bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral Lateral Rectus Recession for Exotropia: A Survival Analysis
Authors: Stoller Scott H , Simon John W , Lininger Lloyd L 
Published: April 2021

ABSTRACT
Exotropia may progress during the childhood years, and the ideal time for surgical intervention remains uncertain. We reviewed our results following bilateral lateral rectus recession in 57 consecutive patients. In order to identify possible predictive covariates, we performed survival analysis using survival time as the time from surgery to failure. The patients' age at the time of surgery ranged from 11 months to 50 years (mean, 68 months). Follow up after surgery ranged from 1 to 105 months (mean, 47 months).
Outcomes were considered failures if there was (1) a distance exodeviation greater than 10 prism diopters at any time after surgery, (2) a distance esodeviation greater than 10 δ more than 6 months postoperatively, or (3) further surgery for exotropia or esotropia. By these criteria, surgery was successful in 58% of cases.
Results of the survival analysis indicated an estimated mean time to failure of 68 months. Patients with intermittent exotropia were more likely to remain aligned postoperatively than were those with constant deviations. The age at onset of exotropia, age at surgery, angle of deviation at different fixation distances, early postoperative alignment, and presence of symptoms, amblyopia, anisometropia, or incomitance before surgery were not predictive of success. We conclude that exotropia surgery may be performed with the same likelihood of success at any age, but patients with intermittent deviations do better.
Mitomycin in the Treatment of Hypertrophic Conjunctival Scars After Strabismus Surgery
Authors: Urban Robert C , Kaufman Lawrence M 
Published: April 2021

ABSTRACT
A recognized complication of strabismus surgery is the development of hypertrophic conjunctival scars over the operated-on muscle. Our standard treatment of these scars has been excision followed by corticosteroid eye drops, which results in a scar recurrence rate of 33%. Antimetabolic chemotherapeutic agents, such as mitomycin, can reduce posttraumatic scarring and vascularization of the ocular surface. We studied the use of mitomycin eye drops as an adjunct to standard treatment of hypertrophic conjunctival scars after strabismus surgery. Four patients were treated with adjunct mitomycin eye drops (0.2 to 0.4 mg/ml). Postoperative follow up ranged from 16 to 56 weeks. None of these cases showed significant scar recurrence. Mitomycin in the higher dosage caused mild superficial punctate keratitis after 8 days of use. Despite a lamellar sclerectomy in a patient treated with 0.2 mg/ml of mitomycin, there was no further clinically apparent loss of scleral tissue. The results of this pilot study suggest that topical mitomycin is a safe and effective adjunct to excision and corticosteroid eyedrops in the treatment of hypertrophic conjunctival scars after strabismus surgery.
How Far Can a Medial Rectus Safely Be Recessed?
Authors: Kushner Burton J , Fisher Marian R , Lucchese Neil J , Morton Gail V 
Published: April 2021

ABSTRACT
Previous studies have suggested that the location of the equator should be important in determining the site of a "safe maximum recession" of a rectus muscle, and that the location of the equator should be a function of axial length. Exactly where in relationship to the equator a muscle can be safely recessed has never been scientifically determined. Over a 4-year period, we measured axial length on all patients we operated on for strabismus. Using a previously derived formula, we were able to calculate the limbus-to-equator distance, given axial length. Based on our analysis of 28 patients in whom we recessed one or both medial recti posterior to the equator, we believe that recessions of the medial recti up to 1.5 mm posterior to the equator should not produce postoperative medial rectus underaction associated with an overcorrection, but recessions that are further than 1.5 mm posterior to the equator may do so. Recessions to a point greater than 11 mm from the limbus do not appear to be associated with late progressive overcorrection provided that the site of recession is not greater than 1 .5 mm posterior to the equator. Using our previously determined formula for estimating the location of the equator, given axial length, we have generated easy-to-use reference tables for determining the location of the equator in terms of millimeters posterior to the limbus. Also, based on axial length data from 180 strabismus patients, we have generated an algorithm for predicting axial length, given age, and refractive error, which may be useful to the strabismus surgeon in predicting the location of the equator when A-scan ultrasonography is not available.
Congenital Nasolacrimal Duct Obstruction: Natural History and the Timing of Optimal Intervention
Authors: Paul T Otis , Shepherd Rodger 
Published: April 2021

ABSTRACT
Nasolacrimal duct obstruction (NLDO) is a relatively common clinical problem. Debate continues about optimal management. Intervening early and intervening late each have advantages and disadvantages.
We reviewed the world literature on NLDO. We assembled information on occurrence, natural history, and results of treatment. Spontaneous remission data were used to derive the probability of continued obstruction versus age. The prevalence a hypothesized treatmentresistant form of NLDO was estimated.
Symptomatic NLDO probably occurs in 5 to 6% of infants. Given a symptomatic case under the age of 14 months, the probability of spontaneous remission within the following month appears to be approximately one of three. Probe failure risk increases with age, doubling every 6 months.
Increasing probe failure risk may be due to selfselection. Preliminary analysis of management strategies suggests that lacrimal duct probing at age 4 months in the office is the most cost-effective strategy. Further descriptive studies of NLDO remission and treatment are indicated.
Neonatal Dacryocystitis Associated With Nasolacrimal Duct Cysts
Authors: Lueder Gregg T 
Published: April 2021

ABSTRACT
Neonatal dacryocystitis is a rare complication of congenital nasolacrimal duct (NLD) obstruction. Recent reports suggest that the association of neonatal dacryocystitis and NLD cysts may be more common than previously believed. The purpose of this study is to describe the nasal endoscopic findings and treatment of three patients with this disorder. In this prospective study, three consecutive patients who presented at 2 weeks of age or less with dacryocystitis were treated with NLD probing and rigid nasal endoscopy. All patients were found to have congenital NLD cysts at the time of NLD probing. The cysts were marsupialized under endoscopic visualization. The treatment was successful in all patients. Dacryocystitis in the early newborn period is commonly associated with NLD cysts. Nasal endoscopic marsupialization of the cysts is an effective adjunct to treatment of these patients.
Facial Asymmetry and Tendon Laxity in Superior Oblique Palsy
Authors: Paysee Evelyn A , Coats David K , Plager David A 
Published: April 2021

ABSTRACT
Both facial asymmetry and superior oblique tendon laxity are associated with congenital superior oblique muscle palsy (SOP). It is unknown whether facial asymmetry and tendon laxity are related to each other, perhaps even causally. We evaluated 29 patients with SOP for presence of facial symmetry, tendon laxity, or both, and correlated these findings with presence or absence of chronic head tilt. Sixteen of 21 (76%) unilateral congenital SOP patients had facial asymmetry and 17 (81%) had tendon asymmetry. Ninety-four percent had either or both abnormalities, but only 57% had tendon laxity (palsy) on the side opposite the facial hypoplasia. All patients with facial hypoplasia had a head tilt toward the hypoplastic side of the face, regardless of which side the palsy was on.
These findings, along with previous studies of congenital muscular torticollis, infer that the two anatomic abnormalities associated with congenital SOP (facial asymmetry and tendon asymmetry) do not occur as part of the same developmental sequence, but the facial asymmetry develops as a consequence of a chronic head tilt from a young age.
Dissociated Horizontal Deviation and Accommodative Esotropia: Treatment Options When an Eso- and an Exodeviation Co-exist
Authors: Wilson M Edward , Saunders Richard A , Berland Jerry E 
Published: April 2021

ABSTRACT
Dissociated strabismus includes movements in the vertical, horizontal, and torsional axes. Dissociated vertical deviation (DVD) is an oversimplified label because it implies a purely vertical deviation. When the abducting component of the dissociated strabismus complex is prominent, the term dissociated horizontal deviation (DHD) is used. We present six patients with accommodative esotropia who developed prominent DHD. Only two patients have a prior history of congenital esotropia. Latent nystagmus was observed in five of the patients. With the combination of DHD and esotropia, an esodeviation during active fixation may become an exodeviation when the patient is visually inattentive.
Five patients required surgery for DHD. Four options are used and discussed. DHD can be treated alone with lateral reclus muscle recession. DHD can be treated as above, but combined with medial rectus muscle recessions or posterior fixation sutures to simultaneously treat the esotropia. The esotropia can be treated alone, possibly with a reduced surgical dosage. If the patient varies from an esodeviation to an exodeviation, but is straight much of the day, observation without surgical therapy may be advisable. Just as a hypotropia can have an overlying DVD, an esotropia can have an overlying DHD. This combination may masquerade as variable angle esotropia or may present as an esodeviation when the patient is visually attentive and an exodeviation when the patient is visually inattentive.
The Treatment of Congenital Nystagmus With Botox
Authors: Carruthers Jean 
Published: April 2021

ABSTRACT
Clostridium botulinum A exotoxin (Botox) is the most potent toxin known to man. It produces a reversible paralysis of cholinergically innervated muscle, an effect useful in the management of non-accommodative strabismus and various disabling focal dystonias.
In the present study, botulinum toxin (Botox) was used to treat congenital nystagmus, injecting the toxin into multiple horizontal rectus muscles at the same treatment session. Three of four patients achieved a significant enough change in acuity to receive daytime-restricted driver's licenses. No treatment was complicated by retrobulbar hemorrhage, ocular perforation, or ptosis. Two patients are continuing the Botox treatments every 3 to 4 months.
Neuroanatomic Abnormalities of Primary Visual Cortex in Macaque Monkeys With Infantile Esotropia: Preliminary Results
Authors: Tychsen Lawrence , Burkhalter Andreas 
Published: April 2021

ABSTRACT
To explore the structural basis for visuomotor deficits in infantile esotropia, we examined binocular connections and metabolic activity in the primary visual cortex of two strabismic macaque monkeys. The animals were documented to have onset of natural esotropia in early infancy. Behavioral testing showed that the animals had normal visual acuity in both eyes and the ocular motor deficits that characterize strabismus with onset in infancy. The neuronal tracer substance biotinylated-dextran-amine was injected into ocular dominance columns (ODC) in area V-1 (striate cortex), revealing a paucity of binocular connections between right-eye and left-eye ODCs. The metabolic label cytochrome-oxidase was used to stain neighboring right-eye and left-eye ODCs, revealing inequalities in metabolic activity compatible with interocular suppression. These results show that infantile esotropes have abnormalities of visual cortex structure that correlate with abnormalities in binocular behaviors.
CHARGE Association: Histopathological Report of Two Cases and a Review
Authors: Hayashi Nobutsugu , Valdes-Dapena Marie , Green W Richard 
Published: April 2021

ABSTRACT
Background: The CHARGE association (C=coloboma, H= heart disease, A=atresla or stenosis of the choanae, R=retarded growth and development or CNS anomalies, G=genital hypoplasia, and E=ear anomalies or deafness) is a rare, recently well-recognized clinical study. The ophthalmic abnormalities have been described in numerous reports, but the ocular histopathologic findings have not been presented in detail.
Methods: We conducted gross and microscopic studies of eyes of two patients with the CHARGE association obtained postmortem.
Results: The eyes in one case had a small, symmetrical, inferior nasal coloboma of the choroid. In the other case, extensive inferior nasal colobomas of the iris, ciliary body, and choroid with retinal dysplasia, ectopie retinal/glial tissue in the sclera and hypoplasia of the optic nerve head were present.
Conclusion: We document the h i sto pathological features of eyes of two subjects with the CHARGE association. The abnormalities of these eyes were typical ocular colobomas presumably resulting from the failure of complete closure of the optic fissure.
An XX Male With Microphthalmos and Sclerocornea
Authors: Kobayashi Miwako , Kiyosawa Motohiro , Toyoura Takio , Tokoro Takashi 
Published: April 2021

INTRODUCTION
Microphthalmos is a severe congenital ophthalmic disease. As knowledge of gene locus for hereditary ocular diseases expands, so does the number of the Xp-Jinked ophthalmic disease (Table).1 A percentage of microphthalmos appears to be caused by the abnormal X chromosome. Microphthalmos and linear skin defects (MLS) syndrome (MIM309801) is a good illustration. This syndrome is a developmental disorder observed in XX individuals with distal Xp segmentai monosomy, or deletions and unbalanced translocations involved in the Xp22.3 region.2-6
Al Gazali2 described a Caucasian XX male with bilateral microphthalmos. This case was further described by Lindsay3 as MLS syndrome. Al Gazali4 reported two MLS syndrome female with de novo X;Y translocations. Their eye findings included microphthalmos, corneal opacities, and orbital cysts on the left side. Temple5 reported a Xp22.2-pter MLS syndrome female with left side microphthalmos. Lindor6 reported a MLS syndrome female with an Xp22.3 microdeletion and a chromosome satellite on the abnormal Xp-arm. Her eye findings were bilateral microphthalmos, sclerocornea, and cataracts. The phenotype of MLS syndrome is various. The dermal lesions of the patients are limited to the face and neck, and varies from slight to severe. MLS syndrome is recognized to be contiguous gene syndrome.3
Migraine in a Pediatric Ophthalmology Practice
Authors: O'Hara Mary A , Koller Harold P 
Published: April 2021

ABSTRACT
Purpose: A prospective study of children between the ages of 2 and 15 years was conducted to investigate the prevalence and characteristics of migraine in children seeking ophthalmic care.
Methods: A questionnaire, based on established criteria for the diagnosis of migraine, was administered to 1479 consecutive children presenting to a single pediatric ophthalmologist (H.P.K.). Over 25% of all respondents reported headaches that met the criteria for migraine. In general, these individuals were older than non-migraine sufferers (mean age of 8.3 years vs. 6.6 years). There were no significant sex differences.
Results: Headache was the chief complaint for 8.9% of all patients seeking ophthalmic care in this study population. Eighty percent of this subpopulation described headaches that met the diagnostic criteria for migraine. This study found childhood migraine symptoms to be present in a significant proportion of the patient population of a pediatric ophthalmologist.
Refractive Status in Children After LongTerm Follow up of Cataract Surgery With Intraocular Lens Implantation
Authors: Spierer Abraham , Desatnik Howard , Blumenthal Michael 
Published: April 2021

Abstract
Purpose: To evaluate the resultant refractive status In children 5 to 11 years after cataract surgery with a high power Intraocular lens (IOL) Implantation.
Methods: Charts of eight patients (10 eyes) who underwent cataract surgery with IOL implantation by the same technique were reviewed. Age at surgery was 2 months to 3 years. High-power IOL of 27.0 to 30.0 diopters (D) was implanted In seven eyes and lower IOL (between 19.0 D to 23.0 D) in three eyes. Follow-up period was between 5 and 1 1 years.
Results: In children who received a high-power IOL, the resultant refraction after 5 to 7 years was found to be between -5.50 and -12.00 D. In the group that had a lower power IOL implanted, the refraction was between -2.50 and +9.00 after 6 to 11 years. The results were plotted on a graph of refraction vs. IOL power and showed that the IOL power that may result in emmetropia in an older child is 23.2D.
Conclusions: The Implantation of a high-power IOL (27 D to 30 D) in eight young children resulted In refractive status within 3 D of emmetropia during the first year or two of life and in high myopia at age 5 to 12 years.
Unilateral or Asymmetric Congenital Ptosis, Head Posturing, and Amblyopia
Authors: Fiergang Dean L , Wright Kenneth W , Foster Jill A 
Published: April 2021

ABSTRACT
Purpose: To determine the prognostic implication of compensatory head posturing in patients with unilateral or asymmetric congenital ptosis.
Methods: A retrospective review of 80 consecutive patients with unilateral or asymmetric congenital ptosis was performed. The presence of documented compensatory head posturing, age of onset, age of presentation, visual acuity, refraction, and amblyopia were recorded, and binocularity was tested.
Results: Five of seven (71%), patients with unilateral or asymmetric congenital ptosis and compensatory head posturing had amblyopia. All of these patients had straight eyes and four of the five amblyopic patients had anisometropia of less than 2 diopters (D).
Conclusion: The high incidence of amblyopia in this group can occur in the absence of significant anisometropia and strabismus. This unusually high incidence of amblyopia in this subgroup of patients with unilateral or asymmetric congenital ptosis and compensatory head posturing warrants compulsive examination and prophylactic part-time occlusion therapy of the nonptotic eye until reliable vision testing can be performed.
Journal of Pediatric Ophthalmology & Strabismus 1999; 36:74-77.
e-Consults
Authors: Ruttum Mark , Alcorn Deborah 
Published: April 2021

In this new feature, our Column Editors prepare a patient case for virtual consultation - the patient's history, physical examination, and pertinent photos are e-mailed to colleagues for a discussion of their individual treatment choices.
For the inaugural column, Mark Ruttum presents a case of complicated strabismus In a child with an orbital floor fracture. Miles J. Burke, William N. Clarke, and Scott E. Olitsky, who served as "consultants," present management options.
Palpebral Fissure Changes in Early Childhood
Authors: Paiva Raquel S N , Minare-Filho Abenor M , Cruz Antonio A V 
Published: April 2021

ABSTRACTPurpose: To describe palpebral fissure changes during early childhood.Methods: Digital imaging was used to analyze the monocular palpebral fissure images of 185 children and 35 adults. Six variables were quantified for each eye: the distance between the pupil center and the upper and lower eyelid margin, the palpebral fissure area, and the obliquity and length of the fissure. The lower eyelid crease pattern also was evaluated qualitatively.Results: The upper eyelid was at its lowest position after birth, and the lower eyelid margin was close to the pupil center. Between ages 3 and 6 months, the position of the upper eyelid reached its maximum and then declined linearly. At the same time, the distance between the pupil center and the lower eyelid margin increased linearly until age 18 months when its position stabilized. Both the horizontal palpebral fissure length and the fissure area followed a logarithmic pattern of growth and were strongly correlated. The obliquity of the fissure was evident at an early age and did not change until adulthood. At birth, the most common pattern of the lower eyelid crease was a single crease. The number of individuals showing a double crease increased with age, and at approximately age 36 months, a double crease became the most common pattern.Conclusion: The palpebral fissure undergoes complex changes during infancy. An accurate knowledge of these changes is important for evaluating eyelid disorders in children.Journal of Pediatric Ophthalmology and Strabismus 2001;38:219-223.
Neuro-Ophthalmic Features in Pediatric Tubercular Meningoencephalitis
Authors: Amitava Abadan K , Alam Seema , Hussain Rashid 
Published: April 2021

ABSTRACT
Purpose: To examine the neuro-ophthalmic profile in childhood tubercular meningoencephalitis and assess its prognostic importance.
Methods: One hundred consecutive patients with tubercular meningoencephalitis underwent evaluation for optic nerve functions, supra- and infranuclear oculomotor involvement, and raised intracranial tension, Patients underwent follow-up for 9 months.
Results: In 100 patients with tubercular meningoencephalitis, 67 had neuro-ophthalmic features. Common findings were retrobulbar neuritis (32) and gaze palsy (20). Others, in decreasing prevalence, were third and sixth nerve palsy, conjugate deviation, primary optic atrophy, and complete ophthalmoplegia. Raised intracranial tension was associated with neuro-ophthalmic features in 53 of 67 patients (P<.05). Complete ophthalmoplegia was significantly associated with mortality on logistic regression analysis (relative risk, 6.35; P=.012). By 6 months, 56% of patients with retrobulbar neuritis progressed to optic atrophy.
Conclusion: Neuro-ophthalmic features, in association with raised intracranial tension, often are a part of pediatric tubercular meningoencephalitis presentation. The type of neuro-ophthalmic features may have prognostic value. Optic nerve involvement is the most common finding in tubercular meningoencephalitis.
Journal of Pediatric Ophthalmology and Strabismus 2001;38:229-234.
Characteristics of Okihiro Syndrome
Authors: Chun Benjamin B , Mazzoli Robert A , Raymond William R 
Published: April 2021

ABSTRACT
Purpose: To describe Okihiro syndrome, a syndrome consisting of Duane's syndrome, radial ray anomaly, and sensorineural deafness.
Methods: The incidence of anomalies in 41 individuals from 9 affected families was assessed by literature review and patient examination, and the frequency of the characteristics occurring together was determined.
Results: Of all the individuals with at least one of the above characteristics, only 12% had all three characteristics. However, 44% had both Duane's syndrome and radial ray anomaly, whereas sensorineural deafness alone occurred in only 17% of patients.
Conclusion: Okihiro syndrome is consistent with autosomal dominance with variable penetrance, manifesting primarily with Duane's syndrome and radial ray anomaly, and less frequently, sensorineural deafness.
Journal of Pediatric Ophthalmology and Strabismus 2001;38:235-239.