bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Importance of Controlled Illumination in Color Vision Testing in a Pediatric Ophthalmology Clinical Practice
Authors: Stager David R , Everett Mary , Swanson William H 
Published: April 2021

ABSTRACT
The AO-HRR pseudoisochromatic plates are commonly used for color vision testing in pediatric ophthalmology; however, the recommended procedure for obtaining proper illumination (a completely darkened room and standard illuminant) is typically not followed. To evaluate the role of the illuminant in clinical testing with the AO-HRR1 132 children, ages 3 to 16 years, were tested with and without the recommended illuminant (MacBeth Easel Lamp) and with the self-illuminated APT-5 Color Vision Tester.
Twenty-two failed the AO-HRR with the recommended illuminant; 28 failed the AO-HRR without the illuminant. Only 13 failed the APT-5. The Cochran Q test for three related samples showed that the differences among the three groups were significant (Q = 17.1, P< .001). Diagnostic evaluation following clinical screening indicated that the differences among the tests were primarily due to false alarms, which were greatest without the recommended illuminant and least with the APT-5.
These results demonstrate the importance of controlled illumination in color vision testing, either by using the recommended illumination with the AO-HRR or a self-illuminated test such as the APT-5.
Ocular Manifestations of Deformational Frontal Plagiocephaly
Authors: Fredrick Douglas R , Mulliken John B , Robb Richard M 
Published: April 2021

ABSTRACT
Frontal plagiocephaly can be caused by two mechanisms: craniosynostosis and external deformational pressure. Synostotic plagiocephaly is known to be associated with vertical strabismus and contralateral head tilt. Thirteen patients with deformational frontal plagiocephaly were examined to evaluate head position, ocular motility, and alignment. Nine of the patients (70%) were found to have ipsilateral torticollis, but only one patient had strabismus and this was a horizontal deviation not obviously associated with head position. The clinical features of synostotic and deformational plagiocephaly are discussed to distinguish the two conditions, which have a different treatment and outcome.
Cytomegalovirus Retinitis in Pediatric Acquired Immunodeficiency Syndrome: Report of Two Cases
Authors: Salvador Francisco , Blanco Román , Colín Alicia , Galán Alicia , Gil-Gibernau J José 
Published: April 2021

ABSTRACT
Two cases of cytomegalovirus retinitis in pediatric acquired immunodeficiency syndrome (AIDS) are described. The first case was a 7-month-old infant who received an HIV-infected blood transfusion in 1983. The infant was treated with specific anti-cytomegalovirus immunoglobulin. The second case was an 8-year-old hemophiliac child who received HIV-infected factor VIII concentrates. Intravenous ganciclovir therapy resulted in marked improvement of ocular lesions. This is, to our best knowledge, the first report of pediatric AIDS-induced retinopathy resulting from postnatal intravenous causes.
Compliance With Safety Glasses Wear in Monocular Children
Authors: Drack Arlene , Kutschke Pamela J , Stair Sarah , Scott William E 
Published: April 2021

ABSTRACT
Many ophthalmologists prescribe polycarbonate "safety glasses" to protect the remaining eye of monocular patients. Others do not routinely do so when the remaining eye is emmetropic since they feel compliance is poor. To evaluate compliance with safety glasses wear In these children, we reviewed the charts of all children (<21 years old) treated with enucleation and followed at the University of Iowa by the Pediatric Ophthalmology Service between 1962 and 1991. Safety glasses were defined as polycarbonate lenses in a frame suitable for protective wear with spherical equivalent =s - 0.7Sor =s + 2.00 diopters. Fifty-six patients were followed after enucleation. Forty-six of these patients met the inclusion criteria and 33 patients were available for follow up. Eighty-five percent of patients wear safety glasses s=50% of their waking hours; 61% wear them 2=80% of the time; 33% wear them 100% of their waking hours. Twenty-one of the 33 patients participate in sports. One hundred percent of the female participants and 80% to 93% of the male participants wear safety glasses, goggles, or face shields during sports. Fifteen of the 33 respondents reported at least one potentially serious accident in which the safety glasses had protected the good eye.
Compliance with safety glasses wear appears to be good in this population and may prevent injury to the remaining eye.
Strabismus Surgery in Patients With Myasthenia
Authors: Davidson John L , Rosenbaum Arthur L , McCall Laurie C 
Published: April 2021

ABSTRACT
The efficacy of eye muscle surgery for strabismus in patients with myasthenia is not well-documented in the literature. We reviewed the results of strabismus surgery in six patients with the confirmed diagnosis of myasthenia. Patients selected for surgery had angles of deviation that were stable for at least 5 months preoperatively. Patient age ranged from 4 to 62 years. AK patients were exotropic. The four adults had moderate limitation of adduction. Surgery included horizontal rectus muscle recession and/or resection in all cases. Three cases involved additional surgery of the vertical rectus or superior oblique muscles. The mean postoperative follow up was 44 months with a minimum of 7 months. Three adults and one child achieved stable satisfactory alignment after one procedure. One child required three procedures to achieve satisfactory alignment. The results suggest that surgery is a viable option in the management of strabismus in selected patients with myasthenia.
Inferior Oblique Overaction in Infantile Esotropia: Fundus Extorsion as a Predictive Sign
Authors: Eustis H Sprague , Nussdorf Jonathan D 
Published: April 2021

ABSTRACT
Background: Inferior oblique overaction develops in 72% of patients with infantile esotropia but generally is not recognized until the patient is between 2 and 4 years of age.
Methods: While undergoing bilateral medial rectus recessions, photographs were taken of the posterior pole of 27 eyes in 14 patients with infantile esotropia and graded for the presence or absence of torsion by a masked observer. Follow up ranged from 10 months to 6 years.
Results: Oblique muscle overaction developed in 15 of the 27 eyes. Of these 15, six demonstrated fundus torsion in infancy, before the oblique dysfunction was recognized clinically.
Conclusion: The presence of abnormal fundus torsion can serve as a marker for patients with infantile esotropia who ultimately will develop overt oblique muscle dysfunction.
Tensile Strength of Insertional Suture Techniques in Strabismus Surgery
Authors: Christiansen Stephen P , Rettele Garrick A , Soulsby Michael E , Walls Robert C 
Published: April 2021

ABSTRACT
Background: The "lost" extraocular muscle is a serious adverse outcome of seemingly uncomplicated strabismus surgery. One potential cause of this complication is suture slippage in the operated muscle or tendon. The purpose of this study was to determine the relative tensile strengths of three suture techniques commonly used in strabismus surgery and to compare the incidence of suture slippage in the tendon or muscle among these techniques.
Methods: The horizontal rectus muscles of 18 adult pigs were assigned to undergo either recession or resection and were randomized to one of three suture techniques studied. Tension applied to the free ends of the suture was incrementally increased until failure occurred. The two techniques were compared in terms of the mean applied tensions at the time of failure and the incidence of slippage.
Results: No statistically significant difference in mean tension at failure between the three techniques used in recessed or resected muscles was found. Suture slippage in the tendon or muscle occurred in 25% of the trials and was almost evenly distributed among the techniques. Mean tension at slippage did not differ significantly between the techniques. No failure of any kind occurred at less than 100 g applied tension.
Conclusion: Each suture technique appeared to adequately secure the tendon or muscle for recession and resection procedures. Changing techniques is unlikely to alter the incidence of lost muscles in strabismus surgery.
Latent Fixation Nystagmus and Nasotemporal Asymmetries of Motion Visually Evoked Potentials in Naturally Strabismic Primate
Authors: Tychsen Lawrence , Boothe Ronald G 
Published: April 2021

ABSTRACT
Purpose: To determine whether macaque monkeys who had onset of natural, alternating esotropia in early infancy have the eye movement abnormalities and motion visually evoked potential (VEP) abnormalities observed in human infantile esotropes.
Methods: Recordings were obtained of horizontal pursuit eye movements and fixation nystagmus under conditions of monocular viewing. Motion VEPs in response to horizontal motion were recorded with the animals sedated to reduce the possibility of eye movement artifact.
Results: The strabismic monkeys had a naso-temporal asymmetry of horizontal pursuit favoring nasally directed motion when viewing with either eye. When fixating stationary targets, latent nystagmus was apparent; the eyes drifted conjugately and the slow phase of the nystagmus was always nasally directed with respect to the fixating eye. Motion VEPs were characterized by a strong horizontal asymmetry with the directional bias inverted approximately 180 deg in the two eyes. These eye movement and motion VEP asymmetries were not observed in a normal macaque.
Conclusions: Macaque monkeys who have infantile esotropia possess asymmetries of horizontal pursuit and motion VEPs like those documented in strabismic humans. Macaques with infantile esotropia appear to be an appropriate animal model for study of neural mechanisms in strabismus.
The Adjustable Globe: A Technique for Adjustable Strabismus Surgery
Authors: Connor Thomas B , Guyton David L , Repka Michael X , Jain Rajni 
Published: April 2021

ABSTRACT
Background: Conventional adjustable strabismus surgery involves postoperative repositioning of individual muscles anchored to the sclera via adjustable sutures.
Greaves has described anchoring opposing rectus muscles to one another, via sutures passing on either side of the limbus. With the muscles dismserted, the "freed" globe can be adjusted to the desired position within the resulting suture cradle. Friction of the sutures against the sclera holds the muscles in place until healing occurs.
Methods: Using a cul-de-sac approach, we performed 23 horizontal and three vertical adjustable globe procedures, with median follow-up of 7 weeks.
Four procedures were performed on nonhuman primates, monitored with iris fluorescein angiography.
Results: Esodeviations were well corrected, but exodeviations were often grossly undercorrected. Prolonged postoperative discomfort and photophobia were experienced. Possible evidence for mild anterior segment ischemia was noted.
Conclusion: Concern about poor results with exodeviations, discomfort, and possible anterior segment ischemia led us to abandon this procedure.
Posterior Superior Oblique Tenectomy at the Scleral Insertion for Collapse of A-Pattern Strabismus
Authors: Shin Grace S , Elliott Richard L , Rosenbaum Arthur L 
Published: April 2021

ABSTRACT
Purpose: To evaluate the efficacy of teneetomy of the posterior fibers of the superior oblique tendon at the scleral insertion to reduce ?-pattern deviations with mild-to-moderate superior oblique overaction.
Methods: We retrospectively reviewed 22 consecutive patients with A-pattern strabismus and mild-to-moderate superior oblique overaction on whom posterior teneetomy of the superior oblique at the scleral insertion was performed between January 1988 and August 1994. Nine females and 13 males were included, with an age range of 3 to 36 years (mean 13.0 years).
Results: The average preoperative A-pattern for all patients was 18.0 prism diopters (Δ) (10 to 33 Δ), and a collapse of 16.1 Δ was achieved (F<.000001).The average preoperative A-pattern for esotropie patients was 21 .0 Δ with an average correction of 18.6 A.The average preoperative A-pattern for exotropic patients was 16.2 Δ with a mean improvement of 14.5 Δ. Twenty patients (91%) were postoperatively measured to have 6 Δ or less difference between up and downgaze. Follow up ranged from 5.0 to 41.0 months (average, 14.0 months).
Conclusions: This technique provides the surgeon with a predictable partial superior oblique weakening operation that carries a low risk of induced superior oblique palsy, unwanted cyclotorsion, or head tilt.
Congenital Aphakia: A Clinicopathologic Report of Three Cases
Authors: Johnson Bruce L , Cheng Kenneth P 
Published: April 2021

ABSTRACT
Background: Congenital aphakia is a rare condition that has been classified as primary when no lens induction of the surface ectoderm occurs and secondary when lens development takes place but later is resorbed or expelled in utero.
Methods: The authors report the clinical and pathologic findings in three infants with congenital aphakia whose eyes were enucleated either at surgery at 11 months or at autopsy after 1 and 3 days of life.
Results: Two cases classified as primary congenital aphakia had severe microphthalmos, anterior segment aplasia, or anomalous development and posterior choroidal and optic disc colobomas. One was in a case believed to be Waardenburg's recessive anophthalmia syndrome and the other had 18 trisomy. A case of secondary congenital aphakia had findings of Peter's syndrome and features suggesting rubella, which had been observed in some previous reports.
Conclusions: Primary congenital aphakia can result from a variety of teratogenic events in the first 4 weeks of embryogenesis and results in microphthalmos and severe anterior segment aplasia/dysplasia. Secondary congenital aphakia is associated with less severe ocular anomalies. The possible role of deletion or mutation involving the PAX6 gene in anterior segment anomalies and induction of lens development is discussed. In addition to chromosomal influences, in utero viral infection, particularly rubella, may play a role in some cases.
Visual Outcome of Craniopharyngioma in Children
Authors: Abrams Lisa S , Repka Michael X 
Published: April 2021

ABSTRACT
Purpose: To assess the visual outcome of children with craniopharyngioma and identify predictors of visual loss.
Methods: A retrospective analysis of all patients younger than 18 at presentation who were evaluated between 1984 and 1995 was performed. Visual outcome was assessed as a function of age, systemic symptoms, visual acuity at presentation, and need for postoperative radiotherapy.
Results: Thirty-one patients were identified, with a mean age of 7.7 years (range, 1.2 to 16.8 years) at the time of surgical resection. The initial visual acuity (known in 20 patients at presentation) in the better-seeing eye was ≥20/40 in 14 (70%) patients and <20/200 in 2 (10%) patients. Twelve (39%) patients presented with visual symptoms and 15 (48%) with systemic symptoms. All patients underwent surgical resection; some patients required multiple surgeries (52%) or adjuvant radiotherapy (48%). The mean postsurgical follow up was 6.5 years (range, 4 days to 25 years). Postoperative visual acuity was ≥20/40 in the better eye in 22 (71%) patients; 8 (26%) patients had visual acuity <20/200 in their better-seeing eye. Optic atrophy developed In 51 eyes of 27 patients (81%).
Conclusions: Craniopharyngioma presents with visual symptoms in children and is associated with significant permanent visual dysfunction. Age younger than 6 years at presentation and visual symptoms at presentation were associated with a significantly poorer visual outcome. Craniopharyngioma should be considered in the differential diagnosis of every child with amblyopia, particularly when no amblyogenic factors such as anisometropia or strabismus are present.
Cyclofusion in Normal and Superior Oblique Palsy Subjects
Authors: Sharma Pradeep , Prasad Krishna , Khokhar Sudarshan 
Published: April 2021

ABSTRACT
Purpose: To evaluate the cyclofusional status in normal and acquired superior oblique palsy subjects. To know the extent to which cyclodeviations can be tolerated asymptomatically.
Method: Incyclovergence and excyclovergence break points and recovery points were evaluated in 40 normal subjects and 17 cases of acquired superior oblique palsy. A Polaroid dissociation stereoprojector was used with special torsional slides at fixation distances of 1 meter and 6 meters. In addition, maximum intorsion tolerated (MIT) and maximum extorsion tolerated (MET), ie, the torsion that allowed baseline horizontal fusion, were studied. The evaluation was repeated in the palsy group 1 month after recovery, which was spontaneous in 8 cases, and after surgery in 9 cases.
Result: The normal values for incyclovergence and excyclovergence were in the range of 12° (break point) and 8° (recovery point). In the case of superior oblique palsy, only the incyclovergence recovery point was significantly diminished (p=. 004), which improved after recovery to near normal values. The intorsion tolerance (MIT) and extorsion tolerance (MET) also showed deterioration in the palsy group. After recovery, the MIT normalized but the MET did not recover at 1meter distance fixation. The maximum torsional tolerance values appear to be more critical.
Conclusion: The cyclofusional vergence under physiological conditions are better than reported earlier. But MIT and MET are better indicators of cyclofusional potential. These low values demand more precise alignment of the torsion in weakening or strengthening surgery of the oblique muscles.
Journal of Pediatrie Ophthalmology and Strabismus 1999;36:264-270.
Critical Age of Botulinum Toxin Treatment in Essential Infantile Esotropia
Authors: Campos Emilio C , Schiavi Costantino , Bellusci Costantino 
Published: April 2021

Abstract
Purpose: To assess the results of botulinum toxin treatment in 60 consecutive children with essential infantile esotropia.
Methods: Bilateral simultaneous injection of botulinum toxin into the medial rectus muscle was performed in 60 patients under direct visualization with an "open sky" technique. Fluothane/sevoflurane insufflation anesthesia was used. Each patient underwent a single bilateral botulinum toxin injection. Patient age at the time of injection ranged from 5-8 months.
Results: Mean patient age at the time of treatment for the 88% of patients who gained a good alignment (within + 10 prism diopters [Δ] of residual esotropia) was 6.5 months, while mean patient age at time of injection for the 12% of patients who were undercorrected or the deviation relapsed was 7.8 months. Follow-up averaged 5.2 years (range: 2-9 years, SD 2).
No variation of the angle of strabismus was observed after 6 months from injection. In some patients with hyperopic refraction, plus lens corrections were prescribed during follow-up to stabilize the alignment.
Conclusion: Botulinum toxin can be effective in essential infantile esotropia when children are treated by age 7 months.
Journal of Pediatric Ophthalmology and Strabismus 2000;37:328-332.
PSYCHIATRIC NURSING in a Psychosocial Setting
Authors: Thompson Joyce , Strand Karen 
Published: April 2021

The revolutionary upheaval in chis nation's health care system may cause many psychiatric nurses in traditional settings to be concerned about their future role.
According to the United States Department of Health and Human Services (1990). there were 66,142 psychiatric registered nurses employed in inpatient hospital settings as of 1988. The advent of managed care, decrease in entitlements, and overburdening of the health care system has again led to less accessibility to inpatient psychiatric hospitalization, and briefer stays once hospitalized As freatment once again moves into the community, nurses may wonder what types of new programs will follow, and if they will employ psychiatric nurses.
One type of community based program uses the principles of psychosocial rehabilitation. The Village Integrated Services Agency is such an organization, allowing nurses to fully use their nursing skills, but without the focus on illness and the constraints on autonomy typically experienced in hospital settings.
Finite Element Based Mechanical Models of the Cornea for Pressure and Indenter Loading
Authors: Vito Raymond P , Carnell Peter H 
Published: April 2021

ABSTRACT
Background: In this article, we examine the finite element method and its use in mechanical modeling of the cornea.
Methods: Both linear elastic and geometrically nonlinear models are considered. The effects of corneal geometry, boundary conditions, thickness, and the number of layers in the model are determined.
Results: Results indicate that, for intraocular pressure loading, the thickness and the choice of boundary conditions at the limbus are significant.
Conclusions: A model of tonometry showed that simulating the layered nature of the cornea and including the increased flexibility of large deformation are critical. (Refract Corneal Surg 1992;8:146-151.)
Cat Keratoplasty Wound Healing and Corneal Astigmatism
Authors: Tripoli Nancy K , Cohen Kenneth L , Proia Alan D 
Published: April 2021

ABSTRACT
BACKGROUND: A major contributor to postkeratoplasty astigmatism may be donor/recipient disparity. Deficient or excess comea at the wound is thought to influence the directions of the steep and flat meridians. Using an established model of penetrating keratoplasty in the cat, this study evaluated the morphometry of histopathologic wound features in the steep and flat meridians.
METHODS: Thirteen cats had successful penetrating keratoplasties after intentionally misshapen donor corneas were misaligned in misshapen recipient beds. At 9.50 ± 0.32 (mean ± 1 SEM) months after keratoplasty, photokeratography was performed and analyzed, corneas were sectioned along the steep and flat meridians, and four histologic sections were processed. Features of the wounds were measured using a Zeiss Videoplan®. The relationships between the morphometry of each feature and every other feature, between the morphometry of each feature and eccentricity, and between the steep and flat section morphometry of each feature were statistically evaluated.
RESULTS: Epithelial thickness, area of lamellar alteration, length of Descemets membrane produced postoperatively, and the depth that preoperative Descemet's membrane was embedded in the stroma were correlated with eccentricity (corneal astigmatism). Stromal thickness and the presence or absence of folded and fragmented Descemet's membrane were not correlated with eccentricity. Wound morphometry at the steep meridians was neither correlated with nor significantly different from wound morphometry at the flat meridians.
CONCLUSIONS: Differences between healing at the steep and flat meridians were not likely contributors to astigmatism. Disproportionate availability of tissue in wound regions may have affected healing throughout the entire wound over time. The absence of Bowman's layer in cats restricts application of our results to understanding the etiology of corneal astigmatism after penetrating keratoplasty in humans. [Refract Corneal Surg 1992;8:196-203.)