Effect of Age at Primary Intraocular Lens Implantation on Refractive Growth in Young Children.

PURPOSE: To evaluate the effect of age at primary intraocular lens (IOL) implantation on rate of refractive growth (RRG3) during childhood. METHODS: A retrospective chart review was performed for children undergoing primary IOL implantation during cataract surgery. RRG3 was calculated for one eye from each patient using the first postoperative refraction, last refraction that remained stable (< 1.00 diopters [D] change/2 years), and the corresponding ages. RRG3 values for pseudophakic patients operated on from ages 0 to 5 months were compared with values for patients operated on at ages 6 to 23 months and 24 to 72 months. Patients with refractive errors that stabilized were grouped by age at surgery to compare age at refractive plateau. RESULTS: Of 296 eyes identified from 219 patients, 46 eyes met the inclusion criteria. There was a statistically significant difference in RRG3 among age groups. The mean RRG3 value was -19.82 ± 5.23 D for the 0 to 5 months group, -22.32 ± 7.45 D for the 6 to 23 months group (0 to 5 months vs 6 to 23 months, P = .43), and -9.64 ± 11.95 D for the 24 to 72 months group (0 to 5 months vs 24 to 72 months, P = .01). CONCLUSIONS: Age at primary IOL implantation affects the RRG3, especially for children 0 to 23 months old at surgery. Surgeons performing primary IOL implantation in infants may want to use age-adjusted assumptions, because faster refractive growth rates can be expected in young children. [J Pediatr Ophthalmol Strabismus. 2020;57(4):264-270.].

Characteristics and Outcomes of Endogenous Endophthalmitis: Eight-Year Experience at a Tertiary Care Center.

PURPOSE: To describe the characteristics and outcomes of endogenous endophthalmitis. DESIGN: Retrospective case series. PARTICIPANTS: Patients with endogenous endophthalmitis. METHODS: A retrospective chart review of patients diagnosed with endogenous endophthalmitis between September 1, 2006, and November 1, 2014. MAIN OUTCOME MEASURES: Clinical findings, treatments, microbial results, visual outcomes, and secondary ocular sequelae. RESULTS: Sixty-three patients (68 eyes) were diagnosed with endogenous endophthalmitis. Ocular symptoms were the first manifestation of disease in 76% of patients. Fungal and bacterial endophthalmitis were seen in 37% (n = 25) and 43% (n = 29) of eyes, respectively. In 47% of eyes (n = 32), the disease was associated with intravenous drug use. Eighteen percent of eyes (n = 12) underwent an initial pars plana vitrectomy (PPV) with intravitreal antibiotics, none of which required a secondary intervention for acute infection. Four percent of eyes (n = 3) received only systemic treatment. Seventy-eight percent of eyes (n = 53) underwent initial bedside aspirate with intravitreal injection of antibiotics (tap-and-injection), of which 55% (n = 29) required a secondary PPV. Of eyes that underwent secondary PPV after initially negative culture results from the tap-and-injection, 52% demonstrated positive culture results at the time of secondary PPV (n = 11/21) despite all but 1 having received appropriate antimicrobial coverage initially. Fifty-four percent of eyes (n = 37) experienced secondary ocular sequelae. Eyes that received initial tap-and-injection had statistically nonsignificant better average initial vision, but worse average vision at each follow-up interval, compared to PPV while being less likely to gain 2 lines or more of vision at every follow-up interval except 6 months, with the difference reaching statistical significance at 1 week (odds ratio = 0.014; P = 0.037). Eyes that underwent initial tap-and-injection were statistically significantly more likely to require a secondary PPV (55% vs. 0%; P = 0.0006) and had fewer positive microbial results (19% vs. 67%) than those that underwent initial PPV (P = 0.002). CONCLUSIONS: Most eyes that received initial tap-and-injection eventually underwent a secondary PPV. Initial PPV may have an important role in management because it was associated with better diagnostic yield and a trend toward better visual outcomes.

Fronto-Limbic Brain Dysfunction during the Regulation of Emotion in Schizophrenia.

Schizophrenia is characterized by significant and widespread impairments in the regulation of emotion. Evidence is only recently emerging regarding the neural basis of these emotion regulation impairments, and few studies have focused on the regulation of emotion during effortful cognitive processing. To examine the neural correlates of deficits in effortful emotion regulation, schizophrenia outpatients (N = 20) and age- and gender-matched healthy volunteers (N = 20) completed an emotional faces n-back task to assess the voluntary attentional control subprocess of emotion regulation during functional magnetic resonance imaging. Behavioral measures of emotional intelligence and emotion perception were administered to examine brain-behavior relationships with emotion processing outcomes. Results indicated that patients with schizophrenia demonstrated significantly greater activation in the bilateral striatum, ventromedial prefrontal, and right orbitofrontal cortices during the effortful regulation of positive emotional stimuli, and reduced activity in these same regions when regulating negative emotional information. The opposite pattern of results was observed in healthy individuals. Greater fronto-striatal response to positive emotional distractors was significantly associated with deficits in facial emotion recognition. These findings indicate that abnormalities in striatal and prefrontal cortical systems may be related to deficits in the effortful emotion regulatory process of attentional control in schizophrenia, and may significantly contribute to emotion processing deficits in the disorder.

Differential sensory fMRI signatures in autism and schizophrenia: Analysis of amplitude and trial-to-trial variability.

Autism and schizophrenia share multiple phenotypic and genotypic markers, and there is ongoing debate regarding the relationship of these two disorders. To examine whether cortical dynamics are similar across these disorders, we directly compared fMRI responses to visual, somatosensory and auditory stimuli in adults with autism (N=15), with schizophrenia (N=15), and matched controls (N=15). All participants completed a one-back letter detection task presented at fixation (to control attention) while task-irrelevant sensory stimulation was delivered to the different modalities. We focused specifically on the response amplitudes and the variability in sensory fMRI responses of the two groups, given the evidence of greater trial-to-trial variability in adults with autism. Both autism and schizophrenia individuals showed weaker signal-to-noise ratios (SNR) in sensory-evoked responses compared to controls (d>0.42), but for different reasons. For the autism group, the fMRI response amplitudes were indistinguishable from controls but were more variable trial-to-trial (d=0.47). For the schizophrenia group, response amplitudes were smaller compared to autism (d=0.44) and control groups (d=0.74), but were not significantly more variable (d<0.29). These differential group profiles suggest (1) that greater trial-to-trial variability in cortical responses may be specific to autism and is not a defining characteristic of schizophrenia, and (2) that blunted response amplitudes may be characteristic of schizophrenia. The relationship between the amplitude and the variability of cortical activity might serve as a specific signature differentiating these neurodevelopmental disorders. Identifying the neural basis of these responses and their relationship to the underlying genetic bases may substantially enlighten the understanding of both disorders.

Functional neuroimaging to characterize visual system development in children with retinoblastoma.

PURPOSE: To use functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to investigate visual system development in children being treated for retinoblastoma. METHODS: Informed consent was obtained for all participants (N = 42) in this institutional review board-approved study. Participants were imaged with a 1.5-T scanner while under propofol sedation. Diagnostic brain and orbital imaging was followed by investigational functional neuroimaging, which included fMRI during photic stimulation through closed eyelids, to measure functional activation in the visual cortex, and DTI, to evaluate diffusion parameters of white matter tracts in the corpus callosum and the periventricular optic radiations. Analysis included 115 examinations of 39 patients with a median age of 16.4 months and age range from 1.5 to 101.5 months at first evaluation. RESULTS: The blood oxygen level-dependent signal was predominantly negative and located in the anterior visual cortex. Activation was affected by tumor lateralization (unilateral or bilateral), macular involvement, and retinal detachment. Patients who had undergone unilateral enucleation showed cortical dominance corresponding to the projection from the nasal hemiretina in the unaffected eye. Diffusion parameters followed a normal developmental trajectory in the optic radiations and corpus callosum, but variability was greater in the splenium than in the genu of the corpus callosum. CONCLUSIONS: Longitudinal functional neuroimaging demonstrated important effects of disease and treatment. Therefore, fMRI and DTI may be useful for characterizing the impact of retinoblastoma on the developing visual system and improving the prediction of visual outcome in survivors.