Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
J Binocul Vis Ocul Motil ; 74(2): 65-68, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38626406

RESUMO

Incomitant hypotropia in thyroid eye disease can be difficult to manage, especially in the presence of orthotropia with fusion in down gaze and reading position. Recessing the affected ipsilateral inferior rectus muscle may result in an undesirable downgaze diplopia secondary to a hypertropia in downgaze. Various surgical techniques have been described to manage this potential complication including asymmetric recession of both inferior rectus muscles, posterior myoscleropexy operation, and the Scott recess/resect procedure of the contralateral inferior rectus. In 2004, Hoerantner et al. introduced the y-split recession of the medial rectus muscle for near esotropic deviations. The anterior portion of muscle is split and secured in a y-shaped configuration, which reduces the muscle lever arm and helps minimize incomitance and muscle slippage. Unlike the traditional Cüppers Faden, a y-split recession results in torque reduction in all gaze positions. In addition, a y-split recession does not involve scleral passes posteriorly reducing the risk of globe perforation. We report a patient with incomitant strabismus secondary to thyroid eye disease who underwent a combination of traditional recession and y-splitting recession of the contralateral inferior rectus muscle, resulting in good functional alignment in primary gaze and in the reading position.


Assuntos
Oftalmopatia de Graves , Músculos Oculomotores , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo , Humanos , Pessoa de Meia-Idade , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/cirurgia , Oftalmopatia de Graves/fisiopatologia , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Estrabismo/cirurgia , Estrabismo/fisiopatologia , Visão Binocular/fisiologia
2.
Am J Ophthalmol Case Rep ; 29: 101785, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36605183

RESUMO

Purpose: Rhegmatogenous retinal detachment (RRD) after retinopathy of prematurity (ROP) laser is rare but has been reported to occur at the border of heavy laser or in combination with tractional retinal detachment (TRD). We describe a rare case of a RRD that developed during treatment for ROP with both laser and intravitreal injections. Observations: The retinal detachment resolved with scleral buckling surgery with residual macular atrophy. Conclusions and Importance: This case highlights the importance of retinal imaging, careful funduscopic examination, and consideration of the risk of RRDs after intravitreal injections and laser in neonates with ROP.

3.
JAMA Ophthalmol ; 140(4): 373-381, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35266979

RESUMO

Importance: Children with strabismus have poorer functional vision and decreased quality of life than those without strabismus. Objective: To evaluate the association between strabismus and mental illness among children. Design, Setting, and Participants: This cross-sectional study analyzed claims data from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, from 12 005 189 patients enrolled in the health plan between January 1, 2007, and December 31, 2017. Eligibility criteria included age younger than 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 strabismus claim based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes. Controls were children in the same database with no eye disease codes other than refractive error reported. Demographic characteristics and mental illness claims were compared. Statistical analysis was conducted from December 1, 2018, to July 31, 2021. Main Outcomes and Measures: Presence of mental illness claims. Results: Among the 12 005 189 patients (6 095 523 boys [50.8%]; mean [SD] age, 8.0 [5.9] years) in the study, adjusted odds ratios for the association of mental illnesses with strabismus were 2.01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) for substance use disorder. There was a moderate association between each strabismus type (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; odds ratios ranged from 1.23 (95% CI, 1.17-1.29) for the association between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for the association between exotropia and anxiety disorder. Conclusions and Relevance: This cross-sectional study suggests that there was a moderate association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder but not substance use disorder. Recognizing that these associations exist should encourage mental illness screening and treatment for patients with strabismus.


Assuntos
Esotropia , Exotropia , Esquizofrenia , Estrabismo , Adulto , Transtornos de Ansiedade/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Qualidade de Vida , Esquizofrenia/epidemiologia , Estrabismo/diagnóstico , Estrabismo/epidemiologia , Adulto Jovem
4.
Am J Ophthalmol ; 240: 135-142, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35314189

RESUMO

PURPOSE: We sought to evaluate the association between 5 eye diseases (including glaucoma, cataract, congenital optic nerve disease, congenital retinal disease, and blindness/low vision) and mental illness in a pediatric population. DESIGN: Cross-sectional study. METHODS: A de-identified commercial insurance claims database, OptumLabs Data Warehouse, between January 1, 2007, and December 31, 2018, was used. Children and teens less than 19 years of age at the time of eye diagnosis were included. Demographics and mental illness claims were compared, looking at the association of mental illness and eye disease claims. RESULTS: A total of 11,832,850 children and teens were included in this study with mean age of 8.04 ± 5.94 years at the first claim. Of the patients with at least 1 of the 5 eye diseases (n = 180,297), 30.5% had glaucoma (n = 54,954), 9.5% had cataract (n = 17,214), 21.4% had congenital optic nerve disease (n = 38,555), 26.9% had congenital retinal disease (n = 48,562), and 25.9% had blindness or low vision (n = 46,778). There was a statistically significant association, after adjusting for confounding variables, between at least 1 of the 5 eye diseases and schizophrenia disorder (OR = 1.54, 95% CI = 1.48-1.61, P < .001), anxiety disorder (OR = 1.45, 95% CI = 1.43-1.48, P < .001), depressive disorder (OR = 1.27, 95% CI = 1.25-1.29, P < .001), and bipolar disorder (OR = 1.27, 95% CI = 1.21-1.31, P < .001), but a reversed association with substance use disorder (OR = 0.88, 95% CI = 0.86-0.90, P < .001). CONCLUSIONS: We found associations between eye disease in children and teens and mental illness. Understanding these relationships may improve mental illness screening and treatment in the pediatric population.


Assuntos
Catarata , Glaucoma , Doenças do Nervo Óptico , Doenças Retinianas , Transtornos Relacionados ao Uso de Substâncias , Baixa Visão , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Cegueira/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Glaucoma/complicações , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Humanos , Transtornos do Humor , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/epidemiologia , Doenças Retinianas/diagnóstico , Doenças Retinianas/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
5.
J Pediatr Ophthalmol Strabismus ; 57(3): 176-184, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32453851

RESUMO

PURPOSE: To investigate self-administered, at-home use of a perceptual learning-based video game consisting of target detection of stimuli in different sizes, spatial frequency, orientation, and contrast as a potential dichoptic therapy to improve binocular function in amblyopic patients resistant to patching. METHODS: Children (ages 8 to 18 years) with strabismic and/or anisometropic amblyopia were recruited from a single institution. All participants (n = 25) were prescribed 6 weeks of patching for 2 hours per day, and those whose visual acuity did not improve were randomized to binocular perceptual learning (n = 7), monocular perceptual learning (n = 8), or patching (n = 10) groups for 8 weeks in this prospective cohort study. After an 8-week long period of treatment cessation, during which participants stopped patching or perceptual learning, participants in the patching group were randomized to binocular or monocular perceptual learning training; those in the perceptual learning groups remained the same. Visual function was assessed by visual acuity, low contrast acuity, reading speed, stereoacuity, and binocularity; compliance was evaluated by exercise logs. RESULTS: There were no significant improvements in visual function parameters, which did not vary by treatment group. However, some visual outcomes, such as binocular summation and reading speed, correlated positively with compliance to perceptual learning therapy. CONCLUSIONS: At-home, self-administered use of this perceptual learning-based video game-based visual training does not consistently add therapeutic benefit to those with amblyopia resistant to patching. Future investigation is required to determine whether methods to increase compliance will lead to more reliable outcomes. [J Pediatr Ophthalmol Strabismus. 2020;57(3):176-184.].


Assuntos
Ambliopia/psicologia , Óculos , Aprendizagem , Percepção/fisiologia , Visão Binocular/fisiologia , Acuidade Visual , Adolescente , Ambliopia/terapia , Criança , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Privação Sensorial , Fatores de Tempo , Jogos de Vídeo
6.
Otol Neurotol ; 39(10): e1150-e1159, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30444848

RESUMO

HYPOTHESIS: Magnetic vestibular stimulation (MVS) elicits nystagmus in C57BL/6J mice but not head tilt mice lacking Nox3, which is required for normal otoconial development. BACKGROUND: Humans have vertigo and nystagmus in strong magnetic fields within magnetic resonance imaging machines. The hypothesized mechanism is a Lorentz force driven by electrical current entering the utricular neuroepithelium, acting indirectly on crista hair cells via endolymph movement deflecting cupulae. We tested an alternate hypothesized mechanism: Lorentz action directly on crista hair cell stereocilia, driven by their currents independent of the utricle. METHODS: Before MVS, vestibulo-ocular reflex responses of eight C57BL/6J mice and six head tilt mice were measured during whole-body sinusoidal rotations and tilts using video-oculography. Mice were then placed within a 4.7 Tesla magnetic field with the horizontal semicircular canals approximately Earth-horizontal for ≥1 minute in several head orientations, while eye movements were recorded via infrared video in darkness. RESULTS: Outside the magnet, both C57BL/6J and head tilt mice had intact horizontal vestibulo-ocular reflex, but only C57BL/6J mice exhibited static counter-roll responses to tilt (normal utiruclo-ocular reflex). When placed in the magnet nose-first, C57BL/6J mice had left-beating nystagmus, lasting a median of 32.8 seconds. When tail-first, nystagmus was right-beating and similar duration (median 28.0 s, p > 0.05). In contrast, head tilt mice lacked magnetic field-induced nystagmus (p < 0.001). CONCLUSIONS: C57BL/6J mice generate nystagmus in response to MVS, while mice deficient in Nox3 do not. This suggests 1) a normal utricle is necessary, and 2) functioning semicircular canals are insufficient, to generate MVS-induced nystagmus in mice.


Assuntos
NADPH Oxidases/metabolismo , Nistagmo Patológico/fisiopatologia , Sáculo e Utrículo/fisiologia , Animais , Humanos , Campos Magnéticos , Imageamento por Ressonância Magnética , Camundongos , Camundongos Endogâmicos C57BL , Reflexo Vestíbulo-Ocular/fisiologia
7.
JAMA Ophthalmol ; 136(6): 622-629, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29710290

RESUMO

Importance: Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. Objective: To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. Design, Setting, and Participants: In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. Main Outcomes and Measures: Rate of successfully made appointments and mean wait time for the first available appointment. Results: A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001). Conclusions and Relevance: Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.


Assuntos
Agendamento de Consultas , Oftalmopatias/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Cobertura do Seguro , Masculino , Oftalmologistas/estatística & dados numéricos , Optometristas/estatística & dados numéricos , Estudos Prospectivos , População Rural/estatística & dados numéricos , Estados Unidos , População Urbana/estatística & dados numéricos , Listas de Espera
8.
Artigo em Inglês | MEDLINE | ID: mdl-26202906

RESUMO

The purpose of this study is to describe how a parent's partnership with professionals progresses and evolves throughout the service provisioning process. Using a phenomenological ethnographic approach, the lived reality of a family is depicted as the parent walks through different stages of the Individualized Family Service Plan process over a 6-month period. Data concerning parent-professional interactions were obtained via observation notes and document reviews whereas data regarding parent perceptions were collected through multiple individual interviews. Overall, the parent conveyed her satisfaction with actual services especially regarding the professionals' knowledge and parental advocacy. However, the parent also indicated frustration with the early intervention planning process and "obligated" partnerships with providers. In particular, the providers' lack of sensitivity was noted, and greater emotional and psychological support was suggested. The overall process of developing partnerships with professionals can be excessively intrusive to the family's lives. Future research directions are offered as a contribution for the development of improved policies for early intervention programs regarding family-centered practice, utilizing the perspectives of families.


Assuntos
Atitude do Pessoal de Saúde , Intervenção Médica Precoce , Pais/psicologia , Médicos/psicologia , Relações Profissional-Família , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Adulto , Antropologia Cultural , Pré-Escolar , Enfermagem Familiar/organização & administração , Feminino , Humanos , Lactente , Masculino , New England , Relações Pais-Filho , Apoio Social , Estresse Psicológico/prevenção & controle , Inquéritos e Questionários
9.
J Endod ; 40(7): 982-5, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24935548

RESUMO

INTRODUCTION: The purpose of this pilot study in a cadaver model was to compare 2 different shaping techniques regarding the induction of dentinal microcracks. METHODS: Three lower incisors from each of 6 adult human cadaver skulls were randomly distributed into 3 groups: the control group (CG, no instrumentation), the GT group (GT Profile hand files; Dentsply Tulsa Dental, Tulsa, OK), and the WO group (WaveOne; Dentsply Tulsa Dental). In the GT group, manual shaping in a crown-down sequence with GT Profile hand files was performed. In the WO group, Primary WaveOne files were used to the working length. Teeth were separated from the mandibles by careful removal of soft tissue and bone under magnification. Roots were sectioned horizontally at 3, 6, and 9 mm from the apex using a low-speed saw. Color photographs at 2 magnifications (25× and 40×) were obtained. Three blinded examiners registered the presence of microcracks (yes/no), extension (incomplete/complete), direction (buccolingual/mesiodistal), and location. Data were analyzed with chi-square tests at P < .05. RESULTS: Microcracks were found in 50% (CG and GT) and 66% (WO) of teeth at 3 mm, 16.6% (CG) and 33.3% (GT and WO) at 6 mm, and 16.6% in all 3 groups at 9 mm from the apex. There were no significant differences in the incidence of microcracks between all groups at 3 (P = .8), 6 (P = .8), or 9 mm (P = 1). All microcracks were incomplete, started at the pulpal wall, and had a buccolingual direction. CONCLUSIONS: Within the limitations of this pilot study, a relationship between the shaping techniques (GT hand and WaveOne) and the incidence of microcracks could not be shown compared with uninstrumented controls.


Assuntos
Cavidade Pulpar/lesões , Dentina/lesões , Preparo de Canal Radicular/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Cavidade Pulpar/diagnóstico por imagem , Dentina/diagnóstico por imagem , Desenho de Equipamento , Humanos , Processamento de Imagem Assistida por Computador/métodos , Incisivo/diagnóstico por imagem , Fotografação/métodos , Projetos Piloto , Radiografia , Distribuição Aleatória , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/instrumentação , Hipoclorito de Sódio/uso terapêutico , Ápice Dentário/lesões
10.
Am J Surg Pathol ; 32(5): 752-7, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18379419

RESUMO

In this report, we summarized the clinicopathologic features of 9 cases of plasmacytoid transitional cell carcinoma (TCC) of the urinary bladder, a rare variant of TCC. All 9 patients were men with a mean of age 64.3 years (range, 46 to 81 y). All but 1 patient presented with gross hematuria; the remaining patient had urgency and microscopic hematuria. Cystoscopic findings revealed a dominant solid mass with surrounding multiple papillary lesions in 6 cases and multiple masslike lesions in 3 other cases. The initial diagnosis of plasmacytoid TCC was made on transurethral resection in 8 cases and cystoscopic biopsy in 1. One patient had TNM stage I disease, 2 had stage II disease, 3 had stage III disease, and 3 had stage IV disease. Four patients were treated by radical cystectomy with chemotherapy, 2 by radical cystectomy alone, 1 each by chemotherapy or intravesical bacillus Calmette-Guerin infusion alone, and 1 did not receive any further therapy. Microscopically, all tumors contained plasmacytoid cells, which composed 30% to 100% of the entire tumor. Eight of 9 cases were associated with high-grade TCC, and transitional cell carcinoma in situ was present in 4 cases. The plasmacytoid tumor cells were characterized by eccentrically located nuclei and abundant eosinophilic cytoplasm. Interestingly, plasmacytoid transitional cell carcinoma in situ was noted in 1 case. Immunohistochemical staining demonstrated that both plasmacytoid and conventional TCC components were positive for cytokeratins 7 and 20. The mean Ki-67 labeling index was 30% (range, 10% to 50%), and p53 expression in the majority of cases was low (5% to 10%), except for in 2 cases (70% and 80%). The mean follow-up in 8 patients was 24.5 months (range, 5 to 47 mo); the other patient was lost to follow-up. Five patients died of disease from 5 to 36 months, 2 patients were alive with disease at 30 and 47 months, and 1 patient was alive and well at 36 months with no evidence of disease. In summary, plasmacytoid TCC tends to present at an advanced stage and to have a poor prognosis. Morphologic recognition and distinction from other plasmacytoid malignant neoplasms is critical for its clinical management and immunohistochemical studies may be required for differential diagnosis.


Assuntos
Carcinoma de Células de Transição/patologia , Plasmócitos/patologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Carcinoma in Situ/patologia , Carcinoma de Células de Transição/química , Carcinoma de Células de Transição/terapia , Núcleo Celular/patologia , Terapia Combinada , Cistoscopia , Citoplasma/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Resultado do Tratamento , Neoplasias da Bexiga Urinária/química , Neoplasias da Bexiga Urinária/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA