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PubMed1996

[Malignant ciliary block glaucoma after deep sclerotomy--ultrasound biomicroscopy imaging].

BACKGROUND: We present the case report of a patient who presented with malignant glaucoma following deep sclerectomy with collagen implant in both eyes. To assess the IOP spike mechanisms in ciliary bloc glaucoma, we performed ultrasound biomicroscopy before and after the second filtration surgery (right eye). MATERIALS AND METHODS: A 60-year-old hyperopic patient with bilateral medically uncontrolled open-angle glaucoma underwent deep sclerectomy with collagen implant in the left eye and one month later in the right eye. Both eyes presented postoperatively a ciliary bloc glaucoma. Ultrasound biomicroscopy was performed pre- and postoperatively during the malignant glaucoma crisis in the right eye. RESULTS: Preoperative ultrasound imaging showed an anterior rotation of the ciliary body. That disappeared with local application of cycloplegics. During the malignant glaucoma crisis, the ciliary body came again in touch with the lens, thus blocking the aqueous humor pathway to the anterior chamber. Malignant glaucoma occurred despite the nonperforation of the eye undergoing deep sclerectomy with collagen implant. CONCLUSIONS: In our patient, the anterior rotation of the ciliary body and its subsequent malignant glaucoma might be either a consequence of a ciliary muscle spasm due to postoperative inflammation or of acute IOP drop. Finally, in hyperopic eyes, the ciliary muscle may be hypertrophied due to constant accommodation.

Aqueous Humor↗
PubMed1989

[Acute psychosis caused by poisoning with cyclopentolate].

The authors report on a 17-year-old female patient who suffered an acute psychotic attack after local application of cyclopentolate 1.0% in both eyes. The literature is reviewed with regard to systemic side effects of local application of cyclopentolate. Toxicity of cyclopentolate may be found in every age group even if tolerated without side effects before and it has no specificity for patients with certain (especially brain) diseases. The rapid short-term cycloplegic effect and the rare cases of systemic toxicity support the authors opinion that cyclopentolate is a very useful and well-tolerated diagnostic substance.

Adolescent↗
PubMed1987

[Juvenile uveitis].

Chronic anterior uveitis in children suffering from juvenile rheumatoid arthritis may develop very early, when the patient is as young as two or three years old; it affects twice as many girls as boys. The arthritis is often localized in one joint (pauciarticular or oligoarticular form); Still's syndrome is very rare. Local treatment with cycloplegics and steroids has to be combined with systemic immunosuppressive medication with cyclophosphamide. Chronic intermediate uveitis (pars planitis) usually affects teenagers in good health. Peripheral fundus changes can be detected most easily by biomicroscopy with the three-mirror contact lens. Cystoid macular edema is frequent and, together with vitreous opacities, is responsible for a deterioration in central vision. In most cases local treatment with subconjunctival injection of depot steroids is sufficient. Immunosuppressive treatment or surgical intervention is only indicated in severe cases where there is a risk of complete loss of vision.

Arthritis, Juvenile↗
PubMed1987

[Fusion amplitude and aniseikonia. Experimental studies of aniseikonia tolerance in unilateral aphakia].

The fusion amplitude of image pairs with aniseikonia was measured using the synoptophore. Aniseikonia was produced in five subjects by alteration of slide drawings. The subject's right eye was in cycloplegia after paralysis with cycloplegic eye drops. To compare these measurements with aniseikonic pictures to those using the same image pairs without aniseikonia the fusion amplitude achieved was expressed as a percentage of the aniseikonia-free fusion amplitude. The relation between aniseikonia, eccentricity of the image borders and percent fusion amplitude was described using a mathematical approach. The experimental results reveal that a minimal increase in overall aniseikonia with greater eccentricities (greater than 5 degrees) leads to a rapid decrease in the fusion amplitude and the occurrence of diplopia. The aniseikonia tolerance level of images with greater eccentricities achieved experimentally and theoretically are in good agreement with results found in unilaterally aphakic patients.

Accommodation, Ocular↗
PubMed1980

[Liindner's method of cylinder retinoscopy without theory].

Brief description of Lindner's cylinder retinoscopy for practical application: The main criteria of this accurate method for checking refraction are the direction, shape, speed and brightness of the retinoscopic phenomena moving in the pupil of the examined eye. To determine astigmatism the use of plus cylinders is recommended. Difficulties may be due to the optical aberration at the periphery of a wide pupil, to a scissors phenomenon, and to optical irregularities of the senile lens, corneal opacities etc. In many cases retinoscopy can be performed well without using mydriatics and cycloplegics, respectively. Children must not be overstrained. Generally, final subjective checking is crucial for the prescription of corrective glasses. Mastery of Lindner's cylinder retinoscopy enables the eye specialist to keep refractometry with simple aids, as an essential part of the ophthalmological diagnosis, in his own hands, against the increasing claim of optometrists and opticians.

Adult↗
PubMed2000

Optic nerve hypoplasia and small eyes in presumed amblyopia.

PURPOSE: To assess the anatomy of eyes presumed to be amblyopic and their fellow eyes. PARTICIPANTS: Two hundred seventy-five patients diagnosed with amblyopia and 88 healthy or glaucomatous subjects. METHODS: All subjects underwent complete examinations, including cycloplegic refraction, slit lamp examination, ophthalmoscopy, and retinal imaging. Axial lengths were determined on 263 amblyopic and 88 healthy and glaucomatous subjects by ultrasonic biometry. MAIN OUTCOME MEASURES: Optic disc areas were determined by magnification correction of disc images performed with formulas. Dysversion of the optic disc was determined by simultaneous viewing of disc photographs, digitized images of both eyes, or both. RESULTS: The mean disc area of eyes presumed to be amblyopic was 1.72 mm(2) +/- 0. 73 SD and 1.95 mm(2) +/- 0.69 SD for nonamblyopic eyes (P =.0017). The mean disc area for 176 optic discs of glaucomatous and healthy eyes was 2.61 mm(2) +/- 0.95 SD. The mean axial length for eyes in the general population is 23.65 mm +/- 1.35 SD. The healthy and glaucomatous group in this study had a mean axial length of 23.89 mm +/- 1.29 SD. The eyes with poorer vision that were assumed to be amblyopic averaged 22.42 mm +/- 2.01 SD in length, whereas their nonamblyopic fellow eyes averaged 22.83 mm +/- 1.89 SD (P =.022). The differences between eyes in the healthy population and eyes that are presumably amblyopic, as well as the healthy and fellow eyes, are highly significant (P <.0001)(7.0 x 10(-16)). CONCLUSION: Vision impairment in presumed amblyopia is associated with optic nerve hypoplasia with relative microphthalmos, which is more notable in those eyes with poorer vision.

Adolescent↗
PubMed2001

Comparison of measured astigmatic retinoscopies from different lid specula.

PURPOSE: We wanted to study the effects of different lid specula on retinoscopy readings in the pediatric population. METHODS: We prospectively enrolled 29 patients from the Eye Clinic at The Children's Hospital of Denver who were being examined under anesthesia and met the inclusion criteria for the study. Any patient with ocular pathology that could affect the pliability of the sclera of both eyes was excluded. Patients with preexisting lid abnormalities or adnexal masses were also excluded. Cycloplegic retinoscopies were performed under anesthesia with the Barraquer wire and the Lancaster solid-blade specula. The amounts and the axes of the astigmatism were tabulated and statistically analyzed with the paired t test. RESULTS: A statistically significant difference occurred in the retinoscopies obtained from the 2 lid specula. The Barraquer lid speculum seemed to induce the least amount of astigmatism (P =.0001). CONCLUSIONS: There was a statistically significant difference in the amount of astigmatism found with each lid speculum. The choice of lid speculum in performing retinoscopies on the pediatric population can influence the final refraction and may have implications for visual outcome.

Adolescent↗
PubMed2001

Refractive surgery for unilateral high myopia in children.

PURPOSE: To evaluate the safety and efficacy of refractive surgery in children. METHODS: Pediatric patients with unilateral high myopia who were 9 years of age or older were offered refractive surgery to supplement optical correction. The patients and families were informed that the operation may not improve their best-corrected visual acuity. Photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) was performed on the more myopic eye with the use of topical anesthesia. Cycloplegic refraction, stereopsis, motility, and best-corrected visual acuity were measured before the procedure and at 2 months and 20 months after the procedure. All patients had completed amblyopia therapy before surgery. RESULTS: Fourteen eyes of 14 patients aged 9 to 14 years received refractive surgery. Average age at the time of surgery was 11.9 years (+/-1,6). Average corrected preoperative visual acuity was 20/147 (+/-0.065 in decimals). Average preoperative refraction was -7.96 D (+/-2,16) spherical equivalent. Twenty months after refractive surgery, the uncorrected visual acuity averaged 20/129 (+/-0.08 in decimals) and best-corrected vision averaged 20/121 (+/-0.08 in decimals). Average refraction was -0.46 D (+/-0,58) at 2 months and -0.67 D (+/-0,68) D at 20 months. An average myopic shift in refraction of -0.22 D was found in treated eyes during the 20 months of follow-up; this was not statistically significant (P =.69). Three patients had LASIK and 11 patients had PRK. LASIK patients averaged -0.875 D of myopic shift over 20 months of follow-up. Those with PRK averaged -0.025 D. This difference was not statistically significant (P =.10). The vision of 5 of 14 patients improved 1 or 2 lines after refractive surgery. Two patients who had 20/80 vision preoperatively improved to 20/60. No patients lost any lines of vision. Only 4 patients demonstrated stereopsis preoperatively, and all retained stereopsis postoperatively. No patient gained stereopsis. CONCLUSIONS: LASIK and PRK can be performed safely and effectively in children who are cooperative enough to undergo the procedures with topical anesthesia. Refractive surgery does not improve vision in densely amblyopic eyes but may give modest improvement in those that are mildly amblyopic. No significant complications were encountered aside from a myopic shift over time.

Adolescent↗
PubMed2002

Sensitivity of photoscreening to detect high-magnitude amblyogenic factors.

PURPOSE: To determine the sensitivity of a unique pupil-size based set of referral criteria of the MTI PhotoScreener(Medical Technology and Innovations, Inc, Cedar Falls, Iowa) to detect high magnitude refractive error. METHODS: The photoscreening photographs of 949 preschool children previously analyzed were reevaluated with the new referral criteria. The original photographs had been obtained from pediatricians' offices and public health and Women, Infants, and Children's (WIC) clinics. The results of this analysis were compared with the gold standard clinical examination and cycloplegic refraction. Sensitivities were calculated for amblyogenic factors based on the magnitude of the refractive error. RESULTS: For 26 patients with anisometropia, the sensitivity to detect anisometropia increased from 46% for +1.25 or greater spherical interocular difference to 100% for +2.50 spherical intraocular difference. For 36 patients with hypermetropia in at least 1 meridian ranging from +3.75 to +7.50 D, sensitivity increased from 53% to detect +3.75 D or greater to 70% for +5.00 D or greater. The sensitivity to detect hypermetropia of +5.75 D or greater was 100%. These criteria detected 82% of patients with astigmatism greater than or equal to +3.00 D, and 100% of patients with astigmatism greater than +3.50 D. CONCLUSION: It is crucial that screening programs avoid over-referrals caused by high false-positive screening rates. The sensitivity of our new criteria increases with higher magnitude refractive error; patients with moderate and severe amblyogenic factors are almost never missed. While the sensitivity to detect lower magnitude refractive error is poor, the amblyogenic impact of such errors remains to be determined.

Amblyopia↗
PubMed2003

Relationship between the axis and degree of high astigmatism and obliquity of palpebral fissure.

PURPOSE: To investigate a possible relationship between the slanting of palpebral fissures and the magnitude and axis of astigmatism in children with astigmatism. METHODS: Cross-sectional study at a referral center of 53 children with astigmatism of more than +1.50 D in at least 1 eye. Visual acuity testing, cycloplegic refraction, slit-lamp biomicroscopy, and ophthalmoscopy were done on every patient. Corneal topography was obtained in 40 cooperative patients. External photographs of the midface were taken in 45 children. The degree of slanting of the palpebral fissures was evaluated based on the photographs. The statistical analysis tool used was repeated measures analysis of variance. Patients in whom photographic analysis was not available were excluded from the part of the statistical analysis dealing with eyelid slant. RESULTS: Palpebral fissure slant (P =.013) and gender (P =.0005) were highly correlated with the obliquity of cylinder axis. There was a possible correlation between gender and eyelid slant (P =.0594), with females having slightly larger degrees of upward palpebral fissure slanting and male more downward slanting of their fissures compared to published angles in an age-matched population. We found a statistically significant correlation between the degree of total astigmatism and a larger abnormal slant (P =.0192) and between the axis and magnitude of corneal astigmatism and abnormal slant (P =.0092). Higher degrees of eyelid slant (> 8 degrees or < -4 degrees ) increased the risk of high cylinder magnitude (> 3.00 D) by an odds ratio of 4.17 (95% CI: 1.03, 19.95). CONCLUSIONS: Children with astigmatism with large degrees of slanting of their palpebral fissures are at higher risk for high astigmatism (> 3.00 D). The axis of the astigmatism is highly correlated with the slanting of the palpebral fissure.

Adolescent↗
PubMed2004

Refractive evaluation in children with growth defect.

PURPOSE: Growth hormone (GH) is considered essential for postnatal somatic growth, exerting its effects on growth by hepatic production of IGF-I. IGF and other growth factors interact with the developing ocular tissues by influencing the synthesis of the extracellular matrix of the sclera and by inducing angiogenesis. The association between optic nerve hypoplasia, reduced retinal vascularization and GH deficiency (GHD) is well known. The purpose of this study is to evaluate the possible influence of congenital GHD on the refraction and on the emmetropization process. METHODS: Eighty children with congenital GHD had a thorough ophthalmologic examination, including cycloplegic refraction and axial length measurement. As a control group we enrolled 483 healthy children. RESULTS: In accordance with other epidemiological studies, the control group showed a slightly myopic mean defect; on the contrary, in GHD group we found a hyperopic defect, related to a shorter axial length, with statistically significant differences. CONCLUSIONS: Our findings emphasise the possible role of growth hormone in ocular development, and its interaction with the physiological process of emmetropization.

Adolescent↗
PubMed2001

Familial clustering and myopia progression in Singapore school children.

BACKGROUND: Familial factors may be related to the progression of myopia in children. A cohort study was conducted to determine the relationship between familial factors and myopia progression in children. METHODS: From a larger clinical trial (n = 311), 153 Singapore children aged 6--12 years were recruited to participate in a cohort study of the risk factors for myopia progression. An in-person interview was conducted whereby information on the history of myopia in first-degree relatives was obtained. Other information collected included housing type, parental education and income. Cycloplegic refractive error as measured by subjective refraction and autorefraction were ascertained every six months. The average length of follow-up was 28 months. RESULTS: The adjusted mean rate of progression of myopia was -0.60 (95% confidence interval -0.66, -0.55) diopters per year. The average rate of progression of myopia for children with a parental history of myopia was -0.63 (95% confidence interval -0.69, -0.56) diopters per year compared to -0.42 (95% confidence interval -0.57, -0.27) diopters per year for children whose parents were not myopic. The different measures of family history of myopia were related to rate of change in refractive error and refractive error in the final visit. There was no association between close work and myopia progression. CONCLUSIONS: A positive family history is related to the progression of myopia and final refractive error in Singapore children, thus supporting evidence that hereditary factors may play an important role in myopia progression.

Child↗
PubMed2003

Emmetropisation in normal and strabismic children and the associated changes of anisometropia.

The purpose of this study was to measure whether emmetropisation failed in children who had strabismus irrespective of their refraction in infancy, and to record simultaneous changes in anisometropia. We also report how often hypermetropia increased before these children presented with esotropia. A total of 2920 infants had a cycloplegic retinoscopy at age 5-7 months and again at 42 months or when defective vision was identified. Changes of refraction in 210 children with strabismus are compared with the remaining 2710 who did not. When the spherical equivalent of the fixing eyes was > +2.75 D in infancy, hypermetropia decreased less in both eyes of those who had microtropia (p <.001) and heterotropia (p <.001) than in normal children. When it was < +2.75 D, the spherical and/or cylindrical refraction more often remained outside the 'normal' range in both eyes of those who had microtropia and heterotropia (p <.05). Emmetropisation was deficient in both eyes of at least 80% of these strabismic children irrespective of their refraction in infancy. Furthermore, in the strabismic children, the mean change of refraction was less (p <.05) in their fellow eyes than in their fixing eyes, the difference between the two eyes being on average three times greater than that in those who had normal vision. Thus, anisometropia increased in 53% of those who had strabismus but remained within normal limits (< ca. 0.75 D spherical equivalent) in 94 % of those who did not. 'Abnormal' anisometropia in infancy did not, per se, permanently affect vision because 72% of all those who had it did not have strabismus. Finally, the spherical hypermetropia of fixing eyes increased in only 35% of the children with esotropia - similar to the incidence in those who had a microtropia (p =.36). This does not obviously support the concept that increasing hypermetropia causes accommodation to increase before convergence.

Accommodation, Ocular↗
PubMed2001

Changes in refraction in anisomyopic patients.

PURPOSE: The purpose of this study was to investigate the evolution of refraction and visual function in patients with myopic anisometropia. DESIGN: A retrospective study on a selected population. METHODS: Forty-six anisomyopic patients underwent a complete ophthalmologic examination (cycloplegic refraction, visual acuity, ocular movement and fundus examination). RESULTS: The results show two different patterns of changes in refraction between the two eyes; in the same patient, the less myopic eye tends to get more myopic, while the more ametropic eye shows a more stable refraction. Furthermore, a recovery of binocular vision and amblyopia can be obtained by occlusion and full-time refractive correction. CONCLUSIONS: The evolution of refraction seems to be different in eyes with anisometropia and it is still to be understood whether it is fixation or reduced fixation that leads to a myopic shift.

Anisometropia↗
PubMed1987

Chemical injuries to the eyes. Emergency, intermediate, and long-term care.

The first step in treatment of chemical injuries to the eyes is immediate, thorough, and if necessary, prolonged irrigation. Ophthalmologic consultation should be obtained early in the course of treatment, and in severe injuries an anterior chamber tap (paracentesis) may be of benefit. Topical cycloplegics and antibiotics should be administered and a "bandage" contact lens placed to protect the corneal epithelium. If the eyelid is involved, care must be taken to protect the cornea and provide a moist local environment. Long-term care of the severely injured eye is fraught with difficulties, including glaucoma and recurrent corneal ulcerations.

Acids↗
PubMed1989

Acute iritis. How to preserve good vision.

Acute iritis, which is often seen in young adults, may cause red eye, photophobia, and aching discomfort. Many times, the condition can be ameliorated or completely reversed by cautious use of cycloplegic agents and corticosteroids. However, undiagnosed or improperly treated iritis can lead to glaucoma and loss of vision.

Adrenal Cortex Hormones↗
PubMed2006

Familial voluntary nystagmus.

PURPOSE: To examine the pathological significance and familial occurrence of voluntary nystagmus. PATIENTS AND METHODS: We examined two families orthoptically as well as with video and search-coil techniques or electronystagmography (ENG). Three members of three generations of the first family and a 9-year-old boy from a second family not related to the first were able to generate a voluntary horizontal nystagmus. RESULTS: The characteristics of the nystagmus of our original patient, his daughter and 8-year-old grandson (1st family) were remarkably similar: duration of 2-5 seconds, amplitudes of 1-4 degrees and frequencies around 15 cycles/second. In the second family, our patient with a congenital esotropia and hyperopia was the only one of his family who could voluntarily produce a nystagmus of about 5 degrees and 10 cycles/second for maximum of 20 seconds. During prolonged reading, the same nystagmus with disturbing oscillopsia developed involuntarily and was not suppressible. We added +0.75 diopters to both lenses of his spectacles to account for the result of our cycloplegic refraction. This stopped the involuntary nystagmus during near fixation. DISCUSSION: To avoid unintentional "bouts" of voluntary nystagmus, a reduction of the convergence impulse by plus-lenses may be effective. The parameters of voluntary nystagmus can be considered family-specific.

Aged↗
PubMed2006

Patterns of eyecare utilization by young Australian children: findings from a population-based study.

OBJECTIVES: To report factors associated with childhood eyecare utilization in a random sample of 1740 Sydney schoolchildren aged 6, examined during 2003-4. METHODS: Information on use of eyecare services, defined as any previous consultation with an ophthalmologist or optometrist, was sought from parents. Children had comprehensive eye examinations, including visual acuity (VA), cover testing, cycloplegic refraction and dilated fundus examination. RESULTS: Prior ophthalmic or optometric assessment was reported by 465 children (29.2%), and was not associated with gender (p = 0.9), parental employment (p = 0.4) or home ownership (p = 0.9). Children of East Asian (odds ratio, OR, 0.7, 95% confidence interval, CI, 0.5-0.9) or other ethnicities (OR 0.7, CI 0.6-1.0) were less likely than European Caucasian children to have been examined. Parent-expressed concern about their child's vision was associated with a 10-fold increased likelihood of previous eye examination (OR 10.2, CI 7.3-14.5). Complaints of eyestrain were associated with a 4-fold increase (OR 4.4, CI 3.2-5.9). Most children with VA < 20/40 in at least one eye (63.1%), amblyopia (80.0%) or strabismus (86.4%) had been assessed. CONCLUSIONS: One third of this childhood sample reported prior examination by an eyecare professional. Given that most children needing vision assessment had been examined and likely effects of parental motivation, this rate seems reasonable and appropriate.

Australia↗