DOCSLIB.ORG

Differences and Similarities Between Idiopathic Intracranial Hypertension, Ocular Myasthenia Gravis, Optic Neuritis, and Horner’S in Children Vs

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Differences and Similarities Between Idiopathic Intracranial Hypertension, Ocular Myasthenia Gravis, Optic Neuritis, and Horner’S in Children Vs DIFFERENCES AND SIMILARITIES BETWEEN IDIOPATHIC INTRACRANIAL HYPERTENSION, OCULAR MYASTHENIA GRAVIS, OPTIC NEURITIS, AND HORNER’S IN CHILDREN VS. ADULTS Grant T. Liu, MD University of Pennsylvania School of Medicine Philadelphia, PA LEARNING OBJECTIVE IDIOPATHIC INTRACRANIAL HYPERTENSION (IIH) Understand the differences and similarities between children Similarities between children and adults with IIH. and adults with common neuro-ophthalmic problems • Diagnosis is made similarly (papilledema, normal imaging, CME QUESTIONS: TRUE/FALSE elevated opening pressure on lumbar puncture) • Morbidity (vision loss) 1. Like adults, children with IIH tend to be obese and female. • Treatment algorithms (acetazolamide, weight loss, optic 2. White matter lesions on MRI at presentation are predictive nerve sheath fenestration/shunting when vision loss is of conversion to MS in children with optic neuritis. severe or progressive despite maximal medical therapy) (Rangwala and Liu, 2007). 3. Carotid dissection is a primary consideration in children • Postpubertal patients tend to be female and with Horner’s syndrome. overweight (Balcer et al. 1999). Differences between children and adults with IIH. KEYWORDS 1. Idiopathic Intracranial Hypertension (Pseudotumor • In prepubescent children, more thin children, boys, and Cerebri) asymptomatic presentations. Fewer with headaches as well. (Balcer et al. 1999; Rangwala and Liu, 2007) 2. Pediatric Optic Neuritis • More sixth nerve palsies 3. Ocular Myasthenia Gravis • Young age makes following with computerized visual field testing difficult 4. Horner’s Syndrome • More cases associated with medication use (tetracycline derivatives, synthetic growth hormone, for instance) (Ko and Liu, 2010) INTRODUCTION • MRI-v recommended in addition to MRI in all cases for Pediatric neuro-ophthalmology is more than just neuro- diagnosis (Rangwala and Liu, 2007) ophthalmology of little people. Compared with neuro- • Definition of elevated opening pressure varies (280 mm ophthalmology in adults, in the pediatric subspecialty the H20 vs. 250 mm H20) (Avery et al. 2010) diseases are different, with greater emphases on congenital • Better visual prognosis (Soiberman et al. 2011) malformations and genetic disorders and less on vascular problems. The approach also varies, particularly with OCULAR MYASTHENIA GRAVIS (OMG) regard to examination techniques and interaction with the parents. In many instances, it is still unclear from a Similarities between children and adults with OMG. physiologic standpoint why such striking differences exist between disease profiles in adults and children. • Juvenile and adult myasthenia gravis are both autoimmune disorders The purpose of this talk is to highlight the similarities and • Presentation with ptosis, strabismus, and/or differences between adults and children with four common ophthalmoplegia (Kim et al. 2003) neuro-ophthalmic problems. • Diagnosis with acetylcholine receptor antibody testing • Use of ice test or rest test • Treatment options include pyridostigmine, prednisone, immunosuppression, and thymectomy. 2012 Annual Meeting Syllabus | 95 Differences between children and adults with OMG. one or more white matter lesions on MRI were more likely to develop MS (3/7 vs. 0/11, p=0.04, Fisher’s • Other forms to consider in infancy: neonatal exact test). We concluded that children with brain myasthenia gravis MRI abnormalities at the time of the diagnosis of optic • Use of the edrophonium test, repetitive stimulation, or neuritis have an increased risk of MS. single fiber EMG may not be possible in some children because of lack of cooperation. Differences between children and adults with optic • Therefore when the acetylcholine receptor antibody neuritis. testing is normal, the diagnosis of ocular myasthenia gravis in a child may lack confirmatory testing. • Visual acuities at presentation may be worse • Amblyopia due to ptosis (deprivational) and ocular (Bonhomme et al. 2009) misalignment (strabismic) make aggressive treatment more • More bilateral optic neuritis and optic neuritis with of a priority (Ortiz and Borchert 2008; Pineles et al. 2010) optic disc edema • Thymectomy in younger children can be performed • More optic neuritis in association with intercurrent illness transthorascopically rather than transcervically or • Presentation as ADEM, a demyelinating or inflammatory trans-sternally. event, and includes white or gray matter lesions on • Thymoma rare MRI, which is i) polysymptomatic and ii) includes • In our series (Pineles et al. 2010), the development encephalopathy (i.e. behavioral or mental status of generalized symptoms (23%) was lower than early change) (Krupp et al., 2007). Acute disseminated case series of pediatric OMG (36-43%) (Mullaney et al. encephalomyelitis (ADEM) is an autoimmune 2003; McCreery et al. 2002), and that of adult OMG demyelinating disease that typically follows an illness (31-49%) (Bever et al. 1983; Sommer et al. 1997). or vaccination. As opposed to MS, ADEM is typically These rates corroborate the notion that development a monophasic illness that does not require long-term of generalized symptoms may be less common in treatment. ADEM is more common in children than pediatric OMG than in the adult population. adults (Dale et al. 2000). Although patients with ADEM can present with fulminate neurologic signs and OPTIC NEURITIS (ON) symptoms, most patients have an excellent recovery. • More recurrent optic neuritis in children. In our study Similarities between children and adults with optic neuritis. of pediatric optic neuritis (Bonhomme et al. 2009), nine patients (31%) had relapses of optic neuritis during the • Clinically, optic neuritis in the pediatric age group is study period and 5 had more than one relapse. diagnosed by the same criteria used in adults, including • Neuromyelitis optica (NMO), although seen, is less sudden or subacute visual loss, central or cecocentral common in children. visual field defect, impairment of color vision, afferent • Older age is a risk factor for development of MS. pupillary defect, and ocular pain on eye movements. (Waldman et al., in press). • Often the initial manifestation of multiple sclerosis (MS). • Postpubertal patients tend to be female and have a According to the ONTT, after acute unilateral optic neuritis, presentation (unilateral without disc swelling) and adults have a 50% chance of developing MS within 15 years course similar to adults. (Optic Neuritis Study Group 2008). Children with optic neuritis are also at risk for development of MS (29%, meta- HORNER’s SYNDROME analysis) (Waldman et al., in press). • White matter lesions on MRI are predictive of Similarities between children and adults with Horner’s conversion to MS. As established by the Optic Neuritis syndrome. Treatment Trial, an abnormal baseline brain MRI with white matter lesions is a strong predictor of MS after • Presentation with ptosis, miosis, and anhidrosis isolated optic neuritis in adults. Fifteen years after • Neuro-anatomy is the same. Consideration of lesions a bout of optic neuritis, 72% of adults with one or affecting the first, second, and third-order neurons more brain MRI lesions at presentation developed MS, in contrast with a 25% conversion rate in those Differences between children and adults with Horner’s with no lesions (Optic Neuritis Study Group 2008). In syndrome. children, an abnormal MRI at presentation is likely also predictive. In our study (Bonhomme et al. 2009) 18 • Congenital cases, with birth trauma in the differential patients were followed for more than 24 months, and diagnosis (Weinstein et al. 1980) 3 of the 18 (17%) developed MS. All three patients had • More presentations with iris heterochromia an abnormal brain MRI scan at their initial presentation • Carotid dissection, lungancer, c and microvascular of optic neuritis. None of the patients with a normal causes more common in adults. brain MRI scan at presentation developed MS over • Need to avoid apraclonidine testing because of risk of an average follow-up of 88.5 months. Patients with drowsiness and unresponsiveness in young children 96 | North American Neuro-Ophthalmology Society • Confirmation with cocaine drop testing preferred Ocular Myasthenia Gravis • Neuroblastoma is a consideration, so workup should 1. Bever C, Aquino A, Penn A, Lovelace R, Rowland L. Prognosis of include urine vanillylmandelic acid (VMA) and ocular myasthenia. Ann Neurol. 1983;14:516-519. homovanillic acid (HVA) testing. 2. Kim J, Hwang J, Hwang Y, Kim K, Chae J. Childhood ocular • Despite opinion to the contrary (Smith et al. 2010), we myasthenia gravis. Ophthalmology. 2003;110:1458-1462. believe that all patients with an obvious or confirmed 3. McCreery K, Hussein M, Lee A, Paysse E, Chandran R, Coats D. Horner’s syndrome also should undergo MR imaging Major review: the clinical spectrum of pediatric myasthenia of the head, neck, and upper chest to rule out a gravis: blepharoptosis, ophthalmoplegia, and strabismus. A report of 14 cases. Binocul V Strabismus Q. 2002;17:181-186. responsible mass lesion. In our study (Mahoney et 4. Mullaney P, Vajsar J, Smith R, Buncic J. The natural history and al. 2006), of 18 children who had complete imaging ophthalmic involvement in childhood myasthenia gravis at The and urine studies, and the diagnosis was unknown, Hospital for Sick Children. Ophthalmology. 2000;107:504-510. responsible mass lesions were found in six (33%). 5. Ortiz S, Borchert M. Long-term outcomes of pediatric ocular • Even children with a history
Load more

Recommended publications
  • Answer Set Companion Answers to Questions
    Case Based Pediatrics For Medical Students and Residents Questions and Answers Editors: Loren G. Yamamoto, MD, MPH, MBA Alson S. Inaba, MD Jeffrey K. Okamoto, MD Mary Elaine Patrinos, MD Vince K. Yamashiroya, MD Department of Pediatrics University of Hawaii John A. Burns School of Medicine Kapiolani Medical Center For Women And Children Honolulu, Hawaii Copyright 2004, Loren G. Yamamoto Department of Pediatrics, University of Hawaii John A. Burns School of Medicine Answer Set Companion Answers to Questions Section I. Office Primary Care Chapter I.1. Pediatric Primary Care 1. False. Proximity to the patient is also an important factor. A general surgeon practicing in a small town might be the best person to handle a suspected case of appendicitis, for example. 2. False. Although some third party payors have standards written into their contracts with physicians, and the American Academy of Pediatrics has created a standard, not all pediatricians adhere to these standards. 3. True. Many factors are involved, including the training of the primary care pediatrician and past experience with similar cases. 4.d 5.e Chapter I.2. Growth Monitoring 1. BMI (kg/m 2) = weight in kilograms divided by the square of the height in meters. 2. First 18 months of life. 3. a) If the child's weight is below the 5th percentile, or b) if weight drops more than two major percentile lines. 4. 85th percentile. 5. 30 grams, or 1 oz per day. 6. At 5 years of age. Those who rebound before 5 years have a higher risk of obesity in childhood and adulthood.
    [Show full text]
  • A Patient & Parent Guide to Strabismus Surgery
    A Patient & Parent Guide to Strabismus Surgery By George R. Beauchamp, M.D. Paul R. Mitchell, M.D. Table of Contents: Part I: Background Information 1. Basic Anatomy and Functions of the Extra-ocular Muscles 2. What is Strabismus? 3. What Causes Strabismus? 4. What are the Signs and Symptoms of Strabismus? 5. Why is Strabismus Surgery Performed? Part II: Making a Decision 6. What are the Options in Strabismus Treatment? 7. The Preoperative Consultation 8. Choosing Your Surgeon 9. Risks, Benefits, Limitations and Alternatives to Surgery 10. How is Strabismus Surgery Performed? 11. Timing of Surgery Part III: What to Expect Around the Time of Surgery 12. Before Surgery 13. During Surgery 14. After Surgery 15. What are the Potential Complications? 16. Myths About Strabismus Surgery Part IV: Additional Matters to Consider 17. About Children and Strabismus Surgery 18. About Adults and Strabismus Surgery 19. Why if May be Important to a Person to Have Strabismus Surgery (and How Much) Part V: A Parent’s Perspective on Strabismus Surgery 20. My Son’s Diagnosis and Treatment 21. Growing Up with Strabismus 22. Increasing Signs that Surgery Was Needed 23. Making the Decision to Proceed with Surgery 24. Explaining Eye Surgery to My Son 25. After Surgery Appendix Part I: Background Information Chapter 1: Basic Anatomy and Actions of the Extra-ocular Muscles The muscles that move the eye are called the extra-ocular muscles. There are six of them on each eye. They work together in pairs—complementary (or yoke) muscles pulling the eyes in the same direction(s), and opposites (or antagonists) pulling the eyes in opposite directions.
    [Show full text]
  • EPOS 2021 Vision 2020 - EPOS 2021
    EPOS 2021 Vision 2020 - EPOS 2021 Final programme & Abstract book EPOS 2021 Virtual Conference 18 - 19 June 2021 www.epos2021.dk EPOS 2021 Vision 2020 - EPOS 2021 2 Contents Final programme . 3 Invited speaker abstracts . 5 Free paper presentations . 33 Rapid fire presentations . 60 Poster presentations . 70 Local organizing Committee: Conference chair: Lotte Welinder Dept. of Ophthalmology, Aalborg University Hospital Members: Dorte Ancher Larsen Dept. of Ophthalmology, Aarhus University Hospital Else Gade Dept. of Ophthalmology, University Hospital Odense Lisbeth Sandfeld Dept. of Ophthalmology, Zealand University Hospital, Roskilde Kamilla Rothe Nissen Dept. of Ophthalmology, Rigshospitalet, University Hospital of Copenhagen Line Kessel Dept. of Ophthalmology, Rigshospitalet (Glostrup), University Hospital of Copenhagen Helena Buch Heesgaard Copenhagen Eye and Strabismus Clinic, CFR Hospitals EPOS Board Members: Darius Hildebrand President Eva Larsson Secretary Christina Gehrt-Kahlert Treasurer Catherine Cassiman Anne Cees Houtman Matthieu Robert Sandra Valeina EPOS 2021 Programme 3 Friday 18 June 8.50-9.00 Opening, welcome remarks 9.00-10.15 Around ROP and prematurity - Part 1 Moderators: Eva Larsson (SE) and Lotte Welinder (DK) 9.00-9.10 L1 Visual impairment. National Danish Registry of visual Kamilla Rothe Nissen (DK) impairment and blindness? 9.10-9.20 L2 Epidemiology of ROP Gerd Holmström (SE) 9.20-9.40 L3 The premature child. Ethical issues in neonatal care Gorm Greisen (DK) 9.40-9.50 L4 Ocular development and visual functioning
    [Show full text]
  • Pediatric Ophthalmology/Strabismus 2017-2019
    Academy MOC Essentials® Practicing Ophthalmologists Curriculum 2017–2019 Pediatric Ophthalmology/Strabismus *** Pediatric Ophthalmology/Strabismus 2 © AAO 2017-2019 Practicing Ophthalmologists Curriculum Disclaimer and Limitation of Liability As a service to its members and American Board of Ophthalmology (ABO) diplomates, the American Academy of Ophthalmology has developed the Practicing Ophthalmologists Curriculum (POC) as a tool for members to prepare for the Maintenance of Certification (MOC) -related examinations. The Academy provides this material for educational purposes only. The POC should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results. The physician must make the ultimate judgment about the propriety of the care of a particular patient in light of all the circumstances presented by that patient. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any information contained herein. References to certain drugs, instruments, and other products in the POC are made for illustrative purposes only and are not intended to constitute an endorsement of such. Such material may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law.
    [Show full text]
  • G:\All Users\Sally\COVD Journal\COVD 37 #3\Maples
    Essay Treating the Trinity of Infantile Vision Development: Infantile Esotropia, Amblyopia, Anisometropia W.C. Maples,OD, FCOVD 1 Michele Bither, OD, FCOVD2 Southern College of Optometry,1 Northeastern State University College of Optometry2 ABSTRACT INTRODUCTION The optometric literature has begun to emphasize One of the most troublesome and long recognized pediatric vision and vision development with the advent groups of conditions facing the ophthalmic practitioner and prominence of the InfantSEE™ program and recently is that of esotropia, amblyopia, and high refractive published research articles on amblyopia, strabismus, error/anisometropia.1-7 The recent institution of the emmetropization and the development of refractive errors. InfantSEE™ program is highlighting the need for early There are three conditions with which clinicians should be vision examinations in order to diagnose and treat familiar. These three conditions include: esotropia, high amblyopia. Conditions that make up this trinity of refractive error/anisometropia and amblyopia. They are infantile vision development anomalies include: serious health and vision threats for the infant. It is fitting amblyopia, anisometropia (predominantly high that this trinity of early visual developmental conditions hyperopia in the amblyopic eye), and early onset, be addressed by optometric physicians specializing in constant strabismus, especially esotropia. The vision development. The treatment of these conditions is techniques we are proposing to treat infantile esotropia improving, but still leaves many children handicapped are also clinically linked to amblyopia and throughout life. The healing arts should always consider anisometropia. alternatives and improvements to what is presently The majority of this paper is devoted to the treatment considered the customary treatment for these conditions.
    [Show full text]
  • Bass – Glaucomatous-Type Field Loss Not Due to Glaucoma
    Glaucoma on the Brain! Glaucomatous-Type Yes, we see lots of glaucoma Field Loss Not Due to Not every field that looks like glaucoma is due to glaucoma! Glaucoma If you misdiagnose glaucoma, you could miss other sight-threatening and life-threatening Sherry J. Bass, OD, FAAO disorders SUNY College of Optometry New York, NY Types of Glaucomatous Visual Field Defects Paracentral Defects Nasal Step Defects Arcuate and Bjerrum Defects Altitudinal Defects Peripheral Field Constriction to Tunnel Fields 1 Visual Field Defects in Very Early Glaucoma Paracentral loss Early superior/inferior temporal RNFL and rim loss: short axons Arcuate defects above or below the papillomacular bundle Arcuate field loss in the nasal field close to fixation Superotemporal notch Visual Field Defects in Early Glaucoma Nasal step More widespread RNFL loss and rim loss in the inferior or superior temporal rim tissue : longer axons Loss stops abruptly at the horizontal raphae “Step” pattern 2 Visual Field Defects in Moderate Glaucoma Arcuate scotoma- Bjerrum scotoma Focal notches in the inferior and/or superior rim tissue that reach the edge of the disc Denser field defects Follow an arcuate pattern connected to the blind spot 3 Visual Field Defects in Advanced Glaucoma End-Stage Glaucoma Dense Altitudinal Loss Progressive loss of superior or inferior rim tissue Non-Glaucomatous Etiology of End-Stage Glaucoma Paracentral Field Loss Peripheral constriction Hereditary macular Loss of temporal rim tissue diseases Temporal “islands” Stargardt’s macular due
    [Show full text]
  • Optic Nerve Hypoplasia Plus: a New Way of Looking at Septo-Optic Dysplasia
    Optic Nerve Hypoplasia Plus: A New Way of Looking at Septo-Optic Dysplasia Item Type text; Electronic Thesis Authors Mohan, Prithvi Mrinalini Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 29/09/2021 22:50:06 Item License http://rightsstatements.org/vocab/InC/1.0/ Link to Item http://hdl.handle.net/10150/625105 OPTIC NERVE HYPOPLASIA PLUS: A NEW WAY OF LOOKING AT SEPTO-OPTIC DYSPLASIA By PRITHVI MRINALINI MOHAN ____________________ A Thesis Submitted to The Honors College In Partial Fulfillment of the Bachelors degree With Honors in Physiology THE UNIVERSITY OF ARIZONA M A Y 2 0 1 7 Approved by: ____________________________ Dr. Vinodh Narayanan Center for Rare Childhood Disorders Abstract Septo-optic dysplasia (SOD) is a rare congenital disorder that affects 1/10,000 live births. At its core, SOD is a disorder resulting from improper embryological development of mid-line brain structures. To date, there is no comprehensive understanding of the etiology of SOD. Currently, SOD is diagnosed based on the presence of at least two of the following three factors: (i) optic nerve hypoplasia (ii) improper pituitary gland development and endocrine dysfunction and (iii) mid-line brain defects, including agenesis of the septum pellucidum and/or corpus callosum. A literature review of existing research on the disorder was conducted. The medical history and genetic data of 6 patients diagnosed with SOD were reviewed to find damaging variants.
    [Show full text]
  • TUBB3 M323V Syndrome Presents with Infantile Nystagmus
    G C A T T A C G G C A T genes Case Report TUBB3 M323V Syndrome Presents with Infantile Nystagmus Soohwa Jin 1, Sung-Eun Park 2, Dongju Won 3, Seung-Tae Lee 3, Sueng-Han Han 2 and Jinu Han 4,* 1 Department of Opthalmology, Yonsei University College of Medicine, Seoul 03722, Korea; [email protected] 2 Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; [email protected] (S.-E.P.); [email protected] (S.-H.H.) 3 Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; [email protected] (D.W.); [email protected] (S.-T.L.) 4 Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea * Correspondence: [email protected]; Tel.: +82-2-2019-3445 Abstract: Variants in the TUBB3 gene, one of the tubulin-encoding genes, are known to cause congenital fibrosis of the extraocular muscles type 3 and/or malformations of cortical development. Herein, we report a case of a 6-month-old infant with c.967A>G:p.(M323V) variant in the TUBB3 gene, who had only infantile nystagmus without other ophthalmological abnormalities. Subsequent brain magnetic resonance imaging (MRI) revealed cortical dysplasia. Neurological examinations did not reveal gross or fine motor delay, which are inconsistent with the clinical characteristics of patients with the M323V syndrome reported so far. A protein modeling showed that the M323V mutation in the TUBB3 gene interferes with αβ heterodimer formation with the TUBA1A gene.
    [Show full text]
  • Multiple Ocular Developmental Defects in Four Closely Related Alpacas
    Veterinary Ophthalmology (2018) 1–8 DOI:10.1111/vop.12540 CASE REPORT Multiple ocular developmental defects in four closely related alpacas Kelly E. Knickelbein,* David J. Maggs,§ Christopher M. Reilly,†,1 Kathryn L. Good*,2 and Juliet R. Gionfriddo‡,3 *The Veterinary Medical Teaching Hospital, University of California, Davis, CA 95616, USA; §Department of Surgical and Radiological Sciences, University of California, Davis, CA 95616 USA; †Department of Pathology Microbiology, and Immunology, University of California, Davis, CA 95616, USA; and ‡The College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80528, USA Address communications to: Abstract D. J. Maggs Objective To describe the clinical, gross pathologic, and histopathologic findings for a Tel.: (530) 752-3937 visually impaired 5.8-year-old female alpaca with multiple ocular abnormalities, as well Fax: (530) 752-6042 as the clinical findings for three closely related alpacas. e-mail: [email protected] Animals studied Four alpacas. Present addresses: 1Insight Procedures Ophthalmic examination was performed on a 16-month-old female alpaca Veterinary Specialty Pathology, following observation of visual impairment while hospitalized for an unrelated illness. Austin, TX 78752, USA Following acute systemic decline and death 4.5 years later, the alpaca’s brain, optic 2Department of Surgical and Radiological Sciences, nerves, and eyes were examined grossly and histologically. Ophthalmic examination of University of California, Davis, three closely related alpacas was subsequently performed. CA 95616, USA Results The 16-month-old female alpaca (Alpaca 1) had ophthalmoscopic findings sug- 3 Red Feather Lakes, CO 80545, gestive of a coloboma or hypoplasia of the retinal pigment epithelium (RPE) and chor- USA oid, and suspected optic nerve hypoplasia OU.
    [Show full text]
  • Ocular Manifestations in Children with Delayed
    A DISSERTATION ON “OCULAR MANIFESTATIONS IN CHILDREN WITH DELAYED MILESTONES-A CLINICAL STUDY” Submitted to THE TAMIL NADU DR. M. G. R. MEDICAL UNIVERSITY In partial fulfilment of the requirements For the award of degree of M.S. ( Branch III ) --- OPHTHALMOLOGY GOVERNMENT STANLEY MEDICAL COLLEGE & HOSPITAL THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY CHENNAI, TAMIL NADU MAY 2018 CERTIFICATE This is to certify that the study entitled “OCULAR MANIFESTATIONS IN CHILDREN WITH DELAYED MILESTONES- A CLINICAL STUDY” is the result of original work carried out by DR.SOUNDARYA.B, under my supervision and guidance at GOVT. STANLEY MEDICAL COLLEGE, CHENNAI. The thesis is submitted by the candidate in partial fulfilment of the requirements for the award of M.S Degree in Ophthalmology, course from 2015 to 2018 at Govt.Stanley Medical College, Chennai. PROF. DR. PONNAMBALANAMASIVAYAM, PROF.DR.B.RADHAKRISHNAN,M.S.,D.O M.D.,D.A.,DNB. Unit chief and H.O.D. Dean Department of Ophthalmology Government Stanley Medical College Govt. Stanley Medical College Chennai - 600 001. Chennai - 600 001. DECLARATION I hereby declare that this dissertation entitled “OCULAR MANIFESTATIONS IN CHILDREN WITH DELAYED MILESTONES- A CLINICAL STUDY” is a bonafide and genuine research work carried out by me under the guidance of PROF. DR.B.RADHAKRISHNAN M.S. D.O., Unit chief and Head of the Department, Department of Ophthalmology, Government Stanley Medical college and Hospital, Chennai – 600001. Date : Signature Place:Chennai Dr. Soundarya.B ACKNOWLEDGEMENT I express my immense gratitude to The Dean, Prof. Dr. PONNAMBALANAMASIVAYAM M.D,D.A.,DNB., Govt.Stanley Medical College for giving me the opportunity to work on this study.
    [Show full text]
  • Without Retinopathy Ofprematurity 93
    BritishJournalofOphthalmology 1993; 77:91-94 91 Follow-up study on premature infants with and without retinopathy of prematurity Br J Ophthalmol: first published as 10.1136/bjo.77.2.91 on 1 February 1993. Downloaded from Rosemary Robinson, Michael O'Keefe Abstract first screened at 6 weeks. When discharged from The ocular complications in population of 131 the neonatal unit, they continue to attend for premature infants, with and without retino- follow up at the Children's Hospital. Follow up pathy of prematurity (ROP) are reported. An is determined by the degree ofvascularisation of increased incidence of strabismus (20% with the retina. If fully vascularised, the child is seen ROP and 25% without ROP) and myopia again at 3 months and then yearly until age 5 (27-5% with ROP and 8-8% without ROP) was years, unless strabismus or amblyopia develop. shown. Significant visual loss occurred in If ROP is diagnosed, assessment is every 3-4 10-7% overall, increasing to 35% with stage 3 weeks if stage 1-2 is present and weekly if stage disease and 100% with stage 4. With the 3. If stage 3 threshold disease is noted then increased survival rate of premature infants, cryopexy is applied. After treatment, all infants the relevance to future management of this are seen at 3 monthly intervals for the first year expanding group of young people is and every 6 months for 5 years, then annually. considered. We classified ROP according to the (BrJ7 Ophthalmol 1993; 77: 91-94) international classification7 and defined signifi- cant ROP as stage 3 or 4 disease.
    [Show full text]
  • I. Infants with Poor Vision
    AAPOS Genetic Eye Disease Workshop 2019 I. Infants with poor vision 1. Infant with poor vision without nystagmus—Debbie Costakos Case #1: An ex 27-week CGA (Corrected Gestational Age) BW 1050g baby girl was referred at age 30 weeks for ROP. ROP resolved spontaneously but the patient was noted to have poor eye contact and no fix and follow at 6 months of age. PMHx was significant for prematurity, intraventricular hemorrhage (grade 3) and periventricular leukomalacia FHx was negative for poor vision Alignment was orthotropic CRx was +3.00 sphere in both eyes DFE revealed normal optic nerves, macula and vessels Case #2: A 6-month-old baby girl was referred at age 6 months for lack of eye contact and no fix and follow. PMHx was not significant FHx was negative for poor vision, strabismus or developmental delay Visual acuity was blinks to light both eyes Alignment was variable intermittent exotropia up to 40 PD X(T) CRx was +5.00 +1.00 x 90 and +4.50 +2.00 x 90 DFE revealed poor foveal reflex in both eyes with a blond fundus Use clinical findings, history and family history to guide the work up. Differential Diagnosis may include: Differential Diagnosis for Infant with poor vision, no nystagmus: Delayed Visual Maturation (DVM) Cortical Visual Impairment (CVI) Albinism Seizure disorder Metabolic disorders Prematurity with PVL, other CNS involvement (with or without ROP). Note: strabismus alone is not a diagnosis for bilateral poor vision Imaging tools are available Workup to consider: OCT—“normal” appearance varies by age ERG Referral to other specialists Brain mri Genetic testing, or not, depending on differential diagnosis and probably yield 2.
    [Show full text]