Size of Facial Port-Wine Birthmark May Predict Neurologic Outcome in Sturge-Weber Syndrome.

OBJECTIVE: To determine whether the size of the birthmark in patients with Sturge-Weber syndrome (SWS) who have brain involvement can help predict neurologic disability. STUDY DESIGN: Fifty-one patients with SWS with facial birthmarks and brain involvement documented on magnetic resonance imaging were included in this retrospective chart review. A neuroradiologist, blinded to all clinical information, assigned a previously validated SWS neuroimaging score. A pediatric neurologist prospectively assigned previously validated neurologic severity scores, based on seizures, hemiparesis, visual field cut, and cognitive impairments. Three raters, blinded to clinical scores, independently graded the size of facial birthmark in each patient based on photographs. Their scores were averaged. Birthmark scores were compared with the imaging and neurologic severity results using nonparametric correlation analysis. RESULTS: Size of facial port-wine birthmark correlates with magnetic resonance imaging scores on the left and right sides (ρ = 0.57 and 0.66 [P < .001], respectively). Size is also positively associated with the neurologic severity rating for patients age 6 years and above (1-sided Fisher exact, P = .032). CONCLUSIONS: The size of facial port-wine birthmark in SWS brain involvement can be developed as a tool to predict neurologic severity of the disease.

Neonatal tooth infection resulting in subperiosteal orbital abscess: A case report.

Neonatal orbital infections are quite rare, and are most often attributed to ethmoid sinusitis. This report describes a case of subperiosteal orbital abscess in a neonate secondary to an infected neonatal tooth. Although there have been two cases reported in the literature describing odontogenic infection resulting in orbital abscess in neonates, these cases were due to infected tooth buds rather than an infected neonatal tooth. We discuss workup and surgical management of this patient, including tooth extraction and intraoral approach to the orbit for abscess drainage.

Adherence With the Use of Target Intraocular Pressure for Glaucoma Patients in a Large University Practice.

PURPOSE: To determine how often glaucoma specialists set a target intraocular pressure (IOP) and how they respond when the target is not achieved. METHODS: We reviewed 250 randomly selected charts of glaucoma patients seen by 5 glaucoma specialists to identify whether a target IOP was specifically set and to detail the plan of action when the target was exceeded. RESULTS: A target IOP was present for at least 1 eye in 66% of patients (165/250). Among the patients of 5 physicians, the percentage with a target IOP for both eyes ranged from 90% to 34%. Half of eyes with no target had an explaining feature, whereas the other half did not. The study visit IOP exceeded the target in at least 1 eye in 29% (50/173) of patients. When the target was not met, 66% (33/50) had a notation of action taken, with no significant difference among physicians in whether any action was taken (P=0.64). The significant differences among the 5 physicians in the use of target IOP were potentially associated with patient demographic and clinical features, such as age, race, treatment intensity, and visual field damage, which differed among the 5 practices (all P<0.05). CONCLUSIONS: Target IOP was recorded in the large majority of patient charts, but its use varied by physician and patient characteristics. On nearly one third of visits, IOP exceeded the target, indicating the need for active decision-making and management changes.