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Backgroundobjectives: To compare the structural anatomy of the anterior segment in pediatric Trisomy 21 (T21) subjects with and without cataracts to age-matched controls. Design: Prospective case-control study. Participants: 40 subjects (57 eyes) age 0-25 years old (9.1 ± 10.6 years). Methods: This prospective case-control study evaluated anterior segment measurements from ultrasound biomicroscopy (UBM) imaging on 342 images. Results: Among persons with T21 cataract, the iris was significantly thinner than T21 individuals without cataract (0.28 vs 0.32 mm, p = 0.0181). T21/cataract subjects also had significantly thinner lenses than subjects without cataract, regardless of whether they have T21 or are controls (3.1 mm vs 3.5 mm, p = 0.0074).Thinner lens (<3.5 mm) was insignificantly associated with increased odds of cataract (OR = 9.5 [0.872,104], p = 0.065). Thinner iris (<0.32 mm) was associated with increased odds of cataract (OR = 8.4 [1.188, 59.273], p = 0.033). Conclusions: These findings support the hypothesis that subtle quantitative anatomic variants are present in the anterior eye of individuals with T21. Specific anatomic variants are unique to the presence of cataract among subjects with T21.
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OBJECTIVE: To investigate the relationship between corneal diameter and internal corneal span determined from angle-to-angle distance using ultrasound biomicroscopy (UBM) in an observational cross-sectional patient population comprised of 54 eyes (28 healthy control eyes, ages 0.1 to 11.3 years; 26 eyes with primary congenital glaucoma, ages 0.1 to 3.5 years) from 41 pediatric participants ages 0.1 to 11.3 years (mean age: 3±3 years, median age: 2 years). METHODS: Forty cornea photographs with reference ruler and 110 UBM images were obtained. Three observers measured horizontal and vertical corneal diameter and angle-to-angle distance in each cornea photo and UBM image using ImageJ and the average values were used. Main outcome measures were Pearson correlation coefficient, linear regression, mean difference between corneal diameter and angle-to-angle distance, and intra-class correlation coefficients among measurements from all three observers for each parameter. RESULTS: Corneal diameter and angle-to-angle distance had a strong positive correlation horizontally (Pearson r = 0.89, p<0.001) and vertically (r = 0.93, p<0.001). Correlation was consistent regardless of presence of primary congenital glaucoma and participant age. Regression analysis demonstrated a linear relationship between the parameters for horizontal (CD = 0.99*AA+0.28, R2 = 0.81, p<0.001) and vertical (CD = 0.91 *AA+1.32, R2 = 0.85, p<0.001) dimensions. Overall, reliability was good-excellent, ranging from an ICC of 0.76 for vertical corneal diameter to 0.90 for horizontal angle-to-angle distance. CONCLUSIONS: Based on the strong positive correlation found between corneal diameter and angle-to-angle distance in our study population, UBM image analysis can be used to accurately estimate corneal diameter from angle-to-angle distance in children with healthy eyes and primary congenital glaucoma. UBM may provide a useful intraocular alternative for estimating corneal diameter and monitoring diseases that affect the cornea in infants and children, such as congenital glaucoma.
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Córnea , Microscopía Acústica , Humanos , Preescolar , Córnea/diagnóstico por imagen , Niño , Microscopía Acústica/métodos , Masculino , Femenino , Lactante , Estudios Transversales , Glaucoma/diagnóstico por imagen , Glaucoma/patologíaRESUMEN
OBJECTIVE: To compare anterior chamber depth (ACD) and lens thickness (LT) measurements by ultrasound biomicroscopy (UBM), A-scan cross vector (CV) overlay with UBM, and immersion A-scan technique in pediatric eyes. METHODS: This prospective comparative cohort study comprised 43 eyes of 25 pediatric participants (mean age: 2.3±2.2 y). UBM and immersion A-scan biometry were performed prior to dilation and intraocular surgery. ACD and LT were measured by UBM image analysis, A-scan CV UBM overlay, and immersion A-scan technique. RESULTS: ACD and LT measurements obtained using immersion A-scan were significantly greater than with UBM image analysis with mean differences of 0.52 mm and 0.62 mm, respectively (p < 0.001). Immersion A-scan and UBM measurements were moderately correlated (r = 0.70 and 0.64, p < 0.001). ACD and LT measurements obtained using CV overlay were not significantly different than UBM measurements and the values were strongly positively correlated (r = 0.95 and 0.93, p < 0.001). CONCLUSION: Immersion A-scan may overestimate ACD and LT compared to UBM in pediatric patients due to oblique placement of the A-scan probe relative to the optical axis. Supplemental use of UBM and/or CV overlay is indicated to improve measurement accuracy in pediatric patients who cannot reliably fixate due to the ability to confirm proper alignment of the probe with the pupil by visualizing the anterior segment.
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Cámara Anterior , Biometría , Cristalino , Microscopía Acústica , Humanos , Cámara Anterior/diagnóstico por imagen , Cámara Anterior/anatomía & histología , Microscopía Acústica/métodos , Femenino , Masculino , Cristalino/diagnóstico por imagen , Cristalino/anatomía & histología , Preescolar , Estudios Prospectivos , Biometría/métodos , Reproducibilidad de los Resultados , Niño , Lactante , Estudios de Cohortes , Sensibilidad y EspecificidadRESUMEN
Purpose: To determine the correlation between blood flow metrics measured by intravenous fluorescein angiography (IVFA) and the blood flow velocity index (BFVi) obtained by laser speckle contrast imaging (LSCI) in infants with retinopathy of prematurity (ROP). Design: Prospective comparative pilot study. Subjects: Seven eyes from 7 subjects with ROP. Methods: Unilateral LSCI and IVFA data were obtained from each subject in the neonatal intensive care unit. Five LSCI-based metrics and 5 IVFA-based metrics were extracted from images to quantify blood flow patterns in the same region of interest. Correlation between LSCI-based and IVFA-based blood flow metrics was compared between 2 subgroups of ROP severity: moderate ROP (defined as stage ≤ 2 without Plus disease) and severe ROP (defined as stage ≥3 or Plus disease). Main Outcome Measures: Pearson and Kendall rank correlation coefficients between IVFA and LSCI metrics; Student t test P values comparing LSCI metrics between "severe" and "moderate" ROP groups. Results: Pearson correlations between IVFA and LSCI included arterial-venous transit time (AVTT) and peak BFVi (pBFVi; r = -0.917; P = 0.004), AVTT and dip BFVi (dBFVi; r = -0.920; P = 0.003), AVTT and mean BFVi (r = -0.927- P = 0.003), and AVTT and volumetric rise index (r = -0.779; P = 0.039). Kendall rank correlation between AVTT and dBFVi was r = -0.619 (P = 0.051). pBFVi was higher in severe ROP than in moderate ROP (8.4 ± 0.6 and 4.4 ± 1.8, respectively; P = 0.0045 using the 2-sample t test with pooled variance and P = 0.0952 using the Wilcoxon rank-sum test). Conclusions: Correlation was found between blood flow metrics obtained by IVFA and noninvasive LSCI techniques. We demonstrate the feasibility of obtaining quantitative metrics using LSCI in infants with ROP in this pilot study; however, further investigation is needed to evaluate its potential use in clinical assessment of ROP severity. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Purpose: The coronavirus disease 2019 (COVID-19) pandemic is projected to drive 1.5 million Americans toward homelessness, adding to the 3.5 million currently affected. Homelessness poses both socioeconomic and public health challenges because housing status is a social determinant of health. Given ophthalmic health's importance in daily functioning, we characterized ophthalmic disease and vision-related quality of life (VRQOL) among a population experiencing homelessness in Baltimore, Maryland. Methods: Questionnaires, including a Visual Function Index-14 (VF-14) for measuring VRQOL, were administered among patients seeking eye examinations at Health Care for the Homeless (HCH) from October 2018 to March 2020. Results: One hundred sixty-two participants were enrolled in this study. The average age was 53 years. Participants' most common vision concerns were blurry vision (70%) and desire for glasses (52%). Best corrected visual acuity (BCVA) measurements revealed significant vision loss (18%, P < 0.001). Physicians mostly diagnosed refractive error (77%), cataracts (36%), glaucoma/glaucoma suspect (25%), and dry eye (24%). Nearly half were referred to additional ophthalmic care (46%). VRQOL trends reflected functional vision categories (P = 0.042 and P = 0.021). The 1:1 VRQOL and BCVA comparison showed correlation (rho = -0.3, P < 0.001). Cronbach's alpha demonstrated VF-14 reliability (alpha = 0.92). Conclusions: We find high ophthalmic disease prevalence within a population experiencing homelessness. Comparison to studies worldwide reveals healthcare disparities despite healthcare system differences, suggesting a need for more targeted solutions. VF-14 is valid and reliable in assessing those experiencing homelessness. Intragroup VRQOL comparisons may reveal subgroup needs. It is imperative that future studies continue monitoring those experiencing homelessness. Translational Relevance: Validation of VF-14 will allow future studies to utilize this patient-oriented metric within populations experiencing homelessness.
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Glaucoma , Personas con Mala Vivienda , Hipertensión Ocular , Humanos , Persona de Mediana Edad , Calidad de Vida , Prevalencia , Baltimore/epidemiología , Reproducibilidad de los Resultados , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/epidemiologíaRESUMEN
Congenital ocular anomalies may be detected on prenatal imaging using fetal ultrasound and magnetic resonance imaging (MRI), although standard prenatal ultrasound for fetal physical development does not currently include ocular and orbital evaluation. We present the case of a male infant born at 39 weeks' gestation with microphthalmia with cyst that was characterized using serial multimodal imaging, including fetal ultrasound and MRI, B-scan ultrasonography, ultrasound biomicroscopy, and postnatal MRI. Multiple prenatal and postnatal imaging modalities yielded comparable evaluations of the ocular and orbital pathology, validating the prenatal assessments.
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Quistes , Microftalmía , Embarazo , Lactante , Femenino , Masculino , Humanos , Microftalmía/diagnóstico por imagen , Ultrasonografía Prenatal , Quistes/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Edad GestacionalRESUMEN
A 2-year-old girl with severe muscular dystrophy presented with unilateral eye pain and corneal clouding. She was found to have absent red reflex, hypotonia, cerebral hypoplasia, and iris bombe on ultrasound biomicroscopy, a feature not previously reported in this syndrome. She responded favorably to surgical management. Iris bombe can be a cause of glaucoma in muscle-eye-brain disease. This highlights the importance of incorporating ultrasound biomicroscopy into the diagnostic algorithm of muscle-eye-brain disease and other types of congenital syndromic glaucoma. [J Pediatr Ophthalmol Strabismus. 2023;60(4):e35-e37.].
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Glaucoma , Enfermedades del Iris , Síndrome de Walker-Warburg , Femenino , Humanos , Preescolar , Iris/cirugía , Iris/anomalías , Síndrome de Walker-Warburg/complicaciones , Enfermedades del Iris/diagnóstico , Enfermedades del Iris/cirugía , Glaucoma/diagnóstico , Glaucoma/etiología , Glaucoma/cirugía , Microscopía AcústicaRESUMEN
PURPOSE: We developed model eyes using six polymer materials to determine which materials were most appropriate in simulating real human sclera and extraocular muscle (EOM). METHODS: Five three-dimensional (3-D) printed polymers (FlexFill, PolyFlex, PCTPE, Soft PLA, and NinjaFlex) and one silicone material were systematically tested by board-certified ophthalmologists and senior ophthalmology residents. Material testing included scleral passes with 6-0 Vicryl sutures through each eye model. Participants completed a survey designed to collect demographic data, subjective assessment of each material's accuracy in simulating real human sclera and EOM, and a ranking for each polymer material to identify which would be most suitable for an ophthalmic surgery training tool. The Wilcoxon signed-rank test was conducted to determine if there was a statistically significant difference in the distribution of ranks between the polymer materials. RESULTS: The distribution of ranks for silicone material's "sclera" and "EOM" components were statistically significantly higher than that of all other polymer materials (all p < 0.05). Silicone material received the highest rank for both "sclera" and "EOM" components. Survey results indicated that the silicone material effectively simulated real human tissue. CONCLUSION: Silicone model eyes performed better than 3-D printed polymers as an educational tool for incorporation into a microsurgical training curriculum. Silicone models provide a low-cost teaching tool that allows for independent practice of microsurgical techniques without requiring a wet-laboratory facility.
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Internado y Residencia , Oftalmología , Humanos , Polímeros , Competencia Clínica , Oftalmología/educación , SiliconasRESUMEN
We present the case of a boy born at 41 weeks' gestational age who was found to have multiple anatomic anomalies, including abnormalities of the oral cavity, eyelids, and digits. He had ankyloblepharon that was localized to the lateral portion of the palpebral fissure bilaterally. Genetic testing confirmed a mutation in the interferon regulatory factor 6 (IRF6) gene, a known etiology for a spectrum of rare disorders that includes eyelid abnormalities. We present a novel surgical technique for bedside ankyloblepharon repair and describe the relevant clinical features of this case.
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Anomalías Múltiples , Fisura del Paladar , Enfermedades de los Párpados , Masculino , Recién Nacido , Humanos , Párpados/cirugía , Mutación , Anomalías Múltiples/genética , Pruebas Genéticas , Fisura del Paladar/genética , Fisura del Paladar/cirugía , Factores Reguladores del Interferón/genéticaRESUMEN
Purpose Children represent approximately one-third of patients with serious ocular injuries. Our study evaluates associations between race and socioeconomic status in presentation and outcomes of pediatric and adolescent traumatic open globe injuries. Methods We conducted a retrospective chart review of traumatic open globe injuries in pediatric and adolescent patients presenting to Johns Hopkins Hospital and University of Maryland Medical Center between 2006 and 2020. Variables assessed included age, gender, parent-identified race, median household income, mechanism of injury, initial and final visual acuity (VA), and length of follow-up. Results Eighty patients ranging from 4 months to 17.7 years (mean 9.3 years) presented with traumatic open globe injury. Identifications were 28 White (35%), 38 Black (48%), and 5 Hispanic (6%). Initial presenting and final VA, pediatric ocular trauma score (POTS), and length of follow-up did not differ significantly among race, gender, or income. Black patients had higher rates of blunt trauma (odds ratio (OR) 3.81; 95% confidence interval (CI) 0.95-15.24, p = 0.07), uveal prolapse (OR 3.58; 95% CI 1.03-12.43; p = 0.049), and enucleation (OR 10.55; 95% CI 1.26-88.31). Hispanic patients presented at a younger age of 2.8 years mean age vs. 9.9 years (p = 0.004) for others. Conclusion Visual outcomes following traumatic open globe injury were independent of race, gender, or income. However, blunt trauma, uveal prolapse, and enucleation rates were higher in Black patients, and ocular trauma occurred at a younger age in Hispanic patients.
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Lesiones Oculares Penetrantes , Lesiones Oculares , Traumatismo Múltiple , Traumatismos del Cuello , Heridas no Penetrantes , Niño , Humanos , Adolescente , Preescolar , Estudios Retrospectivos , Baltimore/epidemiología , Pronóstico , Lesiones Oculares/epidemiología , Lesiones Oculares/cirugía , Índices de Gravedad del TraumaRESUMEN
We report 3 cases of suspected abusive head trauma with retinal hemorrhages on fundus examination and neuroimaging findings not necessarily suggestive of shaking injury. Previous studies have suggested that retinal hemorrhages are rare in patients without neuroimaging abnormalities. These cases demonstrate some common features (rib fractures, developmental delay, and history of abuse) that may increase suspicion for abusive head trauma. Our findings suggest a potential role for ophthalmic consultation in scenarios with high clinical suspicion for abusive head trauma without definitive neuroimaging evidence of head injury. The nonspecific neuroimaging features of these 3 cases highlight the importance of interpreting cases with global clinical context.
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Maltrato a los Niños , Traumatismos Craneocerebrales , Niño , Humanos , Lactante , Hemorragia Retiniana/diagnóstico , Maltrato a los Niños/diagnóstico , Traumatismos Craneocerebrales/diagnóstico , NeuroimagenRESUMEN
Objective The aim of this study is to describe a cost-effective and portable surgical training module for ophthalmology trainees and demonstrate its effectiveness in building confidence and reducing stress with conjunctival closure. Methods A total of 29 trainees (fourth year medical students, postgraduate year (PGY) 1 ophthalmology residents, PGY2 ophthalmology residents) participated in the module during July 2022. They completed a Pre-Module and Post-Module Questionnaire, with some questions assessing their confidence level and other questions assessing their stress level with conjunctival closure. A Likert scale of 1 to 10 was used to evaluate their level of confidence or stress (with 1 indicating low confidence or low stress and 10 indicating high confidence or high stress). Results Prior to completing the module, participants had an average conjunctival suturing skills confidence level score of 2.6 ± 1.6, which increased significantly to 5.6 ± 1.6 after completing the module ( p < 0.001). Participant's stress level score with performing conjunctival closure on live patients significantly decreased from 7.5 ± 2.4 to 5.6 ± 1.5 ( p < 0.001) after completion of the module. When participants were separated into two groups, participants in the PGY1 residents/medical students group had an average conjunctival suturing skills confidence level score of 2.7 ± 1.8, which rose significantly to 5.1 ± 1.5 after completing the module ( p = 0.008), whereas PGY2 residents had an average conjunctival suturing skills confidence level score of 2.6 ± 1.6, which rose significantly to 5.8 ± 1.7 after completing the module ( p < 0.001). Participant's stress level scores with performing conjunctival closure on live patients did not show significant results in the PGY1 residents/medical students group but significantly decreased from 7.2 ± 2.2 to 5.2 ± 1.3 ( p < 0.001) in PGY2 residents. Participants agreed that the video presented was effective for learning the surgical skill and that the module was engaging and prepared them well to learn more advanced conjunctival suturing techniques. Conclusion Our surgical training module is an effective teaching tool for ophthalmology trainees to increase confidence and decrease stress about performing conjunctiva closure. It provides an opportunity for trainees to repetitively practice key surgical techniques on an inexpensive and reusable training model.
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Objective This article characterizes perspectives of ophthalmologists involved in the residency selection process regarding the potential impact of preference signaling on the ophthalmology residency match. Methods An anonymous online questionnaire generated from SurveyMonkey was approved by the Association of University Professors of Ophthalmology (AUPO) Data Resource Committee for distribution to 391 individuals from the AUPO Departmental Chairs, Program Directors, and Directors of Medical Student Education email listservs in August 2022. Results A total of 96 (24.6%) ophthalmology faculty completed the questionnaire. The majority ( n = 76, 79.2%) agreed or strongly agreed that preference signaling should be implemented in the ophthalmology residency application system. Most respondents agreed or strongly agreed that preference signaling will allow for more holistic reviews of applications ( n = 55, 57.3%), agreed or strongly agreed that it will benefit applicants who do not have connections to home programs or faculty that can reach out to desired programs ( n = 81, 84.4%), and agreed or strongly agreed that it will improve the distribution of interviews to applicants ( n = 76, 79.2%). Participants agreed or strongly agreed that applicants who have signaled interest in their program will receive preference when offering interviews ( n = 59, 61.5%), and those signals will be used as a tiebreaker for similar applications ( n = 75, 78.1%). The majority of participants believed that the ideal number of preference signals' applicants should be given three to four signals ( n = 35, 36.0%) or five to six signals ( n = 29, 30.2%). Conclusion A majority of ophthalmology faculty surveyed support the integration of preference signaling into the ophthalmology residency match.
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Introducción: El problema de la violencia no sólo afecta a quien la padece, pues tiene efectos colaterales en los hijos y otros familiares, lo cual deteriora su salud física, mental y emocional. Objetivo: Analizar la situación de desigualdad y la violencia de género en las mujeres. Metodología: El estudio se realizó bajo un enfoque cualitativo de tipo fenomenológico, aplicando la técnica de la entrevista a profundidad con previo consentimiento informado para su grabación, transcripción, análisis e interpretación. Resultados: Se identificaron formas de violencia física, sexual, psicológica, económica y patrimonial debido a las relaciones asimétricas dentro del hogar, producto del machismo y un sistema patriarcal que afectan la calidad de vida y el desarrollo social de las mujeres. Limitaciones: Las mujeres participantes eran vendedoras del mercado municipal y contaban con poco tiempo disponible para las entrevistas, pues el cierre de sus puestos de trabajo podía generar pérdidas económicas. Valor del estudio: La violencia y desigualdad de género son problemáticas en los países latinoamericanos que se deben abordar desde toda perspectiva para su identificación y prevención oportuna. Conclusiones: La situación de violencia y desigualdad de género ha tenido un impacto negativo no sólo en la vida de las mujeres entrevistadas, sino también de su núcleo familiar, sin embargo, cada una de ellas busca mejorar sus condiciones de vida a pesar de estas adversidades.
Introduction: Gender violence does not only affect the women who suffer it, since it causes collateral effects to children and other family members that deteriorates their physical, mental and emotional health. Objective: To analyze gender inequality and gender-based violence against women. Methodology: We carried out qualitative research of phenomenological type, applying in-depth interviews with previously informed consent for its recording, transcription, analysis and interpretation. Results: Physical, sexual, psychological, economic and patrimonial violence were identified in asymmetrical relationships as a result of sexism and the patriarchal system, which affects women's quality of life and social development. Limitations: Female participants were vendors from a local market and had limited time for the interviews, since the closing of their stands could cause economic losses. Value of the study: Gender-based violence and gender inequality constitute a problem in Latin American countries that should be thoroughly studied for its identification and timely prevention. Conclusions: Gender-based violence and gender inequality produces a negative impact not only on the lives of the women interviewed, but also on their families, however, every one of them tries to improve their life conditions and overcome adversities.
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Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Mujeres Maltratadas , Delitos Sexuales , Violencia de Género , Abuso Emocional , Equidad de GéneroRESUMEN
Conjunctival closure is an important step in strabismus surgery and a fundamental surgical skill that requires dexterity and understanding of general surgical principles. Traditionally, ophthalmology residents have improved their surgical technique in supervised wet labs. Social distancing guidelines during the COVID-19 pandemic may have limited the ability for direct supervised surgical teaching. We developed a safe, reusable, low-cost teaching module that allows residents to train independently to develop skills necessary for conjunctival closure. This module uses stepwise teaching and video instruction to improve resident confidence and preparedness in conjunctival suturing.
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COVID-19 , Internado y Residencia , Oftalmología , Estrabismo , COVID-19/epidemiología , Competencia Clínica , Humanos , Oftalmología/educación , Pandemias , Estrabismo/cirugíaRESUMEN
Objective This article describes a novel clinical rotation that uses technology to create a remote ophthalmology learning experience with the goal of improving virtual exposure to medical and surgical ophthalmic training for medical students. Methods Our unique curriculum incorporates mobile-mounted tablets which allow students to virtually participate in inpatient consults, clinic, and ophthalmic surgery. An adaptable mounting device attached to the slit lamp allows students to observe examinations in real time, enhancing recognition of ocular pathologies. Students participate in a robust curriculum that includes independent learning modules, video lectures, interactive modules, podcasts, and surgical video rounds. Students engage with residents and faculty in interactive-guided lectures and case-based discussions that focus on the American Academy of Ophthalmology white paper teaching objectives. Students are mailed surgical instruments and participate in surgical modules and faculty-led virtual wet laboratories. Results Our unique virtual curriculum combines didactic learning, interactive content, and novel technology applications such as mobile tablets, slit lamp-mounted devices, and faculty-led virtual wet laboratories. Conclusion Virtual technologies can be utilized to enhance ophthalmology medical student education in a safe and effective way during the coronavirus disease 2019 pandemic, and to improve educational access in the future.
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Objective The aim of the study is to describe an inexpensive and easily-constructed model eye for the purpose of teaching laser peripheral iridotomy (LPI) and selective laser trabeculoplasty (SLT) to ophthalmology residents. Methods Easily constructed, inexpensive model eyes were utilized to teach residents SLT and LPI utilizing a remote self-study module. A teaching microscope attachment allowed for video-based instruction and feedback. Results This model eye, used in conjunction with video modules is an effective low-cost teaching tool for laser surgery among ophthalmology residents. Attending ophthalmologists rated the use of these model eyes using surveys and found them to be appropriate teaching tools that could lead to improved knowledge and translate to better patient care. Conclusion Our novel method for teaching glaucoma laser surgery allows residents to learn the principles and theory behind common laser procedures while having the opportunity to practice repetitive procedures on low-cost model eyes.
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OBJECTIVE: To identify corneal structure differences on quantitative high-frequency ultrasound biomicroscopy (UBM) among subjects with congenital glaucoma compared with controls. METHODS: This prospective case-control study evaluated 180 UBM images from 44 eyes of 30 subjects (18 control and 12 glaucoma, mean age 5.2±8.0 years, range 0.2-25.8 years) enrolled in the Pediatric Anterior Segment Imaging and Innovation Study (PASIIS). ImageJ was used to quantify a comprehensive set of corneal structures according to 21 quantitative parameters. Statistical analysis compared corneal measurements in glaucoma subtypes and age-matched controls with significance testing and mixed effects models. RESULTS: Significant differences between congenital glaucoma cases and controls were identified in 16 of 21 measured parameters including angle-to-angle, central and peripheral corneal thicknesses, scleral integrated pixel density, anterior corneal radius of curvature, and posterior corneal radius of curvature. Eight parameters differed significantly between primary congenital glaucoma and glaucoma following congenital cataract surgery. CONCLUSION: Multiple measurable corneal structural differences exist between congenital glaucoma and control eyes, and between primary and secondary congenital glaucoma, including but not limited to corneal width and thickness. The structural differences can be quantified from UBM image analysis. Further studies are needed to determine whether corneal features associated with glaucoma can be used to diagnose or monitor progression of congenital glaucoma.
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Glaucoma , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Córnea/diagnóstico por imagen , Glaucoma/diagnóstico , Humanos , Lactante , Microscopía Acústica , Esclerótica , Adulto JovenRESUMEN
In this paper, we present a novel mechanism for the generation of laser pulses based on the phenomenon of thermocavitation. Thermocavitation bubbles were generated within a glass cuvette filled with copper nitrate dissolved in water, where the tip of an optical fiber was placed very close to the bubble generation region. Once the bubble is generated, it expands rapidly and the incoming laser light transmitted through the optical fiber is reflected at the vapor-solution interface and reflected back into the fiber, which is coupled to an erbium-doped fiber ring laser. Laser pulses were extracted from the ring cavity and detected by a fast photodetector, which corresponds to a single thermocavitation event, obtaining a pulse repetition rate from 118 Hz to 2 kHz at 1560 nm, with a pulse width ranging from 64 to 57 µs. The repetition rate can be controlled by adjusting the laser power to induce thermocavitation. To our knowledge, this novel mechanism of laser pulses has not been reported in the literature.