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Biomedical subjects

J W Simon

Publications and source records attributed to J W Simon.

83 records · Page 5Linked to original sources
PubMedDate not supplied

Severe visual loss resulting from occlusion therapy for amblyopia.

Two children developed profound visual loss in the eye being patched full time because of strabismic amblyopia in the fellow eye. The first had been patched for 13 days at age 18 months. Complete resolution was noted on the 40th day of reverse occlusion. The second had been patched for 1 month at age 9 months. After 3 months without treatment, reverse occlusion was instituted and was continued for 3 years. Mild amblyopia persists in both eyes of the second child. Although rare, occlusion amblyopia can occur in young children being patched full time. We usually avoid full-time occlusion and monitor patients at intervals at least as frequent as 1 week per year of age.

Amblyopia↗
PubMedDate not supplied

Preferential looking and recognition acuities in clinical amblyopia.

Although others have noted a correlation between grating and recognition acuities (RA) when both tests are performed on the same day, the value of preferential looking (PL) in predicting eventual visual outcome has not been studied. PL acuities of 64 preverbal patients considered at risk of amblyopia were measured. When these children became verbal, their visual acuities were determined using standard recognition acuity tests. Based on intervening amblyopia treatment between PL and RA measures, 40 patients were designated the minimal treatment group (MTG) and 24 the intensive treatment group (ITG). Chi-square analysis for the MTG showed agreement (P less than .005) between PL and RA in identifying better, equal, and worse eyes. Interocular ratios of PL and RA were significantly correlated for the MTG (P less than .001), but not for the ITG. Monocularly, a consistent correlation between PL and RA was not found. Our data suggest that PL is predictive of recognition acuity in patients whose visual acuity was expected to remain stable.

Amblyopia↗
PubMedDate not supplied

Recognized scleral perforation during eye muscle surgery: incidence and sequelae.

Inadvertent perforation of the sclera is a widely recognized complication of eye muscle surgery. In the 1960s and 1970s, it was estimated to occur in 9% to 12% of patients operated. Fortunately, dreaded vision-threatening sequelae have been much less common. To better define the occurrence and sequelae of this complication, we sent a questionnaire to all 342 members of the American Association for Pediatric Ophthalmology and Strabismus. Scleral perforations, defined to include known retinal damage, occurred in 728 of nearly 554,000 eye muscle procedures performed by 223 surgeons. Perforations were two times more common with residents or fellows operating. They occurred not only during muscle reattachment (633 cases), but also during muscle disinsertion (24 cases), muscle dissection (6 cases), passage of traction sutures beneath the lateral rectus (5 cases), and preplacement of muscle sutures (5 cases). Many other perforations may have been unrecognized and uncounted. Visual loss was uncommon, occurring in only nine patients. Fourteen retinal detachments included four cases with partial and two with total loss of vision. Only three cases of endophthalmitis occurred, one resulting in partial visual loss and two in total visual loss. Techniques suggested by respondent surgeons to avoid perforations are discussed.

Eye Injuries, Penetrating↗
PubMedDate not supplied

Bilateral lateral rectus recession for exotropia: a survival analysis.

Exotropia may progress during the childhood years, and the ideal time for surgical intervention remains uncertain. We reviewed our results following bilateral lateral rectus recession in 57 consecutive patients. In order to identify possible predictive covariates, we performed survival analysis using survival time as the time from surgery to failure. The patients' age at the time of surgery ranged from 11 months to 50 years (mean, 68 months). Follow up after surgery ranged from 1 to 105 months (mean, 47 months). Outcomes were considered failures if there was (1) a distance exodeviation greater than 10 prism diopters at any time after surgery, (2) a distance esodeviation greater than 10 delta more than 6 months postoperatively, or (3) further surgery for exotropia or esotropia. By these criteria, surgery was successful in 58% of cases. Results of the survival analysis indicated an estimated mean time to failure of 68 months. Patients with intermittent exotropia were more likely to remain aligned postoperatively than were those with constant deviations. The age at onset of exotropia, age at surgery, angle of deviation at different fixation distances, early postoperative alignment, and presence of symptoms, amblyopia, anisometropia, or incomitance before surgery were not predictive of success. We conclude that exotropia surgery may be performed with the same likelihood of success at any age, but patients with intermittent deviations do better.

Adolescent↗
PubMedDate not supplied

Exaggerated effect of bilateral medial rectus recession in developmentally delayed children.

Many have suggested that the esotropia associated with developmental delay should be considered separately. However, the esotropia surgery recommended for developmentally delayed children has been similar to that performed in normal children. We have noticed a tendency for developmentally delayed children to develop consecutive exotropia following bilateral medial rectus recessions. Of 94 children undergoing such surgery between 1981 and 1991, 31 were developmentally delayed. Follow up ranged from 7 months to 202 months (mean 24 months). Surgical effect, defined as the change in alignment following each amount of surgery, was greater in the developmentally delayed group than in control subjects (P = .002). The increase in effect of the same amount of surgery in a developmentally delayed patient averaged 5.28 prism diopters, but was much larger in specific instances. Variability of effect was more marked among developmentally delayed children. We conclude that bilateral medial rectus recessions in developmentally delayed children may be better postponed in some cases, deferred for smaller angles, or decreased in amount.

Adolescent↗
PubMedDate not supplied

Idiopathic tractional corectopia.

Four infants were referred for congenital unilateral corectopia. In each case, the abnormal position of the pupil was caused by a fibrous structure that tethered the iris pupillary margin to the peripheral cornea. No patients showed characteristics of intrauterine infection, Rieger anomaly, ectopia lentis et pupillae, or iris coloboma. Amblyopia was not present in any of the patients. Three children demonstrated progression of the corectopia in the first 6 months of life. Two who developed shallow anterior chambers were treated surgically, one with an Nd:YAG laser and the other with incisional surgery. The third was treated with medical mydriasis. All four children have had favorable visual outcomes to date. The origin of the tethering strands is unclear but may be related to incomplete regression of vessels from the embryologic vascular system. We recommend medical or surgical intervention for unilateral corectopia when the pupillary aperture is displaced peripheral to the central visual axis or when the position of the iris threatens angle structures. Prophylactic occlusion therapy may also be indicated.

Female↗
PubMedDate not supplied

Steroid injection versus conservative treatment of anisometropia amblyopia in juvenile adnexal hemangioma.

Because of serious side effects, the indications for intralesional steroid injection of adnexal hemangiomas are unclear. Of 23 children with such lesions who were examined over a period of 9 years, 9 had no evidence of amblyopia and needed no intervention. Five required steroids intralesionally and/or systemically because of threatened occlusion of the pupillary axis. The remaining 9 were considered at risk of anisometropic amblyopia because of induced astigmatism: 5 received injections and 4 were treated with glasses and/or patching alone. The visual, refractive, and cosmetic results of the injected and conservatively managed anisometropes were similar. We recommend that steroid injection be reserved for patients with threatened occlusion of the visual axis and for those with severe astigmatism or amblyopia refractory to conservative management.

Amblyopia↗
PubMedDate not supplied

Alignment success following medical rectus recessions in normal and delayed children.

Others have suggested that developmentally delayed children, who are frequently esotropic, have a poor prognosis following esotropia surgery. To date, no comparison of success rates in normal and delayed children following similar surgery has been made. We compared our long-term results following graded bilateral medial rectus recessions in consecutive normal (n = 62) and delayed (n = 29) children. We defined success as alignment maintained within 10 delta of orthophoria. Survival curves were compared using the Mantel-Haenszel statistic. Delayed children had a significantly poorer outcome (p = .05) throughout follow up, which ranged from 12 to 120 months (mean = 24 months). Early in the period of study, we observed a large proportion of overcorrections among the delayed children. Subsequent modification in the amount of surgery performed appeared to improve the initial and long-term success in these children. We conclude that delayed children do have a poorer prognosis than normal children following medial rectus recession. This prognosis may be improved by more conservative amounts of surgery.

Adolescent↗
PubMedDate not supplied

Subjective and objective outcomes of strabismus surgery in children.

BACKGROUND: The negative psychosocial impact of strabismus in adults has been well documented. Despite the increasingly recognized importance of outcomes research, parents' satisfaction with strabismus treatment in childhood and their assessment of its functional impact and "quality of life" impact have not been investigated. METHODS: A survey instrument was designed to assess parents' perceptions of preoperative, surgical, and postoperative phases of the clinical experience, including the long-term impact of surgery on their children. RESULTS: Overall satisfaction with the surgical result was rated "good" or "very good" in 85% of 77 children under age 6. The correlation between subjective satisfaction and objective alignment within 10 prism diopters (delta) of orthophoria was significant (P < .001). Parents of children under age 4 noted improved eye contact (61%) and appearance (94%). Parents of older children noted improved interactions with others (47%) and self-esteem (55%). Coordination was considered improved in 56% of the entire group. Subjective satisfaction and psychosocial benefits often occurred even in cases deemed objectively unsuccessful. CONCLUSION: Surgical correction of strabismus in childhood is clearly perceived by parents to be both successful and important to them and their children.

Child↗