DOCSLIB.ORG

Long-Term Visual Outcomes of Laser-Treated Threshold Retinopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Long-Term Visual Outcomes of Laser-Treated Threshold Retinopathy Eye (2010) 24, 14–20 & 2010 Macmillan Publishers Limited All rights reserved 0950-222X/10 $32.00 www.nature.com/eye 1,2,3 1,2,3 2,4 CLINICAL STUDY Long-term visual C-S Yang , A-G Wang , C-S Sung , W-M Hsu3,5, F-L Lee1,2 and S-M Lee1,2 outcomes of laser- treated threshold retinopathy of prematurity: a study of refractive status 1Department of at 7 years Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China Abstract important for early detection and timely 2Department of treatment of these ocular morbidities. Ophthalmology, National Purpose To assess the long-term visual Eye (2010) 24, 14–20; doi:10.1038/eye.2009.63; Yang-Ming University outcomes and refractive status in patients with published online 3 April 2009 School of Medicine, Taipei, diode laser-treated threshold retinopathy of Taiwan, Republic of China prematurity (ROP), and to investigate the Keywords: diode laser; retinopathy of causes of impaired visual function. 3Department of prematurity; visual outcome A total of 60 eyes of 30 consecutive Ophthalmology, Taipei Method Medical University, Taipei, patients with diode laser-treated threshold Taiwan, Republic of China ROP were recalled for assessment at the age of Introduction 7 years or more. 4 Department of Results There were 38 eyes (65.5%) achieving The sequelae of retinopathy of prematurity Anesthesiology, Taipei 6/12 or better vision, however, an unfavourable (ROP) is an important cause of infant blindness Veterans General Hospital, visual outcome (6/60 or worse) occurred in four 1 Taipei, Taiwan, Republic of and visual disability in the world. The 10-year China eyes (6.9%). One eye (1.7%) had unfavourable outcome study of the Cryotherapy for structural outcome. Of these 60 laser-treated Retinopathy of Prematurity Cooperative Group 5Department of eyes, 46 eyes (77.0%) were myopic, the overall (CRYO-ROP) has demonstrated the long-term Ophthalmology, Shuang-Ho mean spherical equivalent was À3.87 D. benefit of cryotherapy on eyes with threshold Hospital, Taipei, Taiwan, Anisometropia (X1.5 D) was also noted in 14 ROP.2 Recently, laser photocoagulation therapy Republic of China patients (46.7%). Strabismus was present in has almost replaced cryotherapy for retinal nine patients (30.0%). Perinatal neurological Correspondence: S-M Lee, ablation of active ROP. Laser therapy is reported Department of events of intraventricular haemorrhage to be less traumatic with better structural and Ophthalmology, (IVH) were identified in eight children functional outcomes compared with eyes Taipei Veterans General (26.7%), periventricular leucomalacia (PVL) treated with cryotherapy in threshold ROP.3–5 Hospital, in eight children (26.7%), and cerebral Moreover, the study of the Early Treatment for National Yang-Ming palsy (CP) in four children (13.3%). There University, ROP Cooperative Group (ETROP) revealed 201 Sec. 2, Shih-Pai Road, was a statistically significant association earlier treatment improved grating visual acuity Taipei 11217, of the presence of strabismus with PVL and retinal structural outcomes for Taiwan, (P ¼ 0.002). The presence of anisometropia was subthreshold ROP at the age of 9 months as Republic of China a significant risk factor associated with poor compared with conventional threshold ROP Tel: þ 886 2 2875 7325; visual outcome of 6/15 or worse in laser-treated 6 Fax: þ 886 2 2876 1351. treatment. E-mail: smlee@ ROP (P ¼ 0.002). The visual outcome of premature infants with vghtpe.gov.tw Conclusion The majority of patients with regressed ROP is attributed to both structural diode laser-treated threshold ROP had and functional outcomes. Myopia, strabismus, Received: 29 September favourable anatomical and visual outcomes. anisometropia, astigmatism, and amblyopia are 2008 However, anisometropia, advanced refractive common problems in eyes with regressed ROP. Accepted in revised form: error, strabismus, and perinatal neurological 5 March 2009 Therefore, the importance of long-term follow- Published online: 3 April events remain important causes of impaired up of these children cannot be overemphasized. 2009 visual function. Long-term follow-up is very However, few studies with recent data Laser retinopathy of prematurity visual outcomes C-S Yang et al 15 concerning the long-term functional outcomes after laser treatment. Six patients were excluded from this study therapy and subsequent refractive status of threshold because they were lost to follow-up. The remaining ROP in Asia are available.7 30 children were recruited in this study with informed The purpose of this study is to present our experience parental consent. The patients were recalled at the age about the long-term visual outcomes of premature of 7 years to the eye clinic at Taipei Veterans General infants who received diode laser photocoagulation for Hospital for complete ophthalmologic assessment by threshold ROP during a 7-year follow-up. In this study, the clinicians (CY and AW). The following clinical we highlight the refractive status in these patients. parameters were recorded at each examination. Additionally, we also investigate the causes of impaired visual function in laser-treated threshold ROP. Visual acuity The best-corrected visual acuity (BCVA) was determined Patients and methods by Snellen chart at 6 m. Patients wore the glasses with The study protocol was approved by the Institutional the cycloplegic refraction determined by the Review Board of Taipei Veterans General Hospital. From autorefractometer and it was refined. To include all data January 1997 to December 2000, premature infants who in the statistical analysis and comparison, visual acuity weighed less than 2000 g of birth body weight or were was converted as the log of the minimum angle of less than 34 weeks of gestational age were screened for resolution (logMAR) value, and any eye with vision less ROP in the neonatal newborn room or intensive care unit than 1/60 was assigned as logMAR score of 2.0. Also for at Taipei Veterans General Hospital by a single statistical purpose, when analysing the probable risk ophthalmologist (CY). factors associated with poor visual outcome, visual At the first ophthalmic examination, the eyes of high- acuity of 6/12 or better was considered a good visual risk premature infants were screened at postnatal age of outcome, and visual acuity of 6/15 or worse a poor 4–6 weeks under indirect ophthalmoscope.8,9 The stage visual outcome. and severity of ROP was classified according to the International Classification of ROP (ICROP).10 Follow-up Refraction retinal examination was performed every 1–2 weeks until ROP regression, complete vasculogenesis of retina, or Cycloplegic refraction of the eyes was determined with development of threshold ROP. Threshold disease of desktop computer autorefractometer (Topcon ROP was defined as X5 contiguous or 8 cumulative Corporation, Tokyo, Japan) after instillation of 1% clock-hours of extraretinal neovascularization stage 3 cyclopentolate hydrochloride eye drops twice at a 10 min ROP associated with plus disease within zones I or II. interval. Refractive error was converted to the spherical Plus disease represented the dilatation and tortuosity of equivalent (SE). Myopia was divided into three retinal blood vessels in the posterior pole. Rush disease categories according to its magnitude (dioptre): 0–3.0, was defined as ROP in zone 1 with plus disease, which 3.1–6.0, and 46.0 D. Those with astigmatism were progressed rapidly within days. Infants with threshold classified as having errors of 0–1.5, 1.6À3.0, and 43.0 D. disease received retinal ablation laser photocoagulation Children with high myopia 46.00 D, anisometropia therapy within 72 h of diagnosis. X1.5 D, or astigmatism 43.0 D were considered to have Data were retrospectively collected from the medical advanced refractive error. records. Thirty-seven premature babies, who were hospitalized in the neonatal unit at Taipei Veterans Structural assessment General Hospital from 1997 to 2000 and had received diode laser (810 nm wavelength) treatment (Iris Medical Indirect ophthalmoscopy was performed to detect any Instruments Inc., Mountain View, CA, USA) therapy structural sequelae, including straightening of arcade under laser indirect ophthalmoscope for threshold ROP, vessels, macular distortion or dragging, macular fold, or were identified. The setting of laser treatment was tractional retinal detachment. 250–300 mW at the creamy-white laser intensity, near confluence pattern, and placed to the retina avascular Orthoptic assessment zone anterior to the fibrovascular ridge. Of the 37 children with laser-treated threshold ROP, Cover test, prism cover test, and ocular movements were one infant who had zone I rush disease rapidly evaluated to detect any abnormality of ocular motility. progressed to stage 5 despite photocoagulation. Strabismus was defined as a latent symptomatic or a Unfortunately, this patient died before the age of manifest squint, as well as patients who had received 6 months, and this was not attributed to ROP laser previous strabismus surgery. Eye Laser retinopathy of prematurity visual outcomes C-S Yang et al 16 Perinatal neurological events information of functional outcome of laser-treated eyes is shown in Table 1. The laser-treated eyes had a mean The presence of intraventricular haemorrhage (IVH) or visual acuity of 20/46, with 38 eyes (65.5%) achieving periventricular leucomalacia (PVL) was documented 6/12 or better vision (Table 2). However, an unfavourable from the record of cranial ultrasound. Any neurological
Load more

Recommended publications
  • Management of Vith Nerve Palsy-Avoiding Unnecessary Surgery
    MANAGEMENT OF VITH NERVE PALSY-AVOIDING UNNECESSARY SURGERY P. RIORDAN-E VA and J. P. LEE London SUMMARY for unrecovered VIth nerve palsy must involve a trans­ Unresolved Vlth nerve palsy that is not adequately con­ position procedure3.4. The availability of botulinum toxin trolled by an abnormal head posture or prisms can be to overcome the contracture of the ipsilateral medial rectus 5 very suitably treated by surgery. It is however essential to now allows for full tendon transplantation techniques -7, differentiate partially recovered palsies, which are with the potential for greatly increased improvements in amenable to horizontal rectus surgery, from unrecovered final fields of binocular single vision, and deferment of palsies, which must be treated initially by a vertical any necessary surgery to the medial recti, which is also muscle transposition procedure. Botulinum toxin is a likely to improve the final outcome. valuable tool in making this distinction. It also facilitates This study provides definite evidence, from a large full tendon transposition in unrecovered palsies, which series of patients, of the potential functional outcome from appears to produce the best functional outcome of all the the surgical treatment of unresolved VIth nerve palsy, transposition procedures, with a reduction in the need for together with clear guidance as to the forms of surgery that further surgery. A study of the surgical management of 12 should be undertaken in specific cases. The fundamental patients with partially recovered Vlth nerve palsy and 59 role of botulinum toxin in establishing the degree of lateral patients with unrecovered palsy provides clear guidelines rectus function and hence the correct choice of initial sur­ on how to attain a successful functional outcome with the gery, and as an adjunct to transposition surgery for unre­ minimum amount of surgery.
    [Show full text]
  • Iris Mammillations: Significance and Associations
    IRIS MAMMILLATIONS: SIGNIFICANCE AND ASSOCIATIONS 2 l NICOLA K. RAGGEL2, 1. ACHESON and A. LINN MURPHREE Los Angeles and London SUMMARY mammiform (nipple- or teat-like) protuberances. Iris mammillations are rarely described, distinctive Iris mammillations are an occasional finding with few previous reports. They are most commonly villiform protuberances that can cover the iris. In the l--6 majority of reported cases they are unilateral and found in association with melanosis oculi, with or sporadic, and are seen in association with oculodermal without periocular skin involvement in a naevus of melanosis. In past literature and current clinical Ota. They are thus often less precisely referred to as practice they are frequently confused with tbe iris iris melanosis, a term which should best be reserved nodules seen in neurofibromatosis type 1. Their clinical for increased pigmentation of the iris, irrespective of significance is not established, although it has been the presence of iris elevations overlying the pigmen­ 7 suggested that iris mammillations may be an external ted areas. This is supported by the rare descriptions sign of ocular hypertension or intraocular malignancy. of iris elevations in the absence of any increased iris We report a series of 9 patients between the ages of 3 pigmentation?,8 and 28 years with iris mammillations. The mammilla­ Iris mammillations are usually unilateral, often tions appear as regularly spaced, deep brown, smooth, presenting as heterochromia iridis. Occasional bilat­ 7 conical elevations on the iris, of uniform height or eral cases have been described. ,8 Iris mammillations increasing in height as the pupil margin is approached.
    [Show full text]
  • Strabismus: a Decision Making Approach
    Strabismus A Decision Making Approach Gunter K. von Noorden, M.D. Eugene M. Helveston, M.D. Strabismus: A Decision Making Approach Gunter K. von Noorden, M.D. Emeritus Professor of Ophthalmology and Pediatrics Baylor College of Medicine Houston, Texas Eugene M. Helveston, M.D. Emeritus Professor of Ophthalmology Indiana University School of Medicine Indianapolis, Indiana Published originally in English under the title: Strabismus: A Decision Making Approach. By Gunter K. von Noorden and Eugene M. Helveston Published in 1994 by Mosby-Year Book, Inc., St. Louis, MO Copyright held by Gunter K. von Noorden and Eugene M. Helveston All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the authors. Copyright © 2010 Table of Contents Foreword Preface 1.01 Equipment for Examination of the Patient with Strabismus 1.02 History 1.03 Inspection of Patient 1.04 Sequence of Motility Examination 1.05 Does This Baby See? 1.06 Visual Acuity – Methods of Examination 1.07 Visual Acuity Testing in Infants 1.08 Primary versus Secondary Deviation 1.09 Evaluation of Monocular Movements – Ductions 1.10 Evaluation of Binocular Movements – Versions 1.11 Unilaterally Reduced Vision Associated with Orthotropia 1.12 Unilateral Decrease of Visual Acuity Associated with Heterotropia 1.13 Decentered Corneal Light Reflex 1.14 Strabismus – Generic Classification 1.15 Is Latent Strabismus
    [Show full text]
  • Treatment of Younger Patients with Accommodative Esotropia
    Treatment of Younger Patients with Accommodative Esotropia xianjie liu The First Hospital of China Medical University Yutong Chen The First Hospital of China Medical University Xiaoli Ma ( [email protected] ) Research article Keywords: Accommodative esotropia, Treatment, High AC/A ( accommodative convergence to accommodation ratio ), Amblyopia. Posted Date: March 3rd, 2019 DOI: https://doi.org/10.21203/rs.2.428/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Background: Accommodative esotropia (AET) is a common disease during childhood. In this literature review, we analyze and discuss the different methods of treatment for Accommodative esotropia. Methods: Articles about accommodative esotropia from 2007 to 2017 were retrieved from the PubMed database. We study the articles by title/abstract/all elds, after applying the inclusion and exclusion criteria, nally 9 articles were retained. We compared the effectiveness between these approaches to treatment. Results: All the refraction methods had an effectivity rate of > 50%. The bifocal lenses group showed a higher failure rate (15.58%) than the single-vision lenses group (5.19%). Extraocular muscle surgery can signicantly decrease deviation in patients who have AET with a high AC/A ratio (95.24%,71.30%,78.40%). After Botulinum toxin injection, the residual deviation was signicantly lower than that before the injection (90.44%) and this rate held stable until 12 months after the injection (85.71%) and then decreased to 71.43% at 18 months. The effectivity rate in the prism builders group (surgery with prism group) was signicantly higher than that in the prism non-builders group 100% vs.
    [Show full text]
  • Classification of Strabismus
    Classification of strabismus Pr Dr Monique Cordonnier Université Libre de Bruxelles Most prominent feature to have in mind = BINOCULAR VISION potential ? Yes or No If the strabismus was present during the first 6- 8 months of life, there is no This potential means that potential for treatment (……) may restore normal binocular binocularity, warranting vision stability and avoiding recurrences Binocular vision = eyes are like wheels on the rails of a railtrack 1 What is BINOCULAR VISION ? 1. Normal - Bifoveolar fixation with normal visual acuity in each eye, no strabismus, no diplopia, normal retinal correspondence, normal fusional vergence amplitudes, normal stereopsis. 2. Subnormal (abnormal) – 1 or more of the following; anomalous retinal correspondence, suppression, deficient to no stereopsis, amblyopia, decreased fusional vergence amplitudes. 3. Absence of Binocular Vision - no simultaneous perception, no fusion, no stereopsis Besides, the classification of strabismus is based on a number of features including : . The relative position of the eyes . The time of onset (=clue for binocular vision potential), . Whether the deviation is intermittent (=clue for binocular vision potential) or constant . Whether the deviation is comitant (supranuclear cause) or incomitant (nuclear or infranuclear cause, clue for binocular vision potential if the eyes are straight in one position) . According to the associated refractive error (accommodative strabismus) 2 Most common types of strabismus in children Supranuclear causes Paralytic, muscular or
    [Show full text]
  • Surgical Treatment of Esotropia Associated with High Myopia: Unilateral Versus Bilateral Surgery
    Eur J Ophthalmol 2010; 20 ( 4): 653 - 658 ORIGINAL ARTICLE Surgical treatment of esotropia associated with high myopia: unilateral versus bilateral surgery Yair Morad, Eran Pras, Yakov Goldich, Yaniv Barkana, David Zadok, Morris Hartstein Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin - Israel PUR P OSE . To compare unilateral versus bilateral surgical treatment of esotropia associated with high myopia. METHODS . This retrospective study comprised patients who underwent surgery for esotropia with high myopia performed by the first author (Y.M.) between 2003 and 2008. Surgical results and complica- tions were compared between patients who underwent unilateral versus bilateral surgery. RESULTS . Nine patients were identified with average age of 44.9 years (range 8–70 years). All had bilate- ral high myopia (average –13.35 D, range –9.00 to –17.50 D) and esotropia of 20–75 diopters, together with hypotropia in 5 cases. Bilateral displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by computed tomography scan of the orbits and by ob- servation during surgery. Five patients underwent bilateral surgery and 4 underwent unilateral surgery. After an average follow-up of 29 months (range 4–47 months), 4/5 patients who underwent bilateral myopexy achieved good results with postoperative esotropia of less than 8 diopters, as opposed to 2/4 patients who underwent unilateral surgery. No complications were noted. CON C LUSIONS . Bilateral superior and lateral rectus myopexy is the preferred method of surgical correc- tion of esotropia associated with high myopia. Additional unilateral or bilateral medial rectus reces- sion is probably not indicated in most cases.
    [Show full text]
  • Adult Strabismus Overview Common Types Esotropia Exotropia
    Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Overview • Common Types of Strabismus • Indications for Strabismus Surgery • Common Procedures Adult Strabismus • Psychosocial Benefits Gregory Ostrow M.D Pediatric Ophthalmology and Adult Strabismus Scripps Clinic Medical Group 3811 Valley Centre Drive San Diego, CA 92130 Esotropia Common Types Exotropia www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 1 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 • There are many different Indications for Strabismus presentations of strabismus Surgery • Most can be corrected surgically Classically Taught Benefits of Other Benefits Strabismus Surgery • Develop binocular vision • Improve visual • Restore binocular vision field • Eliminate diplopia • Eliminate torticollis www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 2 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Insurance accepted indications Surgical Procedures for strabismus surgery •Diplopia • Weaken (recession) • Asthenopia (eye strain) • Strengthen (resection or tuck) • Any misalignment of the eyes that • Alter vector forces (transposition) cannot be corrected non-surgically – this is where some prodding is occasionally required Recession (weakening) www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 3 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Resection (tightening) Psychosocial Benefits of Strabismus Surgery www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 4 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D.
    [Show full text]
  • Refraction of 1-Year-Old Children After Atropine Cycloplegia R
    Br J Ophthalmol: first published as 10.1136/bjo.63.5.343 on 1 May 1979. Downloaded from British Journal of Ophthalmology, 1979, 63, 343-347 Refraction of 1-year-old children after atropine cycloplegia R. M. INGRAM From the Kettering and District General Hospital, Kettering SUMMARY The refractions of 1648 children aged 11 to 13 months are reported. Atropine % was used for cycloplegia. 11 83% of the children had bilateral hypermetropia of +2O00 or more D. 13-23 % of them had + 1 50 or more D astigmatism in one or both eyes, and 6 5 % had anisometropia. Anisometropia was significantly (P=0-000 001 %) associated with bilateral hypermetropia, but even more significantly (P=0000000 4%) associated with astigmatism of +1 50 or more D in one or both eyes. Cyclopentolate was used in our pilot study (Ingram month of their birth, but some children born late et al., 1979) for reasons of convenience, but its in the month were refracted early in that month cycloplegic effect has not been proved (Davidson, and others, for one reason or another, attended 1976). Atropine is accepted generally as the most during the following month. Thus their ages ranged efficient cycloplegic drug, and the true range of from 11 to 13 months inclusive. refractions at age 1 year would be more accurately All the refractions were carried out by the recorded after 'atropinisation'. This is a report of author. When cycloplegia was obviously incomplete, the refractions of 1648 1-year-old children examined for example, the pupils were mobile or when the after 'full atropinisation'.
    [Show full text]
  • Sixth Nerve Palsy
    Advances in Ophthalmology & Visual System Mini Review Open Access Sixth nerve palsy Mini review Volume 8 Issue 1 - 2018 Among the ocular motor nerve palsies sixth nerve palsy is the most Smita Kapoor, Rajesh Prabu, Swarna common followed by fourth nerve and third nerve. Acute palsies can Udayakumar pose a diagnostic and therapeutic challenge to the ophthalmologist. University Sankara Eye Hospital, India Abducens nerve is susceptible to damage due to various intracranial pathologies. This is because of its long intracranial path, its angle at Correspondence: Smita Kapoor, University Sankara Eye the petrous tip of the temporal bone and non-flexibility of the path Hospital, Sathy Road, Coimbatore, India, Tel 9566632262, between the brainstem and the meningeal entrance site. Various Email causes include infections (meningitis, varicella zoster), trauma (head Received: January 03, 2018 | Published: January 18, 2018 injury), neoplasms (chondroma, metastasis), systemic disorders (atherosclerosis, leukaemia) and iatrogenic (post spinal anaesthesia). Sixth nerve palsies can occur in both adults and children. Those occurring in adults above the age of 40 years are most commonly caused by atherosclerosis and microangiopathies like hypertension and diabetes mellitus. Patients with acute sixth nerve palsy present with incapacitating diplopia. Ocular motility in these cases improves rectus muscle transposition procedure for treating paralytic strabismus in 94% of the patients by six months spontaneously. In general, at in 1908. Several modifications to his procedure were described by the onset of an isolated sixth nerve palsy in a vasculopathic patient, O’Connor, Jensen, Knapp, Carlson and Jampolsky. However, the neuroimaging is not required. However, a cranial MRI is mandatory original principle of all the surgeries remains the same.
    [Show full text]
  • What's New and Important in Pediatric Ophthalmology and Strabismus In
    What’s New and Important in Pediatric Ophthalmology and Strabismus in 2021 Complete Unabridged Handout AAPOS Virtual Meeting April 2021 Presented by the AAPOS Professional Education Committee Tina Rutar, MD - Chairperson Austin E Bach, DO Kara M Cavuoto, MD Robert A Clark, MD Marina A Eisenberg, MD Ilana B Friedman, MD Jennifer A Galvin, MD Michael E Gray, MD Gena Heidary, MD PhD Laryssa Huryn, MD Alexander J Khammar MD Jagger Koerner, MD Eunice Maya Kohara, DO Euna Koo, MD Sharon S Lehman, MD Phoebe Dean Lenhart, MD Emily A McCourt, MD - Co-Chairperson Julius Oatts, MD Jasleen K Singh, MD Grace M. Wang, MD PhD Kimberly G Yen, MD Wadih M Zein, MD 1 TABLE OF CONTENTS 1. Amblyopia page 3 2. Vision Screening page 12 3. Refractive error page 20 4. Visual Impairment page 31 5. Neuro-Ophthalmology page 37 6. Nystagmus page 48 7. Prematurity page 52 8. ROP page 55 9. Strabismus page 65 10. Strabismus surgery page 82 11. Anterior Segment page 101 12. Cataract page 108 13. Cataract surgery page 110 14. Glaucoma page 120 15. Refractive surgery page 127 16. Genetics page 128 17. Trauma page 151 18. Retina page 156 19. Retinoblastoma / Intraocular tumors page 167 20. Orbit page 171 21. Oculoplastics page 175 22. Infections page 183 23. Pediatrics / Infantile Disease/ Syndromes page 186 24. Uveitis page 190 25. Practice management / Health care systems / Education page 192 2 1. AMBLYOPIA Self-perception in Preschool Children With Deprivation Amblyopia and Its Association With Deficits in Vision and Fine Motor Skills. Birch EE, Castaneda YS, Cheng-Patel CS, Morale SE, Kelly KR, Wang SX.
    [Show full text]
  • Is Hypermetropia Regressing in Accommodative Esotropia? a Hipermetropia Regride Na Esotropia Acomodativa? Fatma Yulek1 , Sema Yuzbasioglu1, Demet Eyidogan1 1
    A RQUIVOS B RASILEIROS DE ORIGINAL ARTICLE Is hypermetropia regressing in accommodative esotropia? A hipermetropia regride na esotropia acomodativa? Fatma Yulek1 , Sema Yuzbasioglu1, Demet Eyidogan1 1. Ophthalmology Department, Ankara Atatürk Education and Research Hospital, Ankara Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey. ABSTRACT | Purposes: To evaluate the relationship of chan­ ou reduzida a menos de 10 D com correção completa da ges in hypermetropia and ocular alignment in patients with hiper metropia). As medidas de refração em cicloplegia obtidas accommodative esotropia. Methods: The medical records of dos prontuários foram convertidas em equivalentes esféricos. consecutive patients diagnosed with refractive accommodative Avaliaram­se ainda a presença de ambliopia, alterações do esotropia (esotropia eliminated or decreased to within 10 D erro refrativo e o alinhamento ocular à admissão e depois do with full hyperopic correction) were retrospectively reviewed. período de acompanhamento. Resultados: Setenta pacientes Cycloplegic refractions culled from medical records were (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, converted into spherical equivalents. Presence of amblyopia, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia changes in refractive error and ocular alignment at admission de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A and after the follow­up period were evaluated. Results: Seventy diminuição média anual no desvio para perto e para longe com o patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, follow­up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 respectivamente.
    [Show full text]
  • Approach to Esotropia Clearer for You!
    This podcast will review an approach to a child presenting with esotropia – the most common type of strabismus. The approach includes history taking, physical examination, specific tests, indication for referral and management of esotropia. This podcast was created by Katia Milovanova, a medical student at the University of Alberta, in collaboration with Dr. Natashka Pollock, a pediatric ophthalmologist at the University of Alberta. 1 Today we will cover the following learning objectives on the topic of esotropia: 1) Define and differentiate the main categories of esotropia. 2) Develop an approach to evaluating a patient with esotropia. 3) Delineate appropriate urgent and non-urgent ophthalmology referrals for esotropia. 4) Discuss general treatment approaches for esotropia. 2 Let’s work through a clinical case as we go, so we can apply the information we are learning. You are a medical student working at an urban family medicine clinic. Tim is a 2.5 year old boy presenting with a new onset esotropia. His mother is worried because she has been noticing his left eye turning in over the last few weeks. Before we begin, we must define ‘strabismus’. Strabismus is simply abnormal alignment of the eyes; one or both eyes may deviate from their primary position. Esotropia is a type of strabismus, in which one or both affected eyes look in towards the nose (colloquially termed ‘cross-eyed’). This is the most common type of strabismus, occurring in 2-4% of the population (which is almost 1 in 20 kids!). 3 It is very important to diagnose and correct esotropia before stereopsis develops around the age of 4.
    [Show full text]