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PubMed2003

A randomized trial of rigid gas permeable contact lenses to reduce progression of children's myopia.

PURPOSE: To test whether rigid gas permeable (RGP) contact lens wear can reduced the rate of myopia progression in school age children. DESIGN: Randomized clinical trial. METHODS SETTING: Single clinical center. STUDY POPULATION: Both eyes of 428 Singaporean children. INCLUSION CRITERIA: 6 through 12 years of age with myopia between -1 and -4 diopters, astigmatism <or= 2 diopters, no prior contact lens wear, no other ocular pathologies. INTERVENTION: Spectacle or RGP lens correction for myopia. After a 3-month adaptation period, 383 children were followed, and 298 (78%) remained after 24 months. OUTCOME MEASURES: Cycloplegic subjective refraction, keratometry, and axial length measured at 12 and 24 months. RESULTS: Children who adapted to contact lenses wore them for a median of 7 hours per day, but no more than 40% wore them at least 8 hours per day, 7 days per week. Spectacles were worn for a median of 15 hours per day at the time of the 24-month follow-up. There was an increase in the spherical equivalent of -1.33 and -1.28 diopters (P =.64), and axial length increased by 0.84 and 0.79 mm (P =.38) over 2 years among children randomized to contact lenses and spectacles, respectively. Adjustment for baseline differences between the groups and for hours per day of contact lens wear did not alter these findings. CONCLUSIONS: Rigid gas permeable lenses did not slow the rate of myopia progression, even among children who used them regularly and consistently. It is unlikely that this intervention holds promise as a method by which to slow the rate of progression of myopia in children.

Child↗

PubMed2003

Wavefront analysis in eyes with accommodative spasm.

PURPOSE: To investigate changes of spherical aberration in eyes with accommodative spasm. DESIGN: Case reports. METHODS: Four eyes of two patients with accommodative spasm were studied. Ocular spherical aberration was measured with a Hartmann-Shack wavefront aberrometer for the central 4-mm zone. RESULTS: The root mean square values of spherical aberration were negative (-0.086 +/- 0.026 microm root mean square). However, when the spasm of accommodation was cured or treated with a cycloplegic agent, the value shifted toward positivity (0.025 +/- 0.004 microm root mean square). CONCLUSIONS: Excessive accommodative tone is manifested objectively by negative spherical aberration in eyes with accommodative spasm.

Accommodation, Ocular↗

PubMed1996

Long-term follow-up of ocular findings in children with Stickler's syndrome.

PURPOSE: To document the longitudinal changes in eye status of children diagnosed with Stickler's syndrome in the first decade of life. METHOD: All patients with cleft palate were referred for eye examination. Of these, patients with systemic findings of Stickler's syndrome were included in this report. RESULTS: Thirty-four eyes in 17 patients met inclusion criteria, with median best-corrected recognition acuity of 20/30. The mean cycloplegic refraction at presentation was -5.00 diopters, and the mean refraction at last visit was -5.50 diopters. CONCLUSIONS: Refractive errors, cataracts, and vitreoretinal abnormalities can be detected early in life in patients with Stickler's syndrome, and refractive error changed little during the follow-up period.

Cataract↗

PubMed1995

Chlorambucil therapy in sympathetic ophthalmia.

PURPOSE: We used chlorambucil therapy in a 28-year-old man with sympathetic ophthalmia, which was incompletely controlled with systemic corticosteroids, and the patient developed serious side effects. METHODS: The patient sustained a penetrating injury with an intraocular metal foreign body. Attempts to remove it with a magnet failed. Vitrectomy with lensectomy successfully removed the intraocular foreign body. Five weeks after the injury and one week after the vitrectomy, sympathetic ophthalmia developed, with severe visual impairment and inflammation and serous retinal detachment in the fellow eye. Sympathetic ophthalmia was poorly responsive to topical cycloplegics, topical corticosteroids, and systemic corticosteroid therapy. The patient developed side effects to the corticosteroids, which were reduced to prednisolone 60 mg daily. Chlorambucil therapy was begun at 2 mg daily, increased by 2 mg per day each week to the maximum of 8 to 12 mg per day. The total dose of chlorambucil was 793 mg; the duration of therapy was 23 weeks. RESULTS: Successful treatment was achieved with chlorambucil therapy. There was clinical remission of inflammation and absorption of exudative retinal detachment. The neurosensory retina sealed down; the retinal pigment epithelium demonstrated severe destruction, with the characteristic sunset-glow and moth-eaten appearance. No malignancy and no serious side effect developed during one year of follow-up. After termination of therapy, the patient had sustained remission of ocular disease. CONCLUSION: Chlorambucil immunosuppressive therapy is an alternative to corticosteroids for the treatment of corticosteroid-resistant sympathetic ophthalmia; however, because chlorambucil has potentially serious late side effects, prolonged follow-up is necessary.

Adult↗

PubMed1997

Ocular leech infestation in a child.

PURPOSE: To describe a patient with manifestations of ocular leech infestation. METHOD: Case report. RESULTS: The ocular foreign body was identified as a leech, Limnatis nilotica, by parasitologic examination. The leech was extracted, and the patient began using topical antibiotic and cycloplegic agents. By the third day after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no epithelial defect on the cornea was observed. CONCLUSIONS: Ocular leech infestation should be considered in patients with a history of swimming in streams and lakes. Attention should also be given to ocular leech infestation in the differential diagnosis of ocular trauma with iris prolapse.

Administration, Topical↗

PubMed1983

Corneal ulcers in patients with cosmetic extended-wear contact lenses.

Although cosmetic extended-wear contact lenses are generally safe, they can be associated with a number of complications. A review of 124 cases of corneal ulcers treated between Jan. 1, 1982, and June 1, 1983, disclosed six cases in otherwise healthy patients (four women and two men, ranging in age from 15 to 41 years) who wore extended-wear contact lenses for correction of myopia. In five of the six, the contact lenses had undergone recent manipulation. Two patients had changed their contact lenses without proper disinfection procedures. Five of the six had been treated with antibiotics before corneal scrapings were cultured and three had been treated with corticosteroids. The cultures grew gram-negative rods (in three cases Pseudomonas organisms and in one case Serratia organisms); both patients whose cultures grew no organisms had received antibiotics. Vigorous treatment with tobramycin and cefazolin eyedrops and cycloplegics produced final corrected visual acuities of 20/20, 20/30, 20/60, 20/20, and 20/50. In the sixth case, the final uncorrected visual acuity was counting fingers at 1 foot.

Adolescent↗

PubMed1996

Ocular findings in Down's syndrome.

PURPOSE: To identify the most common ocular findings in a pediatric group of patients with Down's syndrome. METHODS: A total of 152 children with Down's syndrome between two months and 18 years of age prospectively underwent ocular examination, including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic retinoscopy, and ophthalmoscopy. RESULTS: Ocular findings in decreasing prevalence were the following: upward slanting of the palpebral fissure with the outer canthus 2 mm or higher than the inner canthus (82%), epicanthal folds (61%), astigmatism (60%), iris abnormalities (52%), strabismus (38%), lacrimal system obstruction (30%), blepharitis (30%), retinal abnormalities (28%), hyperopia (26%), amblyopia (26%), nystagmus (18%), cataract (13%), and myopia (13%). Visual acuity was assessed, and the Teller acuity cards were the most useful method of examination. The patients younger than five years old had a higher prevalence of hyperopia than did those in other age groups; patients between five and 12 years old had a higher prevalence of astigmatism; and patients older than 12 years of age had more iris abnormalities, strabismus, and cataract. Myopia and myopic astigmatism were more common in the patients with cardiac malformations. CONCLUSION: The early diagnosis of the ocular abnormalities in patients with Down's syndrome, by using Teller acuity cards in assessing visual acuity facilitates the treatment of refractive errors, strabismus, and amblyopia and may minimize handicaps.

Adolescent↗

PubMed1987

Hypotony and choroidal detachment as late complications of trabeculectomy.

Seven eyes of six patients with glaucoma developed a flat anterior chamber, hypotony, and choroidal detachment two to 26 months after technically uncomplicated trabeculectomy. No signs warranting immediate surgical intervention, such as wound or bleb leakage, contact between cornea and lens, or massive choroidal detachments touching in the midvitreous cavity were found on initial examination. After treatment with topical corticosteroids and cycloplegic eyedrops, five of seven eyes showed marked clinical improvement within one month. The two remaining eyes eventually returned to normal anterior chamber depth, but required repeat filtration surgery for intraocular pressure control.

Administration, Topical↗

PubMed1980

Secondary syphilis with iris papules.

A 30-year-old man developed bilateral iridocyclitis with iris roseolae and papules three months after the rash of secondary syphilis. The inflammation resolved after treatment with penicillin, intramuscularly, topically given corticosteroids, and cycloplegics. The serum immune-complex levels were slightly increased. Iris angiography showed leakage of fluorescein in the region of the papules and roseolae and from the vessels of the pupillary margin. When the eye was clinically uninflamed, a follow-up angiogram showed leakage of fluorescein from the same areas, suggesting that the inflammatory effect on the iris vessels persisted in the region of the roseolae, the papules, and the sphincter vessels.

Adrenal Cortex Hormones↗

PubMed1999

Comparative corneal topography and refractive variables in monozygotic and dizygotic twins.

PURPOSE: To investigate the role of heredity in determining corneal shape, axial length, and overall refractive error. METHODS: Twenty monozygotic and 19 dizygotic twin pairs, age 12 to 73 years, were enrolled in the study. Zygosity was determined by physical similarity and by responses to questions adapted from surveys. Two twin pairs were excluded because of undetermined zygosity and one pair because of keratoconus (both siblings). Refractive error was determined by an automated refractor. Manifest refraction was also recorded, as well as cycloplegic refraction in subjects under age 18 years. Corneal topography data and manual keratometer readings were also obtained. Axial lengths were determined by A-scan ultrasound. Data were analyzed by Student t tests only in the right eye. Left-eye data were comparable for all variables. RESULTS: Mean intrapair difference in refractive error (spherical equivalent) was less for monozygotic than for dizygotic twins (RE: 0.41 vs 1.53; P = .001). Mean intrapair difference in axial length was less for monozygotic twins (RE: 0.39 vs 0.76 mm; P = .031). Corneal topography data (power and meridian) in all zones (3, 5, and 7 mm) also showed smaller mean differences among monozygotic pairs than dizygotic, but the difference was statistically significant only for the 5-mm zone. In addition, most Holladay Diagnostic Summary variables that were studied did not show any statistically significant differences. CONCLUSIONS: Axial length and overall refractive error have a significant genetic basis. Corneal topography data appear to have other overriding determining factors for several of the variables studied.

Adolescent↗

PubMed1999

Uveitis associated with varicella virus vaccine.

PURPOSE: To report a case of uveitis associated with the live attenuated varicella virus vaccine (Varivax; Merck & Co, Inc, West Point, Pennsylvania) in a young, otherwise healthy girl. METHODS: The time of onset of uveitis in relation to vaccination and the number and the pattern of distribution of vesicles were noted. The patient received oral acyclovir and topical steroids and cycloplegic drops. RESULTS: The uveitis and vesicular rash improved significantly after 7 days of treatment. A literature review and communications with the drug's manufacturer disclosed no identifiable previous cases of uveitis associated with Varivax. CONCLUSIONS: Uveitis should be recognized as a possible adverse side effect of the varicella vaccine.

Acyclovir↗

PubMed1998

Unilateral peripapillary myelinated retinal nerve fibers associated with strabismus, amblyopia, and myopia.

PURPOSE: To describe the association of unilateral peripapillary myelinated retinal nerve fibers with myopia, strabismus, and amblyopia and to propose a possible pathologic mechanism. METHODS: Four patients who have the findings associated with unilateral peripapillary myelinated nerve fibers are described and reviewed. RESULT: All patients had poor visual outcomes despite treatment with full cycloplegic refraction and appropriate patching. CONCLUSIONS: Although the origin of this association is unknown, we believe that peripapillary myelinated nerve fibers in a unilateral myopic eye may be secondary to an imbalance between the process of myelination and the formation of the lamina cribrosa. Good results have been reported with amblyopic therapy; however, it is our experience that these patients are somewhat refractory to amblyopia therapy.

Amblyopia↗

PubMed1998

The prediction of surgically induced refractive change from corneal topography.

PURPOSE: To develop a method to predict the refractive power of the cornea from corneal topography. METHODS: We reviewed preoperative and postoperative cycloplegic refraction, keratometry, and corneal topography in 40 eyes of 40 patients who had undergone photorefractive keratectomy, radial keratotomy, myopic keratomileusis in situ, or hyperopic lamellar keratoplasty. For each axial dioptric power map, we calculated the aspheric ellipsoid that best fit that map. Central corneal points were weighted more heavily than peripheral points, based on the Stiles-Crawford effect. The equation of the best-fit ellipsoid yielded the spherical and astigmatic power and axis for each cornea preoperatively and postoperatively. RESULTS: The preoperative corneal spherical and astigmatic powers measured by the best-fit method were consistent with the spherical and astigmatic powers measured by keratometry and simulated keratometry. The change in corneal spherical power predicted by the best-fit method was significantly (P < .05) more accurate at predicting the change in spherical equivalent refraction than change either in spherical equivalent keratometry or in spherical equivalent simulated keratometry. The prediction of the astigmatic change was less precise than that of the spherical, but the best-fit method was the most accurate. CONCLUSIONS: The best-fit method is more accurate than simulated keratometry and standard keratometry are in evaluating corneal refractive power after refractive surgery. An improved method of calculating corneal refractive power may facilitate subjective refraction after refractive surgery, improve the accuracy of intraocular lens power calculation for eyes that have had previous refractive surgery, and improve ablation profiles for excimer laser refractive surgery.

Astigmatism↗

PubMedDate not supplied

The refractive changes and long-term (3 years) results of radial keratotomy performed at high altitude.

PURPOSE: To evaluate the development of regression or progression following radial keratotomy (RK) performed at high altitude (1,720 meters) at long-term follow-up (3 years). METHODS: Thirty-nine eyes of 21 myopia patients (between -3.25 D and -11.00 D) whose ages were 19-32 years were included in the study. The RK procedures were performed in standard Russian style. RESULTS: The average spherical equivalent cycloplegic refractions were -5.49 D +/- 2.08 (SD) preoperatively, -1.64 +/- 1.59 D in the short-term (3.41 +/- 1.46 months) and -1.40 +/- 1.71 D in the long-term (30.72 +/- 4.36 months) follow-up period. There was no statistically significant difference between these values at the short- and long-term follow-up measurements (t = -1.57, P =.12). CONCLUSIONS: The refractive changes following RK performed at high altitude occur through a combination of both the direct effect of reduced barometric pressure and the edematous corneal expansion because of hypoxia. An ophthalmologist performing RK surgery at high altitude must consider the long-lasting therapeutic effects of high altitude surgery compared to surgery at sea level.

Adult↗

PubMedDate not supplied

A case of acute angle-closure glaucoma secondary to posterior scleritis in patient with Sturge-Weber syndrome.

BACKGROUND: Sturge-Weber syndrome has been known to be frequently associated with facial cutaneous angioma and ipsilateral glaucoma. However, as far as we know, no cases accompanied by acute angle-closure glaucoma have been reported in patients with Sturge-Weber syndrome. CASE: A 14-year-old boy with unilateral acute angle-closure glaucoma secondary to posterior scleritis associated with Sturge-Weber syndrome is described. OBSERVATIONS: Slit-lamp examination revealed diffuse episcleral venous hemangioma in the right eye. With ultrasound biomicroscopy, a forward shift of the lens-iris diaphragm, a swelling of the ciliary body, and an anterior rotation of the ciliary processes with annular choroidal effusion were detected. The patient responded well to treatment with systemic corticosteroids and cycloplegics. CONCLUSIONS: In our patient, inflammatory changes of the sclera, including swelling of the ciliary body, choroidal effusion, an anterior rotation of the ciliary processes at the scleral spur, and swelling of the lens, leading to closure of the anterior chamber angle, were suggested to be the major mechanisms of intraocular pressure elevation.

Acute Disease↗

PubMedDate not supplied

The effect of altitude on radial keratotomy.

The authors analyzed refractive results of patients who underwent radial keratotomy (RK) at sea level and high altitude and evaluated the effects of the altitude. A total of 102 eyes undergoing RK procedures performed in two clinical centers having different altitude were analyzed. The results compared between subjects who had undergone RK at sea level (Istanbul/Turkey) and at an altitude of 5750 feet (Van/Turkey) were compared. Subjects were 19-42 years old with myopia from -4.00 to -12.00 diopters (D). The average preoperative spherical equivalent cycloplegic refractions (SECR) were -8.01 +/- 1.86 D and -6.99 +/- 2.15 D in the Istanbul and Van groups, respectively. These were divided into subgroups according to myopia degree and number of incisions and optic zone size. The RK procedures were performed by the same surgeon with diamond blade in standard Russian style. The average changes in SECR were 5.09 +/- 1.29 D and 6.50 +/- 2.24 D in subjects who had undergone RK at sea level and at 5750 feet, respectively. There was a significant difference between the subgroups (P < 0.0002). This difference was especially higher in the high myopia subgroups. Additionally, we obtained a partial relation between increase of RK incision number and SECR change at high altitude but not at sea level. No notable regression and progression were seen in the 3 months of follow-up at high altitude. These results support hypotheses suggesting both corneal hypoxic expansion in the area of RK incisions, which may lead to central corneal flattening, and barometric pressure directly altering corneal shape, which is responsible for the hyperopic shift induced by altitude. Ophthalmologists performing RK surgery at high altitude had better consider redesigning their RK nomograms in light of these findings. However, when the nomogram used at sea level was used at high altitude, the subjects became hyperopic.

Adult↗

PubMed2001

The effect of reading and near-work on the development of myopia in emmetropic boys: a prospective, controlled, three-year follow-up study.

This study aimed to investigate the effect of reading and near work on myopic development in emmetropic boys in school age. It involved totally 114 children in two groups. Right eyes of 67 randomly selected students (mean age=12.93) with mean 6 h of reading and near work (Group 1) were compared with the right eyes of 47 apprentices (mean age=12.96) working as skilled laborers (Group 2). Cycloplegic refraction, keratometric readings and biometric measurements including anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and axial length (AL) were performed for 3 years at 18 month intervals. Two analyses were conducted: (1) for subjects in both groups with baseline refractive error from +0.50 to -0.50 D; (2) for all subjects in both groups with baseline refractive error from +1.00 to -1.00 D. For subjects with baseline refractive error of +/-0.50 D, myopic shift was present in 20 of 41 (48.8%) in group 1 and in seven of 37 (18.9%) in group 2 at the end of the study. The magnitude of the myopic shift was 0.56 and 0.07 D in group 1 and 2, respectively. For subjects with a baseline refractive error of +/-1.00 D, myopic progression was present in 40 of 67 (59.7%) in group 1 and in 10 of 47 (21.3%) in group 2 at the last readings. In this larger refractive range, the magnitude of the myopic shift was 0.61 and 0.12 D in group 1 and 2, respectively. The mean ACD, VCD and AL were significantly higher in the last readings after 36 months than in the first readings (for each, P=0.0001) in group 1. There was no statistically significant difference between two measurements of these parameters in group 2. The final keratometric dioptric readings were lower than the first values (for each, P=0.0001) in both groups at the end of the study. This prospective and controlled study suggested that reading and near work, important environmental factors, might cause refractive myopic shifts in emmetropic students. The myopic shift was primarily related to significant increases in ACD, VCD and AL in this young age group.

Anterior Chamber↗

PubMed2002

Prevalence of astigmatism in infant monkeys.

PURPOSE: Human infants exhibit a high prevalence of astigmatism. Although macaque monkeys are commonly used as animal models in experiments on early ocular growth and emmetropization, the prevalence of astigmatism in infant monkeys is unexplored. In this study we examine the prevalence and nature of astigmatism in infant monkeys. METHODS: Refractive and corneal astigmatism were measured in 132, 2-5-week-old rhesus monkeys (Macaca mulatta) using cycloplegic retinoscopy and keratometry, respectively. Longitudinal measures of refractive development were obtained from 16 normal infants over the first 6 months of life. RESULTS: Infant monkeys exhibited a low prevalence of astigmatism. Approximately 90% of the 2-5-week-old infants had <1.00 D of either refractive or corneal astigmatism. When refractive astigmatism was observed, it was well correlated with the direction and magnitude of corneal astigmatism. When corneal astigmatism was >1.00 D (n=20), it was predominantly against-the-rule in nature (70.0%). The infant monkeys that were followed longitudinally rarely showed significant astigmatic errors at any time during the observation period. When these infant monkeys exhibited significant astigmatism, it was usually transient and not present on subsequent measurements. CONCLUSIONS: Unlike human infants, infant monkeys exhibit relatively little astigmatism. The low prevalence of astigmatism during early development suggests that astigmatism does not provide an essential cue for vision-dependent eye growth in infant primates.

Aging↗