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A corneal topographic analysis of astigmatism after excimer laser photorefractive keratectomy.

OBJECTIVE: To identify the astigmatism changes after excimer laser photorefractive keratectomy (PRK) and the visual influence of astigmatism. METHODS: 109 myopic eyes followed up for more than 1 year were analyzed by videokeratography, and their visual acuities were examined. Before the operation, the astigmatic errors with cycloplegic refractive examination were -1.00 approximately -2.00 D. RESULTS: The position of astigmatism axis was basically consistent with that in corneal topography, but in astigmatism diopter there were some differences between the cycloplegic examination and topographic analysis. A stigmatism was found in 62% of the eyes, asymmetrical in 33% and against-the-rule in 5% by using topographic analysis. There was little change observed in the position of astigmatism axis after PRK observed. Some changes of postoperative astigmatism diopter were seen in different periods. It increased in the postoperative 10 days or 1 month, and afterwards gradually decreased and became stable in 6 months to 1 year. The postoperative residual astigmatism was low in degree, and did not affect the visual acuity. The actually corrected diopter was within the anticipated corrected diopter range of +/- 1.00 D. accounting for 97.4%. CONCLUSION: By using spherical equivalent method of calculation in PRK, the refractive correction of the operation cases with myopia and low degree of astigmatism (< -2.00 D) was satisfactory.

Astigmatism↗

Clinical profile of amblyopia in Pakistani children age 3 to 14 years.

OBJECTIVE: To study the clinical profile of amblyopia in children age 3 to 14 years. DESIGN: A cohort study. PLACE AND DURATION OF STUDY: The study was conducted over a period of two years from June 2001 to June 2003 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan. PATIENTS AND METHODS: This study included 316 children. Visual acuity was tested with Snellen type and Lea symbols chart according to the level of cooperation of the children. Cycloplegic refraction and orthoptic assessment was performed on all children. RESULTS: One hundred and eighty-two children were between 3 to 8 years age and 134 were between 8 to 14 years. Mean age was 8 years. One hundred and twenty children had strabismic amblyopia, 136 children had anisometropic amblyopia, while 60 children had combined mechanism amblyopia (strabismus and anisometropia both). CONCLUSION: The results indicate the importance of screening school-going children for refractive error and amblyopia and the importance of a future prospective study on the magnitude, cause and treatment of amblyopia at more treatable age.

Adolescent↗

The spectrum of ocular inflammation caused by euphorbia plant sap.

OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from Euphorbia species. DESIGN: Clinical case series. SETTING: Ophthalmology emergency referrals in the United Kingdom. PATIENTS: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of Euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. Patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of Euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with Euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by Euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.

Adult↗

Ocular manifestations in children born after in vitro fertilization.

OBJECTIVE: To report the ocular abnormalities found in children born after in vitro fertilization. METHODS: Forty-seven children (25 girls and 22 boys) born after an in vitro fertilization pregnancy (mean +/- SD birth weight, 2335 +/- 817 g; range, 924-4300 g) and referred for ophthalmic evaluation were included in the study. All underwent a thorough ocular examination. Obstetric history was gathered following a detailed questionnaire with the mothers. RESULTS: Of 70 eyes among nonverbal children, visual acuity was "normal for age" in 60 (86%), "fair" in 4 (6%), and "poor" in 6 (9%). Visual acuity in 24 eyes in verbal children ranged from 6/6 to no light perception, with 4 (17%) having poor vision. Cycloplegic refraction disclosed an emmetropia in 22 (27%), hypermetropia in 47 (57%), and myopia in 13 (16%) of the eyes. Anisometropia of more than 1.0 diopters was found in 8 children. Major ocular malformations were observed in 12 (26%) of the 47 children. These malformations included Coats disease, congenital cataract, congenital glaucoma, hypoplastic optic nerve head, idiopathic optic atrophy, coloboma with microphthalmos, and retinoblastoma. CONCLUSIONS: Ocular anomalies were frequently observed in this cohort of offspring born after in vitro fertilization. A diligent and prospective prenatal search for such malformations should unveil the real prevalence of ocular malformations in children born after in vitro fertilization.

Birth Weight↗

Multicenter trial of cryotherapy for retinopathy of prematurity: natural history ROP: ocular outcome at 5(1/2) years in premature infants with birth weights less than 1251 g.

OBJECTIVE: To present ophthalmological outcome data at 5(1/2) years after full term from a natural history cohort of infants who had a birth weight less than 1251 g and were enrolled at 5 centers of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (ROP), including eyes without ROP and with a full range of ROP severity. DESIGN: Of the 1199 surviving children in the cohort, 1068 (89.1%) were examined. Study-certified ophthalmologists assessed ROP residua and conducted cycloplegic refractions. Visual acuity was measured by study-trained testers using the Early Treatment for Diabetic Retinopathy Study charts. Eyes that had developed ROP were categorized by the lowest (most posterior) zone and highest (most severe) stage reached during the acute phase of the disease. No eyes that received cryotherapy are included; data analysis included one untreated eye per patient. Fundus outcomes were classified as "unfavorable" if there was macular compromise by retinal folding (more severe than ectopia) or stage 4B or 5 retinal detachment. Visual acuity outcomes of 20/200 or worse were classified as unfavorable. RESULTS: Unfavorable fundus structural outcome occurred in 33 (3.1%) of the 1068 eyes; all 33 eyes had a history of severe ROP. Specifically, unfavorable fundus structure occurred in 62.5% (10/16) of eyes with zone I ROP and in 44.2% (23/52) of eyes with zone II ROP, stage 3+ disease involving more than six 30 degrees -sectors. There were no unfavorable fundus outcomes among eyes that had fewer than 7 clock-hours of stage 3+ ROP in zone II in this cohort. Snellen visual acuity was tested in 1059 eyes, and 5.1% were unfavorable at 20/200 or worse; these unfavorable outcomes were correlated with more severe ROP. In eyes that had zone I ROP, 68.8% (11/16) had unfavorable acuity, and for eyes that had zone II ROP, 7.5% (36/481) had unfavorable acuity results. For eyes with ROP observed only in zone III, 1.8% (2/110) had unfavorable acuity of 20/200 or worse. CONCLUSIONS: Premature infants with birth weights less than 1251 g seldom have poor structural and functional outcomes (3.1% and 5.1%, respectively). All unfavorable fundus structural outcomes and nearly all unfavorable acuity outcomes occurred in eyes with zone I ROP or zone II ROP involving more than 6 sectors of stage 3+ disease.

Child, Preschool↗

Near-work activity, night-lights, and myopia in the Singapore-China study.

OBJECTIVE: To investigate the relationship among near-work activity, night-lights, and myopia in schoolchildren in Singapore and Xiamen, China. METHODS: The refractive error and ocular dimensions of 957 Chinese schoolchildren aged 7 to 9 years in Singapore and Xiamen, China, were determined using cycloplegic autorefraction and A-scan ultrasound biometry. Information on near-work activity (number of books read per week, reading in hours per day) and night-light use before age 2 years was obtained. RESULTS: The prevalence rate of myopia was 36.7% (95% confidence interval [CI], 33.0%-40.3%) in Singapore and 18.5% (95% CI, 14.0%-23.1%) in Xiamen, China. The crude odds ratio (OR) of higher myopia (at least -3.0 diopters) for children who read more than 2 books per week was 3.50 (95% CI, 2.15-5.70). In a multivariate logistic regression model, the OR of higher myopia for children who read more was 2.81 (95% CI, 1.69-4.69), adjusted for age, night-light use, parental myopia, and country, whereas there was no association between night-light use before age 2 years and higher myopia (OR, 1.54; 95% CI, 0.92-2.58), after controlling for age, books read per week, parental myopia, and country. MAIN OUTCOME MEASURES: The ORs of higher myopia for children who read more and children who are exposed to night-lights before age 2 years. CONCLUSIONS: Reading (number of books per week) may be associated with higher myopia in Chinese schoolchildren. However, night-light use does not seem to be related to higher myopia.

Child↗

Refractive error and ethnicity in children.

OBJECTIVE: To report the baseline prevalence of refractive error in the study population. DESIGN: A multicenter, longitudinal, observational study of refractive error and ocular development in children from 4 ethnic groups. PATIENTS AND METHODS: The study population included 2523 children (534 African American, 491 Asian, 463 Hispanic, and 1035 white) in grades 1 to 8 (age, 5-17 years). Myopia was defined as -0.75 diopters (D) or more and hyperopia as +1.25 D or more in each principal meridian, and astigmatism was defined as at least a 1.00-D difference between the 2 principal meridians (cycloplegic autorefraction). RESULTS: Overall, 9.2% of the children were myopic, 12.8% were hyperopic, and 28.4% were astigmatic. There were significant differences in the refractive error prevalences as a function of ethnicity (chi2, P<.001), even after controlling for age and sex (polychotomous logistic regression, P<.001). For myopia, Asians had the highest prevalence (18.5%), followed by Hispanics (13.2%). Whites had the lowest prevalence of myopia (4.4%), which was not significantly different from African Americans (6.6%). For hyperopia, whites had the highest prevalence (19.3%), followed by Hispanics (12.7%). Asians had the lowest prevalence of hyperopia (6.3%) and were not significantly different from African Americans (6.4%). For astigmatism, Asians and Hispanics had the highest prevalences (33.6% and 36.9%, respectively) and did not differ from each other (P =.17). African Americans had the lowest prevalence of astigmatism (20.0%), followed by whites (26.4%). CONCLUSION: There were significant differences in the prevalence of refractive errors among ethnic groups, even after controlling for age and sex (P<.001).

Adolescent↗

A direct method to measure the power of the central cornea after myopic laser in situ keratomileusis.

OBJECTIVE: To measure the corneal power after myopic laser in situ keratomileusis (LASIK). METHODS: Six central areas in 6 corneal power maps were studied using the Orbscan II statistical analysis device in 26 eyes that underwent myopic LASIK. Refractive and corneal power changes were compared. Factors related to wrong corneal power measurement were evaluated. MAIN OUTCOME MEASURES: Cycloplegic refraction, refractive change at the corneal plane, and Orbscan II corneal power maps. RESULTS: Preoperatively, only posterior-mean power (P<<.001) and anterior-posterior power ratio (P<<.001) varied according to the size of the analyzed area. Postoperatively, total-optical (P =.03), keratometric-mean (P =.04), total-mean (P<.001), anterior-mean (P =.03), and posterior-mean (P<<.001) powers; and anterior-posterior power ratio (P<<.001) varied according to the area. Postoperatively, the difference between keratometric-mean and total-mean powers became larger (P<.001), and the anterior-posterior power ratio was reduced (P<<.001). A posterior-mean power change occurred (P =.04). Refractive change after myopic LASIK was best estimated by 2-mm total-mean power (mean +/- SD difference, 0.07 +/- 0.62 diopters [D]; P =.55) and 4-mm total-optical power (mean +/- SD difference, -0.08 +/- 0.53 D; P =.37). CONCLUSIONS: Total corneal power is more positive and refractive change is underestimated when deduced from the anterior surface radius and keratometric refractive index. The anterior-posterior power ratio is not a fixed value. The best area to estimate the refractive change depends on the method used to obtain the power in diopters. Refractive change tended to be underestimated in larger areas and higher preoperative myopia. Orbscan II total-mean and total-optical power maps accurately assess the corneal power after myopic LASIK independent of preoperative data or correcting factors, and should improve intraocular lens calculation.

Adult↗

Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial.

OBJECTIVE: To identify the baseline factors independently related to 3-year myopia progression and axial elongation in COMET. METHODS: A total of 469 children were enrolled, randomly assigned to progressive addition lenses with a + 2.00 diopter (D) addition or to single vision lenses and observed for 3 years. Eligible children were 6 to 11 years old, with spherical equivalent myopia of - 1.25 to - 4.50 D, bilaterally. The primary and secondary outcomes, myopia progression by cycloplegic autorefraction and axial elongation by A-scan ultrasonography, were measured annually. Multiple linear regression was used to adjust for covariates, including treatment. RESULTS: Younger baseline age (6-7 vs 11 years, 8 vs 11 years, and 9 vs 11 years, P<.001; 10 vs 11 years, P = .04), female sex (P = .01), and each ethnic group compared with African Americans (Asian, P = .02; Hispanic, P = .002; mixed, P = .002; white, P = .001) were independently associated with faster 3-year progression. Children aged 6 to 7 years had the fastest progression of all age groups, progressing by a mean (+/- SD) of 1.31 D +/- 0.13 more than children aged 11 years. Females progressed 0.16 D more than the males. Children of mixed, Hispanic, Asian, and white ethnicity progressed more than African American children by 0.49 D +/- 0.16, 0.33 D +/- 0.11, 0.32 D +/- 0.13, 0.27 D +/- 0.08, respectively. Age and ethnicity, but not sex, were independently associated with axial elongation. Among these myopic children, a 0.5 mm increase in axial length was associated with 1 D of myopia progression. CONCLUSIONS: Younger baseline age was the strongest factor independently associated with faster myopic progression and greater axial elongation at 3 years. African American children had less myopic progression and axial elongation than the other ethnic groups.

Age Factors↗

Development of astigmatism and anisometropia in preterm children during the first 10 years of life: a population-based study.

OBJECTIVE: To assess the development of astigmatism and anisometropia to 10 years of age in preterm children, previously included in a population-based study on the incidence of retinopathy of prematurity. METHODS: Cycloplegic retinoscopies were performed in 198 preterm children at 6 months, 2(1/2) years, and 10 years of age. We analyzed the development of astigmatism of 1 diopter (D) or more and anisometropia of 1 D or more. RESULTS: The amount and prevalence of astigmatism declined between 6 months and 2(1/2) years of age and then remained stable. We found no difference in the course of astigmatism at different ages with regard to stage of retinopathy of prematurity. The amount of anisometropia increased, but its prevalence remained unchanged. Multiple regression analyses showed that astigmatism of 1 D or more at 2(1/2) years of age and cryotreated severe retinopathy of prematurity were risk factors for astigmatism at 10 years of age, and that anisometropia of 2 D or more at 2(1/2) years of age was a risk factor for anisometropia at 10 years of age. CONCLUSIONS: The development of astigmatism and anisometropia showed a similar course, regardless of stage of retinopathy of prematurity. The retinoscopy findings at 6 months of age were of no value in predicting astigmatism and anisometropia at 10 years of age, but the refraction at 2(1/2) years of age was. Retinoscopy at about 2(1/2) years of age in all preterm children may be useful for detecting astigmatism and anisometropia that will persist in children of school age.

Anisometropia↗

The impact of modest prematurity on visual function at age 6 years: findings from a population-based study.

OBJECTIVE: To determine the effects of modest low birth weight and prematurity on visual function of children predominantly aged 6 years. METHODS: Children with a birth weight of 1500 to 2499 g were considered exposed to a modest low birth weight (n = 82) and were compared with children with a birth weight of 2500 g or more (n = 1386). Exposure to modest prematurity, 32 to 36 weeks' gestation (n = 115), was similarly analyzed and compared with birth at term, 37 or more weeks' gestation (n = 1446). Logarithm of the minimum angle of resolution visual acuity was measured in both eyes. Cycloplegic autorefraction (cyclopentolate), cover testing, and dilated fundus examinations were performed. RESULTS: A modest low birth weight increased the risk of amblyopia (relative risk [RR], 5.1; 95% confidence interval [CI], 2.2-12.0), strabismus (RR, 3.7; 95% CI, 1.5-9.1), and anisometropia (RR, 3.7; 95% CI, 1.2-11.1), together with an increased risk of uncorrected visual acuity in the lowest quartile (RR, 1.7; 95% CI, 1.3-2.2). Modest prematurity increased the risk of amblyopia (RR, 4.5; 95% CI, 1.9-10.6), strabismus (RR, 2.6; 95% CI, 1.1-6.0), and uncorrected visual acuity in the lowest quartile (RR, 1.5; 95% CI, 1.1-2.0). CONCLUSION: Modest degrees of low birth weight and prematurity may be associated with increased ophthalmic morbidity at age 6 years.

Amblyopia↗

Malignant glaucoma induced by miotics postoperatively in open-angle glaucoma.

A case of malignant glaucoma that developed in a patient with primary open-angle glaucoma is described. The malignant course was induced during the immediate postoperative period by the inadvertent use of miotics. The malignant course was successfully managed by osmotic agents, acetazolamide, cycloplegics, mydriatics, and topical steroids.

Female↗

Corneal melting with intraocular lenses.

Five patients with collagen vascular disease and keratoconjunctivitis sicca underwent cataract surgery and implantation of intraocular lenses. Postoperative development of corneal melting may have been potentiated by the use of topical 0.1% dexamethasone sodium phosphate alcohol and neomycin sulfate. Permanent visual loss occurred in two patients. Implant removal was necessary in two eyes. Medical management consisted of discontinuance of administration of steroids and antibiotics, as well as the addition of tear substitutes, cycloplegics, and pressure patching.

Aged↗

Progressive hyperopia with long-term follow-up of radial keratotomy.

A number of studies have documented the reasonable efficacy and safety of radial keratotomy, but most were based upon results obtained one year or less after surgery. This study reviewed 109 consecutive radial keratotomy procedures performed on 79 patients between Nov 10, 1979, and Jan 31, 1981. In addition to a number of earlier postoperative visits, 81 eyes in 55 patients (74.3%) were examined between eight and 18 months postoperatively (a "one-year visit") and again between 31 and 57 months postoperatively (a "four-year visit"). Patients had uncorrected visual acuity determination, cycloplegic refractions with best-corrected visual acuity measurements, and keratometry. Of the 81 eyes, 17 (21.0%) became more myopic between one and four years postoperatively; five (6.2%) remained the same; and 59 (72.8%) became more hyperopic. With a significant change defined as 1.0 diopter or more, two eyes (2.5%) became significantly more myopic at four years; 54 eyes (66.7%) remained within 1.0 D of their one-year spherical equivalent; and 25 (30.9%) became significantly more hyperopic. Changes in keratometry generally paralleled refraction changes.

Adult↗

Refractive development of the human eye.

A complete refractive investigation was performed on 148 normal eyes of 79 patients ranging from premature newborns to 36-year-old adults. Cycloplegic refraction, keratometry, and axial length measurements were performed. From these data, we then calculated the refractive power of the lens. The change with respect to age in these measurements was subjected to cross-sectional analysis. The full-term newborn eye had a mean axial length of 16.8 mm, a mean keratometric power of 51.2 diopters (spherical equivalent), and a mean lens power of 34.4 D. The adult values for these measurements were 23.6 mm, 43.5 D, and 18.8 D, respectively. This information concerning the expected change with age in the refractive components should aid in the refractive management of pediatric patients requiring cataract extraction.

Adolescent↗

High hyperopia in Leber's congenital amaurosis.

Few studies comment on the type of refractive errors found in patients with Leber's congenital amaurosis. The association of an uncomplicated infantile form of this condition with high hyperopia but without systemic complications has been suggested. In a retrospective study, we identified 11 patients who satisfied the criteria for the diagnosis of this subtype of Leber's congenital amaurosis. All of our cases were found to have at least +6.00 diopters of hyperopia on cycloplegic refraction. No systemic abnormalities were found in any of these children. We suggest that high hyperopia be included in the diagnostic criteria of this specific form of Leber's congenital amaurosis.

Blindness↗

Reduction of pupillary constriction during cataract surgery using suprofen.

The efficacy of a new nonsteroidal anti-inflammatory agent, suprofen, for reducing pupillary constriction during cataract surgery was ascertained in a double-masked, multicenter, clinical study. Prior to surgery 1.0% suprofen or a placebo was instilled; the surgeon's normal regimen of mydriatics and cycloplegics was used. Suprofen (209 patients) was far more effective than the placebo (203 patients) in maintaining a dilated pupil prior to intraocular lens (IOL) implantation (or instillation of a miotic). The mean pupillary area prior to IOL implantation was 6.3 sq mm larger (20% larger) in patients treated with suprofen than in patients receiving the placebo. The investigators' subjective evaluations of the adequacy of pupil size for IOL implantation and of the difficulty of IOL implantation favored patients treated with suprofen over those receiving the placebo.

Adult↗

Astigmatism associated with adnexal masses in infancy.

High degrees of astigmatism are common in infants with hemangiomas but have not been well documented with other adnexal masses. We reviewed records of 65 patients (69 eyes) with chalazions, epibulbar or orbital dermoids, hemangiomas, and dacryoceles. Astigmatism greater than +1.25 diopters (as high as +5.50 diopters) was most commonly associated with dacryoceles (eight of 12 eyes) and with hemangiomas (14 of 17 eyes). Plus cylinder axes were consistently oriented toward the lesion, and astigmatism tended to resolve with resolution of the lesions. Only one of the 17 eyes with dermoids and two of the 23 eyes with chalazions had astigmatism. Anisometropic amblyopia has been a prominent concern in the treatment of infants with hemangiomas. Patients with dacryoceles may be at similar risk. Repeated cycloplegic refractions are important in determining appropriate treatment of adnexal masses.

Amblyopia↗