bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual Results of Lens-Sparing Vitreoretinal Surgery in Infants
Authors: Maguire Albert M , Trese Michael T
Published: April 2021

ABSTRACT

Lens removal is routinely performed when vitreoretinal surgery is done in infant eyes. We performed vitreous surgery in nine infants (10 eyes) without removing the crystalline lens. Surgery was done to correct vitreoretinal pathology involving the macula. Indications for surgery included: 1) tractional retinal detachment secondary to retinopathy of prematurity, familial exudative vitreoretinopathy, or congenital retinal folds; and, 2) nonclearing preretinal hemorrhage secondary to shaken-baby syndrome. Surgical objectives were achieved in all cases. Postoperatively, 8 of 10 eyes showed no evidence for lens opacification with a median follow-up period of 8 V2 months (range, 5 to 19 months). Two eyes with retrolental adhesions due to stage 5 retinopathy of prematurity developed progressive cataracts and light perception vision. Six of seven eyes without lens opacity had vision of 20/2400 or better (median = 20/800) as measured by Teller acuity methods. Lens-sparing surgery may be performed with favorable anatomic and functional results in eyes with vitreoretinal disease posterior to the equator. Lens preservation may optimize optical rehabilitation and stimulation of the developing visual system.
The Ophthalmologic Manifestations of the Cardio-Facio-Cutaneous Syndrome
Authors: Young Terri L , Ziylan Sule , Schaffer David B
Published: April 2021

ABSTRACT

The cardio-facio-cutaneous (CFC) syndrome is an uncommon multiple congenital anomalies/mental retardation syndrome whose major manifestations are congenital heart defects, relative macrocephaly, stunted growth, ectodermal dysplasia, characteristic facial appearance, and psychomotor developmental delay. All described cases were sporadic and cytogenetically normal. We report three additional patients with this diagnosis. All three patients developed strabismus, requiring extraocular muscle surgery. Two of our patients also had nystagmus. Combining the 18 previously reported cases with our additional 3, 9 of 21 had strabismus, 10 of 21 had ptosis, and 6 of 21 had nystagmus. Ophthalmic craniofacial abnormalities of hypoplastic supraorbital ridges, prominent epicanthal folds, and antimongoloid slant of the palpebral fissures were also common features contributing to the characteristic facies described for this syndrome. The ophthalmologist could aid in the diagnosis and treatment of these patients because of the prominent ophthalmologic symptomatology of the CFC syndrome.
Ophthalmic Features of Alagille Syndrome (Arteriohepatic Dysplasia)
Authors: Wells K K , Pulido Jose S , Judisch G F , Ossoinig K C , Fisher T C , Labrecque D R
Published: April 2021

ABSTRACT

Eight patients with Alagille syndrome (AGS) are reported. In addition to previously reported findings of posterior embryotoxon, pigmentary retinopathy, and choroidal folds, new findings include decreased axial eye lengths, small corneal diameters, and shallow anterior chambers. Optic disc swelling was noted ophthalmoscopically and abnormally increased orbital subarachnoidal fluid was detected through measurements of the arachnoidal diameters with standardized echography.
Insertion Site Dynamics and Histology in a Rabbit Model After Conventional or Suspension Rectus Recession Combined With Ipsilateral Antagonist Resection
Authors: Hertle Richard W , James Milton , Farber Martha G
Published: April 2021

ABSTRACT

We have used a rabbit model to study insertion movement, rotational forces, disinsertion forces, and histology of the surgically created insertion site after recession of the inferior rectus (IR) using a conventional (CONV) or suspension (SUS) technique combined with an ipsilateral superior rectus (SR) resection. During the 5-week observation period, the CONV and SUS recessed IR showed an initial posterior movement followed by an anterior movement while all resected SR had an initial posterior movement which remained stable. SR rotational forces increased and IR remained constant throughout the 5-week observation period. There were no rotation force differences between the SUS and CONV recession techniques. Disinsertion forces showed an initial large decrease in force followed by a gradual increase to preoperative levels by 3 postoperative weeks. Disinsertion force differences between the CONV and SUS recessions were observed for 5 weeks after surgery. Histologic analysis showed a delayed inflammatory response on the SUS recession compared to the CONV recession and at the middle of the insertion compared to the poles which was minimized by 3 weeks after surgery.
Aneurysmal Bone Cyst: Report of a Case Mimicking Orbital Tumor
Authors: Bealer A , Cibis Gerhard W , Barker Bruce F , Egelhoff John C , Freeman Arnold I , Zwick David A
Published: April 2021

ABSTRACT

Aneurysmal bone cysts are rare bone tumors which normally affect the vertebral region or long bones. Involvement of facial bones is uncommon. Although nonneoplastic, these lesions are expansile and may cause local destruction of bone and soft tissues. When making the diagnosis, it is imperative to consider the clinical, radiologic, and histologic features of the entity to avoid confusion with other possibly malignant giant cell tumors. We report an unusual case involving the orbit in a 2 ½-year-old girl.
A New VEP System for Studying Binocular Single Vision in Human Infants
Authors: Skarf Barry , Eizenman Moshe , Katz Laurence M , Bachynski Brian , Klein Raphael
Published: April 2021

ABSTRACT

Visual evoked potentials (VEPsX that provide unequivocal objective evidence of cortical binocularity have been recorded from adults and young infants using a new VEP system developed for this purpose. The system uses alternating field stereoscopy (AFS) to present separate visual stimuli to each eye. With this system, the binocular image pairs to the right and left eyes alternate at a high rate on a single video monitor. The subject wears spectacles incorporating lightscattering liquid crystal lenses which alternate electronically between opaque and clear modes in synchrony with the video monitor. To detect cortical binocularity, the system analyzes VEP activity mathematically and identifies significant responses at test frequencies reflecting binocular cortical interactions exclusively. Three types of binocular stimuli were presented: (1) dynamic random dot correlograms (correlograms); (2) dynamic random dot stereograms (stereograms); and (3) dichoptic checkerboard stimuli. The correlograms are generated when moving random dot patterns presented to each eye alternate between two phases, correlated and anticorrelated. With the stereograms, portions of random dot patterns presented to each eye are shifted horizontally relative to each other at a fixed rate, alternately producing crossed and uncrossed binocular disparities. Subjectively, these patterns appear to shift in depth. Dichoptic checkerboard stimuli are regular checkerboard patterns which reverse at different rates (frequencies) for each eye. Binocular VEPs are generated due to cortical interactions at the difference (beat) frequency. Using this VEP system, we have recorded binocular VEPs from 10 normal adults and more than 40 infant subjects. Responses to the correlograms, which we believe reflect binocular fusion, have been detected as early as 5 weeks of age, while responses to the stereograms, which require sensitivity to disparity changes, have been recorded in babies as young as 12 weeks.
Predicting Visual Acuity in Children With Colobomas Involving the Optic Nerve
Authors: Olsen Timothy W , Summers C Gail , Knobloch William H
Published: April 2021

ABSTRACT

Background: This study evaluates the relationship to visual acuity of four ophthalmoscopic features of colobomas involving the optic nerve. The goal was to identify those features that could predict potential visual acuity of children with these colobomas.

Methods: Fundus photographs of 23 eyes with colobomas involving the optic nerve met the entry criteria and were evaluated by two masked observers. The following features were evaluated: coloboma size, optic nerve color, foveal development, and subfoveal retinal pigment epithelial changes. Simple linear regression was used to identify the feature that most closely correlated with visual acuity. Refractive status was assessed by cycloplegic refraction.

Results: The only component that correlated with the development of good visual acuity was the degree of foveal involvement by the optic nerve coloboma (P=.002, R=0.8). Significant refractive error and anisometropia were common in patients with colobomas involving the optic nerve.

Conclusion: Central visual acuity in children born with colobomas involving the optic nerve correlates with the development of normal foveal anatomy, regardless of the size of the coloboma, the color of the optic nerve, or the presence of subfoveal pigmentary changes. Because refractive error is common, these children should receive an accurate refraction and amblyopia treatment.
Infantile Exotropia
Authors: Biglan Albert W , Davis John S , Cheng Kenneth P , Pettapiece Milton C
Published: April 2021

ABSTRACT

Background: Exotropia is uncommon in healthy children between 6 months and 1 year old.

Methods: The charts of patients treated in our practice between January 1980 and August 1994 were reviewed for a diagnosis of infantile exotropia. All of them had an exodeviation during the first year of life. Children with neurologic defects, prematurity, trauma, craniofacial syndromes, or orbital abnormalities or ocular defects that would reduce vision were eliminated.

Results: Sixty-six healthy patients with normal eyes had an exodeviation of 15 prism diopters (?) or more that persisted through the first year of life. Fifty-four were eliminated because the diagnosis had not been confirmed by a pediatric ophthalmologist before they were 1 year old or they had not been followed for more than 4 years. The 12 remaining patients were followed for at least 4 years (mean, 7.9 years).

The mean age at the first examination was 7.8 months (range, 4 to 12 months). On early evaluation, exotropia was intermittent in four and constant in eight. Three had amblyopia. Ten required surgical correction. Exotropia was corrected with one operation in six patients; four required additional procedures, mostly to correct oblique muscle overaction and dissociated vertical deviation (DVD). At the most recent visit, all 12 patients had equal visual acuity in both eyes and satisfactory ocular alignment. Five had fusion at distance and near, but only two had stereo acuity of 100 seconds of arc or better.

Conclusion: Infantile exotropia is rare. But, like patients with infantile esotropia, those with exotropia can be expected to have good visual acuity but unstable ocular alignment. Also, as with early-onset esotropia, although surgical intervention is usually required, high levels of binocular function develop in some patients with exotropia. Oblique muscle overaction and DVD are common, often becoming manifest by the first year of age. Unlike infantile esotropia, nystagmus is rare.
Evaluation of Mitomycin to Limit Postoperative Adhesions in Strabismus Surgery
Authors: Cruz Oscar A
Published: April 2021

ABSTRACT

Background: Ocular motility dysfunction following strabismus surgery may be the result of postoperative scarring or the formation of adhesions. Mitomycin C (MMC) has been used with encouraging results as an adjunct to standard treatment of hypertrophic conjunctival scars after strabismus surgery. It has been demonstrated that MMC does not inhibit muscle reattachment and might inhibit adhesions and scar formation in the rabbit. We investigated in a rabbit model the effectiveness of MMC in reducing the formation of postoperative adhesions following reoperations and the tensile strength of the new musculo-scleral junction.

Methods: A prospective, masked-observer, controlled study was performed in rabbits. Symmetrical bilateral recessions of the superior and inferior rectus muscles were performed on each rabbit. A reoperation was performed 6 weeks later, in which the muscles were advanced back to their original insertion. During the reoperation, one eye served as the control while the other was treated with a 5-minute intraoperative exposure to topical mitomycin.

Results: Mitomycin reduced the formation of adhesions and the amount of postoperative scarring. The tensile strength of the musculo-scleral junction was reduced in the mitomycin-treated eyes but exceeded the force generated during extraocular auctions.

Conclusion: MMC may be an effective adjunctive therapy in the treatment of strabismus associated with preexisting adhesions or scarring.
Bagolini Lenses vs the Polarized Four-Dot Test
Authors: Arthur Brian W , Cake Sue
Published: April 2021

ABSTRACT

The applicability and accuracy of two minimally dissociative sensory tests were compared in a pediatric ophthalmology clinic. The Polarized Four-Dot (P4D) test and Bagolini striated lenses (BAG) were used to evaluate 133 patients who were at least 3 years old. The outcomes measured were test failure rate and mean age of the test failures. Test sensitivity and specificity were determined using the distance vectograph as a reference.

The failure rate for the BAG test, 14%, was significantly higher than that for the P4D test, 5% (P = .0005). The mean age of the test failures also was higher for the BAG test (4.7 vs 3.8 years). Both sensitivity and specificity for the detection of central suppression were greater using the P4D test.

The P4D test is simple to use, widely applicable, and accurate in the detection of peripheral fusion, central fusion, or suppression, without the confounding colors of the Worth Four-Dot test. We recommend the P4D test as the test of choice for routine evaluation of binocular fusion status.
Clinical Optokinetic Nystagmus Asymmetry in Treated Esotropes
Authors: Wright Kenneth W
Published: April 2021

ABSTRACT

Background: Monocular optokinetic nystagmus (OKN) asymmetry is associated with disruption of early binocular visual development.

Methods: Three groups of treated esotropie patients and a group of normal controls were evaluated for the presence of clinically detectable monocular OKN asymmetry. Clinical assessment of monocular OKN asymmetry was performed by observing eye movements in response to a hand-held rotating drum. Asymmetry was quantitated on a scale of 0 to +3 OKN asymmetry. Clinical OKN asymmetry was evaluated in the following groups of patients: those with congenital esotropia treated with very early surgery achieving high-grade stereo acuity (group 1); those with congenital esotropia treated with late surgery achieving no stereopsis (group 2); those with acquired esotropia achieving high-grade stereo acuity after treatment with spectacle correction (group 3); and normal controls (group 4).

Results:Two of the three patients in group 1 showed +3 OKN asymmetry despite having high-grade stereo acuity; the third one, who was surgically aligned earliest (13 weeks), demonstrated +1 OKN asymmetry. This patient achieved orthotropia, 40 seconds stereo acuity, perfect Randot stereo acuity, and had no dissociated vertical deviation or latent nystagmus. All 10 patients in group 2 (those with late alignment - after 1 year - and no stereo acuity) showed +3 OKN asymmetry. All four patients in group 3 (those with acquired hypermetropic esotropia and highgrade stereo acuity after treatment) and all 10 patients in the normal control group showed no OKN asymmetry.

Conclusion: Clinically obvious monocular OKN asymmetry can occur in patients with congenital esotropia who are aligned early and develop high-grade stereo acuity. Even brief periods of strabismus during the early period of binocular motor development can result in persistent OKN asymmetry. This suggests that binocular motor processing may develop distinct from, and prior to, the development of high-grade stereo acuity. OKN asymmetry appears to be a clinical sign of an insult to early binocular motor development.
Intact Binocular Function and Absent Ocular Torsion in Children With Alternating Skew on Lateral Gaze
Authors: Hamed Latif M , Maria Bernard L , Briscoe S Trevor , Shamis Diana
Published: April 2021

ABSTRACT

Background: A form of skew deviation, called alternating skew on lateral gaze, resembles bilateral superior oblique overaction. Oblique muscle overaction has been recently speculated to result from loss of fusion with subsequent "free-wheeling" of the torsional control mechanisms of the eyes, causing sensory intorsion or extorsion with attendant superior or inferior oblique muscle overaction, respectively. We wanted to investigate whether loss of fusion plays a role in the pathogenesis of alternating skew on lateral gaze.

Subjects and methods: We examined seven consecutive patients with posterior fossa tumors, enrolled in a multi-disciplinary pediatric neuro-oncology program, who displayed alternating skew on lateral gaze. All patients underwent a thorough ophthalmologic evaluation.

Results: Visual acuities in the study patients ranged from 20/20 to 20/40. Five of the seven patients were orthotropic, and showed 40 sec of arc stereopsis. Three patients showed associated downbeat nystagmus. No ocular torsion was found in any of the five patients who showed normal stereopsis upon inspection of fundus landmarks on indirect ophthalmoscopy.

Conclusion: Patients with alternating skew on lateral gaze often have normal binocular vision and stereopsis, and lack ocular intorsion so typical of superior oblique overaction. Alternating skew on lateral gaze is neurologically mediated, with no role for defective fusion in its pathogenesis.
Surgery for Vertical Head Position in Null Point Nystagmus
Authors: Roberts Eric L , Saunders Richard A , Wilson M Edward
Published: April 2021

ABSTRACT

Purpose: We applied the general concepts of Anderson and Kestenbaum to the management of patients with chin up or chin down head posture caused by vertical or horizontal nystagmus.

Methods: We reviewed retrospective charts of seven patients with vertical plane torticollis who had surgical management of null point nystagmus.

Results: Three patients with chin down head posture underwent successful treatment using large recessions of the superior rectus muscles combined with inferior oblique muscle anterior transposition. The four patients with chin up head posture were more resistant to surgical treatment. Two of the four required multiple surgical procedures for adequate correction, but had residual torticollis.

Conclusion: Bilateral superior rectus muscle recession combined with inferior oblique muscle anterior transposition is effective surgical management of vertical plane torticollis with chin down head posture caused by null point nystagmus. Although the treatment of patients with chin up head posture was less successful, surgically induced down-gaze deficits may be necessary to improve outcome.
Mechanized Anterior Capsulectomy as an Alternative to Manual Capsulorhexis in Children Undergoing Intraocular Lens Implantation
Authors: Wilson M Edward , Saunders Richard A , Roberts Eric L , Apple David J
Published: April 2021

ABSTRACT

Background: Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, it is more difficult to perform in very young eyes because the capsular bag is more elastic. Our mechanized anterior capsulectomy technique has compared favorably with manual capsulorhexis in the laboratory using autopsy eyes. We now report the results of circular mechanized anterior capsulectomy in consecutive pediatric patients receiving a posterior chamber intraocular lens (IOL) after cataract extraction.

Methods: Twenty eyes of 17 consecutive patients between 6 months and 13 years of age underwent a mechanized anterior capsulectomy followed by IOL implantation into the capsular bag. The integrity of the anterior capsular edge was evaluated at the completion of capsulectomy, prior to IOL insertion, and at the end of surgery.

Results: A single radial tear developed in three eyes (15%) of two patients (12%). In the remaining 17 eyes (85%), an intact circular capsulectomy edge was verified at the completion of the mechanized capsulectomy, at the end of IOL insertion, and at the completion of surgery. Complete in-the-bag capsular fixation of the IOL was accomplished in all 20 eyes. Both patients who sustained radial tears were older children (age 11 years). All IOLs remain well centered behind a smooth circular anterior capsular edge after a minimum follow up of 6 months.

Conclusion: A mechanized anterior capsulectomy technique can produce a circular capsular opening that resists tearing during lens aspiration and IOL insertion. The vitrector-cut capsulectomy performed well even in the youngest patients in whom manual capsulorhexis would have been difficult to control.
Corneal Diameter in Childhood Aphakic Glaucoma
Authors: Wallace David K , Plager David A
Published: April 2021

ABSTRACT

Background: Glaucoma occurring after successful cataract surgery in infancy and childhood requires persistence to establish timely diagnosis and presents a therapeutic challenge. Previous studies have sought to identify risk factors, which would aiert the clinician for the likelihood of developing glaucoma after cataract surgery in the young patient. Some risk factors are early age of surgery, microcornea, poor pupillary dilation, retained lens cortex, coexisting ocular anomalies, and cataract type. Other studies did not find these associations. In our experience, the majority of young aphakic glaucoma patients have microcornea. This study was carried out to investigate this association.

Methods: The records were reviewed of all patients treated for aphakic glaucoma between 1991 and 1995 to determine the age at cataract surgery, age at glaucoma surgery, age at glaucoma diagnosis, corneal diameters, and other clinical characteristics.

Results: Forty-eight eyes in 29 patients were identified with aphakic glaucoma. Forty-five of the 48 (94%) eyes were found to have microcornea when compared with the normal corneal diameter for their age.

Conclusion: All children undergoing cataract surgery should have their corneal diameters recorded. Patients with corneal diameters smaller than normal should be followed closely for the development of glaucoma throughout childhood and beyond.
Axial Length Estimation in Strabismic Patients
Authors: Kushner Burton J , Qui Catherine O , Lucchese Neil J , Fisher Marian R
Published: April 2021

ABSTRACT

Background: Previous studies have indicated that axial length determination is important in strabismic patients for defining the limit for a safe maximum recession of the medial rectus. Also, the response to strabismus surgery may be, in part, a function of axial length. We previously published a formula for predicting axial length based on age and refractive error; however, its accuracy has not been tested in a patient population that is different from the one used to generate the formula. The purpose of this study is to test a formula for estimating axial length, given age and refractive error, in a population that is different from that from which it was generated.

Method: We measured axial length using ?-scan ultrasonography in 163 consecutive patients undergoing strabismus surgery. Twenty-nine patients were younger than 18 months of age; 134 patients were between 18 months and 10 years of age. We compared the measured axial length determination with the axial length value estimated by a formula generated from our previous published series.

Results: For patients younger than 18 months of age, the equation estimated axial length within 0.5 mm in 41.4% of patients, within 1.0 mm in 79.3% of patients, and within 1.5 mm in 93.1% of patients. For patients between 18 months and 18 years of age, the formula estimated axial length within 0.5 mm in 37.3% of patients, within 1.0 mm in 73.1% of patients, and within 1.5 mm in 87.3% of patients.

Conclusions: The formula may be useful for the strabismus surgeon in estimating axial length when A-scan ultrasonography is not available in an operating room setting, particularly in congenital esotropes who require larger recessions in small eyes. If, however, A-scan ultrasonography is available, it is preferable to using the formula. The formula is not sufficiently accurate for use for calculating intraocular lens power.
Prevalence of Uveitis in an Outpatient Juvenile Arthritis Clinic: Onset of Uveitis More Than a Decade After Onset of Arthritis
Authors: Akdwnan Levent , Kaplan Henry J , Tychsen Lawrence
Published: April 2021

ABSTRACT

Purpose: To determine the prevalence and severity of uveitis in an outpatient pediatrie arthritis clinic in the midwestern United States during the 1990s.

Methods; The prevalence and clinical characteristics of uveitis were studied retrospectively for all children diagnosed with arthritis at Shriner's Hospital for Crippled Children and followed by the pediatrie rheumatology and ophthalmology units of the St Louis Children's Hospital between 1992 and 1995.

Results: Seven children (9%) developed uveitis in a population of 78 patients with juvenile arthritis. Six of the seven children were female, and all six females had antinuclear antibody (ANA)-positive, juvenile rheumatoid arthritis (JRA). The prevalence of anterior uveitis in females with ANA-positive, pauciarticular JRA was 20%, and in polyarticular JRA, 17%. One of the girls with uveitis had combined JRA and sarcoidosis; the boy with uveitis had juvenile spondylitis. Arthritis preceded the onset of uveitis in each child by 1 to 13 years (average, 6.4 years). Progression of the uveitis in three of the children resulted in band keratopathy and cataract, causing significant visual loss in two (ie, in 29% of the children who developed uveitis).

Conclusion: The prevalence and ocular morbidity of uveitis in juvenile arthritis appears to have remained relatively stable over the last 2 decades. Onset of the uveitis in several of the children in our study population occurred more than a decade after the diagnosis of arthritis. Girls with ANA-positive JRA and boys with juvenile spondylitis may need to be followed by periodic slit-lamp examination for longer periods than recommended previously.
5-fluorouracil Reduces Scarring After Strabismus Surgery
Authors: Andreo Larry K , Uyemura Matthew J , Enzenauer Robert W
Published: April 2021

ABSTRACT

Purpose: To examine the effect of topically administered 5-fluorouracil during strabismus surgery on postoperative scarring and the strength of the tendon-muscle union.

Methods: Bilateral superior and inferior rectus muscle recessions were performed on 10 Sta uff land white rabbits. The operated muscles in one eye received a 5-min topical application of 50 mg/mL solution of 5-fluorouracil (5-FU). The fellow eye received placebo treatment with a 5-min application of balanced sterile saline. Both eyes were enucleated 29 days postoperatively and examined for evidence of scarring. The tensile strength of both treated and untreated muscles was measured. Two additional rabbits received no surgery but had their eyes enucleated to serve as controls for tensile strength measurements.

Results: A significant reduction (P=O. 0001) in the amount of scarring was noted in eyes treated with 5-FU. A reduction in the tensile strength of both operated groups compared with the unoperated groups ( P=2. 72x10 12) was noted, with a small but significant difference between the two operated groups (P=0.0423).

Conclusion: This study suggests that 5-FU may be a useful adjunctive therapy in strabismus surgery, especially when extensive postoperative scarring is expected.
Uniocular Childhood Blindness: a Prospective Study
Authors: Mulvihill Alan , Bowell Roger , Lanigan Bernadette , O'Keefe Michael
Published: April 2021

ABSTRACT

Purpose: This prospective study examines uniocular blindness among children younger than 16 attending a large pediatrie ophthalmology department. The aim was to identify the causes of uniocular blindness and determine how much is preventable. We defined blindness according to the World Health Organization definition of vision worse than or equal to 3/60.

Methods: All children who attended the department and were blind in one eye during the period of the study were included. A history was taken, visual acuity was assessed by an age-appropriate method, and an ocular examination was carried out. When necessary, the child also was seen by an orthoptist or pediatrician.

Results: A total of 71 patients were identified. At the time of diagnosis, the patients varied in age from a few weeks to 15 years. The causes were classified into one of the following diagnostic categories: chromosomal/genetic (8.5%), prenatal (47.9%), perinatal (7.0%), or childhood (36.6%). Many cases are prenatal in origin and are not preventable. Other causes that are difficult to prevent include retinoblastoma, toxocariasis, and trauma. One cause, amblyopia, may be preventable or treatable in most instances if detected early.

Conclusions: Most cases of uniocular blindness are not preventable; however, protective glasses should be encouraged to prevent injury to the good eye.
Transscleral Diode Laser Cyclophotocoagulation for Refractory Pediatric Glaucomas
Authors: Bock Charles J , Freedman Sharon F , Buckley Edward G , Shields M Bruce
Published: April 2021

ABSTRACT

Purpose: To evaluate the success of contact transscleral cyclophotocoagulation (TDC) in patients with refractory pediatric glaucomas.

Methods: Twenty-six eyes of 20 patients with therapyresistant pediatric glaucomas were included in this retrospective study. Subgroup analysis was performed for patients 10 or younger and patients older than 10 at time of first TDC procedure. Diode laser cyclophotocoagulation was applied using a fiber optic G-probe. Follow up until time of failure or for a minimum of 6 months was obtained for all procedures in all eyes. Failure was defined as intraocular pressure (IOP) greater than 21 mm Hg, repeat of TDC due to clinically inadequate IOP control, progression to another procedure, or serious complication.

Results: Baseline mean pretreatment IOP was 34.2 ± 10.4 mm Hg (range, 15 to 62 mm Hg). Ten of 26 eyes (38%) were successful 6 months after initial TDC. A mean decrease in IOP of 10.3 ± 14.7 mm Hg was noted after the first procedure (F<0.05). Eighteen eyes (70%) were retreated at least once. The mean decrease in IOP for all patients after all procedures was 12.9 ± 13.4 mm Hg (P<0.001). This represents a mean percent decrease in IOP of 33.2 ± 6.9%. The overall success rate was 50%, including retreated patients. The younger and older subgroups did not differ with regard to overall success, time to failure, or retreatment rate. One patient suffered a retinal detachment. Visual loss was noted in 4 of 22 eyes with reliable visual acuity measurements.

Conclusion: TDC is an effective means of decreasing IOP in some patients with refractory pediatric glaucomas. Although the retreatment rate is high, the procedure generally is well tolerated with few complications.
Effects of Strabismus Surgery on Corneal Topography
Authors: Nardi Marco , Rizzo Stanislao , Pellegrini Guglielmo , Lepri Antonio
Published: April 2021

ABSTRACT

Background: Changes in refraction follow surgery on the extraocular muscles. We examined corneal topography before and after medial or lateral rectus muscle recession using a computer-assisted topographic analysis system.

Methods: A total of 36 patients (52 eyes) were examined. Measurements were taken 1 day before surgery and 1, 15, and 30 days after surgery.

Results: A significant change in astigmatic power was detected 1 day after surgery in the meridian of the recessed muscle, evidencing a localized flattening of the cornea. Induced astigmatism decreased over time. At 30 days following surgery, 6% of patients evidenced a residual change higher than 1 diopter (D); 12% evidenced a residual change higher than 0.5 D.

Conclusion: The increase of astigmatic power recorded 1 day after surgery is higher for medial rectus muscle recession than for lateral rectus muscle recession. Corneal topography changes, located mainly in the meridian of the recessed muscle and the optical zone, are greatly reduced or gone within 1 month of surgery.
Infantile Lensectomy and Intraocular Lens Implantation With Long-term Follow up in a Monkey Model
Authors: Lambert Scott R , Aiyer Akhila , Grossniklaus Hans
Published: April 2021

ABSTRACT

Purpose: To report the long-term clinical and histopathologic findings in infant monkeys following a lensectomy and intraocular lens (1OL) implantation using two different surgical techniques.

Methods: A lensectomy and IOL implantation was performed on the right eye of 10 infant monkeys. A posterior capsulotomy was performed using a limbal approach in 5 monkeys (Group 1), and a pars plana approach in 5 other monkeys (Croup 2). The residual refractive error in the pseudophakic eye was then corrected with a contact lens and the fellow eye was occluded for 70% of the daylight hours. The monkeys were then examined at regular intervals for 2 to 4 years. Visual acuity was assessed using opérant testing and sweep visual evoked potentials (VEPs). At the end of the study, the pseudophakic eyes were studied histopathologically.

Results: The only complications that required reoperation were diaphanous fibrin membranes on the lens optic (n=10) and lens reproliferation into the pupillary space (n=5). The visual outcome was similar in Groups 1 and 2, with better acuities in the phakic eyes compared with the pseudophakic eyes. A higher percentage of both haptics were found in the capsular bag for the monkeys in Group 2 (n=3) than in Group ? (n=1 ).

Conclusions: Although haptic placement was superior using a pars plana approach to perform the primary posterior capsulotomy, no clinically discernable difference was noted in IOL centration between the monkeys undergoing a limbal versus a pars plana posterior capsulotomy and no difference was noted in the visual outcome.

Journal of Pediatrie Ophthalmology and Strabismus 1999;36:271-278.
Congenital Nasolacrimal Duct Obstruction: Therapeutic Management
Authors: Chiesi Carlo , Guerra Roberto , Longanesi Lora , Fornaciari Mirella , Morano Riccardo Pignatti
Published: April 2021

ABSTRACT

Purpose: Congenital nasolacrimal duct obstruction is a common condition, and its diagnosis must be based more on regular in-time epiphora than mattering. The purpose of this study is to better define the diagnostic criteria and therapeutic strategy.

Methods: We have retrospectively evaluated 1563 subjects treated from 1990-1997 at the Pediatrie Ophthalmological Service of Modena University Eye Clinic. The mean age at first examination was 5.7 months. According to symptoms and age, patients were treated with antibiotic therapy, office probing, or general anesthesia probing. Recovery was confirmed only after a 3month symptom-free period.

Results: More than 29% of patients recovered spontaneously or with topical antibiotic therapy. Office probing reduced the number of patients who needed a general anesthesia probing (from 62.97% from 1990-1993 to 33.61% from 19941997). In the period from 1994-1997, we changed the technique and especially the age of patients, obtaining a clearing of the obstruction in about 86% of cases compared with a 39% rate in the earlier period. Since 1994, in cases of general anesthesia probing, we have used a midazolam and ketamine anesthesiologic technique that has reduced risks and increased parental satisfaction and cost-effectiveness. Also, our data show that age at first attempt highly influenced probing failure rate.

Conclusion: If the first ophthalmologic examination is precocious and correctly timed, the possibility of curing the patient using the simplest method is increased. Better results can be obtained with cooperation among pediatricians, ophthalmologists, and anesthesiologists.

Journal of Pediatrie Ophthalmology and Strabismus 1 999;36:326-330.
Intravitreal Ranibizumab for Choroidal Neovascularization in Best’s Vitelliform Macular Dystrophy in a 6-Year-Old Boy
Authors: Heidary Fatemeh , Hitam Wan Hazabbah Wan , Ngah Nor Fariza , George Tara Mary , Hashim Hanizasurana , Shatriah Ismail
Published: April 2021

A 6-year-old boy with a family history of Best’s vitelliform macular dystrophy presented with a unilateral choroidal neovascularization. He responded well to a single injection of intravitreal ranibizumab. His visual acuity improved from 6/18 to 6/9 in the affected eye. His condition remained stable for 1½ years after treatment.
Teaching Interpersonal Management for Effective Professional Nursing Practice
Authors: Wyatt Margaret A , Withersty David J
Published: April 2021

ABSTRACT

It isn't enough for us to do what we can do: The patient and his environment, and external conditions have to contribute to achieve the cure.

Hippocrates

The treatment environment is an important component of patient care. In order to provide more effective patient care one would want to be able to manipulate the environment, particularly the emotional environment. This is difficult to do and even more difficult to teach. The authors describe a teaching module in a baccalaureate program in nursing in which didactic sessions and behavioral rehearsal analysis techniques are combined. The goal is to teach interpersonal manipulation for more effective management of professional nursing practice. The results have been promising.
Women and Mental Illness: A Sexist Trap?
Authors: McGrory Arlene
Published: April 2021

Part Two
Childhood Cancer Is A Family Crisis: A Review
Authors: Fife Betsy L
Published: April 2021

ABSTRACT

A diagnosis of childhood cancer has serious implications for the mental health of each family member because families are organized as interdependent units. The impact of the illness is clearly documented by this review of the literature from 1955 to the present, and specific problems relating to the patient, the parents, and the siblings are discussed. A review of studies designed to help families cope with their distress more effectively is also included, and it demonstrates the need for further experimental research in this area if the increased life span of these children is to be worthwhile.
Conflicting Family Culture: An Impediment to Integration in Stepfather Families
Authors: Stern Phyllis Noerager
Published: April 2021

ABSTRACT

Conflicts over value systems in individual family culture impede integration. Family cultural clashes are resolved more frequently when stepfather-child affiliation accompanies the process. Nursing implications include suggestions for stepfamily classes.
Postadolescent Onset: MALE ANOREXIA
Authors: Kiecolt-Glaser Janice , Dixon Katherine
Published: April 2021

While other anorexies appear to cope with their feelings of inadequacy by diligent effort, postadolescent onset males seem to withdraw from any competition, even the challange of everyday living.
CLIENT SKILLS: NON-VERBAL DECODING
Authors: Marlowe Herbert A , Marcotte Ann
Published: April 2021

Non-verbal behavior appears to be a common area of skill deficiency for the chronically mentally ill. Accurately interpreting non-verbal cues of emotion can be a valuable social perception skill for such people.
Can Training Do the Job?
Authors: Welt Sheila Rouslin
Published: April 2021

Another view on "Non-verbal Decoding"
HUMOR & Seif-Disclosure Within the Milieu
Authors: Warner Sandra L
Published: April 2021

. . .A Funny Thing Happened on the Way to Self-Actualization. . .
BROCHURE AVAILABLE
Authors: Anonymous
Published: April 2021

EATING DISORDERS
PATIENT SAFETY
Authors: Anonymous
Published: April 2021

IN CASE OF FIRE
Psychotherapy with Chronic Schizophrenics: ALLIANCE, TRANSFERENCE, AND COUNTERTRANSFERENCE
Authors: Kahn E Michael
Published: April 2021

Schizophrenic patients may recoil or attack when faced with the stress that relationships impose. The therapist must be aware of these difficulties in establishing alliance and managing transference and countertransference.
Exploring Expressed Emotion Does it Contribute to Chronic Mental Illness?
Authors: de Cangas José P C
Published: April 2021

Expressed emotion, as a powerful predictor of relapse and remission in schizophrenic patients, has implications relevant to consumers and their families, policy makers, politicians, and health professionals.
YOUR TURN
Authors: Anonymous
Published: April 2021

Our Question of the Month
President's Report
Authors: Sills Grayce M
Published: April 2021

APNA President's Report
COST-EFFECTIVENESS AND QUALITY OF CARE PROVIDED BY CLINICAL NURSE SPECIALISTS
Authors: Baradell Janet G
Published: April 2021

Clinical nurse specialists provide care at a lower cost than physicians and psychologists, and with equivalent or better patient outcomes.
Combined Therapies in OCD
Authors: Spencer Vivienne E
Published: April 2021

Helping the patient maintain independence after professional community support has been discontinued was a primary objective from the initial treatment planning.
Understanding Trichotillomania
Authors: Warmbrodt Lynn , Hardy R Elaine , Chrisman Susan Kasal
Published: April 2021

'I feel like pulling my hair out!'
Advanced Practice Psychiatric-Mental Health Nursing in a Community-Based Nurse-Managed Primary Care Program
Authors: Cotroneo Margaret , Outlaw Freida Hopkins , King Joan , Brince Jean
Published: April 2021

In the evolving health care environment, advanced practice opportunities for psychiatric-mental health nurses may lie in managed care models of community oriented primary health care. As providers, care managers, health promoters and educators, and client advocates with family systems expertise, psychiatric-mental health advanced practice specialists are a necessary component of all primary health care. This article describes the development of a community-based primary care practice that integrates physical and mental health care on the same site.
Seeking effective treatment for PTSD
Authors: Anonymous
Published: April 2021

In the pharmaceutical pipeline
Group Therapy for Male Batterers: Comparison of Cognitive-Behavioral & Object Relations Approaches
Authors: Diefenbeck Cynthia A
Published: April 2021

ABSTRACT

Domestic violence is the silent epidemic in America's households, and batterers' recidivism rates are staggering, despite court-mandated treatment found in every state. This article compares and explores cognitive-behavioral and object relations theories, beginning with an overview of the conceptualization of intimate rage from each approach. In addition, the espoused treatment approaches for each theory are examined.
Late Complications of Combined Radial and Transverse Keratotomy After Penetrating Keratoplasty Associated With Atopic Keratoconjunctivitis
Authors: Young Steven R , Lundergan Maureen K , Olson Randall J
Published: April 2021

ABSTRACT: A 31-year-old man underwent bilateral penetrating keratoplasties for keratoconus. He had intolerable anisometropia postoperatively, with high irregular myopic astigmatism in the left eye. He could not wear contact lenses. A combined radial keratotomy and transverse keratotomy were performed, resulting in improved visual acuity. One year postoperatively he developed rapid vascularization of two of the radial incisions. This was associated with an acute allograft rejection, graft failure, and progressive changes in corneal topography. [Refractive & Corneal Surgery 1989; 5:194-197.]
Techniques of Posterior Chamber Lens Implantation Without Capsular Support During Penetrating Keratoplasty: A Review
Authors: Soong H Kaz , Meyer Roger F , Sugar Alan
Published: April 2021

ABSTRACT: Posterior chamber intraocular lenses have numerous advantages over iris-supported lenses and many types of anterior chamber lenses; therefore, the implantation of sutured posterior chamber lenses In the absence of a lens capsule during penetrating keratoplasty has become more common. Suture fixation of the lens implant may be achieved by either 1) sewing the optic or haptics to the iris, or 2) sewing the haptics in the ciliary sulcus using transscleral sutures. In the case of the iris-suture technique, the implant acquires its stability mainly from the fixation sutures, but to some degree, placement of the haptics in the ciliary sulcus may enhance stability. In the case of the scleral fixation technique, implant stability is derived from placement of the haptics in the ciliary sulcus and the transscleral sutures. Several variations upon these two basic suture fixation techniques currently exist, each with its own putative advantages and disadvantages. The different methods are schematically reviewed with diagrams and the comparative benefits and deficits are discussed. [Refractive and Corneal Surgery 1989; 5:249-255.1
Prospective Analysis of Photokeratoscopy for Arcuate Keratotomy to Reduce Postkeratoplasty Astigmatism
Authors: Cohen Kenneth L , Tripoli Nancy K , Noecker Robert J
Published: April 2021

ABSTRACT: Seven eyes of seven patients with visually disabling postkeratoplasty astigmatism underwent arcuate keratotomy to reduce astigmatism. Keratotomy length was prospectively determined by comparing the corneal shape change needed by each patient with shape changes in cadaver eyes induced by arcuate keratotomy. Keratograph ring ovality quantified corneal shape change. Keratotomies were placed in the wound interface using a diamond knife with blade length set to 100% of corneal thickness. Prekeratotomy keratometric astigmatism was 9.27 ± 2.14 D (mean ± SD), and at 2.0 to 18.4 months after keratotomy, astigmatism was 2.75 ± 2.25 D (mean ± SD). All corneas had decreased keratometric astigmatism and less oval keratoscope rings. Five corneas had 3.00 D or less residual kerafomeMc asilgmaìsm. Change in ring ovality was significantly correlated with keratotomy length and keratometric astigmatism change. The utility of keratoscope ring ovality as a corneal topography metric was demonstrated by systematically investigating the response to arcuate keratotomy. [Refractive and Corneal Surgery 1989; 6:388-393].
A Multifocal Lens Effect as a Complication of Radial Keratotomy
Authors: Maguire Leo J , Bourne William M
Published: April 2021

ABSTRACT: A corneal topography analysis system evaluated a patient who after bilateral radial keratotomy complained of disabling visual distortion in each eye even when spectacle correction improved vision to 20/20. The patient showed an excellent spectacle corrected Snellen visual acuity over an extended refractive range, the so-called 'multifocal lens effect.' Topography analysis showed a highly irregular surface in each eye with a central area of corneal flattening with power below 30 diopters. Between the central island of low power and the most peripheral extent of the cornea analyzed, corneal power increased by more than 15 diopters in some hemimeridians. The findings in this case suggest that some patients with a 'multifocal lens effect' and good Snellen visual acuity after radial keratotomy have enough corneal surface distortion and image degradation to properly describe the phenomenon as a complication of surgery. [Refractive and Corneal Surgery 1989; 6:394-397].
Corneal Rupture From Blunt Trauma 22 Months After Radial Keratotomy
Authors: Bloom Howard R , Sands Joshua , Schneider David
Published: April 2021

ABSTRACT: This report describes a case of traumatic corneal rupture 22 months after radial keratotomy in a 39-year-old woman. The patient struck her face on the side of her car resulting in a limbus rupture in her cornea through the horizontal incisions of a four-incision radial keratotomy. An orbital blowout fracture was also present. A sclerotomy was performed to drain persistent choroidal detachment. After the hemorrhage in the anterior chamber resolved, the iris and lens were found to be absent. Visual acuity of 20/40 was achieved with aphakic correction. [Refractive and Corneal Surgery 1990;6:197-199.]