bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.