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Biomedical subjects

G T Lueder

Publications and source records attributed to G T Lueder.

At least 19 recordsLinked to original sources
PubMed2004

Pediatric transscleral sutured intraocular lenses: efficacy and safety in 43 eyes followed an average of 3 years.

PURPOSE: To report longer term results of transscleral sutured intraocular lens (TSSIOL) implantation in a sizable cohort of aphakic children, who were not suitable for contact lens wear and lacked adequate capsular support for sulcus fixation of an intraocular lens. METHODS: Clinical outcome data were collated by retrospective review after surgery on 43 consecutive eyes in 32 aphakic children (mean age at implantation = 10 years; 33% < or = age 7 years). Outcome measures included visual acuity, postoperative refractive error, postoperative complications, and rate of reoperation. Follow-up averaged 37 months. RESULTS: Visual acuity improved after surgery in 70% (30) of operated eyes (in 69% or 22/32 children). Fifty-one percent (22/43 eyes) improved by two lines or more. No patient suffered a loss of acuity or exacerbation of preexisting amblyopia. Postoperative refraction was within +/-2.0 D of the predicted refraction in 93% (40/43) of eyes. Complications, with the exception of one eye (2%), were minor/transient and resolved in the first week after surgery. Complications included small hyphemas (7%, 3/43 eyes), vitreous hemorrhage (5%, 2/43 eyes), and ocular hypertension or hypotony (5%). Two eyes (5%) exhibited episodes of iris capture of the IOL optic, one of which (2%, 1/43) eventually necessitated reoperation for IOL exchange. No retinal detachments or other retinal complications were encountered. CONCLUSION: TSSIOL implantation appears to be a safe and effective method for correcting aphakia in pediatric eyes that lack adequate capsular support. Safety over a follow-up period longer than the average 3 years reported here remains to be determined. The surgery is more difficult to perform than capsular-bag or sulcus implantation and potentially carries greater risks.

Adolescent↗
PubMed2001

Pediatric secondary lens implantation in the absence of capsular support.

PURPOSE: To describe and evaluate alternate techniques for implanting intraocular lenses in children in the absence of adequate capsular support for traditional lens implantation. METHODS: Postoperative results of 18 eyes with posterior chamber intraocular lenses (PCIOLs) sutured to the ciliary sulcus and 10 eyes implanted with anterior chamber intraocular lenses (ACIOLs) were reviewed. Visual outcomes were divided into 2 groups: onset of aphakia during the critical period of visual development (< or = 9 years) and onset after the critical period (> 9 years). Visual outcomes and complications were recorded. RESULTS: Average follow-up was 10.3 months in the PCIOL group and 49.2 months in the ACIOL group. Eyes that became aphakic after the critical period of visual development achieved better overall final visual acuity than the eyes that became aphakic during the critical period; indeed, the eyes that became aphakic during the critical period did not achieve significantly improved vision. There were no complications in the PCIOL group. Complications in the ACIOL group included corectopia, haptic migration through the operative wound requiring removal, and pigment deposits on the lens. CONCLUSIONS: PCIOLs sutured to the ciliary sulcus offer a superior option to ACIOLs for correction of childhood aphakia in children lacking capsular support. ACIOLs had a high rate of serious complications (10%) in this small series. Secondary implantation with transsclerally sutured PCIOLs should be considered in complicated cases when more conservative options have been exhausted.

Adolescent↗
PubMed2000

Pseudopapilledema in neurofibromatosis type 2.

PURPOSE: To report a case of neurofibromatosis type 2 with pseudopapilledema secondary to a prepapillary gliotic membrane. METHOD: Case report. Results of an ocular examination and fluorescein angiography of a patient are described. RESULTS: Fundus examination of a 14-year-old male with neurofibromatosis type 2 revealed an irregular elevation of the optic nerve and a perifoveal epiretinal membrane in the right eye. Fluorescein angiography demonstrated no autofluorescence nor leakage in the area of the optic nerve. CONCLUSION: The patient has pseudopapilledema secondary to an epiretinal membrane overlying the optic disk of the right eye. The possibility of pseudopapilledema should be considered when evaluating patients with neurofibromatosis type 2 and abnormal optic nerves.

Adolescent↗
PubMed2000

Air bag-associated ocular trauma in children.

OBJECTIVE: To describe a series of children with ocular injuries related to air bag deployment. DESIGN: Retrospective, observational case series. PARTICIPANTS: Seven patients with ocular injuries sustained in motor vehicle accidents in which air bags were deployed. METHODS: Review of medical records. RESULTS: All patients had periocular contusions. Minor injuries included corneal abrasions (n = 5), superficial eyelid laceration (n = 1), and traumatic iritis (n = 2). Serious injuries included corneal edema (n = 1) and a traumatic hyphema with secondary glaucoma and cataract (n = 1). The latter patient required surgery. All other injuries resolved with medical therapy. All patients recovered normal visual acuity. CONCLUSIONS: Serious ocular injuries in children may result from air bag deployment. Most such injuries are minor and resolve without sequela. It is recommended that infants and children travel in the rear seat of automobiles to minimize their risk of injury.

Accidents, Traffic↗
PubMed2000

Treatment of nasolacrimal duct obstruction in children with trisomy 21.

BACKGROUND: Nasolacrimal duct (NLD) obstruction and tear film abnormalities occur frequently in children with trisomy 21. This study describes the outcomes of treatment for NLD obstruction in this population. METHODS: The records of 15 children with trisomy 21 treated for NLD obstruction were reviewed. Eight patients were initially treated with NLD probing with or without placement of nonfixated lacrimal stents. Because of poor success with this procedure, the initial treatment of children with trisomy 21 and NLD obstruction was changed to balloon catheter dilation in 1997. Outcomes were considered excellent if the patient had complete resolution of epiphora and dacryocystitis, good if the patient had only mild residual symptoms, fair if the patient had significant residual symptoms, and poor if there was no improvement. RESULTS: Of 8 patients treated initially with NLD probing, 5 had fair or poor outcomes. These patients all had good outcomes after placement of nasally fixated lacrimal stents, balloon catheter dilation, or both. Of 7 patients treated initially with balloon catheter dilation, 5 had excellent or good outcomes and 2 had fair or poor outcomes. CONCLUSION: Simple NLD probing is often unsuccessful in treating NLD obstruction in children with trisomy 21. Balloon catheter dilation appears to be a reasonable alternative first treatment in these patients.

Catheterization↗
PubMed2000

Anomalous retinal correspondence: neuroanatomic mechanism in strabismic monkeys and clinical findings in strabismic children.

BACKGROUND: Anomalous retinal correspondence (ARC) is a neural adaptation to eye misalignment in which non-corresponding retinal points are linked in the visual cortex to provide binocular fusion. ARC within the striate cortex would require that horizontal neurons link right-eye and left-eye ocular dominance columns (ODCs) separated by a distance in the cortex proportional to the angle of strabismus. Two hypothetical mechanisms are possible: (1) The ODCs can be linked by axons of horizontal neurons that project monosynaptically from a right-eye to a left-eye ODC. The further apart the ODCs, the longer the axons; hence, axon length should be greater in subjects with strabismus than in healthy subjects (elongated axon, monosynaptic hypothesis). In this case, the clinical probability of developing ARC should be independent of the angle of strabismus, until an upper-limit angle of strabismus is reached equally to the maximal length of axons available to link nonadjacent ODCs, at which point an abrupt decline of ARC probability should be evident. (2) Alternatively, ODCs can be linked by a chain of horizontal neurons, the number of which increases as the distance among ODCs increases; axon length in subjects with strabismus would be expected to be the same as in healthy subjects (normal axon, polysynaptic hypothesis). In this case, the greater the angle of strabismus, the more horizontal neurons and synapses required for linkage, and the greater the probability of signal degradation. Thus, the clinical probability of developing ARC through a polysynaptic mechanism should be inversely proportional to the angle of strabismus. The purpose of this study was to test these 2 hypotheses neuroanatomically in primates and clinically in children. METHODS: For the neuroanatomic portion of the study, biotinylated dextran amine was injected into ODCs of area V1 to label individual neurons. The length of the horizontal axons from these neurons was then compared in strabismic and normal monkeys. In the clinical portion of the study, the medical records of 192 children with strabismus were reviewed retrospectively. The angle of strabismus (prism cover test) and the presence of ARC (Bagolini striated lenses, Worth/Polaroid 4-dot) were recorded. Plots of the presence of ARC as a function of the angle of strabismus were obtained. RESULTS: There was no significant difference in axon length between healthy (7. 02 +/- 0. 83 mm) and strabismic monkeys (6. 60 +/- 1. 07 mm) (P =.16). In children with strabismus, ARC decreased as the angle of strabismus increased (P <. 05). ARC was more prevalent in children who had primary or postsurgical deviations of </=4 degrees to 5 degrees (8-10 PD), corresponding to </=2 horizontal axon lengths in the foveal striate visual cortex. CONCLUSIONS: The visual cortex adapts to strabismus by combining information from paired ODCs of opposite ocularity that, because of the eye misalignment, are nonadjacent and separated by abnormally long distances across the striate cortex. The cortex appears to achieve the linkage, not by elongating neuronal axons, but by using chains of neurons that have normal-length axons. The visual cortex is most successful stochastically at achieving this linkage (ie, developing ARC) when the gap that must be bridged is no greater than 4 degrees to 5 degrees (8-10 PD), or the retinotopic distance in the foveal visual field is spanned by 2 normal V1 neurons.

Adaptation, Ocular↗
PubMed1999

Congenital smooth muscle hamartoma of the conjunctival fornix.

PURPOSE: Congenital smooth muscle hamartomas are benign tumors composed of proliferating smooth muscle cells. They are usually seen as abnormal patches of skin. Ocular involvement of congenital smooth muscle hamartomas is unusual, with rare reports of patients with external eyelid involvement or proptosis resulting from orbital tumors. We describe a patient with a congenital smooth muscle hamartoma that involved the tarsal conjunctival fornix. METHODS: Review of the patient's medical records, including the results of ophthalmologic, radiologic, and histologic examinations. RESULTS: A healthy 2-year-old boy was initially seen with a conjunctival mass. He had a discrete, gray, cystic-appearing lesion in the inferior fornix of the left eye. A magnetic resonance imaging study revealed no signs of extension of the lesion into the orbit. The lesion was surgically excised. Histologic sections showed large bundles of smooth muscle with a fibrotic background and interdigitating fat, consistent with a diagnosis of a congenital smooth muscle hamartoma. CONCLUSION: To our knowledge, this is the first report of a patient with a congenital smooth muscle hamartoma arising from the conjunctival fornix. It presumably originated from either the smooth muscle of the vascular endothelium or from the capsulopapebral muscle. Congenital smooth muscle hamartoma should be considered in the differential diagnosis of cystic-appearing conjunctival fornix lesions.

Child, Preschool↗
PubMed1998

Vertical strabismus resulting from an anomalous extraocular muscle.

Unusual ocular motility abnormalities have been rarely reported to result from anomalous extraocular structures. These structures, which may be either muscular or fibrotic, attach to the globe and produce a mechanical restriction resulting in incomitant strabismus. To our knowledge, we report the first patient with an anomalous extraocular muscle in whom the clinical, radiologic, surgical, and histopathologic findings are described.

Child, Preschool↗
PubMed1997

Comparison of visual acuity measured with Allen figures and Snellen letters using the B-VAT II monitor.

OBJECTIVE: Allen figure optotypes commonly are used to measure visual acuity in young children. Children with normal acuity measured with Allen figures sometimes are found to have unsuspected amblyopia that is detected when they are tested with Snellen letters. The correlation between visual acuities measured with these two optotype charts has not been well studied. The authors compared visual acuities measured with Allen figure and Snellen letter optotypes using the Mentor B-VAT II monitor. DESIGN: The study design was a nonrandomized, comparative clinical trial. PARTICIPANTS: The study was composed of 12 adult subjects. INTERVENTION: Visual acuities were measured using both Allen figure and Snellen letter optotypes using the B-VAT II monitor. The images were progressively blurred using plus lenses. MAIN OUTCOME MEASURES: Visual acuity was measured. RESULTS: At visual acuity levels of 20/60 or better, Allen figure testing averaged 1.5 lines better than Snellen letter testing; between 20/70 and 20/200 visual acuities, the difference was 2.5 lines. CONCLUSIONS: Allen figure testing with the B-VAT II monitor overestimates visual acuity compared with testing with Snellen letters. This appears to result primarily from the construction of the optotypes. This discrepancy should be considered when visual acuity is measured in young children.

Adult↗
PubMed1996

Visual function after laser hyperthermia and chemotherapy for macular retinoblastoma.

PURPOSE: To determine whether treatment of macular retinoblastoma with chemotherapy and laser hyperthermia can lead to satisfactory visual acuity. METHODS: A child with unilateral macular retinoblastoma was treated with chemotherapy and laser hyperthermia. Visual function was assessed one year after treatment. RESULTS: At age 25 months, the patient had normal visual behavior and a normal spatial-sweep visual-evoked potential. CONCLUSION: Treatment of macular retinoblastoma with chemotherapy and laser hyperthermia may enable recovery of satisfactory visual acuity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Does "Touching Four" on the Worth 4-dot test indicate fusion in young children? A computer simulation.

PURPOSE: "Touching four" dots on the Worth 4-dot test is used sometimes as an indication of fusion in young children. The authors examined the reliability of this test. METHODS: A computer simulation of the Worth 4-dot test generated images representing fusion, suppression, and alternate fixation. Sixteen children, ranging in age from 32 to 48 months, were examined using this test. RESULTS: None of the children could accurately describe the images verbally. Alternate fixation could not be distinguished from fusion by asking the subjects to touch the dots. Monocular suppression was identified accurately in all subjects. CONCLUSION: Touching four dots on the Worth 4-dot test does not distinguish fusion from alternate fixation in children with normal ocular alignment. This has important implications regarding the diagnosis of monofixation syndrome and assessment of the response to a prism adaptation trial in young children.

Adaptation, Ocular↗
PubMed1996

Bilateral macular lesions in incontinentia pigmenti. Bloch-Sulzberger syndrome.

BACKGROUND: Incontinentia pigmenti (IP) is an inherited disorder with many systemic and ocular manifestations. Abnormalities of the retinal pigment epithelium, including peripheral hypopigmented areas, have been reported occasionally in patients with IP. These have not been symmetric, and they have not involved the fovea. The visual function in affected areas has not been described. METHODS: The ophthalmic examination and results of fluorescein angiography are described in a patient with IP and bilateral discrete hypopigmented macular lesions. RESULTS: The patient had normal vision. Fluorescein angiography of the macular lesions revealed transmission of fluorescence in the early phase and staining in the late phase. CONCLUSION: The authors believe that this is the first report of bilateral macular hypopigmented lesions in a patient with IP, and it is the first to document normal vision in an affected area.

Adult↗