Does endophthalmitis following strabismus surgery require scleral perforation?
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Endophthalmitis↗
Biomedical subjects
J N Bloom
Publications and source records attributed to J N Bloom.
The IOLAB, Inc pediatric intraocular lens study. AAPOS Reasearch Committee. American Association for Pediatric Ophthalmology and Strabismus.
PURPOSE: This report is a summary of the data of the IOLAB, Inc pediatric intraocular lens (IOL) implantation investigation. The goal of this study was to evaluate the safety and efficacy of IOL implantation for the treatment of pediatric aphakia, pending approval by the Food and Drug Administration. METHODS: From May 1981 to July 1994, a total of 1260 pediatric eyes received 171 styles of IOLs implanted by 361 US investigators. Preoperative, operative, and postoperative status reports over the first year were required for each eye entered into the study. Annual visit reports were requested thereafter to determine the long-term effects. The study was terminated in November 1995. All IOLs were obtained from IOLAB, Inc (now Chiron Vision Corp). RESULTS: Reporting compliance was 98.3% for the preoperative and operative reports, 45.1% at 1 year, and 13.8% at 3 years. The subjects' ages ranged from younger than 1 yearto 17 years. Nine subjects (0.7%) were younger than 1 year, with the largest group of 533 subjects (42.3%) aged between 6 and 12 years atthe time of surgery. Cataract types were congenital (45.6%), traumatic (37.1%), secondary (11%), senile (0.95%), and unrecorded (5.4%). The IOL was implanted primarily in 74.8% of cases and secondarily in 21.4% of cases. There was no record in 3.8% of the cases. IOL types included anterior chamber (4.1%), iridocapsular (0.71%), posterior chamber (93.6%), and unrecorded (1.59%). There were 130 adverse reactions that required secondary surgical intervention. The most frequently performed surgical procedures included lens removal without replacement, vitrectomy, lens repositioning, and lens replacement. More than half (52%) of all eyes had a visual acuity of 20/200 or worse before surgery; amblyopia was reported in 21.1% of all participants at baseline. Postoperative visual acuity data were available on 563 eyes at 1 year after surgery. Overall, 52.8% of all eyes attained a visual acuity of 20/40 or better by the 1-year visit, and only 15.5% had visual acuity worse than 20/200. In general, the older patient, traumatic cataract, and secondary cataract categories were overrepresented in the better visual acuity outcome group. CONCLUSION: The IOLAB, Inc pediatric IOL study is the first multiple-practitioner, national study designed to evaluate the safety and efficacy of IOL implantation in children. The study results are compromised by the almost 50% loss of follow-up at the 1-year evaluation. Other variables that most likely influenced outcome results were the methods of cataract extraction, medical management, and IOL design, all of which evolved dramatically over the time course of the study. Despite these issues, pediatric IOL implantation seems to be a reasonable treatment modality for aphakia, on the basis of the available 1-year follow-up data of the remaining 45.1% of eyes in the study.
Adolescent↗
A magnetic resonance imaging study of double elevator palsy.
OBJECTIVE: The pathophysiology of double elevator palsy is poorly understood. We assessed two patients with this condition using magnetic resonance imaging (MRI) to evaluate the appearance of the extraocular muscles. DESIGN: Cross-sectional study. SETTING: Radiology department of a university-affiliated hospital in London, Ont. PATIENTS: Two patients from a private ophthalmology practice who had undergone complete transpositions of the horizontal rectus muscles to treat hypotropia associated with double elevator palsy. INTERVENTION: MRI. A volume scanning technique was used to obtain maximum information about the muscles. OUTCOME MEASURE: Appearance of the extraocular muscles. RESULTS: In both patients MRI showed decreased volume of the superior rectus muscle on the affected side. The other rectus muscles were normal. This suggested either congenital hypoplasia or paresis of the involved superior rectus muscle. In addition, the full tendon transpositions of the medial and lateral recti did not appreciably change the middle and deep orbital pathways of the transposed horizontal rectus muscles. CONCLUSIONS: MRI may be a useful adjunct to saccadic velocity assessments in differentiating between primary inferior rectus restriction, primary superior rectus paresis and congenital supranuclear elevator deficiency.
Adolescent↗
Convergence nystagmus associated with spasmus nutans.
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Follow-Up Studies↗
A masked, randomized, dose-response study between cyclosporine A and G in the treatment of sight-threatening uveitis of noninfectious origin.
Thirty-two patients with sight-threatening uveitis and a decrease in visual acuity requiring systemic therapy were randomly assigned to either cyclosporine A or G in a dose-escalation study. Groups received from 2.5 mg/kg of body weight/day to 10 mg/kg of body weight/day of either drug along with low-dose prednisone. More patients taking cyclosporine G had improved visual acuity and a decrease in macular edema, which occurred more rapidly than in the other group, even at the lower doses tested. No difference in renal function was noted between groups at any doses tested. Four patients receiving cyclosporine G had hepatic alterations, but only one required cessation of the drug. The study indicates the potential usefulness of cyclosporine G, particularly at lower doses (4 mg/kg of body weight/day), which could lower the potential for serious renal complications.
Adult↗
A syndrome of acute interstitial nephritis and anterior uveitis.
A syndrome of acute interstitial nephritis (AIN) and anterior uveitis is described in two children and the literature is reviewed. These disorders appear to improve, in uncontrolled studies, with systemic and topical ophthalmic corticosteroid treatment. Although the renal and ocular prognoses appear good, it is important to recognize that patients with AIN are at risk for uveitis and if present, consultation with an ophthalmologist is recommended.
Acute Disease↗
A laboratory evaluation of the Kowa laser flare-cell meter for the study of uveitis.
The Kowa FC-1000 laser flare-cell meter (LFCM) has been described as an instrument which will objectively quantify inflammation of the anterior chamber of the eye. We evaluated the LFCM using the intravenous endotoxin-induced uveitis (EIU) rabbit model of ocular inflammation. In vitro flare and cell calibration measurements utilizing bovine serum albumin (BSA) and latex particles, respectively, were also performed. A linear relationship between the flare measurements and BSA concentrations was noted. In addition, the time course of the LFCM flare count in EIU was comparable to previously published fluorophotometric data. However, the LFCM reported cells in the anterior chamber of the EIU rabbits despite negative cytology and histology results. The LFCM also recorded cells in BSA solutions which contained neither cells nor latex particles. Our results suggest that although the LFCM may be useful for evaluating flare, its cell measurements are not accurate in cases of severe uveitis.
Animals↗
A magnetic resonance imaging study of the upshoot-downshoot phenomenon of Duane's retraction syndrome.
Patients with Duane's retraction syndrome may have an associated upshoot or downshoot of the involved eye in adduction. This vertical movement has been attributed to the lateral rectus muscle slipping over or under the globe and acting as an elevator or depressor, respectively ("bridle-effect"). We used magnetic resonance imaging to investigate this phenomenon in two patients, one with an overshoot and the other with an undershoot. Minimal vertical displacement of the lateral rectus muscle in relation to the orbit was noted both on upshoot and downshoot. The bridle-effect theory must be modified to account for this finding.
Adult↗
Serum neopterin levels following intravenous endotoxin administration to normal humans.
Endotoxin was administered intravenously to five normal subjects. Measurement of serum neopterin levels demonstrated no significant change from baseline during the first 6 h after endotoxin administration, but were elevated two to four-fold at 24 h. In the three subjects in whom it was measured, a two-fold rise of the mean serum neopterin levels persisted at 48 h. The acute inflammatory events initiated by endotoxin administration to normal humans result in a delayed, but sustained, rise in serum neopterin levels which persists well after the acute phase response has subsided.
Acute-Phase Reaction↗
Intravenous fluorescein interference with clinical laboratory tests.
The results of laboratory tests performed after fluorescein angiography may be erroneous because of interference by intravenous fluorescein. We investigated this potential interference in four adults at intervals of five minutes, three hours, six hours, and 12 hours after fluorescein injection. We used a panel of serum and urine chemistry tests on seven commonly used instruments. A significant change in the reported concentration of a serum or urine analyte was defined as a result beyond +/- 3 coefficients of variation of the preinjection baseline value for the test on a specific instrument. The determinations of creatinine, total protein, cortisol, digoxin, quinidine, and thyroxine in serum were affected by intravenous fluorescein. The urine tests were unaltered. The physician must be aware of the problem of interpreting clinical chemistry results after fluorescein angiography.
Adult↗
The diagnosis of cytomegalovirus retinitis.
Immunosuppressed patients are at risk for developing cytomegalovirus retinitis. This disorder is the most common cause of vision loss in patients with the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus retinitis is probably the result of hematogenous spread of the virus to the retina after systemic reactivation of a latent cytomegalovirus infection. Although the ophthalmic infection may initially be asymptomatic, the retinal necrosis it produces may result in both loss of visual field and decreased visual acuity. Routine screening of these patients is required for early diagnosis. The retinitis is detected with ophthalmoscopy as either a perivascular yellow-white retinal lesion frequently associated with retinal hemorrhage or as a focal white granular infiltrate, often without hemorrhage. Both lesions enlarge in a progressively expanding "brushfire" pattern. The diagnosis of cytomegalovirus retinitis, as well as the evaluation of its response to therapy, is determined primarily by clinical criteria. Serial retinal photography is an objective method to assess the changing appearance of these lesions. Ganciclovir and foscarnet are investigational antiviral drugs that appear to be effective in treating cytomegalovirus retinitis. However, maintenance therapy with these medications is required after initial treatment because the disease often relapses. The combined expertise of the internist and the ophthalmologist is needed to diagnose and treat these patients.
Acquired Immunodeficiency Syndrome↗
Uveitis complicating autoimmune chronic active hepatitis.
A patient with autoimmune hepatitis B surface antigen-negative chronic active hepatitis (CAH) developed uveitis during the course of her disease. The occurrence of this eye disorder provides additional support for an autoimmune pathogenesis for CAH. Clinicians should be alert to the association of uveitis with CAH, so that patients at risk may be examined for this potentially serious ocular disease.
Autoimmune Diseases↗
Herpes simplex retinitis and encephalitis in an adult.
A 17-year-old girl developed a viral encephalitis that was followed by massive exudative retinal detachments in both eyes. A diagnosis of herpes simplex encephalitis and retinitis was made as a result of finding rising herpes simplex viral titers. An examination of the patient's cell-mediated immune system showed it to be grossly intact.
Adolescent↗
Fluorophotometry and the rate of aqueous flow in man. I. Instrumentation and normal values.
A new objective fluorophotometer, based on a previous model but with changes in electronic circuitry, was designed and built. The fluorometric method was applied to 38 normal eyes to obtain the aqueous outflow rate and fluorescein decay constant. Aqueous outflow rate has a direct correlation with the anterior chamber depth and an inverse correlation with age. The aqueous flow rate is higher in whites than in blacks, but in our sample, mean pressure was lower in whites. Acetazolamide decreases the aqueous flow rate and the fluorescein constant; the mean decrease in 10 eyes of 5 patients was approximately 38% and 22%, respectively. Fluorophotometry gives a higher value for the aqueous outflow rate than that calculated by tonography.
Acetazolamide↗
Fluorophotometry and the rate of aqueous flow in man. II. Primary open angle glaucoma.
By fluorophotometry, the aqueous outflow rates of 38 eyes of 22 patients with definite or suspected primary open angle glaucoma, who were not receiving therapy, were determined. Although the values obtained do not differ from normal, the factors that modify or control the flow rate are different in normal and glaucomatous eyes. The flow rate decreases as the pressure increases in the glaucomatous group but not in the normal group. The flow rate increases with anterior chamber depth and decreases with age in the normal group but not in the glaucomatous group. The fluorescein decay constant is a measure of the movement of fluorescein from the cornea to the aqueous. This constant increases as the pressure increases in the glaucomatous group but not in the normal group.
Black or African American↗