Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. Journal of AAPOS 2015; 19 (2): 163-8 e1
To identify epidemiologic trends in nonpowder gun-related pediatric eye injuries and to determine factors associated with severe injury requiring hospital admission.US emergency department data on pediatric eye injuries between 2002 and 2012 were reviewed using the National Electronic Injury Surveillance System. Literature review was conducted to determine trends in visual outcomes after treatment and use of eye protection.In 2012 roughly 3,161 children were treated in US emergency departments for nonpowder gun-related eye injuries. Since 2010 rates of severe nonpowder gun pediatric eye injury have increased by over 500% (P = 0.039). Specifically, while rates of hospital admission due to paintball gun eye injury have dropped precipitously (P = 0.0077), rates of admissions for air gun eye injuries have increased by over 600% since 2010 (P = 0.033). Children sustaining eye injury due to air guns are more likely to be diagnosed and admitted with foreign body or ocular puncture injury. Roughly 28% of documented cases of airsoft or BB gun-related injury had visual acuity worse than 20/50 after initial treatment. Over 98% of injuries occurred without eye protection.Air guns are rising in popularity and now account for the majority of pediatric eye injuries requiring hospital admissions. These eye injuries occur without ocular protection and may lead to permanent eye injury. Increasing regulations for eye protection, sales, and usage of air guns are needed to prevent serious pediatric eye injuries.
View details for DOI 10.1016/j.jaapos.2015.01.010
View details for PubMedID 25818283
Application of diffusion tensor tractography in pediatric optic pathway glioma Clinical article JOURNAL OF NEUROSURGERY-PEDIATRICS 2012; 10 (4): 273-280
Magnetic resonance imaging is commonly used in diagnosis and surveillance for optic pathway glioma (OPG). The authors investigated the role of diffusion tensor (DT) tractography in assessing the location of visual pathway fibers in the presence of tumor.Data in 10 children with OPG were acquired using a 3T MRI generalized autocalibrating parallel acquisitions DT-echo planar imaging sequence (25 isotropic directions with a b value of 1000 seconds/mm(2), slice thickness 3 mm). Fiber tractography was performed, with seed regions placed within the optic chiasm and bilateral nerves on the coronal plane, including the tumor and surrounding normal-appearing tissue. Tracking was performed with a curvature threshold of 30.For prechiasmatic lesions, fibers either stopped abruptly at the tumor or traversed abnormally dilated nerve segments. Similar findings were seen with chiasmatic lesions, with an additional arrangement in which fibers diverged around the tumor. For each patient, DT tractography provided additional information about visual fiber arrangement in relation to the tumor that was not evident by using conventional MRI methods. Retrospective reconstruction of visual fibers in 1 patient with new postoperative hemianopia revealed an unexpected superior displacement of the optic tract that might have been helpful information had it been applied to preoperative planning or surgical navigation.Optic pathway DT tractography is feasible in patients with OPG and provides new information about the arrangement of visual fibers in relation to tumors that could be incorporated into surgical navigation for tumor biopsy or debulking procedures.
View details for DOI 10.3171/2012.7.PEDS1270
View details for Web of Science ID 000309485300005
Complete Ocular Paresis in a Child with Posterior Fossa Syndrome PEDIATRIC NEUROSURGERY 2012; 48 (1): 51-54
Posterior fossa syndrome (PFS), also known as cerebellar affective syndrome, is characterized by emotional lability and decreased speech production following injury or surgery to the cerebellum. Rarely, oculomotor dysfunction has been described in association with PFS. Here, we report a case of complete ocular paresis associated with PFS in an 11-year-old male following medulloblastoma resection.
View details for DOI 10.1159/000339382
View details for Web of Science ID 000309885700010
View details for PubMedID 22906880
Neovascularization in Purtscher's retinopathy. Clinical ophthalmology (Auckland, N.Z.) 2011; 5: 1585-1587
We report a case of neovascularization secondary to Purtscher's retinopathy that showed minimal improvement with photocoagulation treatment. A 14-year-old boy with a history of cerebellar medulloblastoma presented with blurry vision and floaters after being struck by a motor vehicle while riding his bike. At presentation, visual acuity was 20/400 in his right eye and counting fingers in his left eye. Fundus examination showed disk edema, retinal whitening, and retinal hemorrhages in both eyes. Optical coherence tomography demonstrated thinning of the temporal retina and disruption of the inner segment-outer segment junction of the photoreceptor layer in the right eye and thickening and edema of the nasal macula, as well as a central foveal hyper-reflectivity, in the left eye. At the initial visit, there was no ischemia or neovascularization (NV). One month later, the patient developed NV of the disk and ischemia in the mid-periphery of the left eye. The patient underwent treatment with pan-retinal photocoagulation. The NV regressed, but visual outcome remained poor at his 5-month follow-up visit.
View details for DOI 10.2147/OPTH.S26076
View details for PubMedID 22125405
Novel Technique for Nd:YAG Posterior Capsulotomy in Pediatric Patients JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS 2010; 47 (1): 41-42
A 7-year-old girl had posterior capsule opacification 2 years after cataract extraction without posterior capsulotomy. This report describes a novel technique for Nd:YAG posterior capsulotomy in pediatric patients for providers who do not have access to an overhead-mounted Nd:YAG laser.
View details for DOI 10.3928/01913913-20100106-09
View details for Web of Science ID 000273750300008
View details for PubMedID 20128553
Cyanoacrylate adhesive use in primary operation and reoperation in rabbit eye muscle surgery JOURNAL OF AAPOS 2009; 13 (4): 357-363
To compare the performance of 2-octyl-cyanoacrylate to 6-0 polyglactin 910 suture in rabbit superior rectus muscle surgery after operation and reoperation procedures.A prospective noninferiority trial was conducted in rabbits. Bilateral superior rectus muscle recessions were performed using cyanoacrylate in one eye and polyglactin suture in the other. At 5 weeks, reoperations to advance the superior rectus muscle were performed on 20 rabbits. Slippage, tensile strength, ease of reoperation, operative time, and inflammatory reaction were recorded. For the primary outcomes, the predetermined margin of noninferiority was 1 mm for slippage and 100 g for tensile strength.In both groups, the proportion of slippage > or =1 mm from the recession site was 1.9%. For the reoperation, it was 36.8% and 15.7% in the suture and cyanoacrylate groups, respectively, and the mean slippage was 0.60 mm and 0.42 mm. Mean tensile strength was 842.8 g for suture and 777.2 g for cyanoacrylate after the first operation and 877.73 g and 844.87 g after the reoperation. There was no difference between groups for surgical difficulty or inflammatory index. For the first operation, surgery using cyanoacrylate was on average 3.85 min faster than suture.Cyanoacrylate can achieve an adequate muscle-sclera bond in the immediate period after surgery to avoid major slippage and does not affect the long-term process of wound healing for both recession and advancement procedures. It is well tolerated and does not add technical difficulty even if used for reoperations. Because it eliminates the risk of globe perforation, cyanoacrylate may be a good alternative to sutures in strabismus surgery.
View details for DOI 10.1016/j.jaapos.2009.04.015
View details for Web of Science ID 000269088600009
View details for PubMedID 19683187
Detection of a congenital cystic eyeball by prenatal ultrasound in a newborn with Turner's syndrome BRITISH JOURNAL OF OPHTHALMOLOGY 2007; 91 (4): 559-560
Genotype and phenotype correlations in congenital glaucoma: CYP1B1 mutations, goniodysgenesis, and clinical characteristics AMERICAN JOURNAL OF OPHTHALMOLOGY 2006; 142 (6): 993-1004
To determine whether there is a correlation among mutations in the cytochrome P4501B1 gene (CYP1B1), the degree of angle dysgenesis observed histologically, and disease severity in congenital glaucoma.Interventional case series.Direct DNA sequencing was used to screen six unrelated children with congenital glaucoma, each set of parents, and all siblings for CYP1B1 mutations. Specimens of the anterior chamber angle obtained at trabeculectomy were examined histologically to identify abnormalities of the aqueous outflow pathway. CYP1B1 mutations were correlated with both the degree of angle dysgenesis and the patients' disease severity (age at diagnosis, difficulty in achieving intraocular pressure [IOP]) control.Four (66.7%) of the six patients were compound heterozygotes for mutations in the CYP1B1 gene. Seven of the eight CYP1B1 mutations were identified, including two novel mutations (R117P, C209R) and five others previously described (G61E, R368H, R390H, E229K, 4340delG). The cases were divided on the basis of histological phenotype into categories of (1) severe goniodysgenesis highlighted by the agenesis of the canal of Schlemm (two patients), (2) moderate goniodysgenesis characterized by the presence of a band of collagenous tissue (CT) in the trabecular meshwork (TM) and/or the juxtacanalicular tissues (JXT) (three patients), and (3) mild goniodysgenesis with deposition of a mucopolysaccharide material in the JXT (one patient). CYP1B1 mutations were identified in both cases of severe angle dysgenesis and two of three cases of moderate dysgenesis. Disease severity closely correlated with the degree of angle dysgenesis.Most patients in our cohort had compound heterozygous CYP1B1 mutations. Specific CYP1B1 mutations may be associated with severe or moderate angle abnormalities.
View details for DOI 10.1016/j.ajo.2006.07.054
View details for Web of Science ID 000242671100014
View details for PubMedID 17157584
Papilloedema secondary to otitic hydrocephalus BRITISH JOURNAL OF OPHTHALMOLOGY 2006; 90 (5): 646-646
Genotype and phenotype correlations in congenital glaucoma. Transactions of the American Ophthalmological Society 2006; 104: 183-195
To determine whether there is a correlation among mutations in the cytochrome P450 1B1 gene (CYP1B1), the degree of angle dysgenesis observed histologically, and disease severity in congenital glaucoma.Direct DNA sequencing was utilized to screen six unrelated children with congenital glaucoma, each set of parents, and all siblings for CYP1B1 mutations. Specimens of the anterior chamber angle obtained at trabeculectomy were examined histologically to identify abnormalities of the aqueous outflow pathway. CYP1B1 mutations were correlated with both the degree of angle dysgenesis and the patient's disease severity (age at diagnosis, difficulty in achieving intraocular pressure control).Four of the six patients (66.7%) were compound heterozygotes for mutations in the CYP1B1 gene. Seven of the eight CYP1B1 mutations were identified, including two novel mutations (R117P, C209R) and five others previously described (G61E, R368H, R390H, E229K, 4340delG). The cases were divided based on histological phenotype into categories of (1) severe goniodysgenesis highlighted by the agenesis of Schlemm's canal (two patients), (2) moderate goniodysgenesis characterized by the presence of a band of collagenous tissue in the trabecular meshwork and/or the juxtacanalicular tissues (three patients), and (3) mild goniodysgenesis with deposition of a mucopolysaccharide material in the juxtacanalicular tissue (one patient). CYP1B1 mutations were identified in both cases of severe angle dysgenesis and two of three cases of moderate dysgenesis. Disease severity closely correlated with the degree of angle dysgenesis.The majority of cases in the cohort had compound heterozygous CYP1B1 mutations. Specific CYP1B1 mutations may be associated with severe or moderate angle abnormalities.
View details for PubMedID 17471339
Alteration of cyclic frequency by botulinum toxin injection in adult onset cyclic esotropia BRITISH JOURNAL OF OPHTHALMOLOGY 2005; 89 (11): 1540-1541
Corticosteroid treatment of periorbital haemangioma of infancy: a review of the evidence BRITISH JOURNAL OF OPHTHALMOLOGY 2005; 89 (9): 1134-1138
To systematically review the literature for corticosteroid treatment of periorbital haemangioma of infancy (HOI) and determine the relative efficacy and safety of oral, topical and intralesional corticosteroids.PubMed and the Cochrane Library were queried using keywords, and further articles were obtained by reviewing bibliographies. Inclusion and exclusion criteria were applied to create a subset of literature for analysis.Systematic review revealed 81 original reports of periorbital HOI cases treated with steroids. Most studies and case series failed to document refractive error or visual acuity before and after treatment. Of cases meeting inclusion criteria, five patients received topical steroids and 25 patients received intralesional steroids. Patients receiving intralesional injections tended to demonstrate reduced astigmatism at follow up after treatment (21 of 28). The lack of studies with relevant objective ophthalmological end points prevented statistical meta-analysis.Intralesional injections may reduce refractive error, while the efficacy of topical steroids is unclear. Studies measuring objective ophthalmic data before and after treatment are sparse, and more studies are needed to determine the relative efficacy of different steroids. There are insufficient data to estimate the incidence of steroid side effects in patients treated with steroids for periorbital HOI or complications of intralesional injections in particular.
View details for DOI 10.1136/bjo.2005.070508
View details for Web of Science ID 000231313300019
View details for PubMedID 16113367
Delayed-onset infantile cataracts in a case of Treacher Collins syndrome ARCHIVES OF OPHTHALMOLOGY 2004; 122 (11): 1721-1722
The pseudopapilledema of neonatal-onset multisystem inflammatory disease AMERICAN JOURNAL OF OPHTHALMOLOGY 2004; 138 (5): 894-895
To report a rare case of neonatal-onset multisystem inflammatory disease with serial photographs to characterize the optic nerve findings.Observational case report.A 6-year-old girl with neonatal-onset multisystem inflammatory disease, who had received systemic corticosteroid therapy for 5 years, had bilateral fibrillar opacities that surrounded the optic disks and extended into the peripapillary nerve fiber layer and vessels. A magnetic resonance imaging examination and lumbar puncture revealed elevated intracranial pressure.The elevated intracranial pressure returned to normal following a corticosteroid taper. Optic disk photographs, taken 4 years earlier, were subsequently obtained. The optic disk appearance had remained unchanged over the 4-year period, consistent with a pseudopapilledema.The optic disk appearance is not consistent with papilledema from increased intracranial pressure. The optic disk findings, in conjunction with the underlying inflammatory syndrome, suggest an infiltrative etiology for the atypical optic nerve findings in neonatal-onset multisystem inflammatory disease.
View details for Web of Science ID 000225083100042
View details for PubMedID 15531344
Myopia BRITISH MEDICAL JOURNAL 2002; 324 (7347): 1195-1199
Needle aspiration of a traumatic subperiosteal haematoma of the orbit BRITISH JOURNAL OF OPHTHALMOLOGY 2002; 86 (5): 593-594
Grand rounds #67. A case of a right sixth nerve paralysis and a left third nerve paralysis. Binocular vision & strabismus quarterly 2002; 17 (3): 216-222
Myopia: was mother right about reading in the dark? BRITISH JOURNAL OF OPHTHALMOLOGY 2001; 85 (5): 509-510
Ophthalmic features of primary oxalosis after combined liver/kidney transplantation BRITISH JOURNAL OF OPHTHALMOLOGY 2000; 84 (11): 1326-1327
Raccoon roundworm (Baylisascaris procyonis) encephalitis: Case report and field investigation PEDIATRICS 2000; 106 (4)
Baylisascaris procyonis is a common and widespread parasite of raccoons in the United States and Canada. With large raccoon populations occurring in many areas, the potential risk of human infection with B procyonis is high. We report a case of severe raccoon roundworm (B procyonis) encephalitis in a young child to illustrate the unique clinical, diagnostic, and treatment aspects, as well as public health concerns of B procyonis infection. Acute and convalescent serum and cerebrospinal fluid samples from the patient were tested for antibodies against B procyonis to assist in documenting infection. An extensive field survey of the patient's residence and the surrounding community was performed to investigate raccoon abundance and to determine the extent of raccoon fecal contamination and B procyonis eggs in the environment. The patient evidenced serologic conversion, and the field investigation demonstrated a raccoon population far in excess of anything previously reported. There was abundant evidence of B procyonis eggs associated with numerous sites of raccoon defecation around the patient's residence and elsewhere in the community. Because B procyonis can produce such severe central nervous system disease in young children, it is important that pediatricians are familiar with this infection. The public should be made aware of the hazards associated with raccoons and B procyonis to hopefully prevent future cases of B procyonis infection.
View details for Web of Science ID 000089623100013
View details for PubMedID 11015551
Progressive neurological deterioration and MRI changes in cblC methylmalonic acidaemia treated with hydroxocobalamin JOURNAL OF INHERITED METABOLIC DISEASE 1999; 22 (5): 599-607
Cobalamin C (cblC) defects result in decreased activity of both methylmalonyl-CoA mutase and N5-methyltetrahydrofolate:homocysteine methyltransferase (methionine synthase), with subsequent methylmalonic acid-uria and homocystinuria. Patients typically show failure to thrive, developmental delay and megaloblastic anaemia. Vitamin B12 therapy has been beneficial in some cases. We report a now 4-year-old Hispanic girl with cblC disease documented by complementation analysis, with progressive neurological deterioration and worsening head MRI changes while on intramuscular hydroxocobalamin begun at age 3 weeks. Oral carnitine and folic acid were added at age 1 year. Blood levels of methylmalonic acid were reduced to treatment ranges. In the absence of acute metabolic crises, she developed microcephaly, progressive hypotonia and decreased interactiveness. Funduscopic examination was normal at age 13 months. At age 19 months, she developed nystagmus, and darkly pigmented fundi and sclerotic retinal vessels were observed on examination. Her neonatal head MRI was normal. By age 1 year, the MRI showed diffuse white-matter loss with secondary third and lateral ventricle enlargement, a thin corpus callosum, and normal basal ganglia. At age 15 months, progression of the white-matter loss, as well as hyperintense globi pallidi, were present. Interval progression of both grey- and white-matter loss was seen at age 27 months. We therefore caution that progressive neurological deterioration and head MRI abnormalities may still occur in cblC disease, despite early initiation of hydroxocobalamin therapy and improvement in toxic metabolite concentrations in physiological fluids.
View details for Web of Science ID 000080750600004
View details for PubMedID 10399092
Cortically visually impaired children: a need for more study BRITISH JOURNAL OF OPHTHALMOLOGY 1998; 82 (11): 1225-1226
Complex limbal choristomas in linear nevus sebaceous syndrome OPHTHALMOLOGY 1998; 105 (8): 1459-1465
This study aimed to describe the clinical and histopathologic findings in four patients with complex limbal choristomas associated with linear nevus sebaceous syndrome (LNSS), a rare disorder including nevus sebaceous, seizures, and mental retardation, and often accompanied by ocular anomalies.Small observational case series.A retrospective review of the clinical and histopathologic records of four patients.Each of four patients had complex limbal choristomas in the setting of clinical and histopathologic LNSS. The limbal choristomas were multiple in three patients and bilateral in two patients. Most choristomas involved the superotemporal limbus (6 of 10), although nasal (3 of 10) and inferior (1 of 10) limbal tumors also were present. Three patients had significant corneal astigmatism or involvement of the central cornea requiring surgical removal of their choristomas, one accompanied by a lamellar keratoplasty and another accompanied by two consecutive penetrating keratoplasties. Each graft eventually vascularized, reducing vision. One patient's vision was limited by amblyopia and another by occipital cortical dysgenesis with visual impairment. Histopathologic examination of the excised choristomas showed foci of lacrimal gland (3 of 4 patients), adipose tissue (3 of 4), neural tissue (1 of 4), cartilage (1 of 4), lymphoid follicles (1 of 4), skin adnexal tissue (1 of 4), and smooth muscle (1 of 4). Other associated ocular findings included an eyelid mass (1 of 4), colobomas of the eyelid (3 of 4), colobomas of the choroid and retina (2 of 4), nonparalytic strabismus (2 of 4), scleral ectasia (1 of 4), partial oculomotor palsy with ptosis and anisocoria (1 of 4), microphthalmia (1 of 4), hypertelorism (1 of 4), and cortical visual impairment (1 of 4).Complex limbal choristomas, although rare, can occur in the setting of LNSS and can be associated with multiple ocular and systemic abnormalities. Visual prognosis appears poor in most cases despite aggressive management.
View details for Web of Science ID 000075231500030
View details for PubMedID 9709758
OCULAR MANIFESTATIONS OF DEFORMATIONAL FRONTAL PLAGIOCEPHALY JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS 1993; 30 (2): 92-95
Frontal plagiocephaly can be caused by two mechanisms: craniosynostosis and external deformational pressure. Synostotic plagiocephaly is known to be associated with vertical strabismus and contralateral head tilt. Thirteen patients with deformational frontal plagiocephaly were examined to evaluate head position, ocular motility, and alignment. Nine of the patients (70%) were found to have ipsilateral torticollis, but only one patient had strabismus and this was a horizontal deviation not obviously associated with head position. The clinical features of synostotic and deformational plagiocephaly are discussed to distinguish the two conditions, which have a different treatment and outcome.
View details for Web of Science ID A1993KY86000005
View details for PubMedID 8501624
SOLITARY INTRAOCULAR LYMPHOMA AS AN INITIAL PRESENTATION OF WIDESPREAD DISEASE ARCHIVES OF OPHTHALMOLOGY 1989; 107 (3): 395-397
A patient presented with a large peripapillary choroidal mass as the initial manifestation of widespread, poorly differentiated, large cell lymphoma. The choroidal tumor had clinical and ultrasonographic characteristics of a uveal malignant melanoma. A systemic evaluation and fine-needle aspiration biopsy specimens of the abdomen and choroid established the diagnosis of a lymphoma. On rare occasion, other neoplasms can simulate the diagnostic pattern of uveal melanoma, and fine-needle aspiration biopsy can be crucial in establishing the correct diagnosis.
View details for Web of Science ID A1989T597500027
View details for PubMedID 2647068