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PubMedDate not supplied

Ocular toxicity of systemic chemotherapy with megadoses of carmustine and mitomycin.

The use of chemotherapeutic agents in high doses in the treatment of advanced-stage cancer enhances drug toxicity, and ocular complications are not uncommon. In this article, we discuss the ocular toxicity in six patients with advanced nonpretreated colorectal cancer who received megadoses of carmustine and mitomycin with the support of autologous bone marrow transplantation. The results obtained did not reveal any subjective or objective pathologic conditions of the ocular apparatus with particular attention to orthoptic examinations, the anterior segment, and the fundus. No patient had changes in visual acuity. Tonometry did not demonstrate significant variations. There were, however, qualitative and quantitative changes in the tear films of all patients, leading to damage to the corneal and conjunctival epithelium.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

[Late complications and functional results at least 5 years following pars plana lentectomy for congenital cataract].

Pars plana or pars plicata lentectomy was introduced for congenital cataract at the University Eye Clinic of Freiburg 12 years ago. Records of 32 patients (48 eyes) who were operated on during a period of 7 years were retrospectively analyzed to determine the anatomical and functional results in comparison to previous methods of treatment for congenital cataract. The documented follow-up was at least 5 years long (maximum 11 years, mean 7.3 years). Seventeen patients had bilateral, 15 patients monolateral cataract operations. Thirteen eyes were operated on during the first 2 months of life, and 31 of the 48 eyes during the first year. Sixteen of the 48 eyes had additional malformations, like microphthalmus, different stages of persistent hyperplastic primary vitreous, or anterior chamber malformation. Visual acuity was at least 20/50 at the last visit in 3 of 15 eyes after monolateral lentectomy and in 19/33 eyes after bilateral lentectomy. Twenty-four children are now able to attend a regular school; only one child is attending a school for the visual handicapped; another child attends a school for deaf children. Postoperatively, secondary cataract or a retropupillary membrane was found in two eyes. Glaucoma developed in two eyes, requiring additional surgery. Postoperative retinal detachment caused by a giant tear complicated the postoperative course in one case. The anatomic results turned out to be better than after discission and aspiration with fewer postoperative complications like secondary cataract, glaucoma, or retinal detachment. The functional outcome is mainly dependent on good postoperative orthoptic and pleoptic management of the children.

Adolescent↗
PubMed1994

[Severe cardiomyopathy revealing amylopectinosis. Two cases in adolescents from the same family].

Type IV glycogen storage disease, also termed Andersen's disease or amylopectinosis, is a rare autosomic recessive hereditary disease usually caused by a deficit in glycogen branching enzyme. We report our observation of two siblings with type IV glycogen storage disease who had normal branching enzyme activity. The initial symptom was severe heart failure. A 14-year-old boy, born to consanguinous parents, was seen for severe global heart failure. Growth retardation had been diagnosed since the age of 6 and abnormal fatigability since the age of 12. Muscle and endomyocardium biopsies revealed abnormal glycogen storage with normal branching enzyme activity. The patient's condition improved after symptomatic treatment, but death occurred due to infectious complications after orthoptic heart transplantation. One year later, the proband's 12-year-old sister, with an uneventful personal medical history, was hospitalized for severe left ventricular failure. Muscle and liver biopsies demonstrated the same anomalies, again without branching enzyme deficiency in the liver. Heart failure was controlled with symptomatic care and the patient's current condition remains satisfactory. This observation demonstrates the clinical expression of familial type IV glycogen storage disease in patients with normal branching enzyme activity. Age at onset is quite variable, reported from 5 to 70 years, as is the clinical course before diagnosis.

Adolescent↗
PubMed1994

Social deprivation and age at presentation in amblyopia.

BACKGROUND: Amblyopia is the most common visual disability in children. Early treatment is thought to be more effective, and therefore factors affecting the age at presentation are important. A relationship between social deprivation and access to health care and screening services is well known. We hypothesized that social deprivation might be associated with later presentation of amblyopia, particularly of anisometropic amblyopia which depends on vision screening for referral. METHODS: Data from a historical cohort of 897 children with amblyopia, from seven UK orthoptic clinics, were used to test this hypothesis. Social deprivation was measured by the Townsend score of the ward in which the child lived. RESULTS: A relationship between social deprivation and age at presentation was found in children with anisometropic amblyopia even after adjusting for differences between clinics (p = 0.01) but no similar association was evident in children with amblyopia associated with strabismus. There was a difference of 22 months in the average age at presentation between children with anisometropic amblyopia in the most deprived and least deprived areas of the study. CONCLUSIONS: If screening for anisometropic amblyopia is to be undertaken, priority should be given to screening children from areas of social deprivation.

Age Factors↗
PubMed1994

Behavioral optometry: a historical perspective.

BACKGROUND: The term behavioral optometry is often used to refer to all aspects of practice associated with case analysis and vision therapy. Practitioners with differing backgrounds and perspectives may use the term differently, resulting in poor communication. METHODS: The evolution of behavioral optometry is reviewed from a historical perspective, to identify the various lines along which the field has developed and to clarify the differing perspectives that result. RESULTS: Behavioral optometry had its origins in strabismus orthoptics and in case analysis systems developed to resolve asthenopic complaints in nonstrabismic individuals. From these roots, behavioral optometry has evolved along two complementary lines. Traditional, physiologically-based models emphasize accommodation-convergence relationships and the mechanisms of vergence dysfunction. Behavioral approaches emphasize the influence of environment and experience upon visual function, the relationship of vision to other aspects of organismic behavior, and the role of vision as a modality for gathering and processing information. CONCLUSIONS: The past 50 years has brought substantial growth in the scope of behavioral optometric care, with consideration of the role of vision in relation to school achievement, VDT use, sports, spatial and motor organization, and information-processing. Models of care emphasize prevention, remediation, rehabilitation, and enhancement. Behavioral optometry is an integral component of optometric education and practice.

Behavioral Medicine↗
PubMed1993

[Mini prisms in decompensated exophoria in children].

This paper gives an original method to treat "intermittent exotropia" with normal binocular vision. 25 consecutive cases of exotropia have been followed, 17 cases near horizontal prism and 3 oblique prism (in association with a congenital fourth nerve paralysis). 4 patients near glasses without prism and only one was treated surgically. The results are promising and this method completes well orthoptic reeducation.

Child↗
PubMed1993

[Apropos of preventive ophthalmologic interventions in the child population of compulsory school age. Authors' experience].

The results are reported of work carried out during the last five years by the Center of Social Ophthalmology, director Prof. G. Scuderi, which is part of the II Division of the Ophthalmologic Clinic of Rome University "La Sapienza" with the object of trying out together with territorial units a model of preventive intervention acting as a filter for specialized university facilities. In other words, already existing facilities and medical personnel were to be used and trained for specific methods and techniques. From 1985 through 1990, 787 children selected by ophthalmologic screening by school doctors among the compulsory school population of the RM 3 and 5 districts were seen and submitted to periodic checks. This cohort included children aged 5 to 14 without significant differences in sex distribution and with prevalence of the 8 to 10 year olds. Each subject was submitted to complete eye examination including refractometry and orthoptics, color vision, biomicroscopic and ophthalmoscopic examination. The principal findings show that about 36% of subjects examined have a natural vision of 11/10 while the high percentage of ametropia observed was mainly represented by astigmatism and hypermetropy, albeit of minor intensity. Strabismus was found in 2.79% and implied marked visual deficit that was often refractory to any type of treatment. In addition, the prevalence was determined of other abnormalities concerning eye motility, color vision and pathologies involving anterior segment and eyeground. In their conclusion, the authors stress the rarity of organic ocular pathology in children (mostly represented by inflammatory changes of the adnexes and conjunctiva) whereas amblyopia was one of the main causes of visual deficit in children. They stress the importance of early therapeutic intervention in order to allow complete visual rehabilitation. The results of the clinical model for prevention were excellent so that it can even be proposed for large scale prevention of amblyopia.

Adolescent↗
PubMed1993

Estimation of left ventricular mass and infarct size from nitrogen-13-ammonia PET images based on pathological examination of explanted human hearts.

The purpose of this study was to develop a technique to quantify left ventricular mass and infarct size in chronic ischemic heart disease from PET images based on correlation with pathological examination of explanted human hearts. Fourteen hearts from patients with cardiomyopathy who had 13N-ammonia scans prior to orthoptic heart transplantation were studied. Accurate estimation of the relative infarct size was possible in patients with a well-delineated, nearly transmural infarct (r = 0.93, y = 1.1x - 0.7, n = 11). Both absolute and relative infarct mass measurements on PET images correlated well with pathological measurements. We identified a population of patients with patchy interstitial or subendocardial scarring with globally reduced perfusion, for which the infarct size could not be estimated using the criteria derived for the patients with well-delineated infarcts.

Adult↗
PubMed1996

["Ex-situ" reconstructive surgery of the renal arteries].

The paper sums up our experience with kidneys which have undergone "bench" extracorporeal arterial surgery. The reasons making this procedure necessary were: renal graft from corpse donor presenting multiple arteries or arterial lesions (12 cases); orthoptic kidneys with stenotic lesions or arterial aneurism (5 cases); transplanted grafts which developed renal artery stenosis (2 cases). Incidence of arterial thrombosis and ureteral fistula was significantly higher in the first group than in grafts where no "bench" surgery had been performed. Medium- and long-term actuarial survival, however, showed no difference. In the second and third groups, extracorporeal arterial reconstructive surgery is a technique with a high risk for the loss of the involved renal unit.

Adolescent↗
PubMed1995

Eye movement in amyotrophic lateral sclerosis: a longitudinal study.

Eye muscles and the sphincter muscles of the bowel and bladder were formerly thought to be spared in amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder. As frequent subclinical impairment of the anal sphincter muscles in ALS has recently been reported, We suspected an earlier and more frequent, if subclinical, involvement of the oculomotor system than hitherto described. Starting in 1993, we repeatedly studied oculomotor involvement in eight patients with (ALS) using routine orthoptic examination techniques as well as electro-oculographic recordings of ocular movements. Three patients had consistently normal clinical examinations but progressive changes in electro-oculography (EOG). Three patients showed intermittent impairment of eye movements with normal EOG (one patient) or with progressive changes on EOG examination. In two patients, both clinical examination and EOG were progressively pathologic. These findings provide further evidence of early oculomotor involvement, e.g., prior to respiratory failure, in ALS than previously suspected. Since EOG changes seemed to be detectable in all but one patient, EOG changes may allow earlier, subclinical detection of impaired eye movement and thus reveal even an increased frequency of oculomotor impairment in ALS. Due to the heterogeneity of ALS the number of patients examined to settle finally the question of oculomotor involvement in ALS needs to be increased. Newly developed software will allow further interpretation and comparison of more data and, thus, should offer further help in detecting early changes.

Adult↗
PubMed1996

[Refractive errors and strabismus in premature infants].

AIM: We aimed to investigate the incidence of refractive errors and strabismus in premature infants relative to their individual birth weight. METHODS: We investigated 107 premature infants with birth weight < 1250 g (group A, n = 54) and > 1250 g (group B, n = 53). All children were evaluated at the ages of 6 and 24 months for their spherical equivalent and the presence of high myopia (< or = 6.0 D) and strabismus. RESULTS: At 6 months the spherical equivalent was -0.93 +/- 4.2 D in group A and 1.09 +/- 1.9 D in group B, at 24 months -0.75 +/- 5.0 D vs 1.44 +/- 1.9 D (P < 0.01). At 6 months the incidence of high myopia was 10% in group A and 0% in group B, at 2 years 12% vs 2% (P < 0.01). Low birth weight and a long period of artificial ventilation correlated with the development of high myopia. At 6 months 21% of group A and 8.5% of group B showed strabismus, at 2 years 25% vs. 8.5% (P < 0.01). CONCLUSION: Because of the increased incidence of high myopia and strabismus we recommend routine retinoscopy and orthoptic evaluation at the age of 6 months in every child weighing less than 1250 g at birth.

Birth Weight↗
PubMed1996

[Early postoperative infections after liver transplantation--pathogen spectrum and risk factors].

Infections occurring during the early postoperative phase after liver transplantation result in a significant rise in morbidity and mortality. The records of 279 orthoptic transplantations performed in 248 patients were analyzed retrospectively. 55.6% of all patients suffered from one or more episodes of bacterial and/or fungal infection during their postoperative hospitalisation. The median onset of bacterial/fungal infection was on day 7 after transplantation. Enterococci (42 episodes), Pseudomonas aeruginosa (38 episodes), staphylococci (37 episodes), Escherichia coli (17 episodes) and Candida albicans (11 episodes) were the most frequently detected organisms. 74 (29.8%) patients developed viral infections. 20 patients (8.1%) showed infection with cytomegalovirus (CMV), 32 patients (12.9%) with herpes simplex virus (HSV) and 6 patients (2.4%) with varicella zoster virus (VZV). 14 patients (5.6%) developed infection with both CMV and VZV. Triple infection with CMV, HSV and VZV occurred in one patient. Statistical analysis of potential risk factors showed a significant influence of blood volume replacement (p < 0.001) and occurrence of at least one rejection period (p < 0.02) for major bacterial/fungal infection and immunosuppression (p < 0.001), cold ischemic time (p < 0.04), occurrence of at least one rejection period (p < 0.005) and blood volume replacement (p < 0.04) for viral infection.

Adolescent↗
PubMed1997

[Acute and chronic heart failure].

Cardiac failure is a syndrome which comprises ventricular dysfunction (confirmed by echocardiography) and compensating mechanisms (immediate activation of the sympathetic nerve and functioning of Starling's mechanism, within hours or days activation of RAAS within days or weeks hypertrophy of the heart). Cardiac failure develops rapidly either in a previously healthy subject (first extensive IM, diffuse myocarditis, acute aortic or mitral regurgitation) or in a damaged heart (IHD, KMP, defect) as a result of sudden excessive burdening (ischaemia, arrythmia, infection, surgery etc.) or spontaneously (end-stage). It is manifested above all by "backward" failure (pulmonary oedema). The pulmonary pressure must be rapidly reduced: i.v. nitrovasodilators act immediately, i.v. furosemide acts within 10-15 min. (in can, however, reduce the circulating volume which has not increased during the first failure). Also O2, anodynes. In the subacute stage (without any precise time limits) which may develop in serious cases from acute failure, or develop as a result of deterioration of chronic failure, in addition to congestion, symptoms caused by "forward" failure are in the foreground. These are symptoms caused by a reduced minute output and hyperfusion of tissue. It is indicated to administer substances which improve work tolerance, i.e. positive inotropics (digitalis, beta-agonist or phosphodiesterase inhibitors). If the blood pressure drops, a combination of dopamine and dobutamine should be administered; if the respiratory volume drops, artificial pulmonary ventilation, in case of persisting oedema continuous arteriovenous haemofiltration, in severe failure intraaorrtic balloon contrapulsation etc. In an irreversible state urgent or elective orthoptic transplantation of the heart should be considered. In chronic heart failure an important component of comprehensive treatment is in addition to treatment of congestion and hypoperfusion, prevention of "cardiovascular remodelling" by means of angiotensin convertase inhibitors etc. Which improve the quality of life and survival. Arrhythmias are an independent prognostic factor.

Acute Disease↗
PubMed1997

A review of school vision screening in Glasgow.

OBJECTIVES: To assess to what extent the primary school vision screening programme was being carried out in the years 1993-94 and 1994-95, what the prevalence of eye defects was in the primary schools and how many children had a positive screening test. DESIGN: Summary sheets of the results of screening were returned by each school nurse. SETTING: All 315 mainstream primary schools served by Greater Glasgow Health Board. SUBJECTS: All school nurses working in these schools. RESULTS: Large numbers of tests were being performed but the screening programme was not fully carried out in 10% of schools in 1993-94 and in 68% in 1994-95, although the number of schools where some screening was performed did increase. The years were not directly comparable due to a change in the age groups screened. When a class was screened 94-96% of children were tested. The rate of positive screening varied from 4% to 15.6% and varied with age and locality. Fewer abnormalities were found at five years than in the older age groups (Primary 1-7.6%, Primary 4-11.4%, and Primary 7-9.7%) and fewer abnormalities were detected in the North-West area where a pre-school orthoptic screening programme was operating (4% in the North-West compared with 11% in the South where no pre-school screening was carried out). CONCLUSION: If the recommended programme is carried out, then 95% of children at age five years could be tested at a stage when amblyopia is still potentially treatable. The reasons for the programme not being completed require to be addressed. Variations between areas need to be confirmed and the reasons for them identified. Further evaluation of the programme is required, exploring the accuracy of it and the long-term outcomes.

Child↗
PubMed1996

[Trabeculectomy in congenital glaucoma: retrospective medium and long-term results].

PURPOSE: We present a retrospective analysis of medium and long-term results of trabeculectomy we have performed in our department as a first surgical procedure in patients with congenital glaucoma between 1976 and 1995. MATERIAL-METHODS: Our study included 26 patients (46 eyes)(ratio M/F = 18/8) with congenital (< or = 2 months = 4 patients including 3 glaucoma present at birth), infantile (> 2 months, < or = 24 months = 18 patients) and juvenile glaucoma (> 24 months and < or = 25 years). In 42 eyes, we performed a trabeculectomy as a first surgical procedure. A trabeculectomy was combined peroperatively with a trabeculotomy in one eye and a trabeculectomy was associated with antimetabolites in 3 eyes. The trabeculodysgenesis was isolated in 38 eyes and was associated with a dysgenesis of the anterior segment in 4 eyes and a Sturge Weber syndrome in 4 other cases. The mean actual follow-up is 88.8 +/- 87.8 months (3 to 304 months) and is presently longer than 15 years in 6 patients. The mean age at the time of surgery was 24.4 months and was reduced to 4.9 months when we excluded the 4 patients with a juvenile glaucoma. An early postoperative objective refraction was performed in all patients. Correcting lenses were prescribed and associated with occlusion if needed. Beside tonometric, ophthalmoscopic and biometric monitoring, we investigated patient's final visual acuity, objective refraction, binocular vision, visual field when possible as well as their educational orientation. RESULTS: The mean 3 months (16.6 +/- 6.2 mm Hg), 12 months (16.1 +/- 6.9 mm Hg) and the mean final IOP (15.3 +/- 6.5 mm Hg) was significantly reduced compared with preoperative IOP (30.3 +/- 8.3 mm Hg). In the last exam, IOP was < or = 16 mm Hg in 33 eyes (71.7%) and < or = 20 mm Hg in 41 eyes (89.1%). Among significant postoperative complications, we observed 2 uveal effusion syndromes. The regression of the optic disc cupping was significant at every control by comparison with its preoperative evaluation. A medical adjunctive treatment was mandatory in 20 eyes. Our 5 failures concerned eyes with multiple surgical procedures. We had to perform one or more additional surgical procedures in 16 eyes (34.7%), knowing that neonatal forms and high myopic eyes have needed more additional surgical procedures. The mean period between different additional surgeries was varying in large amounts (mean period = 32 +/- 82 months). A filtration bleb was visible at the last examination in a minority of patients (n = 11 eyes). Final mean visual acuity was 0.5 +/- 0.4 (n = 35) and was > 0.8 in 10 eyes of the 14 (7 patients) with an actual follow-up longer than 120 months. CONCLUSION: In our experience, trabeculectomy may be considered as a valid and relatively safe first choice procedure in the treatment of congenital glaucoma, although requiring a frequent adjunctive medical treatment and a relatively high incidence of additional surgical procedures. The large induced IOP reduction allows to maintain an excellent visual potential in combination with orthoptic treatment in a very significant number of cases.

Female↗
PubMed1997

Health science graduates: preparation for the workplace.

The research reported in this article was undertaken to assess the perceptions of health science graduates in the fields of health information management, occupational therapy, orthoptics, physiotherapy, and speech pathology regarding their perceptions of the adequacy of undergraduate preparation in meeting the demands of a changing health care environment. An instrument was devised for use by graduates on the basis of the skills and workplace behaviours specified by experienced practitioners in the above fields as necessary in newly recruited graduates. A total of 527 health science graduates completed the 52 item instrument. The statistical analyses indicated that 11 factors define the adequacy of graduates' preparation for the workplace. Health science graduates perceived themselves to have been more thoroughly prepared on certain workplace dimensions than on others. Specifically, graduates perceived themselves to be ill-equipped on dimensions concerned with workplace management, knowledge of the health industry, and coping in the workplace. Graduates also perceived themselves to be inadequately prepared in terms of communicating with clients, health professionals, and the general public. The strengths of their courses were perceived to be in completing essential tasks, having confidence in the clinical role, in ethical practice, in pursuit and application of knowledge, and having a realistic expectation of the workplace role. The results are discussed in terms of the need to address curriculum changes.

Adult↗
PubMed1997

[An experimental model of pleural cancer. Value of orthotopic implantation of human tumor tissue in nude mice].

Pleural cancers are tumours which are frequently refractory to all treatment. Faithful animal models (experimentally reproducing the human disease) are necessary to study the natural history of this disease and to test standard or experimental treatments. The athymic bald mouse is currently used for the construction of experimental models because it avoids immunological rejection. Initially murine models were constructed following subcutaneous injection of cloned cells then implantation of tumour fragments. The tumours obtained are not superimposable on the human disease in terms of local, regional or metastatic development and the results from these studies, using such models, are difficult to transpose to humans. It is possible to implant fragments of histologically intact human tumour into the pleura of bald mice. This orthoptic (site for site) transplantation enables one to obtain in the mouse a tumour which tends to conserve the biological characteristics of the original tumour and to develop locally, regionally and at distance in a fashion which is similar to the human disease. In spite of the inherent limits of immunotolerance of the host and thus difficulties of extrapolation to man, this review attempts to point out the place for these models and for an understanding of the therapy of pleural cancers.

Adenocarcinoma↗
PubMed1997

Epidemiology of strabismus.

In a survey of around 60,000 optometric eye examinations, each with orthoptic assessment, 5% of patients were found to have a binocular vision anomaly. The frequency of each anomaly was found and an estimate was made of its prevalence in the general population. The prevalence rates are generally similar to other studies but are given in more detail. Of 3,075 binocular anomalies 74% had concomitant strabismus, 10% were paretic, 8% had decompensated heterophoria and 6% convergence insufficiency.

Humans↗