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PubMed2004

Duration and effect of single-dose atropine: paralysis of accommodation in penalization treatment of functional amblyopia.

BACKGROUND AND PURPOSE: Atropine dilates the pupil and paralyzes the ciliary muscle accommodation, blurring vision, and therefore is an effective penalization of the sound eye in the treatment of functional amblyopia of the other eye. The degree of blur induced is a function of the amount of the patient's uncorrected hyperopia and the distance from the eye of the viewed material or object. Another factor determining effectiveness of atropine penalization is the duration of the effect of the atropine. It is the purpose of this study to investigate these factors. METHODS: Six normal children underwent complete eye exam with cycloplegic refraction several days before deliberate instillation of atropine 1% in the sound, or right eye. Distance and near acuity was then tested after 30 minutes, and on subsequent days. Additional data points were derived by placing known minus lenses in front of the tested eye. In addition, we also studied one successfully treated amblyopic patient when he terminated chronic daily atropine in his normal, sound eye. RESULTS: Atropine initially produced a linear reduction in logMAR acuity (blur) at distance of about 0.2 logMAR lines per diopters of uncorrected hyperopia. The magnitude of the blur was greater for near, but the effect of increased hyperopia was slightly greater for distance measurements. This blurring of acuity lasted just less than 48 hours for normal subjects, and just over 48 hours following prompt cessation of chronic daily atropine in that one subject. Regression formulae were derived relating uncorrected hyperopia and time interval following atropine cessation on distance and near acuity in children of amblyopic age range. CONCLUSION: The degree of penalization is highly dependent on the uncorrected hyperopic refractive error. A significant penalization effect is present only for one day or so. Daily atropine is therefore indicated for penalization. To better tailor penalization therapy to target sound eye acuity blur, these formulae and graphs can be used, specifically, in addition, to determine the amount of deliberate spectacle hyperopic undercorrection to maximize the penalization effect.

Accommodation, Ocular↗
PubMed2004

[The study of photorefractive keratectomy induced defocus on emmetropization in infant monkeys].

OBJECTIVE: To investigate the effect of photorefractive keratectomy (PRK) induced defocus on emmetropization in infant rhesus monkeys and to determine the role of visual feedback on emmetropization. METHODS: PRK was performed in 8 healthy rhesus monkeys age ranging from 2 to 3 months. Either 3.00 D of relative hyperopic or myopic defocus was produced in one eye and the fellow eye as controls. The eyes were examined periodically with corneal topography, cycloplegic retinoscopy, A-scan ultrasonography, and slit-lamp biomicroscopy. RESULTS: All operated eyes demonstrated re-epithelialization within 3 days post-surgically and maintained transparent. Compensating axial length growth occurred throughout the observation period. The rate of vitreous chamber elongation varied with the post-PRK refractive status of the eye. The hyperopia-induced eyes exhibited a vitreous chamber elongation faster than the fellow eyes (t = 3.656, P = 0.0354), whereas myopia-induced eyes demonstrated a vitreous chamber elongation slower than the fellow eyes (t = 3.576, P = 0.0374). CONCLUSIONS: PRK-induced-defocus altered axial growth rates and emmetropization in infant monkeys predictably. These results indicate that primate emmetropization is regulated by visual feedback and correction of refractive error on children should be careful. PRK-induced-defocus is a promising method for myopic animal model and for the investigation of vision science.

Animals↗
PubMed2004

[The combination of positive cylinders with negative cylinders in the detection of mixed astigmatism].

OBJECTIVE: To study clinical retinoscopy combined positive cylinders with negative cylinders in the detection of mixed astigmatisms. METHOD: 189 cases (340 eyes) with mixed astigmatism were divided into three groups (< 3.00 D; 3.00 approximately 6.00 D; > 6.00 D). There are 156 eyes with mixed astigmatism less than 3.00 D (76 eyes in experiment group, 80 eyes in control group); 132 eyes with mixed astigmatism between 3.00 D to 6.00 D (68 eyes in experiment group, 64 eyes in control group) and 53 eyes with mixed astigmatism over 6.00 D (29 eyes in experiment group, 24 eyes in control group). They were examined with cycloplegic retinoscopy. Retinoscopy of combined positive cylinders with negative cylinders was applied in experiment group, while conventional retinoscopy was used in control group. According to the shape of neutralized image, the accuracy and facility of the axis judgement, operating time and the number of combined lens, the result of retinoscopy was classified into three grades. Grade I: The shape of neutralized image is well distributed. The axis is easy to be evaluated precisely. Operating time is less than five minutes and only need one or two piece of lens. Grade II: The shape of neutralized image is not so well distributed. The axis is not difficult to be evaluated. Operating time is from five to ten minutes and needs two or three piece of lens to combine with. Grade III: The shape of neutralized image is not so well distributed and would be interfered by the combined lens or other factors easily. The axis is difficult to be evaluated precisely. Operating time is more than ten minutes and needs more than three piece of lens to combine with. RESULT: In the group of mixed astigmatism less than 3.00 D, no significant difference was found between experiment group and control group. (chi(2) = 0.094, P = 0.759). However, significant difference (chi(2) = 5.546, P = 0.019) was found between the groups with mixed astigmatisms from 3.00 D to 6.00 D and very significant difference (chi(2) = 8.509, P = 0.004) was found between the groups with mixed astigmatisms over 6.00 D. CONCLUSION: Retinoscopy of combined positive cylinders with negative cylinders is an effective, convenient and precise method for detection higher degree mixed astigmatisms. It's an additional assistance for the conventional retinoscopy.

Adolescent↗
PubMed2004

[Effects of flashing light on ocular growth and development of myopia in pigmented guinea pigs].

OBJECTIVE: To investigate the effects of flashing light exposure on ocular growth and development of myopia in guinea pigs. METHODS: Thirty 4-week-old pigmented guinea pigs were randomly divided into three groups. Animals in group I were reared with the flashing light continuously and lasted for 6 weeks. The flashing frequency was 15 times per minutes and every flash includes 2 seconds light on and 2 seconds dark. Animals in group II and III were reared with normal light on, and the illumination cycle was 12 hours light/12 hours dark in group II and 24 hours light in group III. After 6 weeks, the effects of flashing light on eye development were assessed by cycloplegic retinoscopy, a-scan ultrasonography and eye weight. The histopathology changes of sclera, choroids and retina in posterior pore of the eye were examined using light microscope and transmission electron microscope. RESULTS: At the end of the treatment period, guinea pigs reared in flashing light exhibited -7.00 D myopia, eye axial elongated 0.56 microm, and the weight increased 68 mg. The histopathology examination showed that the posterior sclera fibroblast become more active, the cell number increased, and the place between fibers became larger, the posterior choroids became thinned, and the outer membrane of photoreceptor cells became shorter and irregular, when compared with the control groups. CONCLUSION: Flashing light can promote ocular growth and induce myopia in pigmented guinea pigs.

Animals↗
PubMed2004

[Long-term evaluation of laser in situ keratomileusis for extremely high myopia].

OBJECTIVE: To evaluate the long-term efficacy and safety of laser in situ keratomileusis (LASIK) for extremely high myopia (with a preoperative refraction more than -10.00 diopters). METHODS: 173 eyes of 99 patients with a mean spherical equivalent (SE) of (-13.70 +/- 3.60) D (range -10.00 approximately 23.50 D), including 41 eyes with more than -15.00 D, were treated with LASIK and followed up for more than 18 months. The examinations included slitlamp microscopy, fundus examination, Orbscan II corneal topography system, tonometry, pachymetry, cycloplegic and subjective refraction. RESULTS: At 18 months postoperatively, the uncorrected visual acuity (UCVA) was 0.5 or better in 148 eyes (85.6%), and the best spectacle-corrected visual acuity (BSCVA) remained the same or increased in 147 eyes (84.4%). No eye lost more than two lines of BSCVA. 109 eyes (63.0%) were within +/- 1.00 D of emmetropia. The percentage was 73.5% and 29.3% in eyes with a preoperative SE of less than -14.75 D and more than -15.00 D, respectively. Postoperatively, the posterior corneal surface bulge was detected in all eyes. The mean elevation of the posterior corneal surface against the best-fit sphere was (0.029 +/- 0.010) mm preoperatively, (0.069 +/- 0.031) mm at 3 months, (0.065 +/- 0.025) mm at 18 months. At final follow-up, corneal flap folds were found in 2 eyes, and 6 patients (10 eyes) complained of glare or decreased scotopic vision. CONCLUSION: LASIK appeared to be an effective and safe treatment for correction of extremely high myopia. Meanwhile the candidates should be carefully screened.

Adult↗
PubMed2004

Photorefractive keratectomy for anisometropic amblyopia in children.

PURPOSE: To assess the safety and efficacy of photorefractive keratectomy (PRK) in children with anisometropic amblyopia and to define the characteristics of children who may be candidates for PRK. METHODS: This thesis comprises four parts: (1) a retrospective analysis of risk factors predictive of amblyopia treatment failure in 104 children, (2) a prospective study of pachymetry in 198 eyes of 108 children, (3) development and implementation of a protocol to perform PRK under general anesthesia, and (4) a prospective interventional case-comparison study of PRK in 11 noncompliant children with anisometropic amblyopia to evaluate safety and long-term outcomes. Compliant and noncompliant children with anisometropic amblyopia were analyzed as controls. RESULTS: Factors associated with conventional anisometropic amblyopia treatment failure were poor compliance (P = .004), age 6 years or older (P = .01), astigmatism > or = 1.5 diopters (P = .0002), and initial visual acuity of 20/200 or worse (P = .02). Central and paracentral pachymetry measurements were similar to published adult values. The general anesthesia protocol was efficient, and the laser functioned properly in all cases. All children did well with no anesthesia-related or treatment-related complications. Two years following PRK, the mean reduction in refractive error was 9.7 +/- 2.6 diopters for myopes (P = .0001) and 3.4 +/- 1.3 diopters for hyperopes (P = .001). The cycloplegic refractive error in 9 of 11 treated eyes was within 3 diopters of that in the fellow eye. Uncorrected visual acuity in the amblyopic eye improved by > or = 2 lines in seven of nine children; best-corrected visual acuity improved by > or = 2 lines in six of nine children. Stereopsis improved in five of nine children. The mean visual acuity of the PRK patients at last follow-up was significantly better than that of noncompliant controls (P = .003). The safety and efficacy indices for PRK in this study were 1.24 and 1.12, respectively. CONCLUSIONS: Photorefractive keratectomy can be safely performed in children with anisometropic amblyopia. Visual acuity and stereopsis improved in most eyes, even in older children. Photorefractive keratectomy may have an important role in the management of anisometropic amblyopia in noncompliant children.

Amblyopia↗
PubMed1992

Treatment of common eye emergencies.

Some ocular conditions represent serious emergencies requiring immediate treatment. Chemical exposure requires prompt irrigation with saline. Major trauma with possible globe perforation requires eye shielding and referral for surgical evaluation. Sudden loss of vision may represent vascular occlusion and should be evaluated promptly by an ophthalmologist. Angle closure glaucoma is rare; drug treatment may be instituted in consultation with an ophthalmologist. Patients with orbital cellulitis should be hospitalized for intravenous antibiotic therapy. Less urgent eye conditions can be treated within 24 hours of onset. Minor trauma with hyphema requires cycloplegic medications, eye shielding and ophthalmologic consultation. Visual floaters, light flashes or "curtains" may represent vitreous or retinal detachment and should be evaluated by an ophthalmologist. Foreign bodies can usually be removed by irrigation or careful instrumentation.

Emergencies↗
PubMed2005

[The evaluation of visual disorders in preschool children].

OBJECTIVE: The purpose of this study was to investigate the visual disorders and their causes in preschool children. MATERIALS AND METHODS: We have examined 839 children of 2-6 years. They were divided into two age groups: of 2-3 years (I gr.) and of 4-6 years old (II gr.). We estimated the visual acuity at 3m distance, binocular vision, refractive status by cycloplegic skiascopy (sol. cyclogyli 1% x 2). RESULTS: Impaired vision was found in 14.94% of children, but it was significant in the second group (p<0.05); binocular vision was absent in 4.2% of the children. The evaluation of refraction showed that the cause of visual disorders was hyperopia of various degree (43.26%), hyperopic astigmatism (23.08%), spasm of accommodation (14.42%). The second group had significantly more cases of astigmatism and spasm of accommodation (27.38% and 16.67%, respectively), less common--strabismus (1.19%); it was significantly different from the first group (p<0.05). CONCLUSIONS: Visual disorders were diagnosed in 14.94% of 2-6 years children. Impaired vision of preschool children was caused by the ocular ametropias (hyperopia of various degrees, astigmatism) and disorders of accommodation.

Age Factors↗
PubMed2001

Threshold retinopathy of prematurity: ocular changes and sequelae following cryotherapy.

PURPOSE: To determine ocular changes and sequelae following cryotherapy for threshold retinopathy of prematurity (ROP). METHODS: This is a retrospective study of 49 eyes of 26 premature babies with threshold ROP treated with cryotherapy between 1995 and 1998. All eyes included in the study had favourable structural outcome after cryotherapy. Follow-up examination of all babies was done 12 - 62 months (average 28 months) after cryotherapy. Visual axis, fixation pattern, anterior segment examination, cycloplegic refraction and dilated fundus examination with indirect ophthalmoscopy were undertaken in all eyes during follow-up. RESULTS: Posterior pole retinal residuae observed following cryotherapy were tortousity of blood vessels in 32 (65.3%), narrow temporal arcade in 22 (44.89%), temporal crescent in 17 (34.69%), disc drag in 13 (26.53%) and macular heterotopia in 7 (14.28%) eyes. Myopia was observed in 20 (40.82%) eyes and strabismus in 5 (19.23%) babies. The significant risk factor for ocular changes was ROP with more clock hours of involvement (p < 0.05). Higher period of gestation was associated with posterior pole changes (p< 0.05). CONCLUSIONS: All premature babies with threshold ROP treated with cryotherapy require frequent and long-term follow up to look for retinal residuae, refractive status, and ocular motility disorders.

Cryotherapy↗
PubMed2005

Choroidal detachment after filtering surgery.

BACKGROUND: The purpose of this study is to report the treatment and outcome of eight cases of choroidal detachment, which occurred several days to many years after trabeculectomy. METHODS: This is a retrospective study of eight cases of choroidal detachment after trabeculectomy with or without cataract extraction reviewed at CGMH, Keelung, from 2002 to 2004. One eye with idiopathic scleromalacia with chronic uveitis and secondary glaucoma, five eyes with primary open angle glaucoma and two eyes with chronic angle closure glaucoma after trabeculectomy were reported. Six of the eight cases developed acute onset choroidal detachment within two weeks after surgery. The other two cases suffered from choroidal detachment many years after trabeculectomy for different reasons. Regarding the types of operation, combined glaucoma and cataract surgery was performed in five cases and intraoperative application of adjunctive mitomycin C was used in two cases. Decrease in vision acuity and varying degrees of eye pain with a flat or shallow chamber were noted in all cases. Associated hypotony was found in six of the eight cases. The treatment included topical cycloplegic corticosteroid and oral corticosteroid. RESULTS: Choroidal detachments were improved or complete resolution obtained after medical treatment for about three weeks to one month in all cases. But persistent poor control of intraocular pressure was found in two cases. Ultrasonography was used as a reliable tool to confirm the diagnosis and resolution of choroidal etachment in cases of blurred fundus examination and synechiae miotic pupil. CONCLUSIONS: Choroidal detachment is one of the complications after trabeculectomy. The diagnosis of choroidal detachment can be confirmed most reliably by ultrasonography. Medical therapy is effective for resolution.

Adult↗
PubMed2005

Ocular profile among hearing impaired children.

OBJECTIVE: To report ocular abnormalities among identified hearing impaired children and their prevalence in relation to normal hearing children. METHODS: A sample of 302 identified children with bilateral sensorineural hearing loss at King Abdul-Aziz University Hospital and Rehabilitation Medical Center of the Ministry of Health, Riyadh, Kingdom of Saudi Arabia, after full audiological assessment, aged below 15 years, were screened ophthalmologically during the period from December 1997 to December 2002. Visual testing and cycloplegic refraction using 1% Cyclogyl was performed followed by retinal examination using direct and indirect ophthalmoscopy. Electroretinography was recorded for those with retinal pigmentary changes. One hundred control normal hearing children were examined, and chi square test applied. RESULTS: A total of 302 hearing impaired children were examined, 199 (66%) were boys and 103 (34%) were girls, age ranged between 2-15 years. Hearing loss was bilateral severe to profound. One hundred and eighty-four (61%) have one or more ocular abnormalities, while 147 (48.7%) had one or more significant error of refraction. In the control cases, 23% had error of refraction with a chi square test of 20.2 (p<0.001), which is significant. CONCLUSION: Ocular anomalies are more commonly found among deaf children than those with normal hearing. Early ophthalmological assessment of hearing impairment is advisable to detect any ocular anomalies, followed by correction to help in the academic performance of these children.

Adolescent↗
PubMed2005

Spontaneous resorption of an insect hair in the corneal stroma: a case report.

A case of keratitis, due to an insect hair penetrating into the deep cornea, was reported. The patient felt right ocular pain while riding a motorcycle, as an insect struck into his eye. On examination, an insect hair was seen embedded into the corneal stroma with severe corneal edema, which caused a visual acuity of the right eye decreased to hand motion. The patient was treated by a topical antibiotics, cycloplegics, and anti-inflammatory drugs, without removing the hair. After a 6-week follow-up period, there was a spontaneous resorption of the hair. There was no apparent toxic sign during 6-months of follow up, and the visual acuity improved to 6/6. The insect hair could be left in the deep cornea with careful observation, and spontaneous resorption can occur.

Aged↗
PubMed2005

[Comparison of retinal morphology and ultrastructure in defocus-induced myopia and form-deprivation myopia in rhesus monkeys].

OBJECTIVE: To investigate the changes of retinal ultrastructure of defocus-induced myopia and form-deprivation myopia in infant rhesus monkeys. METHODS: A -3.00 D spectacle lens (n = 9) or diffuser lens (n = 6) was worn over one eye and a zero-powered lens over the fellow eye in 15 healthy rhesus monkeys ranging in age from 1 to 1.5 months. The eyes were examined periodically with corneal topography, cycloplegic retinoscopy, A-scan ultrasonography, and optical coherence tomography (OCT). Three months later, light and electron microscope were used to observe the changes of the retina. RESULTS: In 15 monkeys, all eyes treated with -3.00 D spectacle lens or diffuser lens developed defocus-induced myopia or form-deprivation myopia. Not only defocus-induced myopia, but also form-deprivation myopia showed elongation of rod outer segment, decreased membrane disc of cone outer segment, increased clearance of the membrane disc and decreased thickness of the neurosensory retina (RNL) as compared with the control eyes (P < 0.05). There were no significant differences between the mean OCT and histomorphometric thickness of RNL and retinal pigment epithelium (RPE) after the correction of dehydration (P > 0.05). CONCLUSIONS: There are significant differences in retinal ultrastructure between experimental myopic eyes and control eyes. But the morphological changes in the retina of the defocus-induced myopia showed no significant difference as compared with form-deprivation myopia. The role of changes of retinal ultrastructure in the development of myopia needs further studies. OCT can be used to examine the changes of RNL and RPE in experimental myopia in vivo.

Animals↗
PubMed2005

[Changes of axial dimensions of the eye during growth in emmetropia, myopia and hyperopia].

PURPOSE: The aim ot this study was to evaluate changes ot axial dimensions ot the eye during growth in emmetropia, myopia and hyperopia. MATERIAL AND METHODS: We examined 183 children (363 eyes) aged 4 to 19 with emmetropia, myopia and hyperopia. All measurements were performed after cycloplegia with 1% tropicamidum (Polfa Warszawa). Total and corneal refraction was examined with autokeratorefractometer (Nikon NRK-8000). Then we used ultrasound biometer Ocuscan (Alcon, USA), to measure axial length of the eye, axial length of the vitreous cavity, axial dimension of the lens and axial depth of the anterior chamber. RESULTS AND CONCLUSIONS: 1. Growth of the axial length of the emmetropic eyes is finished at the age of 12, in hyperopic eyes in the age of 11 and in myopic eyes growth is proportional until the age of 14 and then significantly accelerates. 2. Growth of the axial length is mainly caused by increasing axial length of vitreous cavity. A little role in human eye growth is also played by increasing depth of the anterior chamber. 3. Between 4 and 19 years old, mean cycloplegic axial dimension of the lens is slightly decreasing in emmetropic and hyperopic eyes, whereas in myopic eyes is constant.

Adolescent↗
PubMed2004

[Chemical injuries of the eye - management of alkali burns.].

Chemical injuries are among the most severe injuries to the eye. Young men are most often affected. Work related injuries are more common than other types of injuries. Immediate treatment is paramount in preventing blindness. In the case of an alkali injury, an opaque cornea and a white edematous conjunctiva indicate a serious injury. In contrast, a clear cornea and a mildly to moderately irritated conjunctiva indicate a better prognosis. Copious irrigation is always the first treatment for all chemical injuries to the eye. Irrigation should be initiated as soon as possible and is to be continued until the tearfluid has regained a normal pH. Antibiotic ointment, lubrication and cycloplegic drops (e.g. Cyclogyl(R)) form the basis of treatment.

English Abstract↗
PubMed2006

[Diode laser photocoagulation for retinopathy of prematurity--outcomes in one-year observation].

PURPOSE: To evaluate structural and functional outcomes in one-year old patients, treated for retinopathy of prematurity (ROP) with transpupillary diode laser photocoagulation. MATERIALS AND METHODS: 58 children (116 eyes) 12 months old, after treatment for ROP with diode laser photocoagulation, were examined. Both, functional outcome (visual acuity--basing on the examination with Teller Acuity Card Procedure), and structural outcome were evaluated. The cycloplegic refraction was examined in all cases. RESULTS: We have found good functional outcome in 81.9%, and good structural outcomes in 96.5% of examined eyes. 64.6% of eyes had hyperopic refractive error, and 31% were myopic. CONCLUSIONS: Diode laser photocoagulation is an effective method of treatment for ROP.

Female↗
PubMed2006

[The use of tissue plasminogen activator in the post-operative treatment of fibrinoid uveitis].

PURPOSE: To evaluate the efficacy and safety of tissue plasminogen activator in management of postoperative fibrinous uveitis. MATERIAL AND METHOD: Prospective study, interventional case series including 13 patients who developed fibrinous membrane in anterior chamber; patients were operated for cataract (4 cases), for cataract and glaucoma (7 cases) and for corneoscleral lacerations (2 cases). Initial treatment consisted of corticosteroid administration (topically, subconjunctival +/- systemic) and mydriatic-cycloplegic drugs. Inadequate response imposed intracavitary administration of tissue plasminogen activator (25 microg/ml, 0.2 ml). The main outcomes were: complete resolution of fibrinous membrane, presence of adverse events and visual rehabilitation. RESULTS: Fibrinous membrane resorption starts in the next hours and complete resolution was proved in all cases after a mean time 53.55 +/- 37.65 (24-146) hours. In 12 patients we used only one administration of tissue plasminogen activator, but in one case we repeated it. It was not signaled any adverse event drug related. It was an important increase of visual acuity in all cases. CONCLUSION: Intracavitary administration of tissue plasminogen activator is a safe and efficient alternative in the management of postoperative fibrinous membrane.

Adrenal Cortex Hormones↗
PubMed2006

Graded unilateral supramaximal medial rectus recession for moderate angle esotropia.

BACKGROUND AND PURPOSE: Recession of a single medial rectus muscle may be appropriate for certain cases of esotropia. However, the procedure has not been widely accepted nor widely studied, and most reports have dealt with conventional recessions (3.5-6 mm) for small angle esotropia. We reviewed our patients who underwent unilateral supramaximal (6-8 mm) medial rectus recession for both small and medium angle esotropia. DESIGN: Observational case series. METHODS: The records of 56 consecutive patients, undergoing single eye muscle surgery for esotropia, ranging in age from 1 to 11 years were selected and analyzed. All patients had a constant esotropia, despite full cycloplegic refractive correction, measuring 15-40 prism diopters (mean=25.82) at distance and 18-45 prism diopters (mean=30.71) at near. Each patient underwent a graded unilateral medial rectus recession of 6-8 mm. RESULTS: 48/56 (86%) patients achieved "successful" binocular motor alignment (defined as 0-8 prism diopters residual esotropia at the most recent postoperative visit with a minimum of 5 months and an average of 32 months postoperative followup). The average unilateral medial rectus recession performed was 7.4 mm. Five patients (9%) were overcorrected, (defined as any amount of consecutive exodeviation). CONCLUSION: Unilateral supramaximal medial rectus recession appears to be a safe and effective treatment for medium angle non-accommodative esotropia, and has advantages for both patient and surgeon.

Child↗