Down syndrome as a cause of abnormalities in the craniofacial region: A systematic literature review.

Down syndrome (DS) is the most often diagnosed chromosomal disorder in newborns. The incidence is 1:792 live births. The article describes the irregularities and characteristics found in trisomy 21, which greatly affect the functioning of the stomatognathic system. The most significant disorders include the following: false macroglossia, muscular hypotonia and gothic palate. These abnormalities affect articulation, breathing, food intake, and swallowing. We analyzed the morphological characteristics of the craniofacial region in children with DS based on the current literature review. The following databases were used for the analysis: MEDLINE (via PubMed), Scopus, Infona, and Dentistry & Oral Sciences Source. In the course of the study, 199 pieces of literature were analyzed; the analysis also included 18 articles on children and adults with DS. It also took into account the structure of the palate, dental and skeletal defects, size of the tongue, muscular hypotonia, and temporomandibular joint dysfunction. Down syndrome is still a current subject of research. Although macroglossia, hypotonia, malocclusion, and temporomandibular joint abnormalities are not features exclusive to DS, numerous dysfunctions and parafunctions as well as retarded psychomotor development greatly complicate the treatment. Therefore, interdisciplinary treatment of patients with trisomy 21 and early treatment in the first months of life with the use of the Castillo-Morales plate are very important, as they ensure better adaptation to the subsequently used apparatus and reduce the risk of disorders of the stomatognathic system.

Evaluation of the anterior chamber angle in pseudoexfoliation syndrome.

BACKGROUND: Pseudoexfoliation syndrome (PEX) is the most frequently identifiable cause of secondary open-angle glaucoma, known as pseudoexfoliation glaucoma. The exact pathophysiology and etiology of PEX and associated glaucoma remains obscure. OBJECTIVES: The purpose of this study was to determine the differences in the morphology of the anterior chamber angle in people with pseudoexfoliation syndrome and pseudoexfoliation glaucoma compared to a control group. We also evaluated the correlation between intraocular pressure (IOP) and pigmentation of the angle with the amount of exfoliated material in the anterior segment. MATERIAL AND METHODS: The study group was composed of 155 eyes from 103 patients aged between 43 and 86 years. Each patient underwent a complete ophthalmological examination. RESULTS: Some difference was found in intraocular pressure between the PEX group and the control group and between the pseudoexfoliation glaucoma group and the control group, but no significant difference was found between the 2 study groups. There was a significant difference in the incidence of some degree of pigmentation in the anterior chamber angle and no difference in the widths of the angle between each group. A significant positive relationship was observed between intraocular pressure and the degree of pigmentation of the anterior chamber angle in both the PEX group and the pseudoexfoliation glaucoma group. CONCLUSIONS: The results of this study indicate that the amount of pigmentation and exfoliation material in the anterior segment significantly correlates with the level of IOP and possibly with the degree of trabecular dysfunction. It seems that for clear identification of PEX and pseudoexfoliation glaucoma factors, clinical assessment appears to be insufficient.

Comparison of Visual Field Measurement with Heidelberg Edge Perimeter and Humphrey Visual Field Analyzer in Patients with Ocular Hypertension.

BACKGROUND: Glaucoma is a group of eye diseases which result in damage to the optic nerve and vision loss. The most important examination in glaucoma patients is visual field assessment. One of the newer perimeters is Heidelberg Edge Perimeter (HEP). OBJECTIVES: The aim of the study was to compare visual field measurements made with Humphrey II 740 Visual Field (Carl Zeiss Meditec) and Heidelberg Edge Perimeter (HEP) (Heidelberg Engineering). FDF stimulus (flicker defined form) in HEP stimulates magnocellular retinal cells, which are the first to be damaged in the early stage of glaucoma. Even a small loss of magnocellular cells may influence HEP visual field. MATERIAL AND METHODS: The observed group consisted of 45 patients (82 eyes), age 60 ± 9.8 years, glaucoma suspects, not treated pharmacologically or surgically before, with intraocular pressure ≥ 22 mm Hg. Visual field values were measured with two different devices: Humphrey II 740 Visual Field (Carl Zeiss Meditec, Jena, Germany) and Heidelberg Edge Perimeter (Heidelberg Engineering, Heidelberg, Germany). The patients were divided into two groups: Group 1 - tested with SITA Standard program on Humphrey perimeter and ASTA Standard HEP, and Group 2 - tested with SITA Fast program on Humphrey perimeter and ASTA Standard on HEP. RESULTS: Few positive ΔMD results (ΔMD = MD HEP - MD HUM) were obtained in Groups 1 and 2, which means that the deviation value on the HEP perimeter was only slightly higher than the mean deviation value on Humphrey. Therefore, one can conclude that HEP perimeter may detect visual field defects with greater precision. The visual field measurements between ASTA Standard on HEP and SITA Standard on Humphrey as well as ASTA Standard on HEP and SITA Fast on Humphrey are not equal: MD values on HEP perimeter are lower than MD on Humphrey, which can mean that HEP perimeter provides more precise results and shows even early visual field lesions. CONCLUSIONS: HEP perimeter measures visual field defects with greater precision so it should be taken into consideration for earlier glaucoma detection in routine ophthalmological diagnosis.

Heidelberg Edge Perimeter: The New Method of Perimetry.

Glaucoma is an optic nerve neuropathy associated with progressive visual field loss. One of the most frequent eye diseases these days, it is believed to have affected 60 million people worldwide in 2014. Various visual field examination methods are known, from the confrontational test to kinetic and static perimetry. The latest device to access the visual field is the Heidelberg Edge Perimeter (HEP). It is a flicker perimeter, but, unlike others of its kind, it uses a unique stimulus called FDF (Flicker Defined Form). A 5-grade round stimulus is created by reversing the phase of flickering black and white dots, thereby forming illusory outlines. The test uses randomly flickering points in medium illumination (50 cd/m²). The background remains the same during the whole test. Background luminance is 50 cd/m2, the marker showing time is 400 ms, and the frequency is 15 Hz. Current studies show that HEP can detect early visual field loss which remains invisible during a standard visual field test with standard automated perimetry. HEP might also prove useful in the early detection of other diseases connected with visual field loss, for example in neurology.

Using Spectralis and Stratus optical coherence tomography devices to analyze the retinal nerve fiber layer in patients with open-angle glaucoma - preliminary report.

BACKGROUND: During the study at the Ophthalmology Clinic of Wroclaw Medical University retinal nerve fiber layer (RNFL) thickness was examined in 35 patients with open-angle glaucoma. OBJECTIVES: The aim of the study was to analyse RNFL thickness measurements by 2 different optical coherence tomography (OCT) devices. MATERIAL AND METHODS: The study group consisted of 35 patients with open-angle glaucoma (aged 48-76 years, including 20 women and 15 men - 70 eyes) with intraocular pressure below 19 mm Hg, treated pharmacologically. The subjects were examined using a Stratus Time Domain OCT (TD-OCT), produced by Zeiss, and a Spectralis Spectral Domain OCT (SD-OCT), manufactured by Heidelberg Engineering. The OCT examination was carried out with both devices on the same day in random order. RESULTS: The study shows that the results obtained using the 2 devices are correlated, although the average measurements of RNFL thickness were lower for the Spectralis OCT in comparison with those taken by the Stratus OCT. The strongest correlation was found for the temporal and nasal quadrants. CONCLUSIONS: The study results using the Spectralis OCT and Stratus OCT are similar, but not identical, so follow-up tests should be performed on the same apparatus as in the initial testing. Considering the new generation of apparatus and the more precise measurement algorithm, the results obtained using the Spectralis SD-OCT seem more accurate.