DOCSLIB.ORG

Findings of Perinatal Ocular Examination Performed on 3573

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Findings of Perinatal Ocular Examination Performed on 3573 BJO Online First, published on February 20, 2013 as 10.1136/bjophthalmol-2012-302539 Br J Ophthalmol: first published as 10.1136/bjophthalmol-2012-302539 on 20 February 2013. Downloaded from Clinical science Findings of perinatal ocular examination performed on 3573, healthy full-term newborns Li-Hong Li,1 Na Li,1 Jun-Yang Zhao,2 Ping Fei,3 Guo-ming Zhang,4 Jian-bo Mao,5 Paul J Rychwalski6 1Maternal and Children’s ABSTRACT children who despite screening go undetected with Hospital, Kunming, Yunnan, Objective To document the findings of a newborn eye respect to vision and eye disorders. A careful China 2Beijing Tongren Ophthalmic examination programme for detecting ocular pathology review of Pubmed revealed no published literature Center, Capital University of in the healthy full-term newborn. on the universality, much less the sensitivity and Medical Sciences, Beijing, Methods This is a cross-sectional study of the majority false-negative rate of RRT of normal newborns. China 3 of newborns born in the Kunming Maternal and Child Further, this age group has not been studied exten- Shanghai Xinhua Hospital, Healthcare Hospital, China, between May 2010 and sively and the actual prevalence of ocular abnor- Shanghai, China 4Shenzhen Eye Hospital, Jinan June 2011. Infants underwent ocular examination within malities, transient and permanent, is largely University, Shenzhen, China 42 days after birth using a flashlight, retinoscope, hand- unknown. There are few previous studies looking 5Eye Hospital of Wenzhou held slit lamp microscope and wide-angle digital retinal at the incidence of retinal haemorrhages in healthy Medical College, Wenzhou, image acquisition system. The retinal fundus examination full-term newborns. Smaller series have been pub- China 23 6 utilised the RetCam wide-field digital imaging system lished previously and one study looked at fundus Cole Eye Institute, Cleveland 4 Clinic Foundation, Cleveland, (Clarity Medical Systems, Pleasanton, California, USA). findings only in critically ill children. Ohio, USA The external eye, pupillary light reflex, red reflex, opacity In the People’s Republic of China, there is a of refractive media, anterior chamber and posterior move towards a national health standard for chil- Correspondence to segments were also examined. dren. Neonatal eye examination may play a signifi- Dr Paul J Rychwalski, Mail Code i32, Cole Eye Results A total of 3573 healthy full-term newborns cant role in this process. The Ministry of Health as Institute, Cleveland Clinic were enrolled and examined in the programme. There part of its National Children’s Health Standard Foundation, 9500 Euclid was detection of 871 abnormal cases (24.4%). The encourages newborn examination in detail. This Avenue, Cleveland, OH 44195, majority of abnormal exams were 769 (21.52%) retinal standard has the goal of discovering serious USA; [email protected] haemorrhages. Of these, there were 215 cases of congenital, hereditary and acquired diseases in the significant retinal haemorrhage, possible sight neonatal period of healthy newborns. The present Received 29 August 2012 threatening or amblyogenic, representing 6.02% of the study is, to the authors’ knowledge, the first to Revised 19 November 2012 total. In addition, 67 cases (1.88%) involved macular publish results of a large neonatal eye examination Accepted 21 January 2013 haemorrhage. The other 107 cases (2.99%) with programme. abnormal ocular findings included subconjunctival haemorrhage, congenital microphthalmos, congenital corneal leukoma, posterior synechia, persistent pupillary MATERIALS AND METHODS membrane, congenital cataract, enlarged C/D ratio, Under the umbrella of the Chinese Ministry of http://bjo.bmj.com/ retinal hamartoma versus retinoblastoma, optic nerve Health requirements for general neonatal assess- defects, macular pigment disorder and non-specific ment, the authors devised specifications for neo- peripheral retinopathy. natal eye examination. These exams were optional Conclusion Ocular examination of healthy newborns for the families. The Ministry of Health funded the leads to the detection of a significant number of ocular eye examinations with occasional funding received pathologies. The most commonly discovered ocular from the patient and their insurers. Interested fami- abnormality during examination of the newborns in this lies were educated about the programme and on September 26, 2021 by guest. Protected copyright. study is retinal haemorrhage. The long-term impact of signed an informed consent prior to ophthalmic these findings is unknown. Although presumed by some evaluation. The consent form was reviewed by the to benign, neonatal retinal haemorrhages due to birth hospital and the Ministry of Health ethics and insti- trauma could be involved in altering visual development. tutional review boards and included statements of Further work, including prospective examination of the benefits and modest risks of undergoing the eye newborns with long-term follow-up, is needed and examination. supported by our findings. From the start of the project, maternal health- related lectures regarding neonatal eye disease were held on a monthly basis for healthcare workers as INTRODUCTION well as for parents. Lectures covering the paediatric The American Academy of Paediatrics recommends ophthalmology, including anatomy, basic pathology red reflex testing (RRT) shortly after birth.1 and disease treatment, were held as continuing Thereafter, children should have their eyes exam- medical education courses for training of physicians, To cite: Li L-H, Li N, ined by their primary care physician on all well nurses and allied personnel involved in the pro- Zhao J-Y, et al. Br J Ophthalmol visits. Formal testing of recognition visual acuity gramme. This approach was designed to raise partici- Published ’ Online First: [please include will typically commence around 3 years of age. pants awareness of neonatal ophthalmic disorders. Day Month Year] With this schedule, it is assumed that the vast For the first 7 months, the ocular examination rate doi:10.1136/bjophthalmol- majority of ocular health issues will be discovered. was 75.54% (1881 examined out of 2490 live births). 2012-302539 Nonetheless, there remain a significant number of For the 7 months following, examination rates Li L-H,Copyrightet al. Br J Ophthalmol Article2013; author0:1–4. (or doi:10.1136/bjophthalmol-2012-302539 their employer) 2013. Produced by BMJ Publishing Group Ltd under licence. 1 Br J Ophthalmol: first published as 10.1136/bjophthalmol-2012-302539 on 20 February 2013. Downloaded from Clinical science increased to 93.90% (2126 examined out of 2264 live births). Between May 2010 and June 2011, there were 4754 live births in the Kunming Maternal and Child Healthcare Hospital, Kunming, Yunnan Province, China. Of those, 4007 (84.29%) infants received a neonatal eye examination either at the hos- pital or returned after discharge within 42 days of birth. This work focuses the analysis on the 3573 healthy full-term infants who underwent an eye examination within 1 week of birth (mean 2.35 days). In our study, a normal newborn is defined as having ≥37 weeks’ gestational age, weighing ≥2500 g. Further, the normal newborn has no evidence of sys- temic disease and an Apgar score of 7 or more. The male to female ratio was 1785 : 1788. Infants whose mothers had known transmitted diseases (eg, STDs, hepatitis B, HIV positive) were excluded. Infants who were premature or were examined after discharge at 42 days of birth with other follow-up were not included in this series. Figure 1 Retinal haemorrhages discovered on newborn digital eye The examinations were performed by a team consisting of an examination. ophthalmologist and assisted, at times, by a nurse. An external examination of the eyes was performed first, which included the anterior segment and pupillary light reflex using a standard DISCUSSION fi fi flashlight. Infants were then dilated with two drops of 1% tropi- Our data reveals, for the rst time, that a signi cant number of camide administered 10 min apart. After mydriasis, the RRT, healthy newborns exhibit ocular abnormalities on digital ocular fi retinoscopy and hand-held slit lamp examinations were examination. Further, the highest proportion of abnormal nd- performed to evaluate the clarity of ocular media. Topical anaes- ings during the study period was retinal haemorrhages, account- thetic was instilled. The anterior segment was examined using ing for 92% of abnormalities. Results of a study of ocular the non-contact wide-angle portrait camera lens. screening of preschool children report that refractive errors Next a sterile eyelid speculum was placed in the eye to be examined. The anterior chamber angle was then evaluated with the 130° lens, tilted appropriately to image the angle in at least four quadrants. Using the RetCam, a wide-angle digital fundus camera examination was then performed in first one eye and then the other. Photos were taken of the posterior pole, includ- ing the optic nerve and macula. The superior, inferior, nasal and temporal retinal fields were imaged when possible. For patients in whom the eye exam revealed an abnormal finding, repeat examination or referral to the ophthalmology clinic was per- formed at a later date. http://bjo.bmj.com/ Data from the examinations were logged onto a spreadsheet and the Pems 3.3 (Package for Encyclopaedia of Medical Statistics) package was used for analysis. RESULTS Of the 3573 healthy full-term newborns who underwent on September 26, 2021 by guest. Protected copyright. newborn eye examination, 871 (24.4%) cases were found to be abnormal. Of the total examined, 769 (21.53%) had retinal haemorrhages (figures 1 and 2). There were no statistically sig- nificant differences based on gender. Of these, 215 cases (6%) were Grade 3 (table 1) retinal haemorrhage and 67 cases (1.9%) involved macular haemorrhage. There were visually threatening ocular abnormalities in 107 cases (2.99%), of whom 28 were associated with retinal haemorrhage. These cases are sum- marised in table 2 below. Additionally, the examinations revealed multiple other ocular pathology of visual and possibly systemic significance.
Load more

Recommended publications
  • Artificial Intelligence for Pediatric Ophthalmology
    Artificial Intelligence for Pediatric Ophthalmology Julia E. Reid, MD m;y and Eric Eaton, PhDz Purpose of review Despite the impressive results of recent artificial intelligence (AI) applications to general ophthalmol- ogy, comparatively less progress has been made toward solving problems in pediatric ophthalmology using similar techniques. This article discusses the unique needs of pediatric ophthalmology patients and how AI techniques can address these challenges, surveys recent applications of AI to pediatric ophthalmology, and discusses future directions in the field. Recent findings The most significant advances involve the automated detection of retinopathy of prematurity (ROP), yielding results that rival experts. Machine learning (ML) has also been successfully applied to the clas- sification of pediatric cataracts, prediction of post-operative complications following cataract surgery, detection of strabismus and refractive error, prediction of future high myopia, and diagnosis of read- ing disability via eye tracking. In addition, ML techniques have been used for the study of visual development, vessel segmentation in pediatric fundus images, and ophthalmic image synthesis. Summary AI applications could significantly benefit clinical care for pediatric ophthalmology patients by opti- mizing disease detection and grading, broadening access to care, furthering scientific discovery, and improving clinical efficiency. These methods need to match or surpass physician performance in clinical trials before deployment with patients. Due to widespread use of closed-access data sets and software implementations, it is difficult to directly compare the performance of these approaches, and repro- ducibility is poor. Open-access data sets and software implementations could alleviate these issues, and encourage further AI applications to pediatric ophthalmology. Keywords pediatric ophthalmology, machine learning, artificial intelligence, deep learning INTRODUCTION atric ophthalmology, despite the pressing need.
    [Show full text]
  • MIOTICS in CATARACT SURGERY by Harold Beasley, MD
    MIOTICS IN CATARACT SURGERY BY Harold Beasley, MD PROMPT MIOSIS OF the pupil after delivery of the lens in round pupil cataract surgery is recommended to protect the vitreous face, to prevent iris incarceration, and to facilitate the postplacement of corneoscleral sutures.1 It has been postulated that miosis also prevents the formation of peripheral anterior synechia, but this has not been demonstrated experimentally.2 An ideal miotic should produce prompt pupillary constriction and for a duration of 12 to 24 hours. It should also be nonirritating to anterior chamber structures. Acetylcholine ( 1.0 per cent)37 and a weak solution of carbachol (0.01 per cent) ,8 as well as pilocarpine, have been found to be satisfactory for this purpose. The purposes of this study were (1) to evaluate the effectiveness of miotics in preventing peripheral anterior synechia and in preserving the integrity of the vitreous face; and (2) to compare the effectiveness of acetylcholine 1 per cent and carbachol 0.01 per cent as miotics in round pupil cataract surgery. PROCEDURE This study compared three experimental treatments in a double blind procedure in which the code was left unbroken until all the data were accumulated. Selected patients were gonioscoped prior to surgery and only patients with grades Im or iv angles were chosen for this study. All patients were predosed with 2 per cent homatropine and 10 per cent phenylephrine. Prior to the injection of the test solution the pupillary diameters were measured before the section was made and immediately after lens extraction. Measurements were then made at two minutes and at five minutes after the intracameral instillation of 0.4- to 0.5-cc of the test solutions.
    [Show full text]
  • Frequency of Common Factors Leading to Leukocoria in Pediatric Age Group at Tertiary Care Eye Hospital: an Observational Study
    Biostatistics and Biometrics Open Access Journal ISSN: 2573-2633 Research Article Biostat Biometrics Open Acc J Faisal’s Issue - January 2018 Copyright © All rights are reserved by Muhammad Faisal Fahim DOI: 10.19080/BBOAJ.2018.04.555636 Frequency of Common Factors Leading to Leukocoria in Pediatric Age Group at Tertiary Care Eye Hospital: An Observational Study Rizwana Dargahi1, Abdul Haleem1, Darikta Dargahi S1 and Muhammad Faisal Fahim2* 1Department of Ophthalmology, Shaheed Mohtarma Benazir Bhutto Medical University, Pakistan 2Department of Research & Development, Al-Ibrahim Eye Hospital, Pakistan Submission: November 27, 2017; Published: January 19, 2018 *Corresponding author: Muhammad Faisal Fahim, M.Sc. (Statistics), Statistician, Department of Research & Development, Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Ophthalmology, Karachi, Pakistan, Tel: ; Email: Abstract Objective: To know the frequency of common factors leading to leukocoria in pediatric age group at a tertiary care eye hospital. Materials & methods: This was across sectional observational study carried out at Pediatric department, Al-Ibrahim eye hospital Karachi from February to July 2016. All patients younger than 10 years who presented with leukocoria were included. The excluding criteria were previous history of trauma and ocular surgery. Systemic as well as ocular examination and relevant investigations was done to know cause of was used to analyzed data. leukocoria. B. Scan was done in all the cases. If needed X-ray chest, CT scan & MRI orbit was done for confirming diagnosis. SPSS version 20.0 Results: In our country congenital cataract is the most common cause of leukocoria which comprises about 77.3% (133/172) which is treatable. 2nd common cause was persistent fetal vasculature comprises 8.1% (14/172).
    [Show full text]
  • Glaucoma in the Hallermann-Streiff Syndrome
    Brit. j. Ophthal. (1970) 54, 4I6 Br J Ophthalmol: first published as 10.1136/bjo.54.6.416 on 1 June 1970. Downloaded from Glaucoma in the Hallermann-Streiff syndrome D. J. HOPKINS AND E. C. HORAN Department of Ophthalmology, University ofLeeds The Hallermann-Streiff syndrome is a complex association of developmental anomalies principally involving structures of ectodermal origin. The constant expressions of the syndrome are dyscephaly with mandibulo-facial malformation, bilateral congenital cataracts, and dental anomalies, while hypotrichosis, cutaneous atrophy, microphthalmos, and proportionate dwarfism are frequently present (Table I) (Ponte, I962). Numerous inconstant ocular features have been described, including anti-mongoloid palpebral fissures, blue sclerae, keratoglobus, malformation of the drainage angles, peripheral anterior synechiae, iris atrophy, persistent pupillary membrane, posterior synechiae, membranous cataract, amorphous retrolenticular membrane, vitreous opacities, pale optic discs, colobomata at the optic nerve entrance, retinal folds, various atrophic chorio- retinal changes and glaucoma (Table II) (Ludwig and Korting, I950; Fransois, I958; Falls and Schull, I 960; Wolter and Jones, I 965; Ide and Webb, I 969). copyright. Table I Mainfeatures of the Hallermann-Streiff syndrome. A. Constant B. Frequently present i. Dyscephaly with mandibulo-facial malformation 4. Hypotrichosis 2. Bilateral congenital cataracts 5. Cutaneous atrophy 3. Dental anomalies 6. Microphthalmos http://bjo.bmj.com/ 7. Proportionate dwarfism Table II Inconstant ocularfeatures of the Hallermann-Streiff syndrome. I. Anti-mongoloid 5. Peripheral anterior 9. Membranous cataract 13. Colobomata at optic palebral fissures synechiae nerve entrance on September 29, 2021 by guest. Protected 2. Blue sclerae 6. Iris atrophy jo. Amorphous retrolen- ,.,,, 2a. Blue sclerae 6. Iris atrophy ticular membrane 14.
    [Show full text]
  • Ocular Complications of Endocarditis
    7 Ocular Complications of Endocarditis Ozlem Sahin Middle East Technical University Health Sciences Department of Ophthalmology, Ankara Turkey 1. Introduction Cardiac complications are the most common complications in patients with infective endocarditis, and they can be related to significant mortality and morbidity. (1) Extra- cardiac manifestations along with their historical descriptions such as splinter hemorrhages, emboli, Osler’s nodes, Janeway and Bowman lesions of the eye, Roth’s spots, patechiae and clubbing generally result from thromboemboli or septic emboli. (2) Inflammatory complications may occur as a result of septic emboli, and these include endogenous (metastatic) endophthalmitis, focal abscess, and vasculitis. (3) In this chapter we mainly focus on the endogenous endophthalmitis arising as a complication of infective endocarditis. Endogenous (metastatic) endophthalmitis is an inflammatory condition of the intraocular structures including the aqueous, iris, lens, ciliary body, vitreous, choroid and retina. (4-6) It results from the hematogenous spread of organisms from a distant source of infection, most commonly infective endocarditis, gastrointestinal tract and urinary tract infections and wound infections. (7-9) Other sources of infection have included pharyngitis, pneumonia, septic arthritis and meningitis. (10,11) Compared with endophthalmitis following trauma or surgery, endogenous endophthalmitis is relatively rare, accounting 2-8% of all reported endophthalmitis cases. (5) However, endogenous endophthalmitis carries with it the danger of bilateral infection in 15-25% of cases. (6,12) 2. Epidemiology Endogenous endophthalmitis has been reported to occur at any age and no sexual predilection. (13) However, in the recent years the mean age of endogenous endophthalmitis has shifted to 65 years possibly because of the reduction in the incidence of rheumatic heart disease.
    [Show full text]
  • Guidelines for Universal Eye Screening in Newborns Including RETINOPATHY of Prematurity
    GUIDELINES FOR UNIVERSAL EYE SCREENING IN NEWBORNS INCLUDING RETINOPATHY OF PREMATURITY RASHTRIYA BAL SWASthYA KARYAKRAM Ministry of Health & Family Welfare Government of India June 2017 MESSAGE The Ministry of Health & Family Welfare, Government of India, under the National Health Mission launched the Rashtriya Bal Swasthya Karyakram (RBSK), an innovative and ambitious initiative, which envisages Child Health Screening and Early Intervention Services. The main focus of the RBSK program is to improve the quality of life of our children from the time of birth till 18 years through timely screening and early management of 4 ‘D’s namely Defects at birth, Development delays including disability, childhood Deficiencies and Diseases. To provide a healthy start to our newborns, RBSK screening begins at birth at delivery points through comprehensive screening of all newborns for various defects including eye and vision related problems. Some of these problems are present at birth like congenital cataract and some may present later like Retinopathy of prematurity which is found especially in preterm children and if missed, can lead to complete blindness. Early Newborn Eye examination is an integral part of RBSK comprehensive screening which would prevent childhood blindness and reduce visual and scholastic disabilities among children. Universal newborn eye screening at delivery points and at SNCUs provides a unique opportunity to identify and manage significant eye diseases in babies who would otherwise appear healthy to their parents. I wish that State and UTs would benefit from the ‘Guidelines for Universal Eye Screening in Newborns including Retinopathy of Prematurity’ and in supporting our future generation by providing them with disease free eyes and good quality vision to help them in their overall growth including scholastic achievement.
    [Show full text]
  • Clinical Practice Guidelines: Care of the Patient with Anterior Uveitis
    OPTOMETRY: OPTOMETRIC CLINICAL THE PRIMARY EYE CARE PROFESSION PRACTICE GUIDELINE Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 32,000 full-time equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 7,000 communities across the United States, serving as the sole primary eye care provider in more than 4,300 communities. Care of the Patient with The mission of the profession of optometry is to fulfill the vision and eye Anterior Uveitis care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ANTERIOR UVEITIS Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Anterior Uveitis: Kevin L. Alexander, O.D., Ph.D., Principal Author Mitchell W. Dul, O.D., M.S. Peter A. Lalle, O.D. David E. Magnus, O.D. Bruce Onofrey, O.D. Reviewed by the AOA Clinical Guidelines Coordinating Committee: John F. Amos, O.D., M.S., Chair Kerry L. Beebe, O.D. Jerry Cavallerano, O.D., Ph.D. John Lahr, O.D.
    [Show full text]
  • Ophthalmic Drugs
    A Supplement to 22nd EDITION Randall Thomas, OD, MPH Patrick Vollmer, OD The Clinical Guide to Dr. Melton Ophthalmic[ [ Dr. Thomas Drugs Dispense as writ ten — no substit utions. Refills: unlimit ed. May 15, 2018 Dr. Vollmer Peer-to-peer advice to help boost your prescribing prowess. Supported by an unrestricted grant from Bausch + Lomb 001_dg0518_fc.indd 3 5/11/18 10:52 AM FROM THE AUTHORS DEAR OPTOMETRIC COLLEAGUES: Supported by an Welcome to the 2018 edition of our annual Clinical Guide to Ophthalmic unrestricted grant from Drugs. Herein, we provide updates on our collective clinical experiences and Bausch + Lomb heavily season them with pertinent excerpts from the literature. This guide is intended to bring solid, scientifically accurate and clinically relevant information to our optometric colleagues. If you want to understand CONTENTS how the three of us treat, and what factors led us to develop these methods, you’ll find it explained here. The methods and opinions represented are our own. We recognize that other doctors may use alternative approaches. That First-year Impressions ...........3 is true in all of health care. But this three-doctor writing team has logged over 75 combined years of clinical optometry, and we bring that ‘real-world’ spirit to the discussions that follow. Know that, above all, we are doctors who are genuinely concerned for our patients’ well-being and who endeavor to Glaucoma Care .......................... 6 provide them the best of care, and we write from that perspective. The two topics of greatest interest and need for most eye physicians right now are glaucoma and dry eye disease.
    [Show full text]
  • N Dhingra, Department of Ophthalmology, Bridend
    Correspondence 679 Correspondence: N Dhingra, Table 1 Clinical characteristics in infants who received Department of Ophthalmology, cryotherapy for retinopathy of prematurity (1996–2001) or laser Bridend Eye Unit, treatment (2001–2005) Princess of Wales Hospital, 1996–2001 2001–2005 Coity Road, Bridgend CF 31 1RQ, UK Number of infants 42 19 Gestational age at birth (weeks) 26.3 (1.5) 25.8 (1.2) Tel: þ 44 29 20614850; Weight at birth (g) 764 (188) 689 (135) Fax: þ 44 1656 7524156. Postnatal age at surgery (days) 62.5 (14.5) 63 (13.5) E-mail: [email protected] Weight at surgery (g) 1705 (340) 1488 (256) Results reported by mean and SD. Financial interests: None Eye (2007) 21, 678–679. doi:10.1038/sj.eye.6702680; duration of postoperative ventilation, in postoperative published online 23 February 2007 administration of analgesics, and in time until regain of full enteral feeding, was documented in infants who received laser photocoagulation compared with cryo- Sir, treated neonates.4,5 Variation in management during and after retinal Neonatal care has also changed. Since the 1980s, survival surgery for retinopathy of prematurity rates at threshold of viability have increased dramatically, resultinginanevenmorevulnerablegroupofpreterm We read with great interest the paper of Chen et al1 on the neonates who need laser treatment, as illustrated by the considerable variation in practice among decrease in weight at surgery in our unit over the last 10 ophthalmologists regarding the anaesthetic methods years (Table 1).3–5 There is a trend to treat retinopathy in an employed in the treatment of retinopathy of prematurity earlier phase in an attempt to ameliorate long-term visual (ROP) in the UK.
    [Show full text]
  • Approach to Leukocoria Intro Hi Everyone, My Name Is
    PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on the “Approach to Leukocoria.” These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes or at www.pedcases.com/podcasts. Approach to Leukocoria Developed by Chris Novak, Dr. Natashka Pollock and Dr. Mel Lewis for PedsCases.com. March 1, 2016 Intro Hi everyone, my name is Chris Novak. I am a medical student at the University of Alberta. Today’s podcast is designed to give medical students an organized approach to the physical exam finding of leukocoria, or an abnormal red reflex in children. This podcast was developed with Dr. Melanie Lewis, a general pediatrician and Professor at the University of Alberta and Dr. Natashka Pollock, a pediatric ophthalmologist at the Stollery Children’s Hospital in Edmonton, Alberta. The term leukocoria refers to a “white pupil” when examining the eye. In some cases leukocoria may be grossly apparent, or may be noticed by parents in photographs, however it is often an incidental finding on physical exam. While leukocoria is not a common finding, it is a critical sign of vision- and potentially life-threatening conditions including cataracts, hemorrhage, and malignancy like retinoblastoma. Different causes of leukocoria can present from the neonatal period and throughout childhood hence,the American Academy of Pediatrics recommends that all neonates have their red reflex examined before discharge from hospital, and subsequently at all well-child visits. Thus, it is important that all physicians looking after children recognize the critical nature of this presentation so that it is not missed.
    [Show full text]
  • Abnormal Red Reflex: Etiologies in a Pediatric Ophthalmology Population
    CPJXXX10.1177/0009922820916892Clinical PediatricsLin et al 916892research-article2020 Article Clinical Pediatrics 2020, Vol. 59(8) 760 –765 Abnormal Red Reflex: Etiologies in a © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions Pediatric Ophthalmology Population DOI:https://doi.org/10.1177/0009922820916892 10.1177/0009922820916892 journals.sagepub.com/home/cpj Sophie Y. Lin, BA1 , Kimberly G. Yen, MD1,2, Huirong Zhu, PhD2, Alexis Moisiuc, BS2, and Madhuri Chilakapati, MD1,2 Abstract Children who present with an abnormal red reflex (ARR) are often referred to ophthalmology due to concern for retinoblastoma. However, an ARR can indicate a wide variety of pathologies, all of which have the potential to develop amblyopia and irreversible vision loss. In this retrospective cohort study, we demonstrate that children who presented with an ARR had a mean age of 22.0 ± 32.5 months and were more frequently referred by their pediatricians (74.5%). The majority of these patients (61.8%) had a normal examination on further evaluation, followed by refractive error (20.4%). Amblyopia was diagnosed in 83.9% of patients with refractive error, with a mean age of 50.3 ± 49.2 months. Because many ARR-associated pathologies require time-sensitive treatment to prevent vision loss, proper screening is critical for diagnosis. Pediatricians play a key role in screening, so education on more common ARR pathologies can better facilitate referrals and improve outcomes. Keywords abnormal red reflex, leukocoria, screening Introduction to any ocular condition that limits visual stimulation to the eye so if amblyopia is not treated early, vision loss Eliciting the red reflex is a useful clinical test used by can be irreversible.
    [Show full text]
  • Eye, Iris – Synechia
    Eye, Iris – Synechia 1 Eye, Iris – Synechia Figure Legend: Figure 1 Eye, Iris - Synechia, Anterior in a female F344/N rat from a chronic study. There is adhesion of the iris to the posterior cornea (arrow). Figure 2 Eye, Iris - Synechia, Anterior in a female F344/N rat from a chronic study (higher magnification of Figure 1). There is adhesion of the iris to the posterior cornea (arrow) due to abnormal fibrovascular tissue formation. Figure 3 Eye, Iris - Synechia in a male F344/NTac rat from a subchronic study. There are concurrent anterior (A) and posterior (P) iridial synechiae, partial protrusion of the iris into the corneal stroma (staphyloma) (S), and a cataractous lens (L). Figure 4 Eye, Iris - Synechia in a male F344/NTac rat from a subchronic study (higher magnification of Figure 3). There is concurrent anterior (A) and posterior (P) iridial synechiae, as well as partial protrusion of the iris in the corneal stroma (staphyloma) (S), and a cataractous lens (L). Figure 5 Eye, Iris - Synechia, Posterior in a female F344/N rat from a chronic study. There is adhesion of the iris to the lens capsule (arrow). Figure 6 Eye, Iris - Synechia, Posterior in a female F344/N rat from a chronic study (higher magnification of Figure 5). There is adhesion of the iris to the lens capsule (arrow) due to abnormal fibrovascular tissue formation is present in the eye, as well as entropion uveae (arrowhead). Comment: Ocular synechiae are abnormal adhesions of the iris to other ocular structures. Causes include intraocular inflammation, especially of the iris and ciliary body.
    [Show full text]