Retinal imaging in infants.

Digital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.

A hitherto undescribed case of cerebellar ataxia as the sole presentation of thyrotoxicosis in a young man: a plausible association.

A 16-year-old male presented to hospital following an episode of unusual behavior on the football pitch, where he was witnessed as grossly ataxic by his teammates. The assessment demonstrated marked cerebellar signs on examination but no other neurological deficit. The investigation showed the evidence of biochemical thyrotoxicosis with free T4 at 37 pmol/L (normal reference range: 11-27) and thyrotropin (TSH) < 0.003 mU/L. Following admission, full investigations including computed tomographic brain scan with contrast, lumbar puncture with cerebrospinal fluid examination, magnetic resonance imaging, and magnetic resonance angiography did not reveal abnormalities. He was initiated on carbimazole 40 mg every day. Thyroid ultrasonography revealed a goiter with increased blood flow, and his thyroid antibodies showed positive thyroid peroxidase antibodies but negative TSH receptor antibodies. Electroencephalogram did not reveal any abnormalities. His neurological disability resolved completely after his thyroid function normalized. The association of cerebellar syndromes is well described with hypothyroidism; however, it is hitherto undescribed with thyrotoxicosis. The causal relationship is plausible because alternative etiologies were excluded, and the normalization of thyroid function with treatment was coupled with complete resolution of the neurological syndrome. Cerebellar syndromes may well be one of the presenting features of thyrotoxicosis, and this should be in the list of its differential diagnosis.

Chronic granulomatous disease and neovascularisation causing a vitreous haemorrhage.

The authors report the case of a 9-year-old boy with chronic granulomatous disease with longstanding inactive chorioretinal lesions developing a spontaneous vitreous haemorrhage. This was due to an undetected branch retinal vein occlusion and was successfully treated with retinal photocoagulation (laser).

Effect of hyaluronidase on ocular motility in sub-Tenon's anesthesia: randomized controlled trial.

PURPOSE: To assess the effect of hyaluronidase additive on the onset and degree of ocular akinesia in sub-Tenon's anesthesia for cataract surgery. SETTING: Routine cataract operating list. METHOD: This double-blind randomized controlled study comprised 100 patients who had phacoemulsification cataract surgery. Patients were randomized to 1 of 2 groups. For sub-Tenon's anesthesia, Group A received 5 mL lignocaine 2% with sodium hyaluronidase 150 IU/mL and Group B, 5 mL plain lignocaine 2%. Akinesia was assessed by scoring movement in the 6 positions of gaze. Scores ranged from 0 (complete akinesia) to 3 (no akinesia). Movements were measured at 30 seconds and 1, 3, 5, and 10 minutes. Changes in motility scores were compared by the Mann-Whitney U test. RESULTS: There was no significant difference in akinesia between the 2 groups 30 seconds after the injection (P =.224); however, at 1 and 3 minutes, Group A achieved significantly better akinesia than Group B (P =.003 and P =.023, respectively). The median score after 3 minutes was 3.5 (interquartile range 0 to 7.5) in Group A and 7.0 (interquartile range 2.5 to 10.0) in Group B. There was no significant difference between the groups at 5 and 10 minutes (P =.225 and P =.831, respectively). CONCLUSIONS: The addition of hyaluronidase in sub-Tenon's anesthesia significantly improved the rapidity of the onset of akinesia. This benefit disappeared over time; after 5 minutes the akinesia observed in the group receiving hyaluronidase was similar to that in the group receiving lignocaine alone. Thus, there appears to be no benefit to adding hyaluronidase to the anesthetic solution in terms of final ocular akinesia.

Occlusion therapy for the treatment of amblyopia: letting the parents decide.

BACKGROUND: Compliance with prescribed occlusion therapy is a significant problem in the treatment of amblyopia. Parental preference for a particular type of occlusion treatment has not been previously addressed. Unless parental views are taken into account when planning therapy, compliance may be poor and treatment may fail. SUBJECTS AND METHODS: Parents of children with strabismic and/or anisometropic amblyopia who were due to start or had already had occlusion treatment were included in this study. Group A comprised parents of children who had no previous experience of occlusion, and group B comprised parents of children who had previous experience of occlusion therapy. Parental preferences regarding occlusion therapy were investigated by way of a questionnaire, in which they were asked whether they would prefer part-day/full-week occlusion or all-day/part-week occlusion so that the total number of hours of occlusion per week was the same. RESULTS: One hundred parents completed the questionnaire, 47 from group A and 53 from group B. A significant number of parents in group A (95.3%) who had no previous experience with occlusion preferred part-day/full-week occlusion (p < 0.001), whereas there was no such preference among parents who had experience with occlusion, that is only 54.3% of parents in group B showed a preference for part-day/full-week occlusion (p = 0.1). The reasons given by the parents for their preferences varied but were in keeping with their lifestyles so that the type of occlusion regimen chosen by the parents was in accordance with the reasons given for their choice. CONCLUSION: Parental preferences should be considered when occlusion therapy is planned if compliance is to be improved. For maintenance occlusion, it would be reasonable to prescribe the number of hours of occlusion required per week and allow parents the responsibility to implement the pattern of occlusion according to their circumstances--the implied restriction ensuring that the number of hours of occlusion per week is met. Although parents appeared to have preconceived ideas before the commencement of treatment, their preferences changed once treatment had begun.