Ciliary block (malignant) glaucoma.
A review of the history, recognition, mechanisms, and therapy of ciliary block glaucoma has been given. Cycloplegic therapy is stressed in the susceptible eye.
Choroid↗
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Role of cyclopegics in progressive myopia.
Atropine sulfate 1% was instilled in both eyes of 86 children (172 eyes) on a daily basis for a period of two to eight years. No untoward changes in intraocular pressure, pupillary response, accommodation, or appearance of the ocular fundi were noted. A comparison with a similar group of children having only glasses prescribed during a similar time span revealed that atropine is effective in reducing theprogression of myopia in children; a permanent reduction in the degree of myopia may be achieved. Relaxation of accommodation by means of cycloplegic drugs may be a safe and effective treatment of myopia.
Adolescent↗
An evaluation of orthokeratology.
Twenty-three orthokeratology (OK) patients and 16 cosmetic hard contact lens (CL) patients were evaluated. Initially, each patient underwent a complete examination including central and peripheral keratometry, specular microscopy, axial length determination, uncorrected visual acuity, and cycloplegic refraction. The patients were then re-evaluated every three months. When the retainer lens stage was reached, the contacts were removed, and the patients were again re-examined for six additional months. Nine of ten CL patients remained in the study, during which time there was no improvement in unaided visual acuity or spherical equivalent. Both the central horizontal and vertical meridians flattened during this time. Twenty of 21 OK patients were also studied. A different technique of fitting contact lenses was used for this group, which produced significant changes in uncorrected visual acuity (P > 0.01) and spherical equivalent (0.1 > P > 0.05), but not in the central or peripheral corneal curvature. Five of the OK patients failed to respond. Six had variable, unpredictable responses, and nine had good responses. Analysis of the information in this study demonstrates that an OK procedure utilizes techniques of fitting that differ from standard contact lens techniques. The responses to OK are unpredictable and uncontrollable. The quality of uncorrected vision is worse than with contacts or glasses, and the chances of attaining 6/12 (20/40) uncorrected vision are small. Once lenses are removed, the corneal parameters return toward prefit levels.
Adult↗
Phospholine iodide toxicity and Jones' tubes.
A 72-year-old man with epiphora secondary to bilateral canalicular stenosis resulting from long-term treatment with 0.125% to 0.25% echothiophate iodide (phospholine iodide) drops for glaucoma underwent bilateral conjunctivodacryocystorhinostomies with Jones' tubes. Within days after undergoing this surgery, he experienced severe unexplained diarrhea, fatigue, weight loss, and prostration. He cancelled his postoperative ophthalmic appointment because of "medical illness." He required admission to his local hospital where extensive studies were done in an attempt to establish the cause of this life-threatening condition. After stopping the echothiophate iodide drops, all symptoms disappeared within two days. Drug toxicity is a previously unreported complication of conjunctivodacryocystorhinostomy, and this case demonstrates that topical medications have enhanced systemic absorption after lacrimal surgery with placement of fistulizing prosthetic devices. One must be aware of this possible complication, not only with long-acting anticholinesterases, but with topical sympathomimetic drugs (especially in cardiac patients) as well as cycloplegic agents in children.
Aged↗
A new low-concentration preparation for mydriasis and cycloplegia.
This study was designed to evaluate a low-concentration, cycloplegic-mydriatic mixture of phenylephrine and tropicamide in a routine office examination. No clinically significant difference in pupillary dilation was found between the usual instillation of the standard, commercially available phenylephrine 10% and tropicamide 1% drops and the prepared, low-concentration solution. Pupillary dilation was well maintained during direct and indirect ophthalmoscopy and retinoscopy. This solution is easily prepared from readily available drugs, and is simply delivered to the eye using a standard eye dropper. The safety and effectiveness of this low-concentration mixture of phenylephrine and tropicamide make it strongly recommended for routine use.
Administration, Topical↗
Filtration surgery in the treatment of neovascular glaucoma.
The disappointing visual acuity results following cyclocryotherapy for neovascular glaucoma have prompted us to consider filtration surgery as a reasonable alternative in the treatment of selected patients. All cases of surgically treated neovascular glaucoma were reviewed. There were 26 operations in 24 eyes with a follow-up ranging from six months to seven years and a mean of 22.8 months. Adequate pressure control was obtained in 16 of the 24 eyes (67%). In the eyes with successful control of intraocular pressure, vision was 20/400 or better in eight of the 16 eyes (50%). Four patients (17%) lost light perception. Approximately one half of the operations were trabeculectomies, and the others were posterior lip sclerectomies. There seemed to be no significant difference in the final intraocular pressure levels, number or degree of complications, or successes within the two subgroups. Panretinal photocoagulation, topical steroids, cycloplegics, and time for these measures to have their effect are important preoperative adjuncts to surgical treatment. We are encouraged by the long-term preservation of vision and control of intraocular pressure in many of these eyes.
Adult↗
New corneal shapes in keratorefractive surgery.
The corneal shape change as measured by the Humphrey keratometer and the corneascope after radial keratotomy in 50 patients was compared. The Humphrey keratometer analyzes a unique curve fit algorithm of the aplanatic corneal surface and designates this comparison as a shape factor. Both the corneascope photographs and the Humphrey keratometer demonstrated central corneal flattening after successful radial keratotomy. In addition, the normal "plus" shape factor was routinely converted to a "negative" shape factor after the procedure. This is analogous to converting the aplanatic central cornea, which normally approximates the end of an ellipse, to a topography which appears in cross section as the side of an ellipse. This alteration in topography is directly correlated to the magnitude of cycloplegic refractive change seen with this operation. The corneascope map topography of the cornea confirms this alteration in curvature.
Cornea↗
Iridocyclitis and an iris mass associated with secondary syphilis.
A 34-year-old white man developed iridocyclitis and an iris mass. The iridocyclitis was preceded by a nodular rash which spared the palms and soles. An anterior segment fluorescein angiogram was performed which showed numerous permeable vessels. An ultrasound examination of the mass showed that it extended to the ciliary body. He had both a positive RPRCT and FTA-Abs. A skin biopsy was done which disclosed the nodules to be a rare form of secondary syphilis. The patient was treated with topical steroids and a cycloplegic agent, and later prednisone and intravenous penicillin, with eventual resolution of iris mass, iridocyclitis and skin nodules.
Adult↗
Episodic astigmatism heralding generalized myopathy: report of a case managed with a new type of soft contact lens.
A 29-year-old woman presented with marked variations in refraction. A few minutes of physical exertion or reading at a close distance induced up to 2D of myopia and 2D of myopic astigmatism, which regressed upon resting with closed eyes. Cycloplegic agents did not affect the refractive changes, which were shown to be due to variations in corneal curvatures. The eyes were otherwise clinically normal. A few months later the patient developed signs of a progressive, generalized myopathy of unknown origin. The muscular disease was resistant to treatment. The refractive changes were effectively controlled by means of a new type of soft contact lens, with a semi-rigid center.
Adult↗
Determination of optical penalization by vectographic fixation reversal.
Optical penalization for distance is a useful alternative to occlusion for treating amblyopia, and as maintenance therapy following occlusion. It is particularly useful in cases of patching noncompliance. The major key to patient acceptance is choosing the minimal amount of penalization necessary, while still ensuring that the patient actually switches fixation to the amblyopic eye. We have found the vectographic letter slide reliable for identifying the fixing eye for distance vision. Thirty-four patients were treated for anisometropic or strabismic amblyopia with distance optical penalization without the use of cycloplegic agents. Twenty-two patients had improvement of their visual acuity, and 10 patients remained the same during an average follow-up period of 22.5 months. The average visual acuity improved from 20/40 to 20/32. The dominant eye required an average of only +1.25 diopters of fogging for the patient to switch fixation to the amblyopic eye, significantly less than the arbitrary +3.00 diopters advocated by some clinicians.
Amblyopia↗
Keratopathy in a family with the ectrodactyly-ectodermal dysplasia-clefting syndrome.
Four members of a family with the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome and associated keratopathy are presented. The main features of this syndrome include lobster-claw deformities of the hands and feet, abnormalities of the hair and teeth, cleft lip and palate, nasolacrimal abnormalities, and a progressive keratopathy ranging in severity from an asymptomatic pannus to bilateral dense corneal scarring and neovascularization. Despite congenital limb abnormalities, the major functional disability of three of these patients stems from severe photophobia and decreased visual acuity secondary to the corneal disease. Treatment with cycloplegics, topical steroids, and bandage soft contact lenses was unsuccessful. The EEC syndrome is transmitted in an autosomal dominant manner. The spectrum of keratopathy demonstrated in this family can be explained by the different ages of the patients, by variation in gene penetrance and expressivity and by differing durations and severity of dacryocystitis and related keratoconjunctivitis. The etiology of the keratopathy appears to be primarily a manifestation of the underlying ectodermal dysplasia with probable contributions from associated tearfilm abnormalities and external ocular infection.
Abnormalities, Multiple↗
Short- and long-term effects of postoperative corticosteroids on trabeculectomy.
All patients with primary open-angle or primary angle-closure glaucoma requiring trabeculectomy between January 1982 and January 1983 were entered into a randomized prospective study to evaluate the effect of postoperative corticosteroids. Twenty-three eyes in Group 1 received a cycloplegic and topical antibiotic. Twenty-nine eyes in Group 2 received the same treatment, with the addition of topical 1% prednisolone acetate. Twenty-three eyes in Group 3 received the same treatment as Group 2, with the addition of systemic prednisone. Success rate was significantly improved with the use of topical corticosteroids. Systemic steroids did not prove to be of any added benefit over topical use alone.
Adult↗
How safe are ocular drugs in pediatrics?
In comparison with that of adults, the smaller body mass of children raises questions of dosage. In addition, manifestations of ocular drug toxicity are different in some respects. The ocular drugs causing serious adverse ocular or systemic side effects in children include glaucoma medications, corticosteroids, phenylephrine, and the anticholinergic cycloplegics. The reported complications from using these medications in children will be briefly reviewed, and strategies for minimizing the risk of their adverse effects will be suggested, including a discussion of dosages and techniques of administration.
Absorption↗
Photographic detection of amblyogenic factors.
Refractive errors were determined photographically in a group of infants and children and were compared to conventional cycloplegic retinoscopy. The refractor consisted of a mirror telephoto lens and strobe flash designed to mimic the action of a retinoscope. Significant amblyogenic conditions such as anisometropia and high isoametropia were detectable. Strabismus and media opacities were also recordable. The technique provides a potential mass suited for infants.
Amblyopia↗
Two-flash photorefraction in screening of amblyogenic refractive errors.
A selection of amblyopic (n = 14) and nonamblyopic (n = 18) children with different ametropias, anisometropias, and astigmatisms was photorefracted without cycloplegia by two-flash photorefraction (T-FP) in which refractions in both horizontal and vertical meridians of both eyes are measured simultaneously. The results were compared to conventional cycloplegic retinoscopy in a blind study. Significant amblyogenic conditions, such as hyperopic anisometropias of more than 1.0 diopter (D), high ametropias, or astigmatism and strabismus cases of 2 degrees to 3 degrees or more are detectable. The technique provides a simple and useful tool for mass screening of infants. The sensitivity of the method for detecting amblyopia seems to be at least as high as in visual checking. Media opacities are recordable, and a permanent document is obtained.
Amblyopia↗
Traumatic hyphema in children.
The authors reviewed the medical records of 316 children admitted between January 1977 and March 1985 with a diagnosis of traumatic hyphema. In this group of patients, 1 to 17 years old treated without antifibrinolytics, the incidence of secondary hemorrhage was 7.6% (24 of 316 patients) of whom three required surgical evacuation of the clot. The risk of rebleeding did not correlate with the patient's age, use of topical steroids, or cycloplegics. Of 176 patients followed from 1 month to 7 years post-hospital discharge, 91% achieved 20/30 vision or better, but only 77% of the patients with secondary hemorrhage attained this level of vision. Amblyopia, a potential threat in young children, occurred in only two children both of whom also required cataract extraction. From our captive pediatric population of 228,000 the incidence of traumatic hyphema is 17 per 100,000 children per year.
Adolescent↗
Laser iris retraction for angle-closure glaucoma after retinal detachment surgery.
Twelve patients with retinal detachment with postoperative angle closure due to ciliary body edema, refractory to topical cycloplegics and corticosteroids, were managed by peripheral iris retraction with argon laser photocoagulation. This gonioscopic procedure results in immediate visualization of angle structures and prompt reduction of intraocular pressure (IOP). Routine tonometry and appropriate gonioscopy are essential to diagnose this form of glaucoma, which does not have a pupillary block component. Timely use of laser iris retraction reduces the risk of chronic glaucoma secondary to synechial closure. In this series, only two of ten patients, not previously known to have glaucoma, require long-term medication to control IOP.
Aged↗
Development of myopia in infants with birth weights less than 1251 grams. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.
The authors report on the incidence of myopia in a large group of premature infants with birth weights of less than 1251 g followed as part of the multicenter study of Cryotherapy for Retinopathy of Prematurity. None of the eyes reported here underwent cryotherapy. Eyes were refracted using cycloplegic retinoscopy at 3 months (n = 2916), 12 months (n = 2626), and 24 months (n = 961 at 5 of the 23 centers) after term. Myopia was observed in approximately 20% of the children at each test age. The percentage of high myopia (greater than or equal to 5 diopters) doubled from 2% to 4.6% between 3 and 12 months and remained stable thereafter. Lower birth weight and increasing severity of retinopathy of prematurity (ROP) were strong predictors of myopia and high myopia. In addition, anisometropia, astigmatism, and the presence of posterior pole residua from ROP also were associated with a higher incidence of myopia and high myopia.
Anisometropia↗