2007/04/10

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Items 1 - 54 of 54
1: J AAPOS. 2007 Apr 6; [Epub ahead of print]

One-muscle surgery in small-angle residual esotropia.

University of Milan, Department of Ophthalmology, Pediatric Ophthalmology Unit, San Paolo Hospital, Milan, Italy.

PURPOSE: To report the outcome of unilateral lateral rectus resection for treatment of small-angle residual esotropia following bilateral medial rectus muscle recession. METHODS: A retrospective medical record review was performed for all patients who had undergone bilateral medial rectus muscle recession for congenital esotropia prior to 6 years of age that required further surgical treatment of residual esotropia. We compared two different dosing strategies for resection of a single lateral rectus muscle in the nondominant eye. In group 1, the amount of resection was calculated by doubling the angle of strabismus and applying the recommended surgical dosage to one lateral rectus muscle. In group 2, the amount of unilateral resection was the same as the bilateral dosage for the measured angle, but augmented by 1.5 mm. Postoperative evaluation was performed 1 and 6 months after surgery. RESULTS: Data from 35 patients were analyzed, 17 in group 1 and 18 in group 2. No significant intergroup difference was noted in terms of age at first surgery (p = 0.266), initial surgical dosage (p = 0.693), residual angle of esotropia (p = 0.881), or age at reoperation (p = 0.679). Postoperative alignment was better in group 1 patients at 6 months than at 1 month (residual deviation 3.5(Delta) versus 6.7(Delta), p = 0.022). CONCLUSION: Resection of a single lateral rectus muscle with the surgical dosage calculated by doubling the angle of strabismus and applying the recommended surgical dosage to one lateral rectus muscle is a treatment option for patients with small-angle residual esotropia following bilateral medial rectus muscle recession.

PMID: 17419083 [PubMed - as supplied by publisher]

2: J AAPOS. 2007 Apr 6; [Epub ahead of print]

Stereoacuity and binocular visual acuity in prism-induced exodeviation.

Mayo Medical School, Rochester, Minnesota.

BACKGROUND: Intermittent exotropia may be controlled by accommodative or motor convergence. Previous studies have reported that reduced binocular visual acuity in intermittent exotropia is due to the accommodation required to control the deviation. To test this hypothesis, we simulated convergence stress by inducing exodeviations in normal volunteers to investigate whether the transition from nonfused to fused is associated with a gradual or immediate transition in stereoacuity and binocular visual acuity. METHODS: Convergence stress was induced in 25 visually normal adults with 40(Delta) base-out prism and reduced stepwise in increments of 5(Delta) until 20(Delta), and 2(Delta) thereafter. Stereoacuity (Frisby Davis Distance [FD2] and the Distance Randot [DR]) and binocular visual acuity were measured at each step. For each subject, the recovery of fine stereoacuity (</=60 arcsec) was categorized as immediate (nil to fine) or gradual (nil to moderate to fine). RESULTS: Twenty-four of 25 (96%) showed gradual recovery of fine stereoacuity on either FD2 or DR. Median binocular visual acuity at baseline, first level of fusion, and subsequent levels was 20/15. CONCLUSIONS: Under convergence stress, the transition from nonfused to fused is accompanied by a gradual recovery of fine stereoacuity in most individuals, consistent with some studies of patients with intermittent exotropia. Nevertheless, this degradation of stereoacuity was not associated with decreased binocular visual acuity, suggesting that accommodative convergence may not be recruited to restore and maintain binocularity under conditions of convergence stress.

PMID: 17419082 [PubMed - as supplied by publisher]

3: J AAPOS. 2007 Apr 6; [Epub ahead of print]

Strabismus might be a risk factor for amblyopia recurrence.

Department of Clinical Neurophysiology.

BACKGROUND: Previous reports have suggested that one-fourth of amblyopic subjects present with recurrence of amblyopia even after successful primary treatment. Risk factors for amblyopia recurrence are insufficiently studied, but therapy weaning has recently been suggested as a method for reducing the risk of recurrence. METHODS: In the second phase of a prospective study examining the results of treatment for amblyopia, all 35 children with successful primary amblyopia treatment were put on maintenance therapy. Maintenance therapy consisted of low-intensity patching, atropine, or blurring filter, and all children were regularly examined up to at least 8 years of age. Mean age at start of maintenance therapy was 4.3 years (range, 2-7 years). RESULTS: Of the 35 cases with successful primary treatment, 6 cases deteriorated >/=0.2 logMAR, which was considered recurrence of amblyopia. Two of these cases had a second recurrence. Notably, all six subjects presenting with recurrence had microstrabismus. This finding was just outside statistical significance at the 95% confidence level (p = 0.06), but the sample size was small. All but one of the recurrences appeared within 6 months after successful primary treatment. Age at successful primary treatment or initial interocular difference of visual acuity did not affect the risk of recurrence. CONCLUSIONS: Recurrence of amblyopia occurred in 17% of patients despite maintenance therapy and was associated with microstrabismus. The majority of recurrences occurred within the first 6 months after primary treatment.

PMID: 17419081 [PubMed - as supplied by publisher]

4: J AAPOS. 2007 Apr 6; [Epub ahead of print]

Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field.

Daroff-Dell'Osso Ocular Motility Laboratory, LSCD VAMC and CASE Medical School, Cleveland, OH.

PMID: 17419080 [PubMed - as supplied by publisher]

5: Ophthalmology. 2007 Apr 4; [Epub ahead of print]

Archipelago Keratitis A Clinical Variant of Recurrent Herpetic Keratitis?

Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild and Bichat Hospital, APHP, Paris, France.

OBJECTIVE: To describe archipelago keratitis, a presumed clinical variant of herpetic epithelial keratitis. DESIGN: Case series. PARTICIPANTS: A series of 6 patients with an unusual form of superficial keratitis. METHODS: History, including age, gender, clinical evolution, and treatment; slit-lamp biomicroscopy findings; in vivo confocal microscopy findings; and corneal epithelial scrapings were analyzed. MAIN OUTCOME MEASURES: Clinical ocular examination, a diagnostic workup including corneal scraping for herpesvirus polymerase chain reaction, in vivo confocal microscopy, and therapeutic outcome. RESULTS: The authors describe a series of 6 patients with keratitis consisting of foci of epithelial erosions associated with subepithelial nummular inflammatory infiltrates and disposed in a radial, centripetal, archipelagolike pattern originating from the limbus. All the patients had a past history of herpetic epithelial keratitis, herpetic vesicles on the ipsilateral lid, or both. Polymerase chain reaction-based screening for herpes simplex virus 1 and 2 in corneal scrapings demonstrated positive results in 2 patients. In vivo corneal confocal microscopy revealed focal areas of hyperreflective epithelial cells and hyperreflective subepithelial dendritic structures overlying activated keratocytes. All the patients improved with oral valacyclovir treatment followed by topical steroid therapy. CONCLUSIONS: Archipelago keratitis may be a new clinical variant of herpetic keratitis, reflecting herpetic dissemination from the limbus to the center of the cornea.

PMID: 17418418 [PubMed - as supplied by publisher]

6: Binocul Vis Strabismus Q. 2007;22(1):49-56.

Long term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia.

PURPOSE: To investigate the long-term vision outcomes of amblyopia treatment in "successfully" compared with "unsuccessfully" treated patients. METHODS: Forty-two participants (n=42, mean age 14.8 years, range 10-25 years) were enrolled in the study. Individuals with strabismic or mixed (strabismic and anisometropic) amblyopia were examined at a mean of 6.6 years (range 1-18 years) after cessation of amblyopia treatment. Participants were classified as being "successfully" treated (Group 1) if visual acuity of 6/7.5 or better was achieved at cessation of treatment, or "unsuccessfully" treated (Group 2) if visual acuity of 6/9 or less was achieved at cessation of treatment. Visual acuity was analyzed by calculating an interocular score or difference in visual acuity between the amblyopic and non amblyopic normal (control) eye. RESULTS: A deterioration of visual acuity occurred in 62% of the participants in both Groups 1 and 2. The mean deterioration of visual acuity over time for either group was less than one LogMAR chart line and was not "statistically significant" by convention (F [1,39] = 3.361, p=0.074). The outcomes achieved at cessation of treatment did not "statistically significantly" affect the mean deterioration that occurred over time (F [1,49] = 0.031, p=0.860). CONCLUSION: Visual acuity was relatively stable over a mean followup period of 6.6 years. The treatment outcome and the success of amblyopia treatment were found to be irrelevant to long term stability of visual acuity. These findings suggest that amblyopia treatment mostly results in a lasting improvement in visual acuity, and that both unsuccessfully and successfully treated individuals maintain their visual acuity improvement achieved during treatment.

PMID: 17417966 [PubMed - in process]

7: Binocul Vis Strabismus Q. 2007;22(1):17-48.

Relative Scotomata in the "Normal" Eye of Functionally Amblyopic Patients. A Scanning Laser Ophthalmoscope (SLO) Micreperimetric Study.

PURPOSE: To evaluate amblyopic patients with scanning laser ophthalmoscope (SLO) microperimetry to determine whether SLO assessment and data might provide useful information in our understanding of amblyopia and determine its utility in the evaluation of amblyopic patients. METHODS: In this retrospective case series, selected for SLO testing case series, clinical data of forty-six patients with amblyopia were reviewed after completion of treatment for anisometropic or strabismic amblyopia. Ten ophthalmologically age-matched, normal patients served as controls. All patients were tested with the SLO, evaluating for the presence of macular scotomata. SLO findings were assessed within each group and between groups. RESULTS: A macular scotoma was found in the amblyopic eye of 25 of 26 anisometropic amblyopic patients and all 20 strabismic amblyopia patients. Twenty of 26 patients with anisometropic amblyopia had a relative scotoma in the non-amblyopic "normal" eye. All 20 patients with strabismic amblyopia also had a non-amblyopic "normal" contralateral eye scotoma. None of the normal control patients had a scotoma in either eye. Several ocular and binocular clinical features were correlated to scotoma findings within and between groups. CONCLUSION: The SLO proved useful for the assessment of some features of amblyopia. A scotoma was identified not only in the amblyopic eye of all but one amblyopic patient, as expected, but also in almost all of the fellow non- amblyopic, presumed "normal" contralateral eyes, and in spite of treatment normalization of visual acuity and stereoacuity in several cases. Thus, the ocular and binocular pathological effects of unilaterally functional amblyopia are not limited to the amblyopic eye but may also be seen, to a sub-clinical degree, by SLO microperimetry in the supposedly normal contralateral eye as well as in the apparently successfully treated previously amblyopic eye.

PMID: 17417965 [PubMed - in process]

8: Binocul Vis Strabismus Q. 2007;22(1):15-6.

Here We Go, Charging Full Throttle and Headlong Into the Internet. "Binocular Vision and Strabismus Quarterly" Stops the Presses! All But Totally and Re-Establishes Its Old Website at binocularvision.net for continuing E-Publication of this Now E- Periodical.

PMID: 17417964 [PubMed - in process]

9: Eye. 2007 Apr 6; [Epub ahead of print]

Does an iridotomy provide protection against narrowing of the anterior chamber angle during Valsalva maneuvre in eyes with primary angle closure.

1Glaucoma Research Facility, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

PurposeTo evaluate changes at the anterior chamber angle during Valsalva manoeuver, in eyes having primary angle closure (PAC) and a patent laser peripheral iridotomy.MethodsTwenty-three eyes of 23 consecutive patients underwent a recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, iris thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva manoeuver was standardized to a pressure of 40 mmHg for 15 s, using a manometer.ResultsThe mean baseline intraocular pressure changed from 18.86+3.79 to 26.73+4.73 mmHg during Valsalva, (P<0.0001). The anterior chamber angle recess narrowed from 16.62+6.24 to 6.5+4.02 degrees (P<0.0001). There was a significant increase in the thickness of the ciliary body from 0.92+0.25 to 1.17+0.31 mm (P=0.0006) and in the iris thickness from 0.47+0.17 to 0.57+0.11 mm (P=0.007). A significant increase in pupillary diameter (P=0.008) and a decrease in the angle opening distance (P<0.0001) also occurred during Valsalva, whereas there was no significant change in the anterior chamber depth (P=0.056). The angle recess during Valsalva had a positive correlation with the baseline anterior chamber angle (r=0.41, P=0.05) and a negative correlation with the ciliary body thickness (r=-0.52, P=0.046).ConclusionsThe induction of Valsalva maneuver in day-to-day activities can lead to significant anterior segment angle shallowing and can lead to progression from the PAC stage to primary angle closure glaucoma in such predisposed eyes. The presence of a patent laser iridotomy may not prevent irido trabecular apposition during the Valsalva maneuver.Eye advance online publication, 6 April 2007; doi:10.1038/sj.eye.6702646.

PMID: 17417624 [PubMed - as supplied by publisher]

10: Eye. 2007 Apr 6; [Epub ahead of print]

Ketamine sedation during the treatment of retinopathy of prematurity.

1Department of Ophthalmology, St James's University Hospital, Leeds, UK.

AimsTo report the use of ketamine sedation as an alternative anaesthetic method for babies undergoing treatment for retinopathy of prematurity (ROP).MethodsAll babies who underwent treatment for ROP over a 2-year period were included in this study. The babies preoperative weight, medical condition, and ventilation status was recorded. Data were collected on their ventilation status pre-, intra-, and postprocedure. Any change in their cardiac or respiratory status during or in the subsequent 3 days following the treatment was noted.ResultsEleven babies, 22 eyes, required treatment over this period. The procedure was well tolerated with only three babies having intraoperative complications, which all resolved spontaneously. Two babies had postoperative complications requiring additional ventilation. In no case was the procedure abandoned owing to anaesthetic complications.ConclusionsThe use of ketamine sedation allows the laser to be performed in a ward setting and avoids the potential risk of general anaesthesia and inter- and intra-hospital transfer. It has been found to produce few intra- or postoperative complications for the infant, while providing satisfactory conditions for the treatment of ROP.Eye advance online publication, 6 April 2007; doi:10.1038/sj.eye.6702717.

PMID: 17417623 [PubMed - as supplied by publisher]

11: Eye. 2007 Apr 6; [Epub ahead of print]

'Layer by layer' phacoemulsification in posterior polar cataract with pre-existing posterior capsular rent.

1Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.

PurposeTo evaluate a new technique of 'Layer by Layer' phacoemulsification in eyes with posterior polar cataract with pre-existing posterior capsular rent (PCR).MethodsLayer by layer phacoemulsification was performed in eight eyes of eight patients of posterior polar cataract with pre-existing posterior capsular rent. All the patients had evidence of a posterior capsular defect showing presence of iridescent refractile lens particles in vitreous with onion skinning of central dense plaque.ResultsThe mean age of the patients was 43.75+/-2.5 years and six patients were men. All the eyes had vertical posterior capsular defect irrespective of the site of entry of phaco probe. Vitrectomy was not required in any of the eyes. Single piece foldable acrylic intraocular lens was implanted in the bag in all the eyes. The mean preoperative best corrected visual acuity was 0.14+/-0.05, which improved to 0.77+/-0.27.ConclusionOur technique of 'Layer by layer' phacoemulsification is an effective and safe technique for the management of posterior polar cataract with pre-existing PCR.Eye advance online publication, 6 April 2007 doi:10.1038/sj.eye.6702795.

PMID: 17417622 [PubMed - as supplied by publisher]

12: Eye. 2007 Apr 6; [Epub ahead of print]

Vascularised epiretinal membrane associated with vasoproliferative tumour.

1VitreoRetinal Service, Addenbrooke's Hospital, Cambridge, UK.

PMID: 17417621 [PubMed - as supplied by publisher]

13: Eye. 2007 Apr 6; [Epub ahead of print]

Correlation between microaneurysm closure rate and reduction in macular thickness following laser photocoagulation of diabetic macular edema.

1Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

AimTo correlate the microaneurysmal closure rate measured on fundus fluorescein angiography (FFA) with reduction in macular thickness observed on optical coherence tomography (OCT) following laser photocoagulation of diabetic macular edema.Materials and methodsA prospective observational case series. Fifty patients (50 eyes) of type II diabetes mellitus with clinically significant macular oedema (CSME) underwent focal/grid laser photocoagulation. OCT and FFA were performed at baseline and at 2 and 12 weeks following laser photocoagulation to measure the change in macular thickness and the number of leaking microaneurysms respectively. Statistical analysis was performed using paired-ttest and Pearson's correlation test.ResultsA significant reduction in macular thickness was seen at both 2 (P=0.02) and 12 weeks (P<0.0001), most remarkably in the central 1 mm quadrant. However, microaneurysm closure was only 0.67% at 2 weeks, which increased to 89.6% by 12 weeks. The change in retinal thickness correlated significantly with the decrease in the number of leaking microaneurysms at 12 weeks (r=0.597, P<0.0001), but not at 2 weeks (r=-0.228, P=0.112). On OCT, the final reduction in retinal thickness achieved at 12 weeks from baseline correlated significantly with the initial decrease in retinal thickness at 2 weeks (r=0.66, P<0.0001). However, on FFA, the final closure rate of leaking microaneurysms at 12 weeks from baseline did not correlate with the initial closure rate at 2 weeks (r=-0.039, P=0.413).ConclusionFollowing laser photocoagulation for CSME, an OCT at 2 weeks is more informative and better correlates with the final outcome than an FFA at 2 weeks.Eye advance online publication, 6 April 2007; doi:10.1038/sj.eye.6702801.

PMID: 17417620 [PubMed - as supplied by publisher]

14: Eye. 2007 Apr 6; [Epub ahead of print]

Acute central retinal artery occlusion in Adamantiades-Behcet disease.

1Department of Ophthalmology, Charite Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.

PMID: 17417619 [PubMed - as supplied by publisher]

15: Eye. 2007 Apr 6; [Epub ahead of print]

Reply to Tinley and Blates.

1Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Berkshire SL4 3DP, UK.

PMID: 17417618 [PubMed - as supplied by publisher]

16: Eye. 2007 Apr 6; [Epub ahead of print]

Treatment of macula-on retinal detachments.

1Birmingham and Midlands Eye Centre, B18 7QU, Birmingham, UK.

PMID: 17417617 [PubMed - as supplied by publisher]

17: Eye. 2007 Apr 6; [Epub ahead of print]

Reply to Scott and Kirkby.

[1] 1Birmingham and Midland Eye centre, Birmingham, UK [2] 2Birmingham Heartlands and Solihull Hospital, Birmingham, UK.

PMID: 17417616 [PubMed - as supplied by publisher]

18: Eye. 2007 Apr 6; [Epub ahead of print]

Reply to Scott and Kirkby.

1Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH60 6RT, UK. E-mail: sprasad@rcsed.ac.uk.

PMID: 17417615 [PubMed - as supplied by publisher]

19: Eye. 2007 Apr 6; [Epub ahead of print]

Reply to Sangtam et al.

1Faculty of Health and Medical Sciences, Department of Ophthalmology, University of Auckland, Auckland, New Zealand.

PMID: 17417614 [PubMed - as supplied by publisher]

20: J Fr Ophtalmol. 2007 Mar;30(3):320-1.

[Risk factors for microbial keratitis.]

[Article in French]

Service d'Ophtalmologie, Hopital de Bicetre, le Kremlin-Bicetre.

PMID: 17417161 [PubMed - in process]

21: J Fr Ophtalmol. 2007 Mar;30(3):314-5.

[Clinical-tomographic correlation of the iridocorneal opening following laser iridotomy.]

[Article in French]

PMID: 17417160 [PubMed - in process]

22: J Fr Ophtalmol. 2007 Mar;30(3):306-13.

[Neighboring forms of allergy.]

[Article in French]

Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Service d'Ophtalmologie 3, 28 rue de Charenton, 75012 Paris.

Chronic allergic conjunctivitis constitutes a complex ocular surface disease involving many mechanisms, extending well beyond the simple field of mast cells and IgE. Lacrimal film, the eyelids, the environment, especially iatrogenic in origin, closely interact with each other and involve many cell systems such as goblet cells, eosinophils, and lymphocytes. It is therefore imperative to reach a better understanding of the mechanisms associated and eliminate confounding pathologies that may mimic allergic conjunctivitis. Dry eye syndrome or rosacea may be very close to chronic allergic diseases, and long-term use of preservative-containing eyedrops may result in inflammatory reactions that may be very difficult to discriminate from a primarily allergic disease.

PMID: 17417159 [PubMed - in process]

23: J Fr Ophtalmol. 2007 Mar;30(3):300-5.

[Conjunctival provocation test.]

[Article in French]

Service d'Ophtalmologie, Hopital Pellegrin, CHU de Bordeaux, Bordeaux.

The conjunctival provocation test (CPT) is a human model of ocular allergy that has been used to study the ocular response to allergenic stimuli and to evaluate antiallergic therapy. Considerable useful information has been gained on the ocular allergic response and drug efficacy using the conjunctival provocation test and naturally occurring seasonal allergic conjunctivitis. The safety and the efficacy of these CPTs has resulted in many authors using this tool in the etiologic diagnosis of allergic conjunctivitis. This article summarizes the possibilities of these CPTs as a tool for the study, evaluation, diagnosis, and therapeutic follow-up of allergic conjunctivitis.

PMID: 17417158 [PubMed - in process]

24: J Fr Ophtalmol. 2007 Mar;30(3):292-9.

[Childhood allergic conjunctivitis: the allergist's point of view.]

[Article in French]

Consultation d'Ophtalmologie et Allergologie de l'enfant, Unite d'Allergologie de l'enfant, Service Pediatrie A, Hotel Dieu CHU, 63058 Clermont-Ferrand CEDEX 1.

Allergic conjunctivitis is one of the most frequent reasons for a child's consultation with an ophthalmologist. Once the diagnosis of conjunctivitis is made and the clinical form is clearly established, the search for a cause is the most complicated step. Consultation with an allergist is necessary, in particular when questioning the patient points toward an allergic cause or brings up conditions suggestive of atopic disease. Ocular allergy can follow a type I hypersensitivity, i.e., mediated by IgE: most frequently this is acute and chronic allergic conjunctivitis. Demonstrating the allergen requires prick tests, which are easy to carry out and painless; their sensitivity is currently satisfactory. In vitro tests can complete the workup. In case of doubt on the allergen responsability for allergy, an allergenic provocation test can confirm or refute the allergen's involvement. Ocular allergy can also stem from a type IV mechanism, i.e., a cell-mediated mechanism such as in contact allergy involving different topical substances. In these cases, the clinical aspect and the patient's history may require consultation with a dermatologist-allergist for patch tests. To adapt practices when encountering conjunctivitis in a child, the ophthalmologist should be familiar with the allergens that may set off a conjunctivitis episode. Knowledge of the mechanisms at play also helps direct the examination toward allergy or another cause. In all these steps, collaboration between the ophthalmologist and the allergist is indispensable.

PMID: 17417157 [PubMed - in process]

25: J Fr Ophtalmol. 2007 Mar;30(3):288-91.

[Different clinical forms of conjunctival allergy.]

[Article in French]

Service d'Ophtalmologie, CHU, Dijon.

Allergic conjunctivitis is a frequent disorder, benign in most cases and often associated with other manifestations of atopy such as rhinitis or asthma. This disorder is increasing steadily because of the influence of environmental factors such as pollution, smoking, etc. Allergic conjunctivitis can be broken down into five clinical forms: (1) seasonal and intra-annual conjunctivitis, (2) vernal keratoconjunctivitis, (3) atopic keratoconjunctivitis, (4) gigantopapillary conjunctivitis, and (5) contact allergies (palpebral conjunctival form). Analysis of the patterns and signs of the disorder as well as the circumstances surrounding its manifestation and an allergy workup generally facilitate eliminating the allergen responsible once it has been identified.

PMID: 17417156 [PubMed - in process]

26: J Fr Ophtalmol. 2007 Mar;30(3):283-7.

[The cellular players in allergy.]

[Article in French]

Service d'Ophtalmologie, Hopital Bretonneau, Universite Francois Rabelais, 2, boulevard Tonnelle, 37000 Tours.

Ocular allergy, with a significant increase of prevalence, is one of the most usual disease of the ocular surface. But, in a same entity, it means different kinds of clinical diseases with acute hayfever conjunctivitis, usually easy to diagnose, but also chronic perennial forms without any functional or clinical specificity among others ocular surface diseases. These clinical aspects are underlain by complex cellular mecanisms which are essentially located inside the conjunctiva. Initially, allergen cross the lacrimal tear film, the first natural barrier of the eye, then in the conjunctival epithelium, meet the antigen presenting cells, the Langerhans cells, lymphocytes and all the others components of the inflammatory and allergic reaction, including mast cells and eosinophils. The cornea could also be involved in allergic diseases, mostly in severe ones such as vernal or atopic keratoconjunctivitis, but most often, its pathology is due to direct cytotoxic effect of chemical mediators, such as eosinophil proteins, rarely results from mechanical or immunological pathways.

PMID: 17417155 [PubMed - in process]

27: J Fr Ophtalmol. 2007 Mar;30(3):276-80.

[Optical coherence tomography follow-up of a case of solar maculopathy.]

[Article in French]

Service d'Ophtalmologie, HIA Clermont-Tonnerre, Brest.

Solar maculopathy is caused by sun-gazing without protection and in most cases appears to be reversible. Retinal damage may be caused by photochemical changes combined with a rise in temperature at the time of sun observation. We report a case of bilateral solar retinopathy following direct sun gazing after observation of the partial eclipse on 3 October 2005. A 25-year-old Caucasian man presented 24 h after watching the eclipse with symptoms of blurred vision and a bright positive central scotoma. Total direct viewing time was approximately 5 min. While observing the eclipse, the patient kept both eyes open. On presentation, his visual acuity was 20/25 in his right eye and 20/32 in his left eye. Ophthalmoscopic examination revealed a bilateral yellowish-white spot in the center of the foveal region. Static visual field examination did not disclose any absolute scotoma but a decrease in the foveal threshold was noted in both eyes. Optical coherence tomography (OCT) examination revealed a bilateral increased reflectivity of the inner foveal retina that was greater in the left eye. This finding was associated with a hyporeflective area of the underlying retinal pigment epithelium: choriocapillaris complex and an increase in retinal thickness. Eight days later, visual acuity was 20/20 in each eye. Funduscopy showed the yellow lesion had vanished. Four months after exposure, funduscopy was normal and OCT scan showed normal reflectivity of all retinal layers in the fovea. However, static visual field examination disclosed a decreased foveal threshold on the left eye. We compare the OCT findings in this patient with the data reported in the literature. Indeed, various OCT findings have been reported depending on the intensity and frequency of sun exposure. This observation demonstrates that OCT appears to be potentially useful in the evolutive follow-up of solar maculopathy, and emphasizes the importance of eye safety during solar eclipse observation.

PMID: 17417154 [PubMed - in process]

28: J Fr Ophtalmol. 2007 Mar;30(3):271-275.

[Improved visualization of fundus with green-light ophthalmoscopy.]

[Article in French]

Service d'Ophtalmologie, Hopital Saint Anne, Toulon.

Monochromatic light accentuates details of different retinal layers because of its variable absorption and reflectance by structures both within and above these layers. Red-free light is little used, although it is an elementary method. Green-light ophthalmoscopy, with its short wavelength, enhances some fundus and vitreous structures and may make the examination of pathologic conditions (premacular pathology, vascular abnormalities, etc.) easier. Furthermore, it is often more comfortable for the patient.

PMID: 17417153 [PubMed - as supplied by publisher]

29: J Fr Ophtalmol. 2007 Mar;30(3):260-270.

[Clinical evaluation of the Pascal(R) dynamic contour tonometer.]

[Article in French]

Cliniques Universitaires Saint Luc, UCL, Bruxelles, Belgique.

PURPOSE: The Pascal(R) dynamic contour tonometer (DCT) was designed to measure IOP independently of corneal properties. This study aimed at 1) assessing the intra- and interindividual variability of DCT IOP measurements, the differences between DCT and applanation tonometry IOP measurements (APL), and their correlations with central corneal thickness (CCT); 2) analyzing the variability of the ocular pulse amplitude (OPA) and its correlations with age, blood pressure (BP), cardiac beat pulse (CP), diagnosis of glaucoma, IOP, and severity of glaucomatous visual field (VF) defects. METHODS: Twenty-five normal subjects (25 eyes), 14 patients with ocular hypertension (27 eyes), and 54 glaucomatous patients (104 eyes) were included in this prospective study. In the first 12 normal subjects, three consecutive IOP measurements were taken by three different observers using DCT, directly followed by three measurements with APL by the same observer. In the following 13 subjects, the reverse sequence was followed. In the other group, the IOP measurements (three DCT and three APLs) were taken by the same observer. Only DCT measurements with quality levels 1-3 were considered for analysis. RESULTS: In the normal group, DCT IOP measurement variability varied between 4.4%-7.3% (intraobserver variation coefficient) and 8% (interobserver variation coefficient). DCT IOP measurement was not influenced by the sequence of measurements or the observer. DCT overestimated IOP by a mean of 2.2mmHg compared with APL (p<0.001). The 95% limits of agreement for each subject tested with both tonometers ranged from -0.5mmHg to +6.3mmHg. IOP APL and DCT measurements were strongly correlated. Both DCT and APL were not correlated with CCT. OPA ranged from 1.2mmHg to 6.6 mmHg (mean, 3.1+/-1.2mmHg) and was comparable between the three observers. Intraobserver OPA variability ranged from 7.6% to 9.5%. The interobserver OPA variability coefficient was 8.8%. OPA was only correlated with systolic BP (p<0.05). In glaucomatous patients, the correlation between DCT and APL IOP measurements was highly significant (r=0.860, p<0.001). DCT overestimated IOP by a mean 2mmHg compared with APL (p<0.001). IOP differences between both tonometers were not influenced by the sequence of measurements. Unlike APL, DCT was not or only slightly influenced by CCT (p=0.07 for DCT; p=0.001 for APL). The mean difference between IOP DCT and APL was larger in thin corneas (<520microm): 2.8+/-3.1 mmHg versus 0.8+/-2.3mmHg in thick corneas (580 microm) (p=0.001). OPA was not correlated with age. It was positively correlated with IOP (p<0.001), systolic BP (p=0.047), and MD (mean deviation) (p=0.018). It was negatively correlated with diastolic BP (p=0.003), cardiac frequency (p<0.001), severity of glaucomatous VF defects (p=0.002), and PSD (pattern standard deviation) (p=0.008). It was significantly higher in the OHT subgroup and significantly lower in the NTG subgroup (p<0.05). In both groups, the IOP difference between DCT and APL was not correlated with age (p>0.05). CONCLUSIONS: IOP measurements with the Pascal(R) DCT and APL correlated well and were reproducible. DCT IOP measurement variability was slightly higher than APL with relatively wide 95% limits of agreement. Considering the entire study population, DCT overestimated IOP by a mean 2.0mmHg compared with APL. DCT was independent of CCT, especially in thin corneas. The DCT does not appear to be clinically advantageous over the Goldmann tonometer in the IOP measurement in thick corneas. Therefore an IOP follow-up by APL tonometry and pachymetry appeared to be mandatory for the interpretation of the true IOP. Interindividual OPA variations were high, as was measurement variability. OPA was correlated with BP, cardiac frequency, IOP, diagnosis of glaucoma, and severity of glaucomatous VF defects. These must be considered in the clinical interpretation of this parameter.

PMID: 17417152 [PubMed - as supplied by publisher]

30: J Fr Ophtalmol. 2007 Mar;30(3):255-9.

[Management of hyperopia in children.]

[Article in French]

Service d'Ophtalmologie, Hopital La Rabta, Tunis, Tunisie.

PURPOSE: To study the prevalence of hyperopia in school-aged children and to analyze the factors that increase the risk of squint or amblyopia in a retrospective study. METHODS: Three hundred eyes of 150 children with hyperopia who did not have anisometropia >=1.5 D were selected. Complete ophthalmological examination was performed for all children. Hyperopia was defined when spherical equivalent was +0.5 D or greater. Amblyopia was screened and treated by patching therapy and then penalisation. Complete spectacle correction was achieved in children with high hyperopia (+3.5 D or greater) or in presence of squint or amblyopia. A statistical analysis compared the results using the Mann-Whitney test and the chi square test. RESULTS: The mean age was 9.5+/-2.7 years. Girls were statistically more represented than boys. The mean sphere measured overall was +2 D (+/-1.65). Severe hyperopia was detected in 19% of the children; it was latent in 35% of children. Strabismus was detected in 7% and was accommodative in 25%. Esotropia was the most prevalent deviation (72.8%). The prevalence of amblyopia was 12%. The mean sphere measured in amblyopic children was 5.66 D (+/-1.64 D). Initial depth of amblyopia was mild to moderate and 98% of the children achieved iso-acuity after patching therapy. The correlation between severe hyperopia, amblyopia, and squint was statistically significant. Indeed, the risk ratios of squint and amblyopia, 5.2 and 3.70, respectively, were significantly high in children with severe hypermetropia. Complete spectacle correction improved final visual acuity and reduced the angle deviation in accommodative esotropia. CONCLUSION: Children with hyperopia of +3.5 D or greater have an increased risk of amblyopia and squint that threatens their visual function. Hyperopic correction should be prescribed even if no strabismus or amblyopia is detected in order to prevent this risk. Screening programs should also be promoted to detect these children at an early age.

PMID: 17417151 [PubMed - in process]

31: J Fr Ophtalmol. 2007 Mar;30(3):250-4.

[Late endophthalmitis complicating glaucoma filtering surgery without adjunctive antifibrotic agents.]

[Article in French]

Service d'Ophtalmologie, CHU Beni-Messous, Alger, Algerie.

PURPOSE: To identify the incidence, infecting organisms, and clinical results of late endophthalmitis after trabeculectomy without antifibrotic agents. MATERIAL: and methods: The current retrospective study investigated 613 trabeculectomies without adjunctive antifibrotic agents performed between January 1994 and December 2003 in the Clinic of Ophthalmology of Beni-Messous University Hospital (Algiers, Algeria). RESULTS: Eight eyes presented with late endophthalmitis after an uneventful postoperative period, for an incidence of 1.3%. The endophthalmitis occurred between 1 year and 7 years after the filtering surgery. Conjunctival swabs were taken in all cases. Vitreous swabs were taken in only six cases. There were five positive cases. The organisms identified were Staphylococcus aureus (one case), alpha hemolytic streptococci (two cases), Haemophilus sp. (one case), and Pseudomonas aeruginosa (pyocyanic) (one case). The anatomic and visual results were poor after treatment of endophthalmitis. One case deteriorated, ending in enucleation. CONCLUSION: Late endophthalmitis may complicate glaucoma filtering surgery, several months or years later, after a postoperative period without incident. The surgical indications of glaucoma must take into account the complications related to this surgery.

PMID: 17417150 [PubMed - in process]

32: J Fr Ophtalmol. 2007 Mar;30(3):247-9.

[Discoid lupus erythematosus with eyelid involvement. A series of nine patients.]

[Article in French]

Service de Dermatologie, Sfax, Tunisie.

Introduction: Discoid lupus erythematosus (DLE) is a chronic autoimmune skin disease that usually affects the sun-exposed skin. Palpebral involvement occurs uncommonly. MATERIAL: and method: The goal of our study was to present the clinical and therapeutic features of a series of nine patients with discoid lupus erythematosus with eyelid involvement. RESULTS: Lesions of discoid lupus were more frequent in the lower eyelids (seven cases). The palpebral location was the only manifestation of the disease in a 34-year-old woman. In the other cases, cutaneous lesions of typical discoid lupus were noted. Seven patients responded to therapy with antimalarial drugs associated with local corticosteroids and photoprotection. DISCUSSION: Eyelid lesions of discoid lupus erythematosus are rare. Involvement of the lower eyelids is more common. It is important to diagnose discoid lupus of the eyelids because misdiagnosis (isolated form) can delay treatment and cause deformities. The treatment is systemic antimalarial drugs, which have an excellent clinical response.

PMID: 17417149 [PubMed - in process]

33: J Fr Ophtalmol. 2007 Mar;30(3):239-46.

[The vicious circle in dry eye syndrome: a mechanistic approach.]

[Article in French]

Centre National d'Ophtalmologie des Quinze-Vingts, Paris, France.

The mechanistic view of dry eye disease aims at completing the classic etiological approach that classifies the disease as parallel ocular surface disorders leading to lacrimal film impairment and dry eye. This approach proposes two levels of ocular surface impairment (with standard etiologies, previously validated in the NEI/Industry workshop), which may not be independent diseases but rather risk factors and/or ways to enter a self-stimulated biological process involving the ocular surface. All external disorders proposed in this model, although unlikely to be fully exhaustive, are classical mechanisms considered to be causes of tear film impairment and ocular surface damage, by tear instability and evaporation, tear hyposecretion, or both. These mechanisms, sometimes alone - when severe or becoming chronic or repeatedly present on the ocular surface and when two or more are present - may cause the patient to enter the self-stimulated loop. Tear film instability/imbalance can be considered as the key point of dry eye disease. It will cause local or diffuse hyperosmolarity of the tear film and therefore of superficial epithelial cells of the cornea and/or conjunctiva, stimulating epithelial cells and resident inflammatory cells. Cell damage in the cornea and conjunctiva, by means of apoptosis and direct mechanical and/or osmotic stress, will stimulate the reflex neurosensory arc, in turn stimulating lacrimal gland and neurogenic inflammation, with inflammatory cytokine release, MMP activation, and inflammatory involvement of the conjunctival epithelium. Goblet cell loss is thus directly related to chronic inflammation and surface cell apoptosis subsequent to cell hyperosmolarity and chronic damage, resulting in further tear film instability/imbalance. On the other hand, bacterial changes and an imbalance resulting from specific diseases or from tear film abnormalities may trigger release of endotoxins, lipopolysaccharides, and/or lipase activation, causing eyelid inflammation, meibomian gland dysfunction, and lipidic changes, directly influencing tear film stability and favoring tear evaporation. The lipidic hypothesis therefore participates in the vicious circle as a parallel, independent, or complementary loop. This mechanistic approach proposes a synthetic combination of mechanisms previously validated independently, with two levels of ocular surface impairment, a first level including many possible acute or chronic causes that favor or trigger the imbalance and can be reversible if correctly and specifically managed when possible, and the further involvement of a series of biological cascades centered by tear film imbalance and inflammatory stimulation, finally acting as an independent vicious circle, however the patient entered the loop. Clinically, this approach may explain examples of dry eye syndrome occuring after ocular surgery, contact lens wear, chronic allergy or systemic or topical drugs, and the long-lasting effect even though all causal factors have been removed or have disappeared. This model should be considered as a basis for further reflection on biological mechanisms that could be even more complex but individually constitute potential leads for targeting therapeutic strategies to allow patients to leave the loop even though the triggering factors are still present or can only be attenuated, such as in Sjogren syndrome or ocular rosacea. It also should be considered a complement to more classic etiological and severity classifications aimed at understanding and classifying the large number of diseases that may cause dry eye disease and better assessing the major impairment it causes on the patient's quality of life.

PMID: 17417148 [PubMed - in process]

34: J Fr Ophtalmol. 2007 Mar;30(3):233-8.

[Quality of life in patients with wet age-related macular degeneration treated with photodynamic therapy.]

[Article in French]

Service d'Ophtalmologie, Hopital Gui de Chauliac, CHU de Montpellier, Montpellier.

PURPOSE: To analyze the benefit of photodynamic therapy in terms of quality of life in patients with wet age-related macular degeneration. METHODS: A retrospective study was conducted on 33 patients with subretinal neovascularization receiving visual rehabilitation in a low vision clinic (ARAMAV, Nimes) in southern France. Twenty had been treated with photodynamic therapy (PDT group) and 13 had not (non-PDT group). In the non-PDT group, the patients had been treated with thermal photocoagulation, transpupillary thermotherapy, or external radiotherapy, or had not received any treatment. Visual acuity, reading speed, reading endurance, and quality of life were compared. Two quality-of-life scales were employed: the VF-14 and NEI-VFQ-25. RESULTS: A significant difference between the two groups in terms of quality of life was observed. The VF-14 score (p<0.01) and two parameters (near activities and distant activities) of the NEI VFQ-25 were significantly higher (both p<0.01) in the PDT group. Visual acuity, reading speed, and reading endurance were similar in both groups. CONCLUSION: Although no difference in terms of functional parameters was observed, photodynamic therapy could preserve the central retina and thus enable a better use of the residual visual function, which could explain the better quality of life perceived by the patients in the PDT group.

PMID: 17417147 [PubMed - in process]

35: J Fr Ophtalmol. 2007 Mar;30(3):225-231.

[Utility of the Visante(R) OCT in the follow-up of glaucoma surgery.]

[Article in French]

Service d'Ophtalmologie III, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris.

PURPOSE: To evaluate the utility of the Visante(R) OCT in the follow-up of filtering surgery. MATERIAL: and methods: In this study, we evaluated 38 filtering blebs in 31 patients following trabeculectomy (4) and nonpenetrating deep sclerectomy (NPDS) (34). In 11 cases, mitomycin C was used during surgery. In patients who underwent NPDS, a collagen implant was placed within the scleral site in eight eyes and seven eyes had goniopuncture during follow-up. All patients had complete ophthalmologic examination with morphological evaluation of the bleb and intraocular pressure measurement as well as Visante(R) OCT evaluation. RESULTS: The trabeculectomy site as well as the trabeculodescemetic membrane (in NPDS), the scleral flap, the conjunctival flap, the iris, and the relationship between these structures were analyzed. Functioning blebs had a hyporeflective and irregular conjunctival tissue associated with a route for aqueous humor under the scleral flap from the anterior chamber toward the subconjunctival space. This filtration route was also observed within nonfunctioning encapsulated blebs. Flat and encapsulated nonfunctioning blebs had dense and hyperreflective conjunctival tissue. In the particular case of nonfunctioning flat blebs, there was no route for aqueous humor filtration under the scleral flap. CONCLUSION: The Visante(R) OCT is a simple and noninvasive imaging technique with good resolution, allowing the analysis of morphologic changes occurring in eyes after filtering surgery.

PMID: 17417146 [PubMed - as supplied by publisher]

36: J Fr Ophtalmol. 2007 Mar;30(3):e8.

[Prepapillary arterial loop and retinal arterial branch occlusion.]

[Article in French]

Service d'Ophtalmologie, Centre Hospitalier Universitaire, Poitiers.

Preretinal arterial loops are congenital vascular anomalies that originate from a main branch of the central retinal artery on the optic disc. These arterial loops are usually unilateral and asymptomatic, but they can be associated with retinal artery branch occlusion. We report one case of inferior temporal retinal artery occlusion in a patient with preretinal arterial loops. Two different mechanisms are thought to be the cause of occlusion: twisting of the loop or thrombosis.

PMID: 17417145 [PubMed - in process]

37: J Fr Ophtalmol. 2007 Mar;30(3):e7.

[A case report of a recurrence of Mooren's ulcer after cataract surgery.]

[Article in French]

Service d'ophtalmologie, Hopital Pellegrin, CHU, Bordeaux.

We report the case of Mooren's ulcer recurrence after uncomplicated cataract surgery in a 61-year-old woman. This cataract developed because of repetitive inflammation of the anterior chamber and corticotherapy. Local and general corticotherapy with cyclosporin 2% drops was started in association with an anterior lamellar graft and a conjunctival recession due to a preperforation condition. Secondarily cyclophosphamide was necessary to control recurrence with a good anatomic result and an increase in visual acuity. The case updates physiopathologic and diagnostic data on this rare limbic autoimmune ulcerative disease. The diagnosis was made by histology and the dosage of specific autoantibodies against cornea. The prevention of recurrence after surgery requires a long clinical quiescent period, minimally invasive surgery long after inflammation has subsided, and a gradual tapering of corticotherapy over several weeks.

PMID: 17417144 [PubMed - in process]

38: J AAPOS. 2007 Apr;11(2):208.

Reply.

PMID: 17416335 [PubMed - in process]

39: J AAPOS. 2007 Apr;11(2):208.

Reply.

PMID: 17416334 [PubMed - in process]

40: J AAPOS. 2007 Apr;11(2):207-8.

To the editor:.

Jyotirmay Eye Clinic and Dilip Kothari Memorial Pediatric Low Vision Center, Maharashtra, India.

PMID: 17416333 [PubMed - in process]

41: J AAPOS. 2007 Apr;11(2):206.

Control of intermittent esotropia by head shaking.

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Head shaking is a rare phenomenon that refers to repetitive, low-amplitude rhythmic oscillations of the head around the cervical axis. In otherwise neurologically normal children with concomitant ophthalmic disease, head shaking (and/or nodding, ie, vertical oscillations) can be an associated finding or a compensatory mechanism to improve visual acuity.(1) Head shaking as a compensatory mechanism to maintain ocular alignment in intermittent esotropia is the subject of this case report.

PMID: 17416332 [PubMed - in process]

42: J AAPOS. 2007 Apr;11(2):204-5.

Primary superior oblique muscle-levator muscle synkinesis.

Aditya Jyot Eye Hospital, Wadala, Maharashtra, India; Jyotirmay Eye Clinic and Dilip Kothari Memorial Pediatric Low Vision Center, Thane, India.

Congenital ocular aberrant innervations can involve oculomotor, trigeminal, abducens, facial, and glossopharyngeal nerves.(1) Involvement of the trochlear nerve is considered rare or nonexistent.(1) In this report we present a case of upper eyelid retraction while looking in the field of action of the superior oblique muscle, indicating a primary superior oblique-levator muscle synkinesis.

PMID: 17416331 [PubMed - in process]

43: J AAPOS. 2007 Apr;11(2):197-198. Epub 2006 Nov 9.

Anterior necrotizing scleritis after strabismus surgery in a child.

Departments of Ophthalmology and Paediatrics & Child Health, Royal Children's Hospital, Brisbane, Queensland, Australia.

Anterior necrotizing scleritis is a rare but potentially devastating complication of ocular surgery that most often occurs after cataract surgery in elderly patients who may have an underlying systemic autoimmune condition(1) or, less likely, an infectious cause.(2) We describe the management and outcome of a case of bilateral anterior necrotizing scleritis after postoperative infection in a 19-month-old girl who had recently undergone strabismus surgery.

PMID: 17416330 [PubMed - as supplied by publisher]

44: J AAPOS. 2007 Apr;11(2):192-4.

Preexisting posterior capsule defect progressing to white mature cataract.

Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, Gujarat, India.

We present two children discovered to have a total cataract in one eye with a posterior subcapsular cataract in the other eye. Sequential photography documented rapid progression of the posterior subcapsular cataract to a preexisting posterior capsule defect and subsequently to a white, mature cataract. We propose that early intervention be considered in cases with any posterior subcapsular changes (no matter how subtle) and history of total cataract in the fellow eye, especially in any situation where loss of follow-up is likely to occur. In the event surgery is not advised, parents should be warned about possible cataract progression and the importance of regular follow-up examinations.

PMID: 17416329 [PubMed - in process]

45: J AAPOS. 2007 Apr;11(2):187-188. Epub 2006 Sep 18.

Outcomes in children with nasolacrimal duct obstruction: Significance of persistent symptoms while stents are in place.

Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, Missouri.

To evaluate the correlation between persistent symptoms while stents are in place and final outcome in children with nasolacrimal duct obstruction (NLDO). A retrospective observational case series, with medical record review that included indications for surgery, surgical procedure, presence of symptoms while stents were in place, and final outcome after stent removal. Twenty-eight children with NLDO had nasolacrimal duct stents placed in 42 eyes. Twenty-one of the 42 eyes (50%) had minimal or no signs or symptoms of NLDO while stents were in place, and 18 of 21 (86%) were symptom-free after stent removal. Twenty-one of the 42 eyes (50%) remained symptomatic while stents were in place. Eleven of these 21 eyes (52%) had good outcomes after stent removal. Ten (48%) of these patients had persistent symptoms after stent removal requiring further treatment. The prognosis for a good outcome is excellent if symptoms of NLDO resolve while stents are in place. The prognosis is poorer if symptoms of NLDO persist, but more than half of such patients still have good outcomes. Careful counseling of parents regarding these outcomes should be performed before considering additional interventions.

PMID: 17416328 [PubMed - as supplied by publisher]

46: J AAPOS. 2007 Apr;11(2):170-4. Epub 2006 Nov 9.

Incidence of severe retinopathy of prematurity before and after a modest reduction in target oxygen saturation levels.

Duke Eye Center, Durham, NC.

BACKGROUND: Previous studies suggest that reducing target oxygen saturation levels to 85-93% decreases the incidence of severe retinopathy of prematurity (ROP). Our aim was to determine if a more modest reduction in target oxygen saturation levels also reduces ROP incidence. METHODS: One neonatal intensive care unit instituted new oxygen saturation guidelines that changed target levels from the upper 90s to 90-96%. We conducted a retrospective cohort study to determine the proportion of eyes that progressed to (1) threshold or type-1 ROP and (2) stage 3. These proportions were compared between two groups of all eligible infants born up to 10 months before (higher oxygen group, n = 46) and up to 16 months after (lower oxygen group, n = 59) the policy change. Binomial regression was used to calculate relative risks adjusted for birth weight, gestational age, apnea, days of mechanical ventilation, and length of hospital stay. RESULTS: Sixteen of 90 eyes (18%) in the higher oxygen group developed threshold or type-1 ROP versus 16 of 118 eyes (14%) in the lower oxygen group (adjusted relative risk = 0.66, 95% CI = 0.29, 1.51). Twenty-two of 88 eyes (25%) in the higher oxygen group developed stage 3 ROP versus 26 of 118 eyes (22%) in the lower oxygen group (adjusted relative risk = 0.76, 95% CI = 0.43, 1.37). CONCLUSIONS: We observed a small but statistically insignificant reduction in the incidence of severe ROP after a modest reduction in target oxygen saturation levels to 90 to 96% in the first several weeks of life.

PMID: 17416327 [PubMed - in process]

47: J AAPOS. 2007 Apr;11(2):166-9. Epub 2006 Nov 9.

Surgical findings with the tinted AcrySof intraocular lens in children.

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.

INTRODUCTION: The AcrySof foldable acrylic intraocular lens (IOL) has become an accepted and frequent means of treating pediatric aphakia. A new version of this lens with blue-light filtering properties purports to offer superior retinal protection. We describe our experience with this tinted lens and compare it to findings with the standard, nontinted IOL. METHODS: A chart review identified 29 eyes of 21 children (tinted lens group; age 11 months to 13 years) who had the tinted IOL implanted. The standard lens group consisted of 38 eyes (31 patients; age 11 months to 15 years). Most eyes had an intact posterior capsule at the time of implantation. RESULTS: The incidence of postoperative inflammation was fairly high in both groups (71% in the tinted lens group, 60% in the standard lens group). The tinted lens group showed a higher incidence of transient inflammation than the standard lens group (p=0.03) but the rates of nontransient sequelae (posterior synechiae, iris synechiae, membranes formation, capsule, or IOL opacification) were similar (66% versus 47%; p=0.11). Posterior capsule opacification occurred in 15 eyes in the tinted lens group and 16 eyes in the standard lens group (p=0.15) but was visually significant in only 10 and 11 eyes, respectively (p=0.77). CONCLUSIONS: Transient inflammation is higher with implantation of tinted versus nontinted IOLs, but long-term inflammatory sequelae are roughly equal, as is the rate of posterior capsule opacification. The question as to whether the chromophore in the tinted lens caused the higher incidence of transient inflammation is unresolved.

PMID: 17416326 [PubMed - in process]

48: J AAPOS. 2007 Apr;11(2):159-61. Epub 2006 Oct 27.

Cataract surgery for congenital cataract: Endothelial cell characteristics, corneal thickness, and impact on intraocular pressure.

Eye Research Center, Iran University of Medical Science, Tehran, Iran.

PURPOSE: To investigate whether central corneal thickness (CCT), endothelial cell characteristics, and intraocular pressure (IOP) are affected in patients with previous congenital cataract surgery and to focus on their clinical significance. METHODS: CCT and IOP measurements and specular microscopy were performed in 31 eyes of 17 cases of extracted congenital cataracts and 40 eyes of 20 age- and sex-matched participants as control group. The mean of three pachymetry measurements of the central cornea was taken as CCT. IOP was checked using an applanation tonometer. RESULTS: The mean corneal thickness of the eyes with extracted congenital cataract (632+/-45 mum) was significantly greater than that of the control eyes (546+/-33 mum; p<0.001). There was no significant difference in the corneal endothelial cell count, coefficient of variation (CV), and mean cell area (AVG) of endothelial cells between operated eyes and the control group. The mean measured IOP in the operated group (22.8+/-3.3 mm Hg) was significantly greater than IOP in controls (14.1+/-1.8 mm Hg, p<0.001). CONCLUSIONS: Although the corneas were clinically clear and there was no significant difference in endothelial characteristics of eyes with extracted congenital cataract and controls, central corneas of operated eyes were significantly thicker than those of controls. To differentiate the actual glaucoma from ocular hypertension in these patients, the central corneal thickness measurement should strongly be considered.

PMID: 17416325 [PubMed - in process]

49: J AAPOS. 2007 Apr;11(2):148-152.

Severe visual impairment in children with mild or moderate retinal residua following regressed threshold retinopathy of prematurity.

Dean A. McGee Eye Institute, Department of Ophthalmology, University of Oklahoma, Oklahoma City, Oklahoma.

PURPOSE: To describe clinical features of patients from the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) trial who, after developing severe ROP in infancy, had minimal or moderate retinal residua in at least one eye but a visual acuity of worse than 20/200 in both eyes at the 10 year examination. METHODS: Data from the 10 year CRYO-ROP Trial follow-up exams were evaluated to identify all patients with retinal outcomes of no retinopathy of prematurity (ROP) residua, straightened temporal vessels, or macular heterotopia in at least one eye, but visual acuity less than 20/200 in both eyes. Presence of optic atrophy, nystagmus, and optic disk cupping and developmental survey results were examined. RESULTS: Of 247 patients examined at 10 years, 16 met our inclusion criteria. At the last age at which the following data were recorded, seven had optic atrophy at the 10 year examination, one had optic disk cupping >0.5 at the 5(1/2) year examination, and eight had nystagmus under binocular conditions at the 24 month examination. Nine patients had a below-normal developmental test score on the Functional Independence Measure for Children (WeeFIM). After clinical data interpretation, we concluded that the predominant cause of visual impairment was postgeniculate disease in five patients, ROP in six patients, and combined anterior and posterior visual pathway disease in two patients; in three patients data were insufficient to make a determination. CONCLUSIONS: Poor visual function with mild to moderate retinal residua of severe ROP in at least one eye is relatively rare. In such patients, anterior, posterior, or combined visual pathway disease can occur.

PMID: 17416324 [PubMed - in process]

50: J AAPOS. 2007 Apr;11(2):142-147.

Linear nondisplaced orbital fractures with muscle entrapment.

Department of Ophthalmology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio.

PURPOSE: Linear nondisplaced orbital floor fractures with muscle entrapment occur in the pediatric population. These fractures occur with minimal trauma and few external signs of injury. This study reviews the clinical findings, radiologic findings and interpretations, preoperative and postoperative ocular motility, and outcomes in this subset of orbital fracture patients treated with early surgical repair. METHODS: Review of 12 children with linear orbital floor fractures with inferior rectus muscle entrapment, who underwent surgical repair by a single surgeon. RESULTS: All affected eyes demonstrated significant limitation to elevation and, in seven, depression preoperatively. All 12 patients were operated within 4 days of injury. Radiologist interpretation of computed tomographic (CT) findings recognized fracture in 9 of 11 cases in which a dictated report was available. The radiology report correctly identified muscle entrapment in only three cases and was equivocal in three other cases. The ophthalmologist, based on clinical examination and observation of the CT images, correctly identified findings consistent with linear orbital fracture with muscle entrapment in every case. Surgical findings included a nondisplaced linear floor fracture with muscle entrapment. In the early postoperative period limited elevation was present in 10 patients and limited depression was present in 7. Duction deficits and diplopia resolved in 4 days to 5 months. CONCLUSIONS: Despite prompt surgical repair, limited elevation and depression occur in the early postoperative period, possibly due to muscle edema, hemorrhage, and ischemia. Recovery of normal ocular motility may take weeks or months. External signs of injury may be minimal and radiologic interpretation may not recognize fracture or muscle entrapment.

PMID: 17416323 [PubMed - as supplied by publisher]

51: J AAPOS. 2007 Apr;11(2):131-134.

Use of the combined recession and resection of a rectus muscle procedure in the management of incomitant strabismus.

Moorfields Eye Hospital, City Road, London, United Kingdom.

BACKGROUND: Scott described a method of achieving the effect of a posterior fixation procedure by combining resection and recession of a rectus muscle, while maintaining the ability to adjust primary position alignment with adjustable sutures. METHODS: A retrospective review of combined recession-resection procedures on rectus muscles between 1998 and 2002 was carried out. RESULTS: We identified 22 patients, 17 females and 5 males. The mean age at presentation was 44 years. The etiology was felt to be paralytic in seven patients (31.8%), mechanical/restrictive in seven patients (31.8%), and due to residual childhood strabismus in eight patients (36.4%). Twenty patients had undergone previous strabismus surgery, ranging from one to six operations (mean, 1.75). Scott procedures were performed on 25 rectus muscles of 22 patients; 12 on the lateral rectus muscles, 7 on the inferior rectus muscles, 3 on the medial rectus muscles, and 3 on the superior rectus muscles. All but one patient had a measurable improvement in gaze incomitance, and 11 of 12 who had a measurement of the field of binocular single vision showed improvement. Twenty patients had follow-up periods of 3 months or more, with a range of 3 to 30 months and a mean of 9.35 months. CONCLUSIONS: The combined recession-resection procedure advocated by Scott has a role in the management of incomitant strabismus.

PMID: 17416322 [PubMed - in process]

52: J AAPOS. 2007 Apr;11(2):120-4.

Simulated torsional disparity disrupts horizontal fusion and stereopsis.

Department of Clinical Vision Sciences, La Trobe University, Melbourne, Australia.

PURPOSE: To investigate how increasing torsional disparity affects clinical measures of the quality of binocular single vision. METHODS: Synoptophore targets were adjusted to present varying degrees of torsional disparity (relative to the fusion-free rest position of the eyes) such as might be observed in a patient with excyclotropia. This disparity was increased in 2 degrees increments up to 10 degrees in 21 normal subjects. The fusional divergence and convergence amplitudes and random-dot stereoacuity were measured at each level of torsional disparity. RESULTS: Horizontal fusional vergence was not significantly altered from the baseline measures at 2 degrees and 4 degrees of torsional disparity. However, both the divergence and the convergence amplitudes declined and were significantly different than the baseline measures at 6 degrees . A similar decline in the random-dot stereoacuity measurements was evident. Fine levels of stereopsis were decidedly affected at greater than 4 degrees of torsional disparity, while more gross levels were similarly affected beyond 6 degrees . CONCLUSIONS: Although human binocular vision can demonstrate the sensory capacity for cyclofusion beyond 10 degrees , torsional disparity of 6 degrees or more significantly degrades horizontal fusional vergence and stereopsis. Torsion in excess of this degree might therefore be a barrier to asymptomatic and comfortable binocular single vision and may require appropriate attention in the planning of more successful surgery for superior oblique palsy and cyclovertical incomitant strabismus.

PMID: 17416321 [PubMed - in process]

53: J AAPOS. 2007 Apr;11(2):113.

Probing and intubation as primary treatment for nasolacrimal duct obstruction?

PMID: 17416320 [PubMed - in process]

54: J AAPOS. 2007 Apr;11(2):111-112.

Unilateral lens extraction for high anisometropic myopia in children and adolescents: Is this prudent?

Cullen Eye Institute, Baylor College of Medicine, Department of Ophthalmology, Texas Children's Hospital, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

PMID: 17416319 [PubMed - as supplied by publisher]

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