bluuebunny/crossref_metadata_2025 huggingface dataset:
Congruency in Defining Critical Thinking by Nurse Educators and Non-nurse Scholars
Authors: Gordon Joanne M
Published: April 2021

ABSTRACT

This study investigated nurse educators' definition of the concept critical thinking. A sample of 201 baccalaureate nurse educators in midwest nursing programs completed a questionnaire identifying their perception of critical-thinking skills and characteristics, and their agreement with non-nurse critical-thinking experts on items often considered to be critical thinking. This study found that nurse educators agreed with non-nurse critical-thinking experts on the skills and dispositions; however, significant differences were found between nurse educators and non-nurse experts regarding concepts related to critical thinking. Nurse educators were more likely to identify researching, problem-solving, decision-making, and planning as critical thinking. Despite their assertion otherwise, it is apparent from this study that nurse educators have a different perception of critical thinking than scholars in other disciplines. This study suggests that practice disciplines such as nursing may perceive critical thinking differently than educators in nonpractice disciplines.
Student and Staff Relationships in a Clinical Practice Model: Impact on Learning
Authors: Atack Lynda , Comacu Margret , Kenny Renee , LaBelle Nancy , Miller Debra
Published: April 2021

ABSTRACT

This qualitative study describes the perspectives of diploma nursing students and staff nurses on the student-staff relationship and the impact this relationship has on student learning. Staff and students, working in a clinical practice model setting in a large urban hospital, participated in focused interviews following a 15-week clinical practice assignment. Findings revealed there were several commonalities in staff and student perceptions of the relationship. Both staff and students described role perception, staff characteristics, and the workplace environment as important factors influencing the relationship and student learning. Students also identified working in a collegial relationship as being important to learning and their socialization into the nursing profession.
The NCLEX-RN Experience: Qualitative Interviews With Graduate of a Baccalaureate Nursing Program
Authors: Eddy Linda L , Epeneter Beverly J
Published: April 2021

ABSTRACT

It is important for nursing faculty to pay attention to individual as well as institutional results on the National Council Licensure Examination for RNs (NCLEX-RN). This study was designed to identify themes to help faculty understand the NCLEX-RN experience from students' perspectives and help future students pass the examination at the first sitting. A sample of 1998 graduates of a baccalaureate program was selected, which included 10 students who were successful and 9 who were unsuccessful on the first testing attempt. Participants were interviewed about the testing experience and the relationship between nursing education and the NCLEX-RN. Findings indicate that participants who passed on the first attempt accepted responsibility for learning, were proactive in test preparation, took the examination when they felt ready, and used stress management techniques to cope with this challenge. The unsuccessful participants tended to perceive their lack of success on the NCLEX-RN was the responsibility of others, seemed less able to manage stress, and took the examination when they did not feel ready. Both successful and unsuccessful participants felt unprepared to answer NCLEX-RN-type questions and believed nothing had prepared them for this experience.
An International Collaboration in Nursing Education Viewed Through the Lens of Critical Social Theory
Authors: Ekstrom David N , Sigurdsson Hrafn Oli
Published: April 2021

ABSTRACT

Critical social theory, including the work of Jürgen Habermas, provides a valuable lens for viewing phenomena within their sociopolitical contexts. According to Habermas, the lives and experiences of individuals, groups, and societies in the western world are strongly influenced by the forces of economics and power. These influences may interfere with communication and, therefore, the transmission and regeneration of culture and its meaning. This article describes the experience of initiating an international exchange program at a university school of nursing in the eastern United States. Examined through the lens of Habermas' theory, constraints and obstacles encountered in this process are revealed. Specifically, the inhibiting influence that politics and economics may have on active communication and the potential benefits of shared meaning and understanding achieved by interaction and discourse are examined.
Medication Errors: More Basic Than a System Issue
Authors: Polifroni E Carol , McNulty John , Allchin Lynn
Published: April 2021

ABSTRACT

The Institute of Medicine's 2000 report drew attention to both U.S. health care agencies and the medication errors that occur within them. However, this attention focused on a more basic and fundamental issue within the medication error concern: nurses' mathematical skills and competence. This article describes a nationwide study assessing processes to validate mathematical skills for medication administration. Practices within educational and acute care institutions are explored, and recommendations for future action are noted with a call for 100% accuracy on all mathematical examinations for medication administration.
Teaching Baccalaureate Nursing Students to Prevent Medication Errors Using a Problem-Based Learning Approach
Authors: Papastrat Karen , Wallace Sharon
Published: April 2021

ABSTRACT

An objective of the baccalaureate nursing curriculum at Thomas Jefferson University, Jefferson College of Health Professions is to facilitate nursing students' transfer of medication error knowledge into preventive action in the clinical unit. Using a problem-based learning approach, first-semester students are exposed to situations that reflect the real-world scope and complexity of medication administration and errors. Using the frameworks of Failure Mode Analysis and Human Error Mode and Effects Analysis, student groups identify hypotheses, devise solutions, and develop continuous quality improvement processes to prevent errors and facilitate error reporting. Problembased learning is used in subsequent clinical experiences throughout the curriculum. This reinforcement, combined with a focus on increasingly complex pharmacological agents and medication calculations, enables students to employ critical thinking skills and develop the confidence necessary for safe, professional practice.
Creative Learning: The Mandala as Teaching Exercise
Authors: Marshall Margaret Cole
Published: April 2021

ABSTRACT

Faculty committed to undergraduate education have discovered the need to address teaching strategies that focus on the new generation of students. In teaching an undergraduate course on Nursing the Client with a Mental Illness, the affective domain of learning is used to develop interpersonal competence, self-awareness, and self-reflection. The teaching technique used is an experiential exercise that asks students to create group mandalas using art materials on circular pieces of butcher-block paper.

The mandala concept is derived from the Buddhist tradition and means "circle" or "center" in Sanskrit. Carl Jung introduced this technique to the United States and incorporated it into his therapy. As a creative, active learning strategy, the mándalas helped the faculty meet the clinical objectives for the course and the learning needs of a new generation of students. They also helped students learn about Eastern philosophy, group process, self-awareness, and Jungian therapy.
Surgical Results in Dissociated Vertical Deviations
Authors: Duncan Lois B , von Noorden Gunter K
Published: April 2021

ABSTRACT

The effect of surgery on dissociated vertical deviations was compared in three groups of patients treated with one of the following methods: posterior fixation sutures of the superior rectus, superior rectus recession, or superior rectus recession with posterior fixation sutures. Treatment with conventional superior rectus recession combined with posterior fixation sutures (at 12 + mm) resulted in cosmetically acceptable alignment in 88% of eyes. A standard superior rectus recession alone was less dependable. Treatment with posterior fixation sutures of the superior rectus without recession was effective in only 31% of cases after long-term observation.
Ocular Abnormalities in Terminal Deletion of the Long Arm of Chromosome Seven
Authors: Reynolds James D , Golden Wendy L , Zhang Yunjing , Hiles David A
Published: April 2021

ABSTRACT

Patients with distal deletions of the long arm of chromosome 7q have been reported with a variety of non-specific findings. Ocular findings have been limited to hypertelorism, palpebral fissure abnormalities, strabismus and speckled indes and no intraocular pathology with the exception of one case with unilateral optic nerve coloboma. We report a patient with terminal deletion of the long arm of chromosome 7 with marked ocular abnormalities including severe microphthalmus and large retinal colobomas.
Oral Fluorescein Angioscopy in Aphakic Children
Authors: Morgan Keith S , Franklin Rudolph M
Published: April 2021

ABSTRACT

Seven children who had undergone removal of congenital cataracts were evaluated postoperatively for cystoid macular edema during outpatient visits. Fluorescein was administered orally in a fruit juice cocktail, and the eyes examined by angioscopy 10-20 minutes and 45-60 minutes after dye ingestion. No evidence of macular leakage was observed in any of the U eyes examined. It appears that this diagnostic procedure is feasible in young patients, and that the incidence of cystoid macular edema after congenital cataract extraction may be less than has been previously reported.
Muscular Structural Changes Following Fadenoperation
Authors: Alio J L , Chacon M , Faci A , Uson J , Jimenez I , Vives A , Garcia-Julian G , Moros M , Gonzalez L
Published: April 2021

ABSTRACT

The authors describe the macroscopic, histological, and ultrastructural findings observed in an experimental animal model of the fadenoperation. Grossly, muscular fibrosis and musculo-scleral adhesions were well established after the second postoperative month. Histologic findings demonstrated the development of a granulomatous, foreign body reaction around the musculo-scleral fixation suture, collagenization of the muscle tissue from the first postoperative month and degenerative phenomena in the muscle fibers. Electron transmission microscopic study showed atrophy and angulation with distortion of the myofibrillar matrix, along with alteration of the Z bands of muscle fibers, mitochondrial alteration, and dilatation of the sarcotubular system. All these experimental findings suggest the relative irreversible effects of the fadenoperation after the early postoperative period and for the first time, demonstrated that this surgical technique alters the muscle structure.
Management of the Posterior Capsule in Congenital Cataracts
Authors: Parks Marshall M
Published: April 2021

ABSTRACT

Amblyopia is the most serious problem associated with congenital cataracts. In their management, every effort should be directed toward treating the amblyopia. The treatment is surgical, optical, and occlusion of the preferred eye. The surgical component of the treatment should be performed within the critical period to avoid intractable deprivation amblyopia, and consist of a technique that insures the pupillary space to remain clear. Posterior lens capsulectomy with anterior vitrectomy is required to assure this result. However, cystoid macular edema has been reported with this approach. At present, probably there is greater risk to final visual acuity from intractable amblyopia resulting from the cloudy intact posterior lens capsule than from cystoid macular edema.
Goniotomy vs Trabeculotomy
Authors: Hoskins H Dunbar , Shaffer Robert N , Hetherington John
Published: April 2021

SUMMARY

Goniotomy is a safe effective procedure in isolated trabeculodysgenesis occurring in children under the age of two years, and is preferred by the authors in all such cases when visibility allows. It may also be effective for varying periods of time in Sturge- Weber syndrome, Aniridia, Axenfeld's syndrome, and Lowe's syndrome when these occur in infancy.

Trabeculotomy is generally preferred in children with trabeculodysgenesis over the age of three years, in situations where corneal clouding prevents adequate visualization of the trabecular meshwork, and in patients with aniridia. In the latter group, although goniotomy can be effective, its success rate is low, The absence of iris covering the lens does increase the risk of lenticular injury and, therefore, trabeculotomy is usually chosen.
Ectopic (Extradural) Meningioma of the Orbit: A Report of Two Cases in Children
Authors: Johnson Thomas E , Weatherhead Robert G , Nasr Amin M , Siqueira Edir B
Published: April 2021

ABSTRACT

Meningiomas arising from the optic nerve or secondarily invading the orbit from the intracranial cavity are uncommonly encountered in children. Ectopic (extradural) meningiomas are exceedingly rare orbital tumors that do not originate from either the optic nerve or the intracranial meninges. We evaluated and treated two boys aged 7 and 10 years with probable primary ectopic (extradural) orbital meningiomas. Both patients presented with a gradual onset of progressive, painless proptosis. In addition, computed tomographic scans demonstrated involvement of the superomedial orbit without bony erosion or hyperostosis, but with expansion of the adjacent sinus. Neither tumor demonstrated attachment to the optic nerve or intracranial extension at the time of surgery. Both patients were successfully treated with complete surgical excision. Evaluation did not reveal the presence of neurofibromatosis in either child.
Results of a Single Lateral Rectus Resection for Divergence and Partial Sixth Nerve Paralysis
Authors: Hoover Darren L , Giangiacomo Joseph
Published: April 2021

ABSTRACT

A single 5.5-millimeter to 8.0-millimeter lateral rectus resection eliminated diplopia in five of six adult patients with divergence paralysis and in all three patients with a sixth cranial nerve paresis. Preoperative distance esotropia ranged from 11 to 20 prism diopters in primary gaze. Prism therapy failed in seven of nine patients. Lateral incomitance was reduced in three patients with a mild limitation of abduction preoperatively, but was not induced in the six patients with divergence paralysis. Significant overcorrection of the near esodeviation did not occur. A single lateral rectus resection can effectively eliminate diplopia in selected patients with divergence and partial sixth nerve paralysis.
Convergence Insufficiency in Thyroid Eye Disease
Authors: Burke John P , Shipman Tracey C , Watts Mark T
Published: April 2021

ABSTRACT

The incidence of convergence insufficiency in patients with thyroid ophthalmopathy and their response to convergence exercise is unknown. Twenty-seven consecutive patients with thyroid eye disease (TED) were evaluated prospectively. Six patients with symptomatic convergence insufficiency obtained varying degrees of subjective and objective benefit from treatment. None of the six had other TED-related complaints that required therapeutic intervention. The study findings should alert the clinician to consider convergence insufficiency in patients with TED and nonspecific ophthalmic symptoms.
Progressive Overcorrection After Inferior Rectus Recession
Authors: Sprunger Derek T , Helveston Eugene M
Published: April 2021

ABSTRACT

We reviewed 67 cases of inferior rectus muscle recession. In 14 cases, the hypotropia was corrected to a satisfactory alignment in the immediate postoperative period followed by a progressive overcorrection (hypertropia). Patients with thyroid eye disease were at highest risk for progressive overcorrection, as 9 of 18 (50%) developed the problem. Patients undergoing adjustable suture were at a higher risk for development of the overcorrection, as 1 of 35 (3%) surgeries done with standard techniques had the overcorrection while 13 of 32 (41%) done on an adjustable suture had the problem. However, the actual act of adjustment was found not to be a predisposing factor. Also, operating upon multiple muscles was found not to be a risk factor for the complication. Once progressive overcorrection occurred, it was more difficult to correct when the patient had thyroid eye disease.

We also reviewed 77 consecutive cases of superior, lateral, and medial rectus muscle recessions and found no cases of progressive overcorrection.
The Effect of Grating Orientation on Resolution Acuity in Patients With Nystagmus
Authors: Meiusi Rhondi S , Lavoie Jane D , Summers C Gail
Published: April 2021

ABSTRACT

The acuity card procedure is an effective method for the assessment of grating acuity in preverbal and nonverbal patients. However, the effect of nystagmus on this acuity assessment has not been well-described. We studied the effect of grating orientation on the measurement of resolution acuity in a group of nystagmus patients, a group of patients with albinism and nystagmus, and a normal control group.

The resolution acuity was significantly (P « .01) better with horizontal grating orientation in both the nystagmus and the albino groups, but grating orientation did not affect resolution acuity in the control group. This study suggests that grating orientation must be taken into account when using the acuity card procedure in patients with nystagmus.
The Influence of Study Habits on Myopia in Jewish Teenagers
Authors: Zylbermann Roger , Landau David , Berson David
Published: April 2021

ABSTRACT

The prevalence and degree of myopia were measured in 870 teenagers, males and females. We found a statistically significantly higher prevalence and degree of myopia in a group of 193 Orthodox Jewish male students who differed from the rest in their study habits.

Orthodox schooling is characterized by sustained near vision and frequent changes in accommodation due to the swaying habit during study and the variety of print size. A possible myopic effect of this unique visual demand is postulated.
Magnetic Resonance Imaging of the Visual Pathways in Human Albinos
Authors: Brodsky Michael C , Glasier Charles M , Creel Donnell J
Published: April 2021

ABSTRACT

Neuroanatomical and electrophysiological studies of albino visual pathways have demonstrated that retinogeniculate axons arising from the temporal retina decussate abnormally in the optic chiasm to synapse in the contralateral lateral geniculate nucleus (LGN). Anomalies in the LGN secondarily disrupt normal geniculo-cortical and interhemispheric cortico-cortical (callosal) visual connections. It is not known whether retinogeniculate misrouting affects the size or configuration of the afferent visual pathways in human albinos. We used T1 -weighted coronal and sagittal magnetic resonance imaging (MRI) to examine the prechiasmatic intracranial optic nerves, optic chiasm, and corpus callosum in 10 human albinos. In all subjects, these structures were normal in size and configuration. Despite the complex cascade of aberrant central neuronal connections, the human albino visual pathways and their interhemispheric connections appear normal in size and configuration when viewed with MRI.
Fat Adherence Syndrome Treated With Intraoperative Mitomycin-C: A Rabbit Model
Authors: Brooks Steven E , Ribeiro Gerald de B , Archer Steven M , Elner Victor M , Del Monte Monte A
Published: April 2021

ABSTRACT

We used an animal model of restrictive strabismus analogous to the fat adherence syndrome in humans to test the efficacy of topical intraoperative mitomycin-C (MMC) in preventing the development of restrictive scar tissue. A cicatriciel adhesion was created between the inferior rectus muscle and the Inferior orbital rim of each eye in eight rabbits, and passive forced auctions were quantitatively measured with a spring scale. Eight eyes were treated intraoperatively with topical MMC 0.5 mg/mL, the other eight with sterile water. Passive forced auctions were again measured 4 weeks postoperativefy and representative orbits were exenterated for histopathologic examination.

Significant restriction of motility was produced in six of the eight control eyes. Though prophylactic treatment with MMC may have been beneficial in some cases, on average, the restriction developing in these eyes did not significantly differ from that In the control eyes. In addition, longer exposure times to MMC led to marked orbital inflammation and severe restriction of ocular motility. Finally, histopathologic evaluation of the orbits of the MMC-treated eyes revealed marked fibrosis of perimuscular connective tissues.

Although MMC may have a role in the management of fat adherence syndrome, further study is needed to establish safe and efficacious methods of delivery.
Augmenting Surgery for Sensory Esotropia With Near/Distance Disparity With a Medial Rectus Posterior Fixation Suture
Authors: Elsas Frederick J , Mays Andrew
Published: April 2021

ABSTRACT

Ten esotropie patients with near/distance disparity and diminished vision in one eye had monocular horizontal strabismus surgery combined with a posterior fixation suture placed on the medial rectus. Before surgery, all patients were at least 20 prism diopters (Δ) more esotropie at near than at distance fixation. The disparity In the near/distance deviation was reduced by 18 Δ.
Screening for Retinopathy of Prematurity: Do Former Guidelines Still Apply?
Authors: Schalij-Delfos Nicoline E , Zijlmans Bart L M , Wittebol-Post Darel , Tan Karel E W P , Cats Bernard P
Published: April 2021

ABSTRACT

Early detection of retinopathy of prematurity (ROP) in premature and very-low-birth-weight infants is crucial. In this retrospective study, 581 infants either with a birth weight below 1500 g or a gestational age of less than 32 weeks, or who did not fit these criteria but were judged to be at increased risk, were screened for ROP. ROP developed in 159 (27.4%). The incidence of ROP appeared to be inversely proportional to birth weight and gestational age. Infants with a birth weight below 750 g had a significantly higher risk of developing stage 3 and 4 ROP. The mean age at detection was 7.6 ± 1.6 weeks. Nearly all of the ROP cases and all of the stage 3 and 4 cases were detected between the 5th and 10th week. Because screening should be focused on these visionthreatening stages, ophthalmic examinations should be concentrated in, but not limited to, the period between the 5th and the 10th postnatal week.
Results of Sutureless Wound Construction in Children Undergoing Cataract Extraction
Authors: Basti Surendra , Krishnamachary Murali , Gupta Satish
Published: April 2021

ABSTRACT

A prospective study was performed to evaluate the efficacy of self-sealing (sutureless) wound construction for cataract surgery in children. Self-sealing wounds were constructed during cataract surgery in 25 eyes of 24 children between 7 and 16 years of age. Absence of wound leak at the conclusion of surgery was taken as indicating a secure wound. Watertight wounds were achieved In 19 eyes, 11 of those In children older than 11. Six eyes demonstrated wound leak, and sutures had to be applied to achieve a secure wound. All wound leaks occurred in children younger than 11. Patients younger than 11 who underwent primary posterior capsulotomy and anterior vitrectomy had a significantly higher incidence of wound leak after sutureless cataract surgery (P<.001). We conclude that the self-sealing wound probably should not be used for cataract surgery in children younger than 11.
Postoperative Results in Inferior Oblique Palsy
Authors: Kutschke Pamela J , Scott William E
Published: April 2021

ABSTRACT

Purpose: Although rare, the entity of isolated inferior oblique palsy has been discussed in past literature. The purpose of this study is to expand on the number of cases as well as the surgical options. Postoperative clinical findings, especially head-tilt measurements also are discussed.

Methods: The charts of patients were retrospectively reviewed following surgical correction of unilateral inferior oblique palsy. Data analyzed included type of surgical correction, pre- and postoperative measurements in all fields of gaze, torsion, and sensory status.

Results: Twenty-eight patients were studied. Patients were separated into groups based on the type of procedure performed. Indications for each type of procedure will be discussed. Twenty-three patients had a single surgical procedure. Of these, 16 had excellent surgical results. Five patients required reoperation with four achieving an excellent surgical result. Head-tilt testing at the last postoperative visit was positive for iatrogenic superior oblique palsy (4) and residual inferior oblique palsy (3).

Conclusions: In the largest series of unilateral inferior oblique palsy to date, the results appear to be good if the indications for the proper surgical procedure are followed. The number of cases of iatrogenic superior oblique palsy appear to be consistent with that discussed in previous literature, but not higher than the incidence of residual inferior oblique palsy. Postoperative head-tilt measurements were consistent with the deviation found in other fields of gaze.
Management of Experimental Globe Perforation During Strabismus Surgery
Authors: Sprunger Derek T , Klapper Stephen R , Bonnin Jose M , Minturn John T
Published: April 2021

ABSTRACT

Background:The incidence of potentially vision-threatening globe perforation during strabismus surgery is reportedly between less than 1% and 12% of cases. Optimal treatment of globe perforation is not known; however, traditionally it has been treated with cryotherapy at the time of surgery or observation without treatment. The indirect-ophthalmoscope-directed diode laser may provide a safe and effective alternative treatment.

Methods: We perforated the globes of six adult Dutch rabbits (12 eyes) and treated four eyes with cryotherapy and four with diode laser; the remaining four were not treated.

Results: Histologic examination of the untreated eyes revealed a cellular reaction around the polyglactin suture that formed a non-uniform chorioretinal adhesion. The cryotherapy eyes had a tenuous chorioretinal adhesion and retinal pigment epithelium (RPE) cells in the vitreous on several sections. The laser-treated eyes had a firm, wide chorioretinal adhesion, with minimal tissue disruption and no release of RPE cells. No complications occurred.

Conclusion: We conclude that indirect-ophthalmoscope-directed diode laser retinopexy was safe and efficacious for globe perforation during strabismus surgery on rabbits and could be expected to be useful in humans.
Astigmatic Refractive Errors Associated With Limbal Dermoids
Authors: Robb Richard M
Published: April 2021

ABSTRACT

A retrospective review of 17 patients with limbal dermoids revealed that 13 (76%) had astigmatism of 1.00 diopter or greater in the involved eye. In all but one patient, the minus cylinder axis of the astigmatism coincided with the location of the dermoid. Thirteen patients had surgery to remove the dermoids at ages ranging from 8 months to 15 years. The preoperative astigmatism persisted postoperatively with little change in its orientation or amount regardless of age at the time of surgery.
Ophthalmological Issues in the Neurofibromatoses
Authors: Korf Bruce R
Published: April 2021

ABSTRACT

The neurofibromatoses are a set of at least two distinct disorders characterized by the development of nerve sheath tumors and diverse other features. Both are genetically determined as autosomal dominant traits, and both genes have been identified, with resultant major insights into pathogenesis. The neurofibromatoses have prominent effects on the visual system, which are important both for diagnosis and clinical management. This review focuses on clinical aspects of the neurofibromatoses, highlighting ophthalmological issues and recent advances in molecular genetics.
A Sweep VEP Test for Color Vision Deficits in Infants and Young Children
Authors: Ver Hoeve James N , France Thomas D , Bousch G Andrew
Published: April 2021

ABSTRACT

Purpose: Color vision testing in young children typically is precluded by the motor and cognitive skills required by standard tests; yet this information can be useful for diagnosis and counseling in many conditions. The purpose of this study is to evaluate a visual evoked potential (VEP) method for assessing red-green color vision anomalies in pediatrie patients.

Method: The relative chromatic luminance (C=R/R+G) of a rapidly reversing red-green checkerboard was varied across a wide range within a short viewing period (10 sec). Swept-parameter VEP methods were used to measure the cortical response to the range of C presented.

Results: Individuals with normal color vision exhibit a VEP response that exceeds noise levels across all values of C, often with an amplitude minima near the photopic equiluminant point (C=0.5). Results from children with established protan and deutan color vision anomalies show loss of VEP amplitude and phase at values of C consistent with the respective color defect. A patient with achromatopsia showed a generalized depression of VEP response across all values of C tested.

Conclusion: Color sweep VEP techniques appear promising for the clinical assessment of color status in pediatric patients.
Magnetic Resonance Imaging in Evaluation of Congenital and Acquired Superior Oblique Palsy
Authors: Özkan Seyhan B , Aribal M Erkin , Sener Emin Cumhur , Sanaç Ali Sefik , Gürcan Fazila
Published: April 2021

ABSTRACT

Background: According to the recently popularized classification of superior oblique (SO) palsy based on congenital variations of the tendon, the primary pathology is the abnormality of the SO tendon rather than an innervational problem in congenital cases. If this hypothesis is true, denervation atrophy of SO muscle should not occur In patients with congenital SO palsy.

Methods: Eight patients with traumatic and nine patients with definite congenital SO palsy underwent magnetic resonance imaging (MRI) of the orbit. SO muscle width and cross-sectional area measurements were taken from coronal images and compared with the clinically uninvolved superior oblique muscles.

Results: Atrophy of varying degrees was observed in the SO muscle both in congenital and acquired cases. No significant difference was found in the appearance of the SO muscle between acquired and congenital SO palsy groups.

Conclusion: We have been unable to demonstrate abnormalities of the SO tendon in both groups. The MRI appearance of the SO muscle suggested that in congenital SO palsy, the pathology is not limited to the tendon; there also is an abnormality of the muscle itself.
Suppression of Vestibular Nystagmus by Forced Convergence in Normal Human Subjects
Authors: Shirado Osamu , Gizzi Martin , Harper Harry , Wang Weijia
Published: April 2021

ABSTRACT

Background: It has been suggested that the principal mechanism of nystagmus suppression in the nystagmus blockage syndrome is either adduction of the eye or convergence. We examined this issue using the nystagmus of the vestibulo-ocular reflex (VOR) as a model.

Methods: A motorized, computer-controlled rotary chair was used to produce VOR in darkness, using either sinusoidal or velocity step stimulation. Left eye position was monitored and horizontal slow-phase eye velocity was calculated. Subjects were cued to converge or perform other gaze tasks.

Results: Convergence suppressed nystagmus. With sinusoidal stimulation, nystagmus was nearly extinguished in extreme lateroversion, probably due to mechanical tethering of the eye. However, VOR gain suppression of 47% during convergence was observed even when the monitored eye was close to primary position. With velocity step stimulation, nystagmus was nearly extinguished at moderate angles of adduction.

Conclusions: Convergence is sufficient to suppress nystagmus, without vision and without regard to whether the eye is adducted.
Subnormal Binocular Vision in the Williams Syndrome
Authors: Olitsky Scott E , Sadler Laurie S , Reynolds James D
Published: April 2021

ABSTRACT

Purpose: Patients with Williams syndrome have been found to have a high prevalence of strabismus. This may be due to a primary sensory abnormality. The purpose of this study was to determine the prevalence of subnormal binocular vision in patients with Williams syndrome.

Methods: Patients being followed in an interdisciplinary Williams syndrome clinic were prospectively evaluated to determine their binocular status.

Results: Eleven patients with Williams syndrome underwent an ophthalmologic evaluation. Twenty-seven percent of patients had strabismus (3/11). Eight patients demonstrated no measurable strabismus. Six of these patients were found to have monofixation syndrome.

Conclusions: There is a high prevalence of subnormal binocular vision in Williams syndrome. This subnormal binocular vision may explain the high prevalence of strabismus in this syndrome.
Retinal Perforation in Strabismus Surgery
Authors: Noel Leon-Paul , Bloom Jeffrey N , Clarke William N , Bawazeer Ahmed
Published: April 2021

ABSTRACT

Purpose: Perforation of the retina is a major complication of strabismus surgery. The reported incidence of perforation varies from 0.13% to 12%. This study was undertaken to determine, from a large collaborative database, the incidence of suspected and unsuspected retinal and choroidal injury in pediatrie horizontal muscle surgery.

Method: All children with horizontal strabismus surgery seen between September 1992 and October 1995 were examined with indirect ophthalmoscopy immediately following their procedure. Surgery was performed by both resident and attending physicians. Cases involving muscle reoperation, high myopia, or patients with connective tissue disorders were excluded.

Results: Strabismus surgery was performed on 765 patients, who underwent 1 129 muscle recessions and 349 muscle resections. These children also had 161 vertical or oblique muscle procedures performed. Intraocular trauma resulting from horizontal muscle surgery was noted in 14 patients, including three retinal perforations. One of these patients was treated with cryotherapy; the other two received no therapy other than intraoperative and postoperative antibiotics.

Discussion: The incidence of retinal perforation was 0.4% and the incidence of choroidal injury without perforation was 1.4% in this large series of children undergoing horizontal strabismus surgery. Retinal detachment or endophthalmitis did not develop during the 6week follow-up period.
Spectrum of Pediatric Dacryocystitis: Medical and Surgical Management of 54 Cases
Authors: Campolattaro Brian N , Lueder Gregg T , Tychsen Lawrence
Published: April 2021

ABSTRACT

Background: Dacryocystitis in infants and older children is a serious complication of congenital or acquired nasolacrimal duct obstruction. To define the modes of presentation and treatment strategies of this disorder better, we reviewed the clinical courses of 54 children treated for dacryocystitis at St Louis Children's Hospital.

Methods: Clinical, neuroradiologic, and laboratory data were collated for all cases of dacryocystitis treated from 1990 to 1995. Average follow up of the children in this consecutive series was 1.75 years (range, 4 months to 5 years).

Results: Of the 54 patients, 36 (67%) had chronic lowgrade dacryocystitis, which was treated with nasolacrimal duct probing on an outpatient basis. The remaining 18 patients (33%) had acute dacryocystitis, which was treated with a combined medical/surgical strategy. Medical treatment consisted of hospital admission for administration of intravenous antibiotics followed by inpatient surgery, which varied according to the age of the patient and the clinical history: 1) Acute dacryocystitis in neonates was treated surgically by nasolacrimal duct probing and nasal endoscopy for excision of intranasal duct cyst; 2) Acute dacryocystitis with periorbital cellulitis was treated surgically by nasolacrimal duct probing; 3) Acute dacryocystitis due to facial trauma was treated surgically by dacryocystorhinostomy and stent placement; and 4) Acute dacryocystitis complicated by orbital abscess was treated by inferior orbitotomy for orbital abscess drainage, simultaneous nasolacrimal duct probing, and stent placement.

Conclusion: Dacryocystitis in the pediatrie population may present in either chronic or acute forms. An effective and safe treatment for acute dacryocystitis is hospital admission, both for administering intravenous antibiotics and monitoring to rule out orbital cellulitis or abscess formation. Intravenous antibiotic therapy is followed within a day or two by surgery tailored to the clinical history. In the majority of both chronic and acute cases, nasolacrimal duct probing appears to be an effective treatment strategy.
Diplopia Following Subcutaneous Injections of Botulinum A Toxin for Facial Spasms
Authors: Wutthiphan Sorot , Kowal Lionel , O'Day Justin , Jones Stephen , Price Jane
Published: April 2021

ABSTRACT

Purpose: To study the incidence, cause, recovery time, and prevention of diplopia following subcutaneous injection of botulinum A toxin for the treatment of facial spasms.

Methods: Patients who experienced diplopia after botulinum A toxin injections had their deviations examined in detail. When the muscle that caused diplopia was identifiable, the injection closest to that muscle was omitted in the next treatment in an attempt to prevent diplopia.

Results: Of 250 patients receiving about 1500 sets of injections, 25 (1.7%) incidents of diplopia occurred in 10 patients. Excluding two patients who declined further treatment after having diplopia on their first botulinum A toxin treatment, seven of the remaining eight patients had multiple incidents of diplopia. The most common pattern of diplopia was "uncertain diagnosis." The most common identifiable cause of diplopia was paresis of the inferior oblique muscle. Omission of the injection into the central portion of the lower eyelids in the next treatment prevented recurrence of diplopia in only one of the four patients. No significant correlation between botulinum A toxin doses injected and times to recovery was noted.

Conclusions: Diplopia following botulinum A toxin treatment is uncommon. Seven patients (3% of patients studied) had 22 episodes of diplopia (88% of episodes). When diplopia occurs, it tends to recur on reinjection, sometimes with a prolonged recovery time. This response may not be dose dependent. The extraocular muscles of some patients may be more susceptible to chemodenervation than others, or botulinum A toxin may diffuse to extraocular muscles more easily in some patients than in others.
Retinopathy of Prematurity in Infants Less Than 29 Weeks' Gestation: 3x/£ Years Pre- and Postsurfactant
Authors: Kennedy John , Todd David A , Watts Jane , John Elizabeth
Published: April 2021

ABSTRACT

Objective: To determine the effects of surfactant on retinopathy of prematurity (ROP).

Design: YJe compared infants for VA years both before and after the introduction of surfactant in our neonatal intensive care unit (NICU) using prospectively collected data. Exogenous surfactant (Exosurf) was introduced into our NICU on July 1, 1991.

Methods: We compared the incidence and severity of ROP in two groups of infants born at less than 29 weeks' gestation who required cryo- or laser therapy. Premature infants born during the first 3% years following the introduction of surfactant were compared with those born during the 31/2-year period prior to its introduction. The infants were examined by one ophthalmologist (J.K.) and classified according to the International Classification of ROP.

Results: A total of 124 infants born presurfactant and 152 infants born postsurfactant were examined for the presence of ROP. No significant difference between the two groups regarding any stage of ROP or the necessity for treatment was found. In infants of less than 27 weeks' gestation, a significant reduction In the number requiring cryo- or laser therapy was noted (12 of 48 examined [25.0%] vs 6 of 62 examined [9.7%], respectively; P<0.05).

This decreased need for treatment, however, was found in infants without hyaline membrane disease who did not receive surfactant.

Conclusion: Exosurf has had no significant impact on the incidence or severity of ROP. Due to its effect on improved survival rates, the surfactant produces a larger proportion of infants at risk of developing ROP. Other changes in NICU protocol may be causing a reduction in the incidence of severe ROP.
Cortical Visual Impairment Following Perinatal Hypoxia: Clinicoradiologic Correlation Using Magnetic Resonance Imaging
Authors: Casteels I , Demaerel P , Spileers W , Lagae L , Missotten L , Casaer P
Published: April 2021

ABSTRACT

Purpose: To evaluate the value of magnetic resonance Imaging (MRI) in the visual prognosis of cortical visual impairment following perinatal hypoxia.

Methods: MRI findings of 19 babies with the diagnosis of a perinatal hypoxic-ischemic insult and cortical visual impairment (CVI) were reviewed. Two groups of patients based on gestational age were compared. Babies with a gestational age s*34 weeks were included in group 1(n=8). Infants <34 weeks' gestation were included in group 2 (n=11). All 19 children underwent MRI.

Results: Normal MRI always correlated with better visual outcome, regardless of the gestational age at which the insult occurred. Among infants born at or later than 34 weeks' gestation, a favorable visual recovery occurred in two with normal MRI findings. The presence of infarcts or periventricular leukomalacia indicated that full visual recovery would not occur. Among infants born before 34 weeks' gestation, the MRI findings were normal in two who had a favorable visual outcome. A normal visual cortex and the absence of periventricular leukomalacia were helpful in prognostieating the visual outcome. A general delay in the myelination - particularly in the myelination of the optic radiation - was a common finding and until now has not been described in children with CVI routinely.

Conclusion: MRI's ability to follow the process of myelination may be of predictive value. MRI, therefore, should be obtained in a child with CVI following perinatal hypoxia.
Tuberous Sclerosis in Infancy
Authors: Mullaney Paul B , Jacquemin Claude , Abboud Emad , Karcioglu Zeynel A
Published: April 2021

ABSTRACT

Purpose: To report two infants with tuberous sclerosis who initially were considered to have retinoblastoma.

Patients and Methods: An 8-day-old infant was referred with small tumors in the posterior poles of both eyes. A left microphthalmos with ciliochoroidal coloboma was present. Computed tomographic (CT) scanning of the brain showed scattered high-density subependymal foci in the lateral ventricle thought to be consistent with calcification resulting from intrauterine viral infection. Argon laser photocoagulation was applied to lesions in the right eye. Because one tumor was situated on the retina straddling the coloboma in the left eye, external beam radiotherapy was administered.

A 5-month-old girl presented with a large mass in a left microphthalmic eye. Calcification was present on B-scan ultrasonography and CT scanning. Vitreous seeding was noted to originate from the tumor. The contralateral eye manifested four small gray translucent retinal tumors in the posterior pole. CT scan and magnetic resonance imaging (MRI) revealed multiple periventricular subependymal lesions, including one at the foramen of Monro.

Results: Repeated examinations in the younger child under anesthesia revealed small new retinal lesions that appeared to enlarge gradually. She developed intractable seizures and her electroencephalogram revealed a modified hypsarrhythmia recording. A careful review of available CT scans and MRI displays suggested the diagnosis of tuberous sclerosis. The child's most recent examination under anesthesia revealed multiple newly developed hamartomas. In the older child, prompt diagnosis was made on the basis of the intracranial radiologie findings.

Conclusion: Retinal hamartoma presentation may vary in infancy. Small, initially fleck-like gliotic lesions appear to enlarge gradually and eventually may form gray, translucent tumors. Large astrocytic hamartomas of the retina associated with tuberous sclerosis may resemble retinoblastoma, particularly if the mass is large, calcified, and associated with vitreous seeding. Although ophthalmic presentation was reminiscent of retinoblastoma in both patients, radiologie evidence of subependymal hamartomas pathognomic for tuberous sclerosis helped establish the correct diagnosis. We stress the importance of intracranial radiologic findings in this regard.
A Comparison of Prophylactic Ondansetron Hydrochloride and Droperidol for Strabismus Repair in Adults
Authors: Doe Erin A , Jones Perry , O'Hara Mary A
Published: April 2021

ABSTRACT

Background: Prophylactic administration of an antiemetlc is a common procedure for patients undergoing strabismus surgery. Droperidol and ondansetron hydrochloride are commonly used antiemetlcs. This study compared the rates of postoperative nausea and vomiting (PONV) in adult patients undergoing strabismus surgery with prophylactically administered Droperidol or ondansetron hydrochloride.

Methods: A double-masked, randomized, prospective study was conducted comparing droperidol with ondansetron hydrochloride when administered prophylactically to adults undergoing strabismus surgery.

Results: Forty-five patients entered the study with a mean age of 30 years. Twenty percent of patients had nausea immediately postoperatively and 37% had nausea before discharge with no significant differences between groups. Overall rate of emesis, time in the recovery room, and time to discharge was not significantly different between the droperidol and ondansetron hydrochloride group.

Conclusion: No real differences in the ability to prevent PONV between the two medications were found in this study.
Sarcoidosis Presenting as Multilobular Limbal Corneal Nodules
Authors: Hegab Samiha M , Al-Mutawa Samia A , Sheriff Sayed M
Published: April 2021

ABSTRACT

Purpose; To review reported external ocular manifestations of sarcoidosis and to present bilateral, m u It i lobular, nodular, limbal, corneal nodules as being a unique manifestation of the disease.

Patients and Methods: A 16-year-old Saudi girl presented with bilateral, multilobular, solid, limbal nodules, with a vascular supply from the conjunctiva! vessel, and associated membraneous conjunctivitis and healed trachoma. The Schirmer's test revealed less than 2 mm in both eyes with tear meniscus less than 2 mm. Biopsy of an associated palpebrai conjunctiva! nodule was performed, in addition to a gallium scan, chest X-ray, and a serum angiotensin-converting enzyme (SACE) level.

Results: The culture showed ß-hemolytlc streptococci. Gallium scan showed intake by both lacrimal glands. Her chest X-ray results were normal, as was the SACE level. Biopsy of the excised conjunctiva! nodule disclosed a noncaseatlng granulomatous reaction with epithelioid and giant cells, and chronic inflammatory cell infiltrate confirming a diagnosis of sarcoidosis.

Conclusion: A multilobular, nodular, perilimbal mass as a unique manifestation of sarcoidosis is presented. A streptococcal membraneous conjunctivitis and heated trachoma superimposed. A review of sarcoidosis of the external eye is included.