Objective: To evaluate outcome at 5 1/2 years after randomization in eyes that underwent cryotherapy and in control eyes of patients in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity.Design: During infancy, patients with bilateral threshold retinopathy of prematurity (ROP) were assigned to receive cryotherapy for one eye and no cryotherapy for the other eye. Those with threshold ROP in only one eye (asymmetric) were randomly assigned to cryotherapy or no cryotherapy for that eye. Then, 5 1/2 years later, testers who were masked to the treatment status of each eye measured the patients' monocular visual acuity by using the log of the minimum angle of resolution visual acuity chart that was used in the Early Treatment Diabetic Retinopathy Study. This was the most refined visual acuity testing yet performed on this cohort. Structural outcome was evaluated by participating ophthalmologists' assessment of ROP residua in the posterior pole of the fundus.Patients: Patients were 291 children who had been preterm infants with birth weights of less than 1251 g in whom threshold ROP had developed. Two hundred forty patients had bilateral threshold ROP, and 51 had threshold ROP in only one eye.Results: For the 234 children examined, both visual acuity and fundus structure showed a reduction in unfavorable outcomes in treated vs control eyes: 47.1% vs 61.7%, respectively (P<.005), for visual acuity and 26.9% vs 45.4%, respectively (P<.001), for fundus status. Detailed analysis uf visual acuity outcomes for all eyes revealed that while fewer treated eyes (31.5%) than control eyes (48%) were blind (P<.001), there was a slight trend toward fewer eyes with a visual acuity of 20/40 or better in the treated (13%) vs control (17%) groups (P=.19).Conclusions: The results support the long-term efficacy and safety of cryotherapy in the treatment of severe ROP. However, the data show preliminary evidence of a possible adverse effect of this treatment on visual acuity.

BACKGROUND:The effect of severing the check ligaments and intermuscular membranes on the dose-response curve for medial rectus recessions in patients with infantile esotropia has not been previously studied by randomized assignment techniques using contemporary control and experimental groups and masked precautions.METHODS:A prospective study of 101 patients was performed over an 8-year period. Patients were randomly assigned to either augmented or nonaugmented groups. In the former group, the medial check ligaments and intermuscular membranes were severed; in the latter group, no surgery was performed on the medial check ligaments or intermuscular membranes. Patients were postoperatively evaluated by an observer masked to group assignment.RESULTS:No difference in response to surgery was observed between the two groups at the time of evaluation, which took place, on average, 6 to 7 months after surgery.CONCLUSION:Severing the check ligaments and intermuscular membranes on patients with infantile esotropia undergoing medial rectus recessions does not appear to affect the dose-response curve.

Results obtained in 32 patients with A-pattern horizontal strabismus and overacting superior oblique muscles treated with combined bilateral superior oblique tenotomies and bilateral symmetric surgery on the horizontal rectus muscles were analyzed retrospectively. The magnitude of reduction of the A-pattern correlated positively (r = 0.69) with the size of the preoperative A-pattern. Overall, 27 of the 32 patients (84%) had a satisfactory reduction in their A-pattern. Esodeviated patients received less correction in the primary position than exodeviated patients. Postoperative complications were minimal if the superior oblique tendon was hooked under direct visualization, and minimal dissection was performed on the surrounding tissue prior to transecting it near the nasal side of the superior rectus muscle.

An inexpensive Polaroid SX-70 camera system for external eye photography can be assembled from easily obtainable parts. The advantages of this system include a "what-you-see-is-what-you-get" capability, instantly available prints (which permit repeat photography while the patient is still present), and convenient storage of acceptable prints.

Bailey-Lovie-Ferris visual acuity charts and Teller visual acuity cards were used to compare recognition and grating visual acuity at near testing distances in 32 children with anisometropic amblyopia without strabismus. Appropriate optical corrections were worn. Test-retest intraobserver reliability was higher for letters (r =.95) than for gratings (r = .68). Using 20/30 visual acuity or better as the criterion for normal visual acuity, eight eyes with letter visual acuities ranging from 20/42 to 20/138 would have been inaccurately found to be normal by using the Teller visual acuity cards alone. Grating visual acuity measurements tended to be better than letter visual acuity; and, in general, they did not worsen proportionately with poorer letter visual acuity.

Letters and Corrections1 April 1987Pupillary Abnormalities: Light and SightDAVID S. BARDENSTEIN, M.D., NORMAN N. K. KATZ, M.D., DAVID S. FRIENDLY, M.D., MARSHALL M. PARKS, M.D.DAVID S. BARDENSTEIN, M.D.Search for more papers by this author, NORMAN N. K. KATZ, M.D.Search for more papers by this author, DAVID S. FRIENDLY, M.D.Search for more papers by this author, MARSHALL M. PARKS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-106-4-643_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: A survey of major pediatrics and neonatology textbooks shows few recommendations concerning the need for immediate referral of infants, toddlers, and children with abnormal pupillary reflexes (leukocoria). The differential diagnosis of childhood leukocoria includes various conditions of which the most important are retinoblastoma, cataract, persistent hyperplastic primary vitreous (PHPV), retinal detachment, infections, and inflammations.The prognosis for life in patients with retinoblastoma is directly related to the size and degree of extension of the tumor and thus to the promptness with which the disease is recognized. The great improvement in survival of patients with retinoblastoma has been...References1. BELLAR R, HOYT C, MARG E, and ODOM J. Good visual function after neonatal surgery for congenital monocular cataracts. Am J Ophthalmol. 1981;91:559-65. CrossrefMedlineGoogle Scholar2. PARKS M. Visual results in aphakic children. Am J Ophthalmol. 1982;94:441-9. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: DAVID S. BARDENSTEIN, M.D.; NORMAN N. K. KATZ, M.D.; DAVID S. FRIENDLY, M.D.; MARSHALL M. PARKS, M.D.Affiliations: Washington, D.C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1987Volume 106, Issue 4Page: 643-643KeywordsChildrenInfantsInflammationLife expectancyPediatric infectionsPediatricsReflexesRetinal detachment ePublished: 1 December 2008 Issue Published: 1 April 1987 PDF downloadLoading ...

One hundred sixteen strabismus patients with amblyopia treated with initial full-time or part-time conventional occlusion of the preferred eye followed when necessary with maintenance occlusion up to a maximum of nine years were studied. Based on the need for maintenance occlusion, patients were divided into a primary occlusion group, composed of patients who did not require maintenance occlusion and a maintenance group occlusion group, composed of patients who did require maintenance occlusion. The main difference between the two groups of patients was the degree of amblyopia at the onset of occlusion therapy, being significantly greater in the maintenance occlusion group. The maintenance occlusion group showed a significantly higher incidence of visual acuity regression when evaluated at ages 12 and 13 years. Occlusion therapy administered to strabismus patients in the manner described in this study resulted in significant visual improvement with a regression in visual acuity of no more than an average of one line on the Snellen chart.

Five infants who were victims of physical abuse had extensive bilateral retinal hemorrhages on initial evaluation and subsequently developed signs of permanent retinal damage. None showed external evidence of trauma to the eyes. Vitreous hemorrhage developed after a delay of several days or more in three cases that were followed closely from the time of the traumatic incident. In several eyes, apparent intraretinal blood-filled cavities were seen acutely in the macular region and elsewhere. Late scarring of the macula typically had a cystic or crater-like configuration. Electroretinography showed loss or reduction of the positive B-wave with preservation of the negative A-wave in every case. We propose that splitting of the retina resulting from the direct mechanical effects of violent shaking was responsible for all of these findings.

We assessed the potential clinical usefulness of pattern-reversal visual-evoked potentials in the diagnosis of amblyopia. Twenty-seven children with anisometropic amblyopia and four children without amblyopia participated. Estimates of visual acuity for each eye (Snellen visual acuity) were obtained by conventional psychometric methods. Visual-evoked potentials to reversing checks subtending 15 minutes of visual arc were also obtained. Visual-evoked potential testing and interpretation were done in a masked fashion. Ten of the 31 children were retested seven to 21 days after the first test to estimate reliability of the procedures. Of the 27 amblyopic children, 22 were correctly identified by the visual-evoked potential test alone. In four patients initial visual-evoked potential tests failed to identify the disparity in visual acuity between the eyes and retests in two of the four again had false-negative results. In one child initial visual-evoked potential testing incorrectly identified the amblyopic eye but repeat testing did identify it. Of the four children with symmetrically good vision, three were correctly identified as normal by the initial visual-evoked potential test. The other normal child was incorrectly identified by the visual-evoked potential test as having amblyopia.

We developed an automated visual acuity testing program that uses an E optotype with surrounding confusion bars. The computer software program runs on Apple II equipment and a black-and-white monitor with a five-inch screen. The program is available in response box and joystick versions. The test is suitable for children older than 31/2 to 4 years of age and for adults. A t-test on the same floppy disk as the visual acuity programs is used to test the probability that the differences in test results are greater than chance. Visual acuities of 20 normal subjects were reduced by means of plus lenses. Test-retest acuity correlation coefficients were similar for letter charts and computer-generated E optotypes, suggesting approximately equal reliability under the test conditions employed. Visual acuities of 12 amblyopic eyes were obtained by a Ferris-type letter chart and computer-generated E optotypes. The correlation coefficient was +0.93, suggesting similar test results by these two methods.

The preterm infant is subjected to prolonged exposure to ambient nursery illumination at levels that have been found to produce retinal damage in animals. We prospectively investigated the effect of exposure to light in two intensive care nurseries by comparing the incidence of retinopathy of prematurity among 74 infants from the standard bright nursery environment (median light level, 60 foot-candles [ftc]) with the incidence among 154 infants of similar birth weight for whom the light levels were reduced (median, 25 ftc). There was a higher incidence of retinopathy of prematurity in the group of infants who had been exposed to the brighter nursery lights, particularly in those with birth weights below 1000 g (86 percent vs. 54 per cent, P less than 0.01 by chi-square test). We conclude that the high level of ambient illumination commonly found in the hospital nursery may be one factor contributing to retinopathy of prematurity and that safety standards with regard to current lighting practices should be reassessed.

The case of a nine-year-old white female who presented initially with idiopathic inflammatory pseudotumor and was ultimately diagnosed (22 months later) as having Wegener's granulomatosis is presented. A review of the literature reveals that, to date, there are 21 well-documented cases of Wegener's granulomatosis occurring in children under the age of 16. Of these 21 cases, eight patients (39%) manifested ocular or orbital signs during the course of the disease. Four of these cases (50%) presented initially with idiopathic inflammatory pseudotumor. The diagnosis of Wegener's granulomatosis should be considered in children with orbital pseudotumor. Long-term follow-up may be necessary to exclude this possibility.

Although many types of conjunctival infections in neonates are relatively inconsequential, chlamydial, gonococcal, and herpes simplex infections can cause permanent ocular damage and serious systemic complications. These specific causes are discussed along with silver nitrate conjunctivitis, staphylococcal infections, and nasolacrimal duct obstructions.

The Antiemetic Effect of Droperidol Following Outpatient Strabismus Surgery in Children Michael Abramowitz;Tae Oh;Burton Epstein;Urs Ruttimann;David Friendly; Anesthesiology

Radiographic studies disclosed that a 5-year-old girl with proptosis and inferior displacement of her left globe had a lytic lesion in the superior orbital rim. Tissue removed at the time of the initial biopsy was not sufficiently distinctive for a definitive diagnosis, but microscopic examination of residual tumor clearly established the diagnosis of hemangioendothelioma of the frontal bone. Electron microscopic studies demonstrated that the vascular structures, which resembled endothelium, contained many thin microfilaments and mitochondria and scattered dense bodies. Each vessel was surrounded by a prominent mantle of pericytes.

Low doses (0.05 mg/kg) of intravenously administered droperidol were given intraoperatively to randomly assigned pediatric strabismus patients in a controlled double-masked paradigm. No difference between control and treatment groups in the severity of vomiting was noted in the postanesthesia recovery room, but such a difference was probably present in the hospital rooms during the interval between room arrival and the meeting of hospital discharge criteria. Administration of the drug did not appear to produce somnolence sufficient to delay postoperative recovery.

There is growing evidence that a variety of corneal disorders may be expressions of altered immune mechanisms. Phlyctenular keratoconjunctivitis is probably such a condition. Typically described as arising from hypersensitivity to tuberculin protein, other antigens clearly may participate, particularly staphylococcus products. When corneal involvement occurs, it need not be confined to the peripheral cornea. The symptoms of the process may be disproportionate to obvious findings and so exaggerated as to suggest a psychiatric disorder. Resultant visual deficits, if the disease is corneal, progressive, unrecognized, and untreated may be profound. Representative examples of this disease are cited. Immune mechanisms are reviewed. The importance of recognizing the characteristic sign and symptom complex is stressed. Appropriate diagnostic studies and treatment regimens are presented.

Departments of Anesthesiology and Child Health and Developnent and Ophthalmology, the George Washington University Medical Center and the Children's Hospital National Medical Center, Washington, D. C. 20010