Assessment of infant and early childhood development in a periurban Bolivian population.
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Bolivia↗
Biomedical subjects
C Auer
Publications and source records attributed to C Auer.
[Towards systematic screening for mucoviscidosis?].
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Algorithms↗
Childhood vaccination in a squatter area of Manila: coverage and providers.
In 1988 a vaccination coverage cluster survey was performed in a squatter area of Manila, Philippines. 24% of the surveyed children (aged 1-2 years) were fully immunized and 19% not immunized. 60% of the children were vaccinated through private organization. The dropout rates of these children were significantly lower than those of the children vaccinated through governmental agencies. This suggests that services have to be provided by agencies that are based in the squatter area. Efforts for improved coverage should focus on lowering the high dropout rates and strengthening coordination between the governmental and the various private health agencies that provide vaccination service in this squatter area. The survey also indicated approaches to strengthening collaboration between different service providers.
Child Health Services↗
Health status of children living in a squatter area of Manila, Philippines, with particular emphasis on intestinal parasitoses.
In 1988 a study was performed in a squatter area of Manila, Philippines. Three substudies were carried out: (1) an analysis of the reported health situation and the available health services for the population of Smokey Mountain, (2) a vaccination coverage survey and (3) a cross-sectional stool sample survey. Respiratory infections, diarrhea, measles and malnutrition were the most frequently reported causes of ill-health and death. Not only governmental but also various non-governmental health services have been developed over the last few years. Better coordination and cooperation between the various health care providers, furtherance of community participation, improvements in the performance of the community health volunteers and stronger emphasis on preventive health care (such as health education) are suggested. The vaccination coverage cluster survey performed among children aged 1-2 years revealed that 24% of the surveyed children were fully immunized and 19% not immunized at all. The drop-out rates of children vaccinated through non-governmental organizations were significantly lower than those of the children vaccinated through a governmental agency. The cross-sectional stool sample survey performed among 238 children aged 8 months to 15 years revealed that 96% of the surveyed children were harboring intestinal parasites. Most common was Trichuris and Ascaris. The prevalence of hookworm was 10%, and those of Entamoeba histolytica and Giardia lamblia 21% and 20%, respectively. Most children (84%) were affected by multiparasitism. The need to adapt the concept of Primary Health Care to the context of the urban poor and not only to provide health services but also to change social and economic conditions is emphasized.
Adolescent↗
Duration of automated suprathreshold vs quantitative threshold field examination. Impact of age and ocular status.
We investigated the impact of age and ocular status on the duration of automated threshold and suprathreshold testing of the visual field in a study of 57 eyes with glaucomatous field loss, 58 eyes with ocular hypertension, and 190 eyes of normal controls. It was faster to run a three-zone threshold-related suprathreshold 120-point full-field screening test on younger subjects and normal controls than on older subjects or subjects with early glaucomatous field loss. In contrast, the time required for full quantitative thresholding of 76 points within the central 30 degrees was unaffected by either age or ocular status. Normal individuals required 40% more time to complete the quantitative threshold test than the "full-field" screening test.
Adult↗
Screening with automated perimetry using a threshold-related three-level algorithm.
Eighty eyes were tested using the computer-driven, automated threshold-related, three-level screening strategy of the Humphrey Field Analyzer. Using Goldmann perimetry as the standard, different statistical algorithms were used in an attempt to differentiate eyes with glaucoma (n = 24) from normal controls (n = 56). Seventeen or more absolute and/or relative defects anywhere in the full field test area identified approximately 95% of the glaucoma eyes and screened out 80% of the control eyes. Retesting these criteria on a second group of 25 glaucomatous and 108 control eyes provided comparable results. The number of stimulus presentations can be substantially reduced, without deterioration in either sensitivity or specificity, by using a two-level strategy and limiting testing to the nasal field.
Algorithms↗
The natural history of serous retinal pigment epithelium detachment in patients with age-related macular degeneration.
One hundred ten patients with serous detachment of the retinal pigment epithelium (RPE) were reexamined to enhance our knowledge of the natural course of this condition. All patients were greater than 50 years of age, had age-related macular degeneration, and had neither blood, lipid, nor angiographic evidence of a definite choroidal neovascular membrane (NVM) at the time of the initial examination. All patients were followed up for at least six months except for two patients who had developed a choroidal NVM within the first six months of the initial exam. Forty-five of 140 eyes (32%) developed a choroidal NVM within an average of 19.6 months (median, 12 months). This was associated with a final visual acuity of 20/200 or worse (P less than 0.0001). Ophthalmoscopic and angiographic features present at the initial visit which were associated with the development of NVM and poor final visual acuity were: sensory retinal detachment; increased size of PED; hot spot; late filling; notching; and irregular filling. At the most recent examination, 39% of the eyes had a final visual acuity of 20/20 to 20/40, while 24% of the eyes had a final visual acuity of less than or equal to 20/200.
Aged↗
Automated differential threshold perimetry for detecting glaucomatous visual field loss.
Because early glaucomatous visual field defects occur asymmetrically across the horizontal meridian, we analyzed data from automated perimetry by comparing sums of threshold values of corresponding groups of points in the superior and inferior hemispheres of the central 30 degrees tested by the Humphrey Field Analyzer. We developed patterns and criteria from 25 early glaucomatous and 36 normal control eyes to achieve optimal balance between sensitivity (96%) and specificity (86%). Application of these criteria to an independent group of 27 glaucomatous and 105 control eyes yielded a sensitivity of 88.9% and specificity of 85.7%. Minor modification of the criteria improved sensitivity and specificity to more than 90% for both patients and controls.
Adult↗
Effect of epsilon-aminocaproic acid on postvitrectomy hemorrhage.
We performed a prospective study involving 96 patients undergoing vitrectomy for proliferative diabetic retinopathy to determine the effect of epsilon-aminocaproic acid on the occurrence of postoperative intraocular hemorrhage. epsilon-Aminocaproic acid significantly reduced postoperative vitreous hemorrhage during the immediate postoperative period. Follow-up examinations two to six weeks after discharge from the hospital disclosed no statistically significant difference in the severity of vitreous hemorrhage between the treated and untreated groups. The loss of drug effect at this stage was in part due to spontaneous repeated bleeding in the treated group and in part to spontaneous clearing of hemorrhage in the untreated group. There was no statistically significant difference in the rate of repeated bleeding between the two groups or in rate of spontaneous clearing.
Aminocaproates↗
Analytic approaches to the interpretation of automated threshold perimetric data for the diagnosis of early glaucoma.
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Adult↗
Multivariate analysis of prognostic factors in penetrating ocular injuries.
We used a multivariate statistical analysis to identify factors predicting visual outcome in 281 eyes that underwent primary repair of a penetrating ocular injury. Visual acuity of 20/800 or better on initial examination was the most important factor, with these eyes 28 times more likely to have a final visual acuity of 20/800 or better than eyes with initial visual acuities worse than 20/800. The effect of other factors differed depending on the initial visual acuity. In patients with initial visual acuities of 20/800 or better, youth (less than or equal to 18 years) was a significant predictor of final visual acuities of 20/50 or better. In patients with initial visual acuities worse than 20/800, a laceration limited to the cornea was the best predictor of good visual outcome. Absence of an expelled or subluxed lens and lacerations limited to a location anterior to the rectus muscle insertions were also important predictors of good visual outcome. When an intraocular foreign body was present these factors were no longer significant and older age (greater than 18 years) was the most important predictor of good visual outcome.
Adolescent↗
Evaluation of vitrectomy in penetrating ocular trauma. A case-control study.
A case-control retrospective evaluation of vitrectomy in penetrating ocular trauma was performed by matching 89 eyes, managed with vitrectomy, with 89 similar eyes that did not undergo vitrectomy. The cases were matched according to factors previously shown to correlate with the visual outcome, including the following: (1) type of trauma; (2) length and posterior extent of the laceration; (3) type and degree of lens involvement; and (4) type and location of any intraocular foreign body. The groups differed in the distribution of initial visual acuity, which was worse in the vitrectomy group. When the final visual results were compared, no statistical advantage from vitrectomy was found. However, beneficial trends were demonstrated in air rifle and double-penetrating injuries, as well as in other severe injuries in which initial visual acuity was worse than 5/200.
Adolescent↗
Cystoid macular edema in pseudophakia.
Cystoid macular edema after cataract surgery, with or without intraocular lens implantation, has been reported to develop in more than 50% of patients as detected by fluorescein angiography. It is associated with reduced visual acuity in up to 8% of cases. Analysis of ongoing clinical trials at the Wilmer Institute indicates that clinically significant cystoid macular edema develops in a lower percentage of cases (2% total incidence and 0.3% persistent cystoid macular edema) if the intraocular lens implantation was uncomplicated. The factors associated with cystoid macular edema and the importance of considering clinically significant rather than just fluorescein-proven cystoid macular edema are discussed. Results of intraocular lens studies reported to the Federal Drug Administration are updated, and results of an ongoing study of prostaglandin inhibitors at the Wilmer Institute are reported.
Aged↗
Quantitative analysis of wide-field endothelial specular photomicrographs.
Samples from the center of a wide-field specular micrograph adequately assessed cell density and frequency distribution of cell areas. A preliminary analysis of the spread of values indicated whether an increased sample size was required. An algorithm determined how large a sample taken from the central photograph (three, five, or nine rectangles) was necessary to permit detection of a 10% change in cell area. This analysis of sample size also indicated that sampling by small-field specular microscopy was not representative of the surrounding square millimeter of corneal endothelium.
Cell Count↗
Vitreous hemorrhage after vitrectomy for diabetic retinopathy.
The records of 596 consecutive vitrectomy cases performed for complications of diabetic retinopathy were reviewed to determine the incidence of intraoperative and postoperative vitreous hemorrhage and to determine if blood cleared more rapidly in aphakic compared to phakic eyes. Uncontrollable intraocular bleeding occurred in two eyes (0.5%). Vitreous hemorrhage was present on the first postoperative day in 278 eyes (63%). This early hemorrhage cleared in an average of 9.1 weeks in phakic eyes and 3.4 weeks in aphakic eyes. Further vitreous hemorrhage occurred in 88 eyes (23%). Sixty-four percent of later hemorrhages occurred in 88 eyes (23%). Sixty-four percent of later hemorrhages occurred within six months of the operation and 80% occurred within one year. Later vitreous hemorrhage cleared in an average of 16.2 weeks in phakic eyes and 5.3 weeks in aphakic eyes. Of the 311 eyes with vitreous hemorrhage at some time during the postoperative course, twenty-nine eyes (9%) underwent reoperation to remove nonclearing blood. Nonclearing vitreous hemorrhage was the main cause of final visual loss in only 15 (3.4%) of 438 eyes with adequate follow-up, and 6 of these 15 eyes had final vision of 5/200 or better.
Adult↗
The crystalline lens after vitrectomy for diabetic retinopathy.
We reviewed the records of 596 consecutive cases of vitrectomy performed for complications of diabetic retinopathy at the Wilmer Eye Institute. Accidental lens damage occurred during surgery in three eyes. Fourteen (8%) of 180 phakic eyes underwent later cataract removal. Follow-up of at least six months and detailed description of the lens at final examination were available in 151 eyes. Of these, visually significant opacities occurred in 32 eyes (21%), and the lens opacities accounted for substantial loss of final vision in 6 (19%) of these 32 eyes. Moderate or severe lens opacities that developed postoperatively were as follows: anterior subcapsular or cortical changes in 2 eyes (1%), nuclear sclerosis in 11 eyes (7%), posterior subcapsular changes in 25 eyes (17%). One hundred twenty-five preoperative, operative and postoperative factors were analyzed for each patient to detect correlations with postoperative lens changes. Nuclear sclerotic changes correlated with older patient age. Posterior subcapsular changes correlated with three intraoperative factors: longer duration of the operation, use of intravitreal gas, and use of a gas bubble filling more than 50% of the vitreous cavity. Posterior subcapsular changes were progressive with longer follow-up.
Adult↗
Specular microscopy of hard contact lens wearers.
Wide-field specular microscopy, slit-lamp examination, and pachometry were performed on 22 successful hard contact lens wearers and 22 controls matched for age, race, sex, and refractive error. A minimum of 600 cells per control and 1200 per contact lens wearer were manually digitized from the specular photomicrographs. Frequency distributions of cell areas were compared between the two groups using the parameters of mean, median, standard deviation, coefficient of variation, skewness and kurtosis. Slit-lamp examination was normal and there was no significant difference in corneal thickness between the patient group and the control group. Comparison of mean, median, and standard deviation also revealed no significant difference, but skewness (P less than .001), kurtosis (P less than .001) and coefficient of variation (P less than .004) were greater in the hard contact lens wear group. Hard contact lens wearing time correlated with increasing pleomorphism (P less than .05). Specular microscopy also revealed morphologic changes including deep stromal striae, intra- and extracellular "blackout" areas, and clustering of extremely small and large cells. The possible relationship between endothelial hypoxia and structural stromal changes are discussed.
Adult↗
Pars plana vitrectomy for complicated retinal detachments.
The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.
Adolescent↗