Binocular vision & strabology quarterly, Simms-Romano's最新文献

Purpose: To evaluate longer term histological changes of extraocular muscles induced by bupivacaine toxicity.

Methods: The superior rectus and inferior rectus of white rabbits were injected with 0.4 mg of agent in 0.3 ml of bupivacaine., Then, histological changes of these rectus muscles were examined at 1,2,4 and 8 weeks after injection.

Results: Bupivacaine injection induced myotoxic changes in both orbital and global layers. Regenerating myofibers were found at 1 week after injection. These changes were reduced by 4 weeks post injection. At 4 weeks increasing muscle fiber size in both orbital and global layer were seen. There was no scar formation after 8 weeks post injection.

Conclusions: Extraocular muscle bupivacaine injection can cause acute myonecrosis followed with regeneration. After 8 weeks the muscles recovered with arranged myofibers almost at normal level. However we found increased myofiber diameter at 4 weeks after injection which was remained stable until 8 weeks post injection, Further investigation about functional change in these muscles is needed to facilitate application of this methodology.

Pseudo-strabismus, or more precisely, pseudo-esotropia, is commonly encountered in pediatric ophthalmology. In our practice, the left eye was reported by parents as being deviated more frequently than the right eye. We attribute this laterality to the fact that most parents are right handed. They therefore tend to hold their children with their left arm, and to feed them with their right hands, in both cases viewing the left eye of the child in the adducted position.

Techniques for the adjustment of surgery intraoperatively (especially those termed Stage I and II techniques) have proven maximally successful in improving surgical results for comitant strabismus. Stage III adjustments (end-operative) have been described but not studied. In a retrospective study of 20 eye muscle procedures in 12 patients with neuroparalytic and mechanical strabismus, the usefulness of various intraoperative adjustment techniques Stage I, II, and III was investigated for the first time. Stage I adjustments (adjusting the surgical plan based on the binocular misalignment following induction) were not helpful. Stage II adjustments (R. Bedrossian technique: adjusting the amount of surgery performed to create an actual change in binocular alignment under anesthesia matching the change in alignment desired clinically) were appropriate for horizontal mechanical and (all) vertical cases but not appropriate for horizontal neuroparalytic cases. Stage III adjustments, at the end of surgery, were appropriate in virtually all cases (20 muscles, 12 patients). Significant overcorrection, well beyond the theoretically ideal final intraoperative binocular alignment of 30 PD (prism diopters) was appropriate in all cases, but varied with type of case. Verticals (all) required a 5-10 PD overcorrection. Horizontal mechanical cases required a 22-30 PD overcorrection. Horizontal neuroparalytic cases required a 15-38 PD overcorrection, in the last group, in each case, graded according to the presence of contractures and the size of the preoperative deviation. The use of Stage III (and Stage II as noted above) adjustments brought postoperative binocular alignment to orthotropia +/- 10 PD in all cases, the conventional standard for satisfactory results in strabismus surgery.

Background: Various case reports have shown possible associations between optic neuritis and different vaccines. Some of the vaccines include influenza, hepatitis B and anthrax

Purpose: To present evidence for a causal relationship between optic neuritis and Live Attenuated Influenza Vaccine (LAIV), administered as nasal flu vaccine.

Methods: Case Report. In a 13-year-old male with bilateral optic neuritis, detailed clinical history, neuro-ophthalmologic examination, magnetic resonance imaging, stereo-disc photos, visual field testing, ocular coherence tomography, blood tests and cerebral spinal fluid analysis were performed.

Results: Exam findings on presentation: BCVA: 20/CF OD; 20/LP OS. Positive relative afferent pupil defect OD. Unremarkable anterior segment and posterior segment exam. No papillitis or papilledema. Global visual field defect OU based on Humphrey 30-2. MRI: diffuse enlargement of Optic Chiasm with inflammation of distal optic nerves bilateral. Blood cultures and CSF were negative. Patient received 3 divided doses of methyl prednisone with mild improvement of vision upon hospital discharge and marked improvement of vision at 2 month follow up.

Conclusion: In this child, no infectious, vascular, granulomatous, viral or immune-related cause of optic neuritis was identified. This case provides compelling evidence that supports the nasal flu vaccination as a cause of optic neuritis.

Background: The positive predictive value (PPV) of conventional preschool acuity screening is about 50% whereas previous Polaroid photoscreening with experienced interpretation can achieve PPV greater than 85%. The Plusoptix photoscreener has immediate computer interpretation and a CPT code available to pediatricians.

Methods: Two Plusoptix SO9 were used in two pediatric group practices with previously validated refractive criteria and new manufacturer's binocular alignment criteria. CPT billing was monitored. Referred patients had prior gold-standard AAPOS examinations.

Results: 12% of 675 photoscreened preschoolers were referred. Of the 39 with AAPOS gold-standard exams, the PPV from strabismus referrals was 17%, while 26 of 27 refractive referrals had true amblyopia risk factors (PPV 96%). Screening CPT code 99174 reimbursement rose from zero to half of insurers in 15 months.

Conclusion: Plusoptix photoscreening is valid after adjusting the binocular alignment criteria. Such photoscreening should be employed by pediatric practices to detect and ultimately to reduce amblyopia vision impairment in children.

A female child with morning glory disc anomaly (MGDA) in two eyes is described in this report. The patient had no systemic abnormalities. Magnetic resonance imaging of the cranium, sella and orbits revealed an asymmetry of the right and left optic nerve sheath complexes. The presence of asymmetric optic nerve sheath complexes in patients with bilateral MGDA has not been previously reported.

The purpose of this presentation is first to describe the symptoms and problems encountered in cranial nerve palsies (CNP). The purpose is also to describe the different means of treatment during the observational preoperative period and their positive or negative impact on each of the symptoms and problems. Finally, we will present our way of handling these patients in their preoperative period: practical, inexpensive, and unsophisticated means that keep the patient comfortable and prevent the secondary untoward effects that can take place.

Background: The benefits of occlusion treatment for amblyopia are well established.True compliance can be difficult to assess and is usually based on patient history. We hypothesize that more visits to the physician provides more chances to improve compliance.

Methods: We conducted a prospective, comparative, blind trial in which 30 children with amblyopia were randomly assigned to be followed up more frequently (every 4 to 6 weeks) (study group) or as established on our standard regular basis (month intervals based on age in years) (control group). The primary outcome was to study differences in treatment compliance between these groups. The secondary outcome was to report compliance in a group of Chilean children and to compare survey results with adherence, to assess concordance between them.

Results: Baseline clinical characteristics were similar in the two groups. 30 patients were recruited. Mean compliance for all patients was 82%. Study group compliance was 83% versus 76% in control group (p = 0.5). Without epidemiology, intention to treat analysis (ITT), study group compliance was 97% compared to 76% in control group (p = 0.049). Pearson correlation between negative responses to a parental survey after treatment, of the percentage of adherence and compliance, was -0.57 and statistically significant (p = 0.013).

Conclusions: There were no differences in patient compliance comparing more frequent evaluation versus a follow up evaluation based in an age according scheme. There is a high compliance to occlusion therapy in this group of Chilean children. If parents reported more negative adherence aspects in the survey, the worse the compliance.