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PubMed1999

Comparison of topical 0.3% ofloxacin with fortified tobramycin plus cefazolin in the treatment of bacterial keratitis.

PURPOSE: Ofloxacin is a broad spectrum fluoroquinolone antibiotic with good ocular penetration. We compared ofloxacin 3% solution with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proven bacterial keratitis. METHODS: Thirty eyes with culture-proven bacterial corneal ulcers were enrolled in a prospective randomised, controlled, double-masked study for comparison. The ofloxacin drop and saline were decanted into two identical-looking bottles to the tobramycin and cefazolin. The cases were randomly allocated into treatment with 0.3% ofloxacin solution or a combination of fortified antibiotics (1.5% tobramycin and 10% cefazolin solutions; control group) along with supportive cycloplegic, vitamins and anti-glaucoma therapy. Student's t-test was used to compare the results. RESULTS: Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated. Resolution of the ulcer was achieved in 93% and 87% of cases in the ofloxacin and control groups respectively. The mean time required for symptomatic relief was 7.8 +/- 1.54 days and for epithelial healing 15.0 +/- 3.86 days in ofloxacin group, compared with 8.33 +/- 1.54 days for symptomatic relief and 15.46 +/- 3.86 days for epithelial healing in the control group. Post-resolution best corrected visual acuity of 20/200 or better was achieved in all but one eye in both groups. CONCLUSIONS: Ofloxacin and combined fortified tobramycin and cefazolin topical drops were comparable for treating cases of bacterial corneal ulcer. However, considering its easy availability and cost-effectiveness, monotherapy with ofloxacin is preferred over the combined fortified tobramycin and cefazolin therapy.

Adolescent↗
PubMed1999

A comparative study on the effect of radial keratotomy in patients who live at sea level and high altitude.

PURPOSE: To compare the refractive and keratometric results of matched pairs of patients who underwent radial keratotomy (RK) at sea level and high altitude. METHODS: The results of 30 eyes that underwent RK procedures in two clinical centres at different altitude were analysed. One centre was at sea level (Istanbul) and the other at an altitude of 1720 m (Van). The patients in the two centres were matched regarding gender, age, degree of myopia, number of incisions and optic zone size. There were 15 eyes in each group. All operations were performed with a diamond blade using a Russian technique by the same surgeon. RESULTS: The mean pre-operative spherical equivalent cycloplegic refractions (SECR) were -6.33 +/- 1.15 D and -6.32 +/- 1.01 D in the Istanbul and Van groups, respectively (p = 0.96). The mean post-operative SECRs were -1.93 +/- 1.03 D and -0.28 +/- 0.57 D in the Istanbul and Van groups, respectively (p < 0.001). The mean SECR changes were 4.40 +/- 0.92 D and 6.03 +/- 1.13 D in subjects who had undergone RK at sea level and at 1720 m, respectively (p < 0.001). CONCLUSION: These results show that a higher myopic correction can be provided in patients who undergo RK at high altitude compared with those operated on at sea level. The RK nomograms used by refractive surgeons performing RK surgery at high altitude may need to be redesigned in the light of future studies with long-term follow-up.

Adult↗
PubMed2006

Severe uveitis in an HLA-B27-positive patient with ankylosing spondylitis.

BACKGROUND: A 36-year-old male presented with bilateral, anterior, chronic uveitis, with cystoid macular edema. Decimal visual acuity was 0.25 in the right eye and 0.20 in the left eye. Ankylosing spondylitis had been diagnosed 13 years previously, with peripheral and axial involvement. He had no history of extra-articular manifestations of ankylosing spondylitis before this uveitis attack. Treatment with the anti-tumor necrosis factor agent etanercept was initiated 5 months before the attack of uveitis. INVESTIGATIONS: Slit-lamp biomicroscopy, laser-flare photometry, optical coherence tomography, chest radiography, angiotensin-converting-enzyme test, mycobacterial culture from gastric lavage, serology tests for syphilis, brucellosis, toxoplasmosis, toxocarosis, antinuclear antibodies, rheumatoid factor, antineutrophil cytoplasmic antibodies, antimyeloperoxydase antibodies and antiproteinase 3 antibodies. DIAGNOSIS: Atypically severe HLA-B27-positive uveitis, in a patient with ankylosing spondylitis treated with etanercept. MANAGEMENT: Intensive topical corticosteroid and cycloplegic treatment, subtenon triamcinolone acetonide injection, switch in treatment from etanercept to infliximab followed by discontinuation of tumor necrosis factor inhibitors, intravenous pulses of methylprednisolone followed by oral corticosteroids, and intravenous cyclophosphamide.

Adult↗
PubMed2002

Characteristic ocular findings in Asian children with Down syndrome.

AIMS/PURPOSE: To identify the characteristic ocular findings in Asian children with Down syndrome. METHODS: A total of 123 Korean children with Down's syndrome between 6 months and 14 years of age were examined for ocular findings from March 1999 to April 2000. Ocular examinations including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic refraction, and ophthalmoscopy were performed. RESULTS: The ocular findings in decreasing prevalence were the following: upward slanting of the palpebral fissure (78 patients, 63%), epicanthus (75 patients, 61%), epiblepharon (66 patients, 54%), astigmatism (38 patients, 31%), hyperopia (35 patients, 28%), myopia (31 patients, 25%), strabismus (31 patients, 25%, 18 esotropia and 13 exotropia), nystagmus (27 patients, 22%), nasolacrimal duct obstruction (21 patients, 17%), blepharoconjunctivitis (20 patients, 16%), retinal abnormalities (18 patients, 15%), cataract (four patients, 13%), and glaucoma (one patient, 0.8%). Brushfield spots and keratoconus were not found. CONCLUSIONS: Asian children with Down syndrome demonstrate unreported, high incidence of epiblepharon, the high rate of exotropia, and essentially no notable Brushfield spots, which are in contrast to the ocular findings in Caucasian patients with Down syndrome.

Adolescent↗
PubMed2004

The ocular manifestations of Weissenbacher-Zweymuller syndrome.

PURPOSE: Weissenbacher-Zweymuller syndrome (WZS) is an autosomal recessive disorder of delayed skeletal maturation. Its characteristic features include rhizomelic dwarfism with metaphyseal and vertebral changes. It has been challenged whether WZS is a part of the spectrum of Stickler syndrome. We report ocular findings in the largest ever-presented series of patients with WZS. METHODS: Patients underwent a paediatric examination, including assessment of growth and development, genetic work-up and X-ray of vertebra and long bones. All had a complete ophthalmic examination, cycloplegic refraction, and face and body photography. RESULTS: All patients had hypertelorism and protruding eyes. Four patients had refractive errors necessitating optical correction ranging from +3 to -8 D. Two patients had strabismus. None had vitreoretinal degeneration, glaucoma, or cataract. CONCLUSIONS: Ocular manifestations of WZS differ from those in Stickler syndrome, indicating that the two likely represent distinct clinical entities. Strabismus and various refractive errors often accompany WZS. An ophthalmologist should follow children with this disorder from an early age to prevent amblyopia.

Adolescent↗
PubMed2005

Long-term visual prognosis of infantile-onset high myopia.

PURPOSE: To investigate the clinical course and changes of refractive status in infantile-onset myopic children who received fully corrected glasses and to determine their visual prognosis. METHODS: In all, 57 children with infantile-onset high myopia (spherical equivalent over -5.0 D prior to the age of 5 years) were included in this study. All children received initial full-correction glasses at the mean age of 3.52 years. The cycloplegic refraction, axial length, and the best-corrected visual acuity were collected every 6 months. The mean follow-up time was 9.36 years. RESULTS: We noted that the tendency toward progression or regression of myopia appeared to be related to the degree of refractive error. Lower grades of high myopia (-5.0 to -7.75 D) showed a greater tendency to progress than those of the highest initial myopic refraction level (< or = -11.0 D). While the latter group exhibited a more-substantial regression rate than those cases of the lower initial refraction level. About 80% of infantile-onset high myopes demonstrated a final best-corrected vision of greater than 20/40, with 37% of children revealing a best-corrected vision level even better than 20/25. CONCLUSION: Clinical course of infantile high myopia is different to school myopia. Usually, higher degree of high myopia showed a stable state of myopia, or even possible regression, whereas the lower grades of high myopia revealed a strong tendency to progress.

Age of Onset↗
PubMed2006

Retinal function in infants with optic nerve hypoplasia: electroretinograms to large patterns and photopic flash.

AIMS: Optic nerve hypoplasia (ONH), which is defined as a congenital deficiency of retinal ganglion cells, may also involve more distal layers of the retina. We investigated electrophysiological function of the retina in ONH using electroretinograms (ERGs). METHODS: ERGs were recorded from 48 subjects (3.5-35 months) with unilateral or bilateral ONH. Pattern reversal (4 degrees checks) was presented under chloral hydrate sedation, using an optical system to correct a cycloplegic refraction. A photopic flash stimulus was also used. Fundus photographs were used to measure the disk diameter/disk macula ratio (DD/DM), and to document other clinical signs. Eyes were classified as moderate (0.15-0.3) or severe (<0.15) ONH, and those with DD/DM greater than 0.3 were used as reference eyes. RESULTS: Pattern ERG recording was completed in 89 eyes and was detectable in 80% of eyes with ONH (61/76 tested) and in all 13 reference eyes. Photopic flash ERGs were of good quality in all eyes. The severity of ONH correlates with the amplitude of the photopic flash b-waves and with the amplitude of the N95 component of the pattern ERG (P<0.01). However, the ERGs to large patterns were well preserved (>3.5 microV) in 10 of 35 eyes with severe ONH. Tortuous retinal vessels in eyes with either moderate or severe ONH were associated with smaller amplitude photopic b-waves and markedly diminished or undetectable pattern ERGs. CONCLUSIONS: This study supports the hypothesis that retinal dysfunction distal to the ganglion cells is common in ONH, but is not predictable on the basis of ONH severity alone. Additionally, tortuous retinal vessels in ONH may be a sign associated with retinal dysfunction.

Child, Preschool↗
PubMed2006

Peripheral and posterior pole retinal lesions in association with high myopia: a cross-sectional community-based study in Hong Kong.

PURPOSE: To evaluate the prevalence and factors associated with posterior pole and peripheral retinal lesions in Chinese subjects with high myopia. METHODS: Three hundred and thirty-seven asymptomatic adults with high myopia of refractive error <or=-6 D were examined in a cross-sectional community-based study. All subjects underwent cycloplegic refraction, ultrasound biometry and dilated fundal examination. Statistical analysis was performed to assess factors associated with the presence of posterior pole and peripheral retinal lesions. RESULTS: The mean age of the 337 subjects was 36.0 years and the mean spherical equivalent refractive error was -10.2 D. Thirty-eight eyes (11.3%, 95% CI=8.1-15.2%) were found to have one or more posterior pole lesions and subjects with posterior pole lesion had significantly older age, longer axial length and higher degree of myopia (all P<0.001) compared with subjects without posterior pole lesion. After controlling for axial length, both the severity of refractive error and older age were significantly associated with the presence of posterior pole lesion (both P<0.001). For peripheral retinal lesions, 189 eyes (56.1%, 95% CI=50.6-61.5%) were found to have one or more peripheral retinal lesions. The presence of peripheral retinal lesion was associated with younger age and higher degree of refractive error (P=0.046 and 0.002, respectively). CONCLUSION: Posterior pole and peripheral retinal degenerative lesions were found in a considerable proportion of subjects with high myopia. As some of these retinal lesions might predispose to visual impairment, highly myopic individuals should be educated on the symptoms of various eye conditions and seek care immediately if symptoms arise.

Adolescent↗
PubMed2003

Prevalence of undetected ocular conditions in a pilot sample of school children.

Parents of 134 children (age 5-18 years; 84% participation) attending a private school gave informed consent for their child's participation in a pilot study to demonstrate the feasibility and estimate sample size for a larger study of myopia prevalence, the Sydney Myopia Study. LogMAR visual acuity and other ocular assessments, including cycloplegic autorefraction (tropicamide 1%) and examination of the media and fundus, were performed. The prevalence of significant ocular conditions was 28.2%. Eleven children (8.4%) wore glasses. Five were referred for a change in their correction. Previously undetected ocular conditions (19.8%) included one child with ocular pathology and four children with strabismus. Uncorrected refractive error (16.8%) was the most common reason for referral and was more predominant in the senior students (25%), corresponding with an age-related shift in mean spherical equivalent refraction towards myopia (less than 7 years: +0.40 +/- 0.60 D; more than 15 years: -1.15 +/- 1.18 D). Three senior students were classified as having socially significant correctable vision impairment. These findings suggest that reliance on ad hoc referrals could result in delayed referral and that vision screening in both early and later school years may be desirable.

Adolescent↗
PubMed1999

The development of myopia in Hong Kong children between the ages of 7 and 12 years: a five-year longitudinal study.

The purpose of this work was to characterize the development of refractive error in Hong Kong children between the ages of 7 and 12 years. A non self-selected sample of 7-year old children was recruited and followed for 5 years, non-cycloplegic refractions being carried out annually. A life-table was used to determine myopia incidence and prevalence. The mean annual change in the spherical equivalent refraction (SER) was -0.32 D; 75 out of 83 subjects followed for 5 years became less hyperopic or more myopic, the maximum progression occurring between 9 and 11 years of age. The mean change in SER over the 5 years in children who were myopic at age 12 years was significantly greater than that in children who remained non-myopic. The incidence of myopia at age 7-8 years was 9% and at age 11-12 years was 18-20%. At age 7 years the prevalence of progressive myopia was 1.6% and 2.5% of subjects had anisometropia. Any treatment to prevent myopia should start by the age of 6 years and treatment to retard development should commence before age 9 years.

Aging↗
PubMed2002

Central corneal thickness is lower in osteogenesis imperfecta and negatively correlates with the presence of blue sclera.

BACKGROUND: Osteogenesis imperfecta (OI) is a rare, autosomal-inherited, connective tissue disorder characterised by bone fractures, deafness and blue sclera. Additional ocular findings are decreased ocular rigidity, myopia, glaucoma, keratoconus, corneal opacity, small corneal diameter and congenital Bowman's layer agenesis. PURPOSE: This cross-sectional, masked, case-control study aimed to assess whether central corneal thickness (CCT) is affected in patients with OI and to focus on the clinical significance of scleral blueness. MATERIALS AND METHODS: Twenty-three children with OI (13 boys, 10 girls) and 15 age-, sex- and refraction-matched healthy control subjects (eight boys, seven girls) were assessed for CCT by ultrasound pachymetry. The CCT was compared between two different patient subgroups (type-I OI with blue sclera, n = 12; type-IV OI without blue sclera, n = 11). Mann-Whitney U-test or analysis of variance was used as indicated and only right eyes of each subject were included in statistical analysis. Results were expressed as mean +/- S.D. and statistical significance was taken as p < 0.05. RESULTS: Mean age and sex distribution was similar between the groups (10.1+/-2.5 vs 9.8+/-1.8 years, p > 0.05). Patients with OI had significantly lower CCT (459.5+/-24.6 microm) than in control subjects (543.6+/-21.4 microm; p < 0.001). The CCT was below 500 microm in 22 of 23 children (95.6%) with OI, 15 of which (65.2%) were below 450 microm. In contrast, CCT was over 500 microm in all eyes in the control group. Type-I OI eyes with blue sclera had significantly (p = 0.005) lower CCT readings (446.5+/-16.3 microm) than type-IV OI eyes without blue sclera (473.6+/-25.0 microm). Mean keratometric values were similar between the groups (44.2+/-1.7 vs 43.8+/-1.6 dioptre, p > 0.05). Mean cycloplegic refraction was similar between the groups (-0.32+/-0.5 vs -0.18+/-0.4 dioptre; p > 0.05), although five of 23 OI patients had myopia, and mean intraocular pressure was lower in OI patients than controls (12.7+/-1.8 mmHg vs 15.6+/-1.9 mmHg; p < 0.001). CONCLUSIONS: The CCT is thinner and negatively correlated with the blueness of the sclera in patients with OI. The CCT readings may therefore be of utmost importance in the diagnosis of OI. An ophthalmologist should be aware of an artificially low intraocular pressure measurement in such patients. In addition, when considering a keratorefractive treatment, CCT must be evaluated carefully to avoid unexpected results or complications. Sturdy protective spectacles should be prescribed to those who are not bed bound. Possible correlation of low CCT with biochemical changes in scleral collagen or systemic parameters awaits further investigation.

Adolescent↗
PubMed2003

Variation of multifocal electroretinogram with axial length.

INTRODUCTION: The first-order kernel response of multifocal electroretinogram (mfERG) decreases in myopia. A recent study indicates that the flash ERG is also reduced with increased axial length. The aim of this study was to investigate the variations in the first-order response (K1) and the first slice of second-order response (K2.1) across the retina for different axial lengths. METHODS: Thirty healthy subjects with axial length from 23.72 to 28.13 mm (spherical equivalent refractive errors from plano to -10.50 D) were recruited for mfERG measurement using VERIS 4.0. All subjects were fully corrected after cycloplegic refraction and pupils were dilated prior to mfERG recording. There is one trough, n1, and one peak, p1, in the K1 response and three troughs, n1, n2, n3, and three peaks, p1, p2, p3, in the K2.1 response. The amplitudes and implicit times of K1 and K2.1 responses were analysed to determine the characteristic of the responses across retina and the correlation to axial length. RESULTS: The amplitudes of p1 (in the first-order kernel-K1) decreased in the central region and the paracentral region (ring 3) as the axial length increased. The central retinal region showed high rates of reduction in both n1 and p1 (in K1). The amplitudes of n1p1 and n2p2 (in the first slice of the second-order kernel-K2.1) were reduced in the paracentral region (from ring 2 to ring 5) as axial length increased. The average n1 and p1 in K1, and n1p1 and n2p2 in K2.1 mfERG responses are decreased in amplitude by 6-10% per millimetre elongation of axial length. CONCLUSION: Eyes with longer axial lengths, usually with high myopia, have a weaker mfERG response and this attenuation is across the measured retina (from central to paracentral regions) but different kernel responses show a different pattern of attenuation at different retinal eccentricities. The weaker mfERG responses may be related to the morphological changes associated with increased axial length.

Adult↗
PubMed2004

Prevalence of refractive errors in teenage high school students in Singapore.

We aimed to study the prevalence of refractive conditions in Singapore teenagers. Grade 9 and 10 students (n = 946) aged 15-19 years from two secondary schools in Singapore were recruited. The refractive errors of the students' eyes were measured using non-cycloplegic autorefraction. Sociodemographic data and information on risk factors for myopia (such as reading and writing) were also obtained using an interviewer-administered questionnaire. The prevalence of refractive conditions was found to be: myopia [spherical equivalent (SE) at least -0.50 D] - 73.9%, hyperopia (SE at least +0.50 D) - 1.5%, astigmatism (cylinder at least -0.50 D) - 58.7% and anisometropia (SE difference at least 1.00 D) - 11.2%. After adjusting for age and gender, currently doing more than 20.5 h of reading and writing a week was found to be positively associated with myopia [odds ratio 1.12 (95% CI 1.04-1.20, p = 0.003)], as was reading and writing at a close distance and a better educational stream. The prevalence of myopia (73.9%) in Singapore teenagers is high. Current reading and writing habits, reading at close distances and a better educational stream are possible risk factors for myopia.

Adolescent↗
PubMed2001

[Results of combined divergence operation in intermittent exotropia in 120 children].

BACKGROUND: Intermittent exotropia is the most frequent indication for surgical correction of exodeviations in childhood. Overcorrection with prolongated or persistent consecutive esotropia can impair binocular vision particularly in early childhood. We wanted to investigate this potential risk and the dose/effect relation of recess-resect surgery on children. PATIENTS AND METHODS: 120 children up to ten years of age underwent recess-resect surgery for intermittent exotropia in our clinic from 1991 to 1999 (< 2% of the surgical cases). The cycloplegic refraction was spectacle corrected with a reduction of 0.5 dpt. Preoperatively, a diagnostic occlusion was performed for three days. The amount of surgery was calculated using our dosage schedules based on effects one week postoperatively. The squint angles as measured by the alternate prism and cover test at 5 m and 0.3 m pre- and 3 months postoperatively and the binocular functions as measured by the Bagolini striated glasses, Titmus, Randot, TNO, or Lang tests were evaluated. RESULTS: (Medians) Squint angles in primary position were: preoperative: distance (5 m)--15 degrees, near (0.3 m)--16 degrees; postoperative (n = 104); distance--4 degrees, near--3 degrees. Effectivity of surgery: distance: 1.3 degrees/mm, near 1.4 degrees/mm. Consecutive esotropia requiring surgical correction occurred in 1 child. Second surgery for intermittent exotropia in the years 1991 to 1999 was necessary in 5 children. Binocular functions (n = 95): Preoperative = postoperative: 61%, postoperative > preoperative 21%, postoperative < preoperative 18%. The diagnostic occlusion was helpful to differentiate "pseudo-divergence excess type" from "divergence excess type" exotropia. The average deviation did not increase under the diagnostic occlusion. The effectivity of surgery (degree/mm) in the children group was lower than in a compared group of older patients (> 10 years) with intermittent exotropia. CONCLUSION: Using our own dosage schedules and surgical technique, residual exodeviations are common after recess-resect surgery in childhood. The risk of consecutive esotropia or persistent impairment of binocular vision is low.

Child↗
PubMed2001

[Accuracy of measurements of video-refractometry in higher ametropia].

BACKGROUND: Measurement of refraction of non-cooperative patients is a real challenge for the ophthalmologist. Retinoscopy produces exact results in experienced hands, but requires practice and time. The Videorefractor VRB 200 (manufactured by Tomey, Erlangen) was especially designed for refracting children. The aim of this study is to prove the accuracy of this tool in measuring refraction. MATERIAL AND METHODS: 259 patients (age 10 month to 77 years) were measured with the VRB 200. Each patient was examined by retinoscopy in cycloplegia and refracted with the Topcon autorefraktor RM-A 6000. Ametropia was evoked at 5 emmetropic volunteers by lenses of different power, placed in a trial frame. These measurements were performed with and without use of cycloplegic drugs. RESULTS: The VRB 200 showed an average error of spherical equivalent at ametropia of the range -4 to +4 Diopters (dpt) < 2 dpt. At higher ametropia the error grew increasingly. Repeated measurements of one patient showed high variation of the results. Astigmatism was measured worse by growing magnitude, especially at diagonal axis (45 degrees and 135 degrees). Anisometropia > 2 dpt has been discovered in only 72%. It was possible to examine many infants and handicapped patients, which was impossible by using the RM-A 6000. An examination by retinoscopy was possible in all cases, but needed a lot of time and patience. CONCLUSIONS: The concept of good handling suffers especially by the increasing inaccuracy at ametropia beyond +/- 4 dpt. At this state of development the VRB 200 is no alternative in practical use to the conventional retinoscopy.

Adolescent↗
PubMed2002

[Amblyopia of the fellow eye in assumed unilateral congenital fibrosis syndrome].

BACKGROUND: Amblyopia of the ptotic eye in spite of head posturing and of the fellow eye in ptosis with motility disorders are well known. We emphasize the importance of exact ophthalmological and orthoptic examinations to avoid amblyopia in both ptosis and fellow eye, even in cases of mild ptosis, especially if they are combined with motility disorders. PATIENT: A 5 year-old girl presented to our outpatient clinic because of ptosis of the left eye and hypertropia of the right eye. Visual acuity of the right eye was 0.32 and of the left ptotic eye 1.0. Cycloplegic retinoscopy showed + 2.0 sphere in both eyes. Ocular motility showed a mild reduction of elevation of the left eye in ad- and abduction. This led to the diagnosis of congenital fibrosis syndrome of the inferior rectus muscle of the left eye. Due to the preferred fixation with the left ptotic eye and the consecutive deviation of the fellow eye amblyopia of the right eye had developed. Occlusion therapy of the left eye resulted in an improvement of visual acuity of the right eye to 0.9 and centralisation of fixation within one month. CONCLUSION: Even children with mild ptosis, especially in combination with motility disorders, require a complete ophthalmological and orthoptic examination to avoid amblyopia also of the fellow eye.

Blepharoptosis↗
PubMed2005

[Accuracy of the autorefractor power refractor in clinical work--a comparative study].

BACKGROUND: The aim of this prospective study was to investigate accuracy and efficiency of the autorefractometer PowerRefractor compared to established autorefractometers and retinoscopy as standard method. PATIENTS AND METHODS: 150 patients (300 eyes) were examined. Patients were initially (pupil not influenced) analyzed with the Power Refractor (PR (neutral)). After that a examination followed under standardized Cyclopentolat cycloplegia with the Power Refractor (PR (cyclo)), the hand-held Retinomax K-plus (Nikon), the table-top mounted RK-5 (Canon) and retinoscopy. RESULTS: Deviation from retinoscopy (percentage of values with more than 1 dpt difference/maximal deviation): Sphere: PR (neutral): 66.3 %/8.5 dpt; PR (cyclo): 48 %/5 dpt; RK-5: 26.7 %/4.75 dpt; Retinomax K-plus: 6.7 %/1.25 dpt; Cylinder: PR (neutral): 12 %/6.25 dpt; PR (cyclo): 21 %/4.75 dpt; RK-5: 1.3 %/2.75 dpt; Retinomax K-plus: 2.3 %/2.5 dpt; spherical equivalent: PR (neutral): 44.7 %/7.1 dpt; PR (cyclo): 35.3 %/5.4 dpt; RK-5: 9 %/4.5 dpt; Retinomax K-plus: 1.3 %/1.,4 dpt; error of entire refraction: PR (neutral): 62.7 %/7.8 dpt; PR (cyclo): 61.3 %/7.3 dpt; RK-5: 24 %/4,5 dpt; Retinomax K-plus: 14.7 %/3.6 dpt CONCLUSIONS: The best accuracy compared to retinoscopy had Retinomax K-plus followed by RK-5. PowerRefractor had the biggest deviations of the tested devices. PowerRefractor may be a usefull device for screening small children and handicapped people because of the one meter observing distance. For a precise refraction especially in children a retinoscopy under cycloplegic conditions is still necessary.

Adolescent↗
PubMed1999

[Ultrasound biomicroscopy and therapy of malignant glaucoma].

BACKGROUND: Malignant glaucoma is a rarely diagnosed condition though it has been known since over one hundred years and understood to be based on an ciliary blockage since thirty years. Now it is possible to visualise pathomechanism of ciliary block by ultrasoundbiomicroscopy. PATIENTS AND METHODS: Between January 1994 and November 1998 thirteen patients with ciliary block glaucoma had been observed. Four underwent ultrasoundbiomicroscopy. RESULTS: Ciliary block glaucoma is caused by obliteration of the posterior chamber. Ultrasoundbiomicroscopy showed, that in phakic eyes the lens, in pseudophakic eyes the capsule together with the anterior vitreous membrane and in aphakic eyes the vitreous alone are the blocking agents. Hyperopia, a narrow iridocorneal angle and ciliary sulcus as well as plateau iris configuration and a history of miotics are the predisposing risks for ciliary block glaucoma, especially after additional surgery such as cataract extraction, iridotomy, iridectomy and trabeculectomy. Clinical features are always a raised intraocular tension accompanied with a flattening of the anterior chamber, which are to be differentiated from an angle closure glaucoma. This is easy, if iridectomy, irido-capsulovitreotomy or pseudophakia are present and difficult in the very rare spontaneous cases. Cycloplegics and YAG-laser iridectomy may break the ciliary block, but the most preferable therapy is lensectomy (phakic eyes) and partial removing of the anterior vitreous and a peripheral sector of lens capsule combined with an iridectomy. This is easily performed with the vitrector via pars plana. CONCLUSIONS: Ultrasoundbiomicroscopy starts to confirm the theories on ciliary block glaucoma and allows to assess the different modes of treatment. The most successful treatment is lens extraction and partial vitreo-capsulo-iridectomy via pars plana.

Aged↗