthritis
Authors: Bloom Jeffrey N , Ni Ming , Moore Terry L , Osborn Thomas G , Hageman Gregory S
Published: April 2021

ABSTRACT

Although the uveitis associated with juvenile rheumatoid arthritis (JRA) is presumed to have an autoimmune etiology, its pathogenesis is unknown. We utilized immunohistochemical techniques to detect the presence of serum antibodies directed against ocular tissues in these patients.

The staining patterns of serum from patients with JRA, with and without uveitis, were compared with normal controls. Antibodies directed against epitopes in iris and ciliary body basement membranes, lens epithelium and fibers, Bruch's membrane, and iris and retinal blood vessels were observed in the sera of several individuals. These staining patterns were statistically more frequent among the pauc iarticular and polyarticular JRA patients, with and without uveitis, than either the systemic JRA or normal populations.

These results demonstrate the presence of antiocular antibodies in the sera of JRA patients, with and without uveitis. Whether those nonuveitic JRA patients with antiocular antibodies will develop uveitis is unknown at this time.
A Magnetic Resonance Imaging Study of Horizontal Rectus Muscle Palsies
Authors: Bloom Jeffrey N , Cadera Werner , Heiberg Elisabeth , Karlik Stephen
Published: April 2021

ABSTRACT

The assessment of extraocular muscle function is usually performed indirectly by an examination of ocular motility. We have utilized magnetic resonance imaging, in both cine and static modes, to directly observe the contractility behavior of the extraocular muscles. This noninvasive technique was applied to the study of patients with horizontal rectus muscle palsies. In all cases, the palsied muscle was of a smaller diameter than its normal counterpart. This size differential was noted in all fields of gaze. Additional studies are required to determine the relative contributions of denervation atrophy and loss of tonus to this diminution of muscle size.
Advancement of Medial Rectus Muscle to the Original Insertion for Consecutive Exotropia
Authors: Ohtsuki Hiroshi , Hasebe Satoshi , Tadokoro Yasunori , Kobashi Rie , Watanabe Sei , Okano Masaki
Published: April 2021

ABSTRACT

Twenty-four patients who underwent surgery to correct consecutive exotropia that developed iatrogenically after surgical overcorrection were studied retrospectively. All patients underwent single or bilateral advancement of the medial rectus muscle to the original muscle insertion. The mean preoperative exodeviation was 26.7 prism diopters at distance and 3S.2 Δ at near. Postoperatively, in cases receiving advancement of a single medial rectus, the mean amount of correction was 23.2 Δ at distance and 29.6 Δ at near. In cases receiving bilateral medial rectus advancement, the mean amount of postoperative correction was 26.3 Δ at distance and 39.8 Δ at near. Adduction deficiency was normalized in five patients (71%), while convergence insufficiency was improved in only nine patients (45%) after surgery. Twelve (50%) patients had binocular single vision at distance on a normal or abnormal basis as determined by the Bagolini lens test.
Vernier Acuity Cards: A Practical Method for Measuring Vernier Acuity in Infants
Authors: Holmes Jonathan M , Archer Steven M
Published: April 2021

ABSTRACT

The feasibility of a practical preferential looking technique, similar to Teller acuity cards, was investigated for the assessment of vernier acuity in preverbai infants. Forty-two infants ages 1 to 13 months were tested with cards having vernier offsets of 2 to 64 minutes of arc and spatial frequencies of 0.25 to 2.0 cycles per degree. All infants showed a robust preferential looking response to the largest vernier offsets. Vernier thresholds decreased with age from 64 minutes of arc at 1 month to 4 minutes of arc at 13 months. Smaller vernier offsets were more readily detectable when embedded in higher spatial frequency gratings. Vernier acuity can be assessed in preverbai infants using a preferential looking technique similar to that employed with the Teller acuity cards. Vernier acuity is known to be more sensitive to amblyopia than grating acuity; therefore, this technique may prove useful in the assessment of amblyopia.
Visual Alignment From the Midline: A Declining Developmental Trend in Normal, Strabismic, and Monocularly Enucleated Children
Authors: Dengis Carol A , Steinbach Martin J , Gottz Herbert C , Stager Christine
Published: April 2021

ABSTRACT

Children, 1 .8 to 5.0 years of age, were asked to sight through a tube at targets. There were three groups tested: children with normal binocular vision, children with strabismus, and children with one eye enucleated. The younger normal and strabismic patients placed the tube midway between the two eyes. Surprisingly, the younger enucleated children also placed the tube at the midline. This "Cyclops effect" diminished as the children grew older, with a transition to sighting monocularly by the age of 4 years. The tendency to align with the midline by the younger children, regardless of the degree of their binocular vision, presumably is a natural response to a cyclopean projection center in the midline. As children mature, they learn to meet the demands of monocular preference tasks by aligning objects in front of one eye.
Longitudinal Study of Levodopa/Carbidopa for Childhood Amblyopia
Authors: Leguire Lawrence E , Walson Philip D , Rogers Gary L , Bremer Don L , McGregor Mary Lou
Published: April 2021

ABSTRACT

To determine the tolerability and efficacy of levodopa/ carbidopa combined with occlusion therapy for childhood amblyopia, a double-masked placebo-controlled randomized longitudinal study was performed on 10 amblyopic children between 6 and 14 years of age. Subjects received, on average, 20/5 mg levodopa/ carbidopa or 20 mg of placebo three times per day combined with part-time occlusion over a 3-week period. Visual function was assessed by Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts and by contrast sensitivity. Tolerability was assessed by questionnaire, SMAC (standard laboratory tests; consists of a chem 20 and complete blood count [CBC]) analysis, and physical examination. Compliance with occlusion and capsule consumption were assessed by questionnaire and by capsule count, respectively. At the end of the dosing regimen, the ìevoàopalcarbiàopa group significantly improved in visual acuity by 2.7 lines and in mean contrast sensitivity by 72% in the amblyopic eye. The placebo group improved in visual acuity by 1 .6 lines in the amblyopic eye. Tolerability and occlusion compliance were similar between groups; however, capsule ingestion compliance was significantly lower in the levodopa/carbidopa group. One month after the termination of treatment, the levodopa/carbidopa group maintained a significant 1.2-line improvement in visual acuity and 74% improvement in contrast sensitivity in the amblyopic eye. The placebo group did not maintain an improvement in visual acuity between the eyes. It is concluded that levodopa/carbidopa, at an average of 0.48/0.12 mg/kg, is well tolerated and, when combined with part-time occlusion, is efficacious in improving visual function in amblyopic children.
Accommodative Esotropia in Adults
Authors: Shippman Sara , Weseley Alan C , Cohen Kenneth R
Published: April 2021

ABSTRACT

The accommodative convergence/accommodation (AC/A) ratio is thought to be fixed throughout life. We present 11 patients who, in adulthood, show a situational increase in their AC/A ratio. Since all patients had a history of accommodative esotropia with and without a nonaccommodative component, we feel the situational increase in the AC/A ratio is in response to the additional effort needed to correct the patients' facultative hyperopia. These patients demonstrate the importance that all adults with acute onset of commitant esotropia and a history of accommodative esotropia should wear full correction before a prism is incorporated into their glasses or surgical intervention is considered.
The Surgical Management of Nontraumatic Ectopic Lenses
Authors: Salehpour Omid , Lavy Tim , Leonard James , Taylor David
Published: April 2021

ABSTRACT

We report the results of limbal lensectomy for ectopia lentis in 50 eyes of 30 children over a period of 7 years. The reasons for surgery were poor visual acuity in 47 eyes and dislocation of the lens into the anterior chamber in three. Best-corrected visual acuity Improved in all except two patients, both of whom had glaucoma: in one (with an unusual syndrome), a vitreous hemorrhage occurred that resulted in light-perception-only vision; in the other, a persistent uveitis developed that eventually required secondary vitrectomy. Visual acuity was unchanged in two patients. Peaked pupil occurred in seven. We conclude that, unless there are associated ocular diseases, limbal lensectomy in childhood ectopia lentis effectively improves visual acuity with few complications.
Prevalence of Glaucoma After Surgery for PHPV and Infantile Cataracts
Authors: Johnson Christina P , Keech Ronald V
Published: April 2021

ABSTRACT

The prevalence of glaucoma associated with pediatrie aphakia has been reported to range from 0% to 27%. Few studies have included a significant number of patients with persistent hyperplastic primary vitreous (PHPV) cataracts. The purpose of this study was to evaluate the prevalence of glaucoma in young children undergoing surgery for PHPV and infantile cataracts.

The charts of all of the patients who underwent lensectomy/vitrectomy for infantile and PHPV cataracts at the University of Iowa Hospitals and Clinics between 1975 and 1992 were reviewed. Patients with ocular abnormalities that might predispose to glaucoma and patients with less than 6 months follow up were excluded. A total of 72 patients (109 eyes) were identified: 25 patients (26 eyes) with PHPV cataracts and 47 patients (83 eyes) with infantile cataracts. Mean age at time of surgery for both groups was 3.5 months. Mean follow up was 84.5 months for those with PHPV, and 76.9 months for those with infantile cataracts. Glaucoma developed in eight (32%) of the 25 patients with PHPV and in 15 (32%) of the 47 with infantile cataracts. Mean time to onset of glaucoma was 64.6 months for those with PHPV and 47.5 months for those with infantile cataracts (P=.70).

Although there was no significant difference between the prevalence of postoperative glaucoma in those with infantile and those with PHPV cataracts, the prevalence of glaucoma in these patients is high. Children with aphakia should be closely monitored for glaucoma throughout their lives.
Comparison of Grating and Vernier Acuity in Infants With Developmental Delay
Authors: Holmes Jonathan M
Published: April 2021

ABSTRACT

Background: Grating acuity measured by Teller cards Is mildly reduced in children with developmental delay. Vernier acuity, the ability to detect offsets, also can be measured, but has not been studied in children with developmental delay.

Methods: In a prospective cross-sectional pilot study, 12 nonverbal children with developmental delay established by pediatrie assessment of developmental milestones were tested blnocularly with vernier and Teller cards. Ages ranged from 4 to 24 months. Vernier offsets ranged from 2 to 64 minutes of arc.

Results: All children were testable with Teller acuity cards. Binocular grating acuity ranged from 1.7 to 7.4 cpd (median, 1.0 octaves below normal). Binocular vernier acuity ranged from unrecordable to 8 minutes of arc (median, "unrecordable"). Only four of the 12 children demonstrated a measurable vernier acuity. Normal children of this age have a vernier acuity of 2 to 16 minutes of arc measured by this technique.

Conclusion: The response to vernier acuity cards appears to be more severely degraded by developmental delay than the response to Teller cards.
Small-Target Random Dot Stereogram and Binocular Suppression Testing for Preschool Vision Screening
Authors: Simons Kurt , Avery Kelly Elhatton , Novak Audrey
Published: April 2021

ABSTRACT

Background: New, small-target (<1°) random dot stereogram (STRDS) and binocular suppression (STBS) tests appropriate for preschool vision screening were developed to correct the shortcomings of previous such tests, particularly missed cases of anisometropic amblyopia such as found with some RDS-based testing.

Methods: In Experiment 1, the tests were administered to 14 patients with current or a recent history of moderate (≤ 20/60) anisometropic amblyopia, or with accommodative esotropia or monofixation syndrome. All subjects had good binocularity (≤100" contour stereoacuity). In Experiment 2, the new tests were administered in a screening setting to a group of 112 three- to five-yearolds to determine testability. Visual acuity, cover testing, and photoscreening were administered as control measures.

Results: In Experiment 1, eleven of the 14 patients failed both tests. Two anisometropic amblyopes passing one or both tests had an acuity ≤20/30 in the worse eye and ≤25" stereoacuity. Three anisometropic amblyopia patients failing the STRDS passed another RDS test with similar disparity but a larger target size, confirming a report34 that anisometropic amblyopes may pass RDS testing with parafoveal stereopsis despite the presence of central suppression. The STRDS and STBS tests indicated 80% and 96% specificity, respectively, with the original methodologies; STRDS specificity increased to 95% with retesting with a different methodology. Administration time was 30 sec to 60 sec per test.

Conclusion: Small-target RDS or suppression testing may be more effective for strabismus and amblyopia screening of preschoolers than previous RDS test formats.
Retinopathy of Prematurity and Surfactant Treatment
Authors: Axer-Siegel Ruth , Snir Moshe , Ma'ayan Ayala , Na'or N , Davidson Samuel , Weinberger Dov , Yassur Yuval
Published: April 2021

ABSTRACT

Purpose: Surfactant therapy in premature infants has reduced the severity of respiratory distress syndrome (RDS), thus leading to a reduction in mortality. However, the anticipated effect of surfactant therapy on the incidence and severity of retinopathy of prematurity (ROP) is ambiguous. The acute rise in Pao2 and the increased survival of low-birth-weight infants may augment the risk of ROP, whereas their improved health and respiratory status may lower it.

Methods: We reviewed the findings of sequential ophthalmologic examinations performed in our neonatal intensive care unit. Premature infants of gestational age under 32 weeks and weighing less than 1500 g at birth who received surfactant treatment were compared with a group of historical controls consisting of premature infants of the same mean birth weight and gestational age who did not get this supplement.

Results: ROP was present in 13 (65%) of the 20 surfactant-treated babies, and threshold disease was noted in six (30%). In the historical control group, 20 (77%) of 25 infants had ROP, of whom 10 (40%) were treated for threshold disease. These differences were not statistically significant.

Conclusion: Surfactant therapy was not associated with an increased incidence of ROP in our series.
Observer Sensitivity to Retinal Vessel Diameter and Tortuosity in Retinopathy of Prematurity: A Model System
Authors: Freedman Sharon F , Kylstra Jan A , Capowski Joseph J , Realini Tony D , Rich Cadmus , Hunt David
Published: April 2021

ABSTRACT

Background: Abnormally increased diameter and tortuosity of retinal blood vessels in the posterior pole, or "plus disease," is recognized as a powerful predictor of poor outcome in eyes with retinopathy of prematurity (ROP). Although the diagnosis of plus disease depends upon the examiner's ability to examine retinal blood vessels, the ability of the human observer to identify changes in retinal blood vessel diameter and tortuosity accurately has not been studied.

Methods: Using computer-aided analysis of fundus photographs from eyes with a wide range of ROP severity, we generated tracings of posterior pole blood vessels which varied by quintiles of mean vessel diameter and tortuosity. Subjects (23 naive and 12 expert observers) ranked groups of tracings in order of increasing mean vessel diameter and tortuosity. These ranking tests were performed on tracings derived from the same fundus and tracings derived from distinct fundi. In a similar fashion, subjects also compared one designated standard fundus tracing with 25 distinct fundus tracings.

Results: Vessel diameter was assessed correctly more often than vessel tortuosity, both among similar (>99% vs 92% of the time, respectively, P<0.001), or among distinct (88% vs 78% of the time, respectively, P<0.001) fundus Images. The mean vessel diameter and tortuosity of 25 distinct fundus images were correctly ranked versus a standard image in 89% of attempts. Assessments of increments in vessel diameter and tortuosity were independent. Naive and expert subjects performed indistinguishably on all tests.

Conclusions: Intelligent human observers have considerable ability to discern clinically relevant increments in blood vessel diameter and tortuosity. This ability may facilitate standardization in the diagnosis of plus disease in ROP.
Second Generation Binocular Polaroid Test
Authors: Nuzzi Giuseppe , Cantù Cristiana , Camparini Monica
Published: April 2021

ABSTRACT

Background: Jbe aim of the study was to introduce a new test to detect small areas of suppression in the binocular visual field and to lower the minimum age at which a suppression test could be identified correctly. Two tests were compared: the Binocular Polaroid Test (poltest), introduced in clinical practice a few years ago and used in screening programs for vision impairment; and the Second Generation Binocular Polaroid Test (poistar), more recently designed to have simpler answers than the poltest.

Methods: One hundred and eighty-two children were examined consecutively. To assess the validity of the two tests, sensitivity, specificity, predictive value, and phi coefficient were calculated. The applicability of the two tests and the speed of the responses was assessed by means of the test of probability of binomial distribution.

Results: The polstar has appeared to be simpler and easier in younger patients (age range 20 to 36 months, P=0.078), and has shown 100% of specificity with a sensitivity of 84% for the polstar 1 and of 1 00% for the polstar 2.

Conclusion: The results appear to demonstrate that the poltest has been improved, and that the polstar may be considered an interesting investigation device for early detection of monocular visual impairment.
Automated Analysis of Electromyographic (EMG) Recordings During Botulinum Injections
Authors: Hunter David G , Nguyen Thong , Patel Saurabh N , Repka Michael X
Published: April 2021

ABSTRACT

Purpose: Botulinum toxin is injected into extraocular muscles using electromyographic (EMG) guidance to confirm needle location prior to injection. The purpose of this study was to develop and test an automated, objective method of storing and grading EMG signal quality obtained during botulinum injection. A reliable, nonsubjective estimate of signal quality will enhance future studies of the complications or effectiveness of botulinum toxin injections into extraocular muscle.

Methods: Injections were administered using a standard procedure. The EMG was digitized, recorded, and analyzed using discrete Fourier transform and power spectrum analysis. Audible signal quality was also graded subjectively by the surgeon. Patients were followed to determine the clinical response to the injection.

Results: Eighteen patients 24 injections) were studied. Each sample was collected and analyzed in less than one second. The EMG contained signals over a range of frequencies from 50 to 500 Hz, with an average peak near 90 Hz. Substantial variability of the signal was observed between patients. Contracting muscle had a higher total power and peak frequency in most, but not all, cases. Total signal power correlated moderately with subjective estimates of signal quality. Neither subjective nor computer-derived signal quality estimates correlated with the response to injection or complications.

Conclusions: Computerized signal analysis can automatically characterize EMG signal power and frequency distribution. Although this technique has the potential to identify needle location at the time of botulinum injection accurately, signal variability limited the clinical and research utility of the present protocol.
Extraocular Muscle Fiber Morphometry Following Combined Recession-Resection Procedures in Rabbits
Authors: Christiansen Stephen P , Harral Russell L , Brown Harry
Published: April 2021

ABSTRACT

Purpose: In earlier studies, we have reported extraocular muscle fiber atrophy following recession and fiber hypertrophy following resection of a horizontal rectus muscle. Changes seen in the operated muscle were mirrored in the antagonist and were thought to be a compensatory response to sustained changes in tension across the muscle pair caused by the surgery and by changes in the rotational position of the globe. The purpose of this study is to examine the effects of combined recession-resection on extraocular muscle fiber diameter.

Methods: In 16 anesthetized rabbits, a 6-mm recession of the medial rectus was combined with a 6-mm resection of the lateral rectus in the left orbit. The horizontal rectus muscles were removed from both orbits of four rabbits at 2-, 4-, 8-, and 16-week postoperative intervals. Cross-sections were cut from the midbelly of each muscle, and muscle fiber diameters were measured with a computerized morphometry unit. Mean fiber diameters from the operated orbit of animals at each postoperative interval were pooled and compared with means from the unoperated orbit using the paired-samples t test.

Results: No statistically significant change in fiber diameter was seen in either the global or orbital fiber layers at any postoperative interval examined.

Conclusions: Because resection would be expected to increase and recession to decrease the resting tension across an agonist-antagonist pair, our results suggest that a combined recession-resection yields no significant net change in resting tension, and minimizes compensatory changes in extraocular muscle fiber diameter.
Binocular Cortical Interactions in the Monofixation Syndrome
Authors: Struck M C , Ver Hoeve James N , France Thomas D
Published: April 2021

ABSTRACT

This study examines the relationship between clinically assessed binocular sensory status and binocular visual evoked potentials (BVEPs) in 11 patients with monofixation syndrome (MFS) and in 12 patients with absent binocular fusion (ABF). BVEPs were elicited using a two-sinusoid "beat" technique. The luminances of red/green anaglyphic circular fields were modulated independently at temporal rates of 6 and 8 Hz. This stimulus elicits a BVEP at 14 Hz in children with normal stereoscopic vision. In this study, we found that this BVEP also is present in patients with MFS, whereas it is near background noise levels in patients with ABF. These results demonstrate the presence of functional binocular cortical mechanisms in patients with MFS. The findings are consistent with the hypothesis that elicitation of this class of BVEPs requires gross sensory fusion, but not fine stereoscopic vision.
Dissociated Vertical Deviation: Head and Body Orientation Affect the Amplitude and Velocity of the Vertical Drift
Authors: Goltz Herbert C , Irving Elizabeth L , Hill John A , Kraft Stephen P , Steinbach Martin J
Published: April 2021

ABSTRACT

Purpose: Five subjects with dissociated vertical deviation (DVD) were studied to determine if the amplitude or velocity of the vertical components of the DVD were affected by head/body orientation with respect to gravity.

Methods: Deviations were measured in head upright, head supine, and supine positions, with head hanging postures using a binocular CCD video-based infrared eye tracker. Subjects were required to fixate a target presented in the primary position during alternate or cover/uncover tests.

Results: Amplitude and velocity of DVD both in onset and recovery were affected by head/body orientation with respect to gravity. In four of five subjects, the amplitude of the DVD was asymmetric between the two eyes when the head was upright. When the head/body was moved from an upright to a supine with head hanging backward condition, the amplitude of the DVD in the two eyes inverted. The eye with the larger DVD in the upright position had a smaller DVD in the head-hanging orientation. A similar relationship existed between velocity and head/body orientation. We found that DVD velocity increased with amplitude.

Conclusions: Passive effects of gravity on the eye-inorbit do not influence DVD magnitude or frequency of occurrence. The data suggest, however, that otolithic and possibly neck afferent inputs play a role in DVD magnitude and may be a part of the etiology of the condition.
Treatment for Amblyopia: Results Using Occlusive Contact Lens
Authors: Eustis H Sprague , Chamberlain David
Published: April 2021

ABSTRACT

Purpose: Amblyopia treatment occasionally is complicated by patch intolerance, resulting in a poor outcome. Therefore, a prospective study was designed to examine the efficacy and safety of using occlusive contact lenses in the treatment of amblyopia.

Methods: Twenty-five patients, aged 2.5 to 9.5 years, who were using an opaque hydrogel contact lens for the treatment of amblyopia, were followed prospect i vely.

Results: Overall, 92% of patients improved at least one line of visual acuity. Eight patients improved ≥2 octaves and 12 other patients improved ≥1 octave. In three patients, the change in visual acuity was <1 octave. Complications were seen in nine patients: contact lens irritation in five; poor contact fit in three; and peeking around the lens in one. The recurrence rate was high. In 11 of 25 patients, amblyopia rapidly returned to a reduced level when the contact lens was discontinued.

Conclusions: Occlusive contact lenses can be used in treating amblyopia in children. This treatment is ideal in patients who were patch-intolerant and failed with conventional treatment. Patients should have close follow up, however, to monitor any anterior segment complications from contact lens use and to identify the patients in whom amblyopia recurs.
Comparison of the HOTV and Lea Symbols Charts for Preschool Vision Screening
Authors: Hered Robert W , Murphy Suzanne , Clancy Mary
Published: April 2021

ABSTRACT

Purpose; Two preliterate acuity charts, the Lea Symbol chart and the HOTV chart, were compared prospectively in an established preschool vision screening program. The charts were compared by measuring time required to test, reliability coefficients, and the percentage of children testable with each chart.

Methods and Materials: Seven hundred and seventyseven 3- to 5-year-old children were randomized to four screening sequences that determined the order of chart use. Each child was screened on two occasions within 6 weeks. Testing was performed at 10 feet, and optotypes were not isolated for testing.

Results: Mean test time was significantly less for older children, but was not related to the chart used. Reliability coefficients were similar for the Lea Symbols and the HOTV charts. The percentage of children testable by each chart improved with increased age of the child. More 3 year olds were testable with the Lea Symbols chart compared to the HOTV chart (92% versus 85%, P=.05).

Conclusions: Vision screening with either chart was more rapid and more frequently achieved with 4- and 5year-old children compared with the 3 year olds. For the population as a whole, each chart gave similar results. Among the 3 year olds, however, testability rates were better for the Lea Symbols chart. The Lea Symbols chart is an acceptable option for preschool vision screening, and may be more efficacious than the HOTV chart for screening 3-year-old children.
Diagnosis and Management of Iris Juvenile Xanthogranuloma
Authors: Karcioglu Zeynel A , Mullaney Paul B
Published: April 2021

ABSTRACT

Background: Juvenile xanthogranuloma is a benign, self-limiting cutaneous disorder most commonly encountered during infancy. Approximately 10% of cases may develop ocular or adnexal involvement, most commonly in the iris.

Methods: We review clinical and morphological features of four cases of iris juvenile xanthogranuloma that reflect the diagnostic and therapeutic spectrum.

Results: Tissue diagnosis was confirmed in all cases; in one case, the disease was diagnosed with a skin biopsy and treated with local and systemic steroids, and its persistence in the iris was confirmed with a second tissue specimen obtained five months after systemic steroid treatment.

Conclusion: The diagnosis and treatment of juvenile xanthogranuloma may be straightforward, particularly in cases when the ocular lesion receives early attention and responds well to topical steroids, and when there is no hyphema. However, in other instances, this entity may be difficult to manage and may necessitate iris biopsy for diagnosis and radiation therapy for treatment.
Myopic Shift After Cataract Removal in Childhood
Authors: McClatchey Scott K , Parks Marshall M
Published: April 2021

ABSTRACT

Background: Children who have had cataract removal tend to have decreasing hyperopia (myopic shift) as they grow older. We wondered if the rate of myopic shift could be determined by age at surgery, cataract type, glaucoma, or other factors.

Methods: We studied 156 aphakic eyes of children who had cataract surgery before age 10 and documented refractions for more than 3 years. Refraction was corrected with contact lenses and spectacles; glaucoma was managed with medicine and surgery. Stepwise multiple regression was used to analyze differences in the rate of myopic shift between subgroups.

Results: The average refraction tended to follow a logarithmic decline with age (P<0.01, R
p 2
=0.97). The average rate of myopic shift (the slope of spectacle plane refraction vs log of age, where age is in years and log is base 10) was -5.5, with a standard deviation of 3.8. Age at surgery had a small but statistically significant effect on the rate (P<0.01, R
p 2
=0.04). No other studied factor reached statistical significance. However, among the 86 eyes with cataract removal after age 6 months, age at surgery was not as significant (P=0.21), and unilateral cataract eyes tended to have a greater rate than bilateral cataract eyes (-7.7 vs -5.7; P=0.05, R
p 2
=0.05).

Conclusions: Aphakic refraction tends to follow a logarithmic decline with age. The rate of myopic shift is determined partly by age at surgery and whether the cataract was unilateral or bilateral, although the effects are small. A wide variation in the rate of myopic shift exists. The following factors made little difference in the rate: cataract type, glaucoma, sex, side, and best corrected visual acuity.
Retinopathy of Prematurity in Multiple-Gestation, Very Low Birth Weight Infants
Authors: Friling Ronit , Rosen Shirley D , Monos Tova , Karplus Michael , Yassur Yuval
Published: April 2021

ABSTRACT

Ninety-nine infants from multiple gestation births and weighing ≤1500 g at birth were matched with infants from single births to clarify the relationship of multiple gestation to retinopathy of prematurity (ROP).

There was no significant difference in the incidence of ROP between the twins and the singletons (relative risk [RR]=0.84, 95% confidence intervals [Cl]=0.61, 1.16). Logistic regression analysis confirmed that very low birth weight (VLBW), not single or multiple gestation, was the most significant predictor of ROP occurrence in either group.

In 27 pairs of twin siblings from the original twin group, where both weighed ≤1500 g at birth, we found that the second-born twin seemed at higher risk for developing ROP, but logistic regression showed that the lower birth weight of the second twin, not birth order, was the more significant predictor of ROP.

These results indicate that ROP screening in VLBW twins may be conducted according to the same standard protocols as for singletons.
The Effect of Chemoreduction on Retinoblastoma-induced Retinal Detachment
Authors: Shields Carol L , Shields Jerry A , DePotter Patrick , Himelstein Bruce P , Meadows Anna T
Published: April 2021

ABSTRACT

Background: Retinoblastoma with total retinal detachment traditionally has been managed with enucleation. We employed a Chemoreduction protocol in an effort to reduce the tumor size to allow for focal treatment and salvage of the eye.

Methods: A prospective study was performed to assess the effects of a 2-month Chemoreduction regimen of vincristine, etoposide, and carboplatin on massive retinoblastoma with total retinal detachment.

Results: We treated 17 eyes with total retinal detachment from retinoblastoma in 13 patients over a 14-month period. At the initial examination, the mean tumor base was 15 mm and mean thickness was 10 mm. The eyes were classified as Reese-Ellsworth group V in 16 cases (94%) and group III in one case (6%). The retina was totally detached with serous subretinal fluid in all cases.

After 2 months of Chemoreduction, all tumors showed a response, and the tumors decreased to a mean base of 10 mm and thickness of 5 mm. Overall, a mean of 33% decrease in base and 47% decrease in thickness was noted. The subretinal fluid had resolved completely in seven eyes (41%), leaving flat retina. In three eyes (18%), partial resolution was achieved; in seven eyes (41%), minimal resolution of the subretinal fluid at the 2-month period was noted. By last follow up, at a mean of 10 months after initiation of Chemoreduction, complete resolution of the subretinal fluid occurred in 13 eyes (76%) and partial resolution of subretinal fluid occurred in four eyes (24%).

Conclusion: Preliminary observations suggest that Chemoreduction may be an important tool in the initial management of retinoblastoma, even for large tumors with total retinal detachment. Tumor shrinkage may be dramatic and subretinal fluid resolution may be complete.
Periorbital and Orbital Cellulitis in the Haemophilus influenzae Vaccine Era
Authors: Barone Stephen R , Aiuto Leslie T
Published: April 2021

ABSTRACT

Background: Prior to development of the Haemophilus Influenzae vaccine, a significant number of periorbital and orbital Infections were associated with H Influenzae type b bacteremia. The incidence of invasive H influenzae type b disease has decreased dramatically since the introduction of these vaccines. The effect of the H influenzae type b vaccine on the microbiology of periorbital and orbital infections has not been examined.

Methods: Charts of 134 hospitalized patients with the discharge diagnosis of periorbital or orbital cellulitis from 1985 to 1995 were reviewed.

Results: In contrast with studies performed in the pre-vaccine era, H Influenzae type b was not a significant pathogen. The pathogen was isolated from only 2 of 133 blood cultures performed, and was not isolated from any of the 101 patients discharged after July 1987. Sinusitis, however, remains an important cause of these eye Infections. Of patients who underwent radiographic evaluation, sinusitis was present in 96% of children with orbital cellulitis and 81% of patients with periorbital cellulitis.

Conclusions: H Influenzae type b Is no longer a significant pathogen In periorbital or orbital cellulitis and management should be modified accordingly.
Diagnosis and Surgical Management of Strabismus Associated With Thyroid-related Orbitopathy
Authors: Flanders Michael , Hastings Molly
Published: April 2021

ABSTRACT

Background: In the healing phase of thyroid-related orbitopathy, fibrosis and contracture of the extraocular muscles may result in restrictive ocular motility. Ocular misalignment may occur in both eyes and along three different axes of rotation. Successful surgical treatment depends on precise identification of the muscles that are restricting motility and producing the misalignment.

Methods: Between 1980 and 1994, 22 patients were surgically treated for restrictive strabismus caused by thyroid-related orbitopathy. Preoperati ve Iy, all patients underwent complete neuroophthalmic, oculoplastic, and orthoptic examinations. Analysis of auctions, measurement of torsion, and the use of monocular neutralization techniques were essential additions to the usual motility exam. Patients were placed into diagnostic categories based on the clinical pattern of extraocular muscle restriction. Adjustable recessions were done for all initial surgeries.

Results: Patients with unilateral inferior rectus involvement or with ipsilateral inferior rectus-contra latera I superior rectus involvement had large vertical deviations (equal to or >20 prism diopters [A]). Patients with bilateral inferior rectus involvement had small vertical deviations (<20 ?). Excyclotorsion correlated strongly with the presence of tight inferior recti. Vertical comitance (upgaze versus downgaze measurement of equal to or <15 ?) correlated with the ipsilateral inferior rectus-contra I ate ral superior rectus pattern of involvement. Vertical incomitance (upgaze versus downgaze measurement of >15 ?) correlated with unilateral inferior rectus involvement. Eighteen of 22 patients had excellent postoperative alignment and elimination of diplopia in functional positions of gaze. Those with less favorable results developed reversal of the hypertropia and exotropia in downgaze. Sixteen out of 19 patients who underwent inferior rectus recession had induced inferior eyelid retraction.

Conclusion: Different combinations of extraocular muscle restriction in this series of patients produced characteristic patterns of misalignment. Appropriate, adjustable, strabismus surgery was successful in restoring binocular vision in 21 out of 22 patients with a minimum of complications.
Ultrastructural Studies of Primary Congenital Glaucoma in Rabbits
Authors: Knepper Paul A , Goossens William , McLone David G
Published: April 2021

ABSTRACT

Background: The cause of congenital glaucoma is unknown.

Methods: To determine whether the site of impaired aqueous outflow is the entrance to the trabecular meshwork (TM), within the TM, the aqueous drainage plexus, or a combination thereof, the process of TM development was examined by scanning and transmission electron microscopy on postnatal day 3 and weeks 1, 2, 3, 4, and 6 in New Zealand rabbits homozygous for the buphthalmic (bu/bu) gene compared with age-matched controls.

Results: Openings to the entrance of the TM in congenital glaucoma were observed, and there was no evidence of an endothelial membrane occluding aqueous flow to the TM. The morphology of the congenital glaucoma TM was abnormal in all bu/bu rabbits by 2 weeks and was characterized by a smaller entrance to the TM at the iris base, smaller intertrabecular openings within and between the trabecular lamellae, and at 6 weeks, iris pillars with extensive lateral extensions in the angle recess. Most intertrabecular spaces were open, however, the inner intertrabecular spaces adjacent to the aqueous plexus were compressed.

Conclusion: These results suggest the development of congenital glaucoma, which involves a mutation in an autosomal recessive gene and leads to loss of function of a gene(s) required for the differentiation of the TM.
Posterior Chamber Intraocular Lens Use in Children
Authors: Cavallaro Brian E , Madigan William P , O'Hara Mary A , Kramer Kenyon K , Bauman Wendall C
Published: April 2021

ABSTRACT

Purpose: The authors report on the efficacy of intraocular lens implantation during pediatric cataract surgery and the results of a consecutive series of intraocular lens implantations in children.

Methods: Twenty-one children underwent implantation of intraocular lenses in 23 eyes. Twenty-one surgeries were primary implantations immediately following anterior lensectomy. Two surgeries were secondary implantations. Primary posterior capsulectomy was performed in 18 of 21 primary implantations. All but two eyes underwent a primary anterior vitrectomy. Topical prednisolone acetate was administered in all cases. Oral prednisone was administered in 17 of 23 cases. Pre- and postoperative visual acuity, cycloplegic refraction, and postoperative complications related to inflammation such as intraocular lens (IOL) capture, IOL deceleration, and posterior capsule opacificatlon were examined.

Results: Eighteen of 23 eyes have achieved a visual acuity of 20/40 or better. None of the cases in which oral prednisone was used developed complications related to postoperative inflammation. One of the six cases (17%) in which oral prednisone was not used developed such complications.

Conclusion: Intraocular lens implantation accompanied by primary posterior capsulectomy, anterior vitrectomy, and management of postoperative inflammation appears to provide appropriate and safe optical rehabilitation in children.
changes in helping professionals' knowledge and attitudes following a human sexuality workshop led by a nurse
Authors: deLemos Hilda
Published: April 2021

ABSTRACT

This study hypothesized that attitudes toward human sexuality would become more positive and knowledge would increase following a human sexuality training workshop. The experimental subjects, who were practicing professionals, were given the SKAT in the first hour of the workshop and again in the last hour of the workshop on the third day. There were 57 subjects: 16 in group 1; 16 in group 2; and 25 in group 3. The control group consisted of 8 subjects who were practicing professionals who did not attend the workshop, but who took the SKAT test and then repeated the exam three days later.

The results of the study supported the research hypothesis in the areas of attitudes on heterosexual relations, sexual myths, and autoeroticism and sexual knowledge. The control group did not change significantly on their pre and posttest scores.

The raw scores showed that there was approximately a 7.5 point difference in the mean scores of the experimental groups tested in urban areas and those subjects from rural areas. The urban scores were higher which indicated more liberal attitudes toward human sexuality and more cognitive knowledge. Sixteen of the subjects decreased on their posttest scores of the attitudinal sections of the SKAT but this did not affect the overall statistical significance of the study. Those experimental subjects who decreased were from a rural area and were public health nurses, females, married, and over thirty years old. Sexual knowledge increased in all the experimental subjects. The findings showed a wide range of differences between individuals' perceptions and their actual scores on the sexual knowledge section.

Human sexuality is an area of considerable concern in today's contemporary culture. The increased openness about sexual behavior is resulting in the consumer seeking counsel and answers to their sexual problems from helping professionals. The professionals need to possess self-knowledge before they can help others. Health professionals have tended to exhibit a lack of adequate knowledge about sex education and counseling.1
Anxiety Levels of Hospitalized Psychiatric Patients Throughout Total Hospitalization
Authors: Kristic Janet
Published: April 2021

ABSTRACT

The purpose of this study was to determine the trend of anxiety levels of psychiatric patients throughout a short-term hospitalizaron. The sample included patients hospitalized in a 27bed psychiatric unit at a University-affiliated hospital. The average hospitalization was ten days. Fifteen patients were randomly selected over a two-month period. There were no limitations as to age, sex, diagnosis, previous hospitalizations or socioeconomic status. Patients who were too disturbed to complete the test forms were not included in the study.

The IPAT 8-Parallel-Form Anxiety Battery was administered at daily intervals. Form A was given within 24 hours after admission. Forms B through G were administered, one per day, over the next six days. Form H was withheld until the patient had been informed of his discharge plans. On the average, three days elapsed between the administration of Forms G and the final form, Form H.

A Friedman Analysis of Variance indicated that the changes in anxiety levels over time approached statistical significance. A Wilcoxan Signed-Ranks Test showed that some mean scores fluctuated significantly from the initial mean anxiety level. The results supported the observation that anxiety tends to be high at admission and upon notification of discharge. The results also identified a third peak at approximately the fifth day of hospitalization.

Implications for nursing care were discussed. The trends in anxiety fluctuation may provide a basis for prediction of periods of particular stress for patients that should have implications for nursing care. Patterns of anxiety fluctuations during a short-term hospitalization period provide areas for further research, some of which were discussed in the report.
Hierarchy of Birth Planning Values: An Aid in Genetic Counseling
Authors: Townes Branda D , Priest Susan R , Ellison Richard M
Published: April 2021

ABSTRACT

A technique based upon behavioral decision theory was proposed to help individuals understand the motivational bases of their childbearing decisions. An instrument, the hierarchy of birth planning values, provides a structure through which a person can examine in a systematic fashion the costs and benefits of having versus not having a (another) child. Two case histories illustrate the use of the hierarchy in genetic counseling.
Weight Loss in Retarded Children - A Pilot Study
Authors: Rotatori Anthony F , Parrish Phyllis , Freagon Sharon
Published: April 2021

ABSTRACT

The paper describes a behavioral/nutritional weight reduction pilot study that was directed by a school nurse. The paper delineates components of the program as well as weight losses attained by moderately/mildly retarded children attending a public school program.
A Systematic Approach to Selecting Group Participants
Authors: Adrian Sarah
Published: April 2021

ABSTRACT

As health care professionals, nurses are faced with how to best select or refer individuals for participation in health care groups. This article explores how to assess candidates for group participation by utilizing inclusion and exclusion criteria offered by literature. An assessment format, designed by the author and based on these criteria, is offered to assist nurses in selecting group participants. Clinical examples illustrate the author's experience in utilizing this format.
Causal Attributions: Bias in the Nurse-Patient Relationship
Authors: Karshmer Judith Foster , Kornfeld-Jacobs Gila , Carr Ann
Published: April 2021

ABSTRACT

The study relates the social psychological concept of attribution to professional nursing practice. Namely, dispositional vs. situational causal attribution as affected by position (nurse/patient) and role (actor/ observer) and its impact on the therapeutic relationship. Contrary to most studies in this field this one moves out of the laboratory and tests actual psychiatric patients and correspondent nursing staff.

Twenty nurses and twenty patients responded to statements representing situational and dispositional causal attributions about 22 behaviors of nurses and 22 behaviors of patients. Both patients and nurses tended to attribute the behavior of patients to causes inherent in their personality more often than to external factors. Nurses also tended to give more internal causation to their own behavior while patients gave equal numbers of external and internal causes to nurses' behavior.

The findings which support an information processing approach to understanding perceptions are discussed as to their implications for the nurse-patient relationship.