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1.
Eye (Lond) ; 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34975150

RESUMO

OBJECTIVES: To analyze the top 100 cited papers on ophthalmic trauma. METHODS: A literature search of Ophthalmology journals within the ISI Web of Science database for the most cited papers related to ophthalmic trauma. RESULTS: The most cited articles were published between 1943 and 2013, the greatest number being published in 2000. Ophthalmology (45), Archives of Ophthalmology (17), and the American Journal of Ophthalmology (15) published most of the articles. The institutions with the highest number of publications were Wilmer Eye Institute (10) and Massachusetts Eye and Ear Infirmary (7). Sixty-seven percent of the articles originated from the USA. The most common type of trauma studied was non-open-globe injuries and the most frequent topic studied were pathological conditions secondary to trauma (34), particularly endophthalmitis (8), and optic neuropathy (6). Articles presenting a standardized classification system for eye injury received the highest average of citations per publication. Types of research most frequently cited were observational clinical studies (62) and epidemiological studies (30); the least frequent were clinical trials (2). CONCLUSION: This bibliographic study provides a historical perspective of the literature and identifies trends within the most highly influential papers on ophthalmic trauma. Many of these articles emerged within the past three decades and came from Ophthalmology journals that remain high impact to this day. Clinical trials have been difficult to conduct and are lacking, reflecting a critical need in ophthalmic trauma research, as most of our understanding of ophthalmic trauma comes from observational and epidemiological studies.

2.
Ophthalmol Retina ; 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-35007768

RESUMO

OBJECTIVE OR PURPOSE: To describe the clinical course and outcomes of aggressive retinal astrocytic hamartoma (RAH) treated with oral mTOR inhibitors (mTORi). DESIGN: Retrospective clinical case series. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Five patients with genetically confirmed TSC and visually significant RAH due to tumor growth or exudation. METHODS, INTERVENTION, OR TESTING: Review of the electronic medical record in this retrospective clinical case series was performed to determine baseline and follow-up ophthalmologic examination characteristics along with ancillary imaging findings, in patients receiving off-label treatment with either oral sirolimus or everolimus for symptomatic RAH. MAIN OUTCOME MEASURES: Visual acuity, change in tumor size, degree of exudation, and adverse effects of mTORi were evaluated. RESULTS: The five patients in this series ranged in age from 8 months to 54 years. Four were treated with sirolimus, and one received everolimus. In all cases, tumor height was stable or decreased following treatment (median follow-up: 39 months, range 11-73 months). Exudation improved following treatment in all cases. In the 8-month-old infant, frequent upper respiratory tract infections prompted cessation of treatment. In one patient, the mTORi was temporarily held due to elevated liver enzymes. No other significant adverse effects were noted. CONCLUSIONS: Sirolimus and everolimus should be considered in the management of vision-threatening RAH, particularly in the setting of exudative and rapidly growing tumors. Four out of five patients in this series tolerated oral mTORi and continued on therapy. There were no serious complications.

3.
Br J Ophthalmol ; 2021 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-34880051

RESUMO

BACKGROUND/AIMS: To determine success rate and complications associated with nasal transposition of the split lateral rectus muscle (NTSLR) for treating strabismus from 3rd-nerve palsy. METHODS: An international, multicentre, registry of patients with unilateral 3rd-nerve palsy treated with NTSLR was created. Patients with concurrent surgery on the contralateral eye were excluded. Primary outcome was horizontal alignment within 15 prism dioptres (PD) of orthotropia. Incidence of technical difficulties and vision-threatening complications by 6 months post-procedure were reported. RESULTS: Ninety-eight patients met inclusion criteria. Median age was 33.5 years (IQR 10.75-46). Aetiologies included congenital (31%), neoplastic (16%) and traumatic (15%). Twenty-five per cent of patients had prior ipsilateral strabismus surgery. Median exotropia decreased from 70PD preoperatively (IQR 50-90) to 1PD postoperatively (IQR 0-15.5), with a success rate of 69%. Performing concurrent superior oblique muscle tenotomy (SOT) was independently associated with success (p=0.001). Technical challenges occurred in 30% of cases, independently associated with a history of ipsilateral strabismus surgery (p=0.01). Eleven per cent of patients had vision-threatening complications, independently associated with more posterior placement of the split lateral rectus (LR) muscle (p<0.001), and most commonly transient serous choroidal effusion. Surgical placement of the split LR muscle within 4.25 mm of the medial rectus (MR) muscle insertion reduced this risk. CONCLUSION: NTSLR significantly improved primary position alignment altered by 3rd-nerve palsy. Concurrent SOT and placement of the split LR muscle ≤4.25 mm posterior to the MR muscle insertion optimised outcomes. NTSLR proved technically challenging when prior ipsilateral strabismus surgery had been performed.

4.
JMIR Hum Factors ; 8(4): e29941, 2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34860669

RESUMO

BACKGROUND: Bedside manner describes how clinicians relate to patients in person. Telemedicine allows clinicians to connect virtually with patients using digital tools. Effective virtual communication or webside manner may require modifications to traditional bedside manner. OBJECTIVE: This study aims to understand the experiences of telemedicine providers with patient-to-provider virtual visits and communication with families at a single large-volume children's hospital to inform program development and training for future clinicians. METHODS: A total of 2 focus groups of pediatric clinicians (N=11) performing virtual visits before the COVID-19 pandemic, with a range of experiences and specialties, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semistructured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded, and the corresponding transcripts were reviewed for data analysis. The transcripts were coded based on the identified main themes and subthemes. On the basis of a higher-level analysis of these codes, the study authors generated a final set of key themes to describe the collected data. RESULTS: Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialties and practices. A total of 3 key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt that telemedicine required new skills for patient interaction, and not all were comfortable with their training. CONCLUSIONS: Telemedicine provides benefits as well as challenges to health care delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. The inclusion of webside manner instructions within training curricula is crucial as telemedicine becomes an established modality for providing health care.

6.
Brain Inj ; 35(10): 1218-1228, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34383619

RESUMO

PURPOSE: To examine the association between Post-Concussion Symptom Scale (PCSS) scores, Convergence Insufficiency Symptom Survey (CISS) scores, and oculomotor deficits post-concussion. METHODS: Records of adolescent patients examined in a multidisciplinary concussion clinic between July 2014 and May 2019 were reviewed. PCSS and CISS scores, results of eye examination and oculomotor assessment, concussion history, and demographics were abstracted. RESULTS: One hundred and forty patient records (median age, 15.3 years; 52 males, presented 109 days (median) from their most recent concussion) met inclusion criteria. Mean total scores on PCSS and CISS were 46.67 ± 25.89 and 27.13 ± 13.22, respectively, and were moderately correlated with each other (r = 0.53, p < .001). Oculomotor deficits were observed in 123 (88%) patients. Step-wise linear regression identified increased PCSS total score to be significantly associated with decreased amplitude of accommodation (p < .001). Increased CISS total score was significantly associated with receded near point of convergence, developmental eye movement test error scores, and cause of concussion. CONCLUSION: High PCSS scores may indicate an accommodation deficit and thus prompt an oculomotor assessment in patients following a concussion. Using the CISS and a detailed oculomotor assessment may reveal underlying oculomotor deficits, which may benefit from treatment.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Adolescente , Concussão Encefálica/complicações , Movimentos Oculares , Humanos , Masculino , Testes Neuropsicológicos , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/epidemiologia
7.
Am J Ophthalmol ; 235: 32-37, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34283987

RESUMO

PURPOSE: To evaluate outcomes of botulinum toxin (BTX) injection of the inferior oblique (IO) muscle. DESIGN: Retrospective case series. METHODS: Setting: Single center, ophthalmology department at Boston Children's Hospital. STUDY POPULATION: All patients treated with IO muscle injection of BTX (onabotulinumtoxinA) between 2010 and 2020. OBSERVATION PROCEDURE: Sensorimotor evaluations at short-term (<2 months), medium-term (2-4 months), and long-term (≥4 months) intervals. OUTCOME MEASURE: Primary outcomes included median improvement in V-pattern strabismus and primary position hypertropia. Secondary outcomes included IO muscle overaction. Wilcoxon signed-rank tests were performed to identify differences before and after injection. RESULTS: Record review identified 20 patients with a median age of 4.5 (range, 1-69) years. Median BTX dose injected (31 IO muscles) was 5.0 (range, 3.0-7.0) units. Indications included V-pattern strabismus (N = 8), hypertropia (N = 7), or both (N = 5). Median long-term interval was 6.4 (range, 4.1-26.6) months. Injections were concurrent with treatment of horizontal strabismus in all but 3 cases. Median V-pattern magnitude changed from 10 prism diopters (PD) preoperatively to 0 PD short-term (P = .006) and 3.5 PD long-term (P = .34). Median hypertropia changed from 8.5 PD preoperatively to 1.5 PD short-term (P = .01) and 8 PD long-term (P = .87). Median IO muscle overaction grade improved significantly at short-term (P < .001) and long-term (P = .007) intervals. There were no complications associated with the IO muscle injections. CONCLUSIONS: BTX injection of the IO muscles can be a useful adjunct to the management of V-pattern strabismus. Intervention for primary position hypertropia may be helpful for short-term relief with no expectation of long-term benefit.

8.
Am J Ophthalmol ; 233: 135-143, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33991515

RESUMO

PURPOSE: To evaluate the timing of ocular hypertension (OHT) after pediatric closed-globe injury (CGI) and traumatic hyphema. We hypothesize that OHT will occur at different times based on injury characteristics. DESIGN: Retrospective, cohort study. METHODS: Setting: Single-center, tertiary-care, pediatric hospital. PARTICIPANTS: Subjects included patients ≤18 years of age at the time of injury who suffered CGI and traumatic hyphema between 2002 and 2019. Observation Procedure(s): Intraocular pressure and injury demographics were abstracted for every visit after injury. OHT was defined as >21 mm Hg at presentation or after a reading of ≤21 mm Hg at a prior visit. MAIN OUTCOME MEASURES: The primary outcome measure was the timing of OHT categorized into 4 periods: presentation, acute (days 1-7), subacute (days 8-28), or late (day >28). Secondary outcome measures were identification of risks factors for OHT by multivariable logistic regression. RESULTS: OHT occurred in 119 of the 305 (39%) subject eyes. OHT occurred in 35 patients at presentation, 69 times acutely, 35 times subacutely, and 36 times late. Pupil damage predicted acute-period OHT (P = .004). OHT at presentation predicted subacute period OHT (P = .004). Iridodialysis and cataract predicted late-period OHT (P = .007 and P < .001, respectively). CONCLUSIONS: OHT after CGI and traumatic hyphema in pediatric patients is common. Injury demographics predict this complication. Integration of these risk factors with current literature allows proposal of a risk-stratification tool to guide efficient surveillance for OHT.

9.
J Pediatr Ophthalmol Strabismus ; 58(3): e12-e15, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039163

RESUMO

A 9-year-old boy with partial third nerve palsy underwent medial transposition of the left lateral rectus muscle and left inferior oblique myectomy. He developed optic nerve compression, which improved after a superior oblique tenotomy. A primary superior oblique tenotomy or a maximum lateral rectus muscle split may help avoid this complication. [J Pediatr Ophthalmol Strabismus. 2021;58(3):e12-e15.].


Assuntos
Doenças do Nervo Oculomotor , Estrabismo , Criança , Edema , Humanos , Masculino , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Nervo Óptico , Órbita , Estrabismo/etiologia , Estrabismo/cirurgia
10.
Vision Res ; 184: 30-36, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33838503

RESUMO

Many patients with concussion experience visual symptoms following injury that lead to a diagnosis of convergence insufficiency, accommodative insufficiency, or saccadic dysfunction. However, these diagnostic categories are based on aggregates of clinical tests developed from a non-concussed population and therefore may not accurately describe visual deficits in the concussed population. Thus, we sought to understand individual metrics of visual dysfunction in chronically symptomatic post-concussion patients. This retrospective cross-sectional study included patients examined at the multidisciplinary concussion clinic (MDCC) at Boston Children's Hospital over four years. Patients aged 5-21 years who had a complete assessment of eye alignment, vergence, accommodation, and visual tracking, and had visual acuity better than or equal to 20/30 in each eye were included. Patients with history of amblyopia, strabismus, or ocular pathology were excluded. Chart review yielded 116 patients who met inclusion criteria (median age 15 years, 64% female). The majority of patients (52%) experienced a single concussion and most were sports-related (50%). Clinical data show vergence, accommodation, or visual tracking deficits in 95% of patients. A receded near point of convergence (NPC, 70/116) and reduced accommodative amplitude (63/116) were the most common deficits. Both NPC and accommodative amplitude were significantly correlated with one another (r = -0.5) and with measures of visual tracking (r = -0.34). Patients with chronic post-concussion symptoms show deficits in individual metrics of vergence, accommodation and visual tracking. The high incidence of these deficits, specifically NPC and accommodative amplitude, highlights the need for a detailed sensorimotor evaluation to guide personalized treatment following concussion.

11.
Clin J Sport Med ; 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33605602

RESUMO

OBJECTIVE: To describe the collaborative findings across a broad array of subspecialties in children and adolescents with postconcussion syndrome (PCS) in a pediatric multidisciplinary concussion clinic (MDCC) setting. DESIGN: Retrospective analysis. SETTING: Multidisciplinary concussion clinic at a pediatric tertiary-level hospital. PATIENTS: Fifty-seven patients seen in MDCC for evaluation and management of PCS between June 2014 and January 2016. INTERVENTIONS: Clinical evaluation by neurology, sports medicine, otolaryngology, optometry, ophthalmology, physical therapy, and psychology. MAIN OUTCOME MEASURES: Specialty-specific clinical findings and specific, treatable diagnoses relevant to PCS symptoms. RESULTS: A wide variety of treatable, specialty-specific diagnoses were identified as potential contributing factors to patients' postconcussion symptoms. The most common treatable diagnoses included binocular vision dysfunction (76%), anxiety, (57.7%), depression (44.2%), new or change in refractive error (21.7%), myofascial pain syndrome (19.2%), and benign paroxysmal positional vertigo (17.5%). CONCLUSIONS: Patients seen in a MDCC setting receive a high number of treatable diagnoses that are potentially related to patients' PCS symptoms. The MDCC approach may (1) increase access to interventions for PCS-related impairments, such as visual rehabilitation, physical therapy, and psychological counseling; (2) provide patients with coordinated medical care across specialties; and (3) hasten recovery from PCS.

13.
J AAPOS ; 24(4): 197-203, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32758701

RESUMO

Community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) in the United States on February 26, 2020, and the rapid spread that followed forced patients, providers, payors, and policy makers to adapt to an unprecedented, nearly instant, and enormous demand for virtual care. Although few US ophthalmology practices incorporated telemedicine prior to COVID-19, its use has now become the norm. Regarding the use of synchronous patient-to-provider virtual visits (SPPVV) in pediatric ophthalmology, we have pooled our collective experience at three academic practices across the country to describe initial workflows, technology solutions, use cases, and barriers to care.


Assuntos
COVID-19/epidemiologia , Oftalmopatias/epidemiologia , Oftalmologia/métodos , Pandemias , SARS-CoV-2 , Telemedicina/organização & administração , Criança , Comorbidade , Oftalmopatias/diagnóstico , Humanos , Estados Unidos/epidemiologia
14.
Telemed J E Health ; 26(9): 1113-1117, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32408801

RESUMO

Virtual visits (VVs) are necessitated due to the public health crisis and social distancing mandates due to COVID-19. However, these have been rare in ophthalmology. Over 3.5 years of conducting >350 ophthalmological VVs, our group has gained numerous insights into best practices. This communication shares these experiences with the medical community to support patient care during this difficult time and beyond. We highlight that mastering the technological platform of choice, optimizing lighting, camera positioning, and "eye contact," being thoughtful and creative with the virtual eye examination, and ensuring good documenting and billing will make a successful and efficient VV. Moreover, we think these ideas will stimulate further VV creativity and expertise to be developed in ophthalmology and across medicine. This approach, holds promise for increasing its adoption after the crisis has passed.


Assuntos
Infecções por Coronavirus/epidemiologia , Oftalmologia/métodos , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Betacoronavirus , COVID-19 , Confidencialidade/normas , Técnicas de Diagnóstico Oftalmológico/normas , Documentação , Humanos , Reembolso de Seguro de Saúde , Iluminação , Pandemias , Relações Médico-Paciente , Padrões de Prática Médica/normas , SARS-CoV-2
15.
Am J Med Genet A ; 182(7): 1754-1760, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32293785

RESUMO

Shwachman-Diamond syndrome (SDS) is an autosomal recessive multisystem disorder characterized by exocrine pancreatic dysfunction, bone marrow failure, and leukemia predisposition. Approximately 90% of cases are due to biallelic mutations in the Shwachman-Bodian-Diamond (SBDS) gene. Additional phenotypic features variably associated with SDS include skeletal, neurologic, hepatic, cardiac, endocrine, and dental abnormalities. We report five subjects with SDS who developed a range of inflammatory manifestations. Three patients developed inflammatory eye conditions. Single cases of juvenile idiopathic arthritis, chronic recurrent multifocal osteomyelitis, and scleroderma were also noted. Clinical presentation and treatment responses are described. Proteomic analysis revealed increased inflammatory signatures in SDS subjects as compared to controls. Treatment of inflammatory manifestations in patients with SDS may be complicated by potential myelosuppressive toxicities of anti-rheumatic medications. Further research is needed to better understand the potential link between inflammatory disorders and SDS to inform effective treatment strategies.


Assuntos
Doenças Autoimunes/genética , Inflamação/genética , Proteínas/genética , Síndrome de Shwachman-Diamond/genética , Adolescente , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/patologia , Doenças da Medula Óssea/diagnóstico , Doenças da Medula Óssea/genética , Criança , Pré-Escolar , Sistema Endócrino/patologia , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/patologia , Lipomatose/diagnóstico , Lipomatose/genética , Lipomatose/patologia , Masculino , Mutação/genética , Fenótipo , Proteômica , Síndrome de Shwachman-Diamond/diagnóstico , Síndrome de Shwachman-Diamond/patologia , Adulto Jovem
16.
Transl Vis Sci Technol ; 8(2): 9, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30944769

RESUMO

Purpose: StrabisPIX is a smartphone application that allows clinicians to prescribe a series of self-obtained images of head position and eye alignment in nine positions of gaze that are uploaded onto a secure platform for clinician review. This study evaluates the clinical utility of this application. Methods: In this prospective, nonmasked, cross-sectional study, 30 strabismus patients aged ≥2 years were evaluated. Participants received standardized instructions, used StrabisPIX to obtain images as prompted, and completed a satisfaction survey. During the same visit, an orthoptist obtained standard clinical images with a professional camera. All 60 image sets were evaluated by three observers. Results: StrabisPIX image quality was similar to that of clinic photographs. Clinic photographs had significantly higher acceptability for horizontal versions (81% vs. 67%), vertical versions (76% vs. 60%), and head posture (93% vs. 81%). Abnormalities were detected at a similar rate for versions, head posture, eyelid position, and pupil size. StrabisPIX had significantly higher detection of alignment abnormalities (89% vs. 77% for clinical photos). Interrater/intrarater agreements were moderate to high (κ = 0.44-1.00) for all parameters except pupil abnormality, which had poor to fair agreement. Most patients reported that StrabisPIX was easy to learn and use. Conclusions: Overall, StrabisPIX images had similar quality and were as useful as images obtained in the clinic in detecting abnormalities. Translational Relevance: The StrabisPIX application will enhance the use of telemedicine by allowing physicians to prescribe self-obtained images documenting strabismus.

17.
Am J Ophthalmol ; 206: 235-244, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31004592

RESUMO

PURPOSE: To determine the frequency of occurrence of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders. DESIGN: Retrospective cross-sectional study. METHODS: Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients < 21 years old who were > 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined. RESULTS: Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had convergence insufficiency and accommodation deficits; and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had convergence excess only; and 1 (1%) had both convergence excess and accommodative deficits. CONCLUSION: A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.


Assuntos
Acomodação Ocular/fisiologia , Concussão Encefálica/complicações , Convergência Ocular/fisiologia , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Visão Binocular/fisiologia , Adolescente , Concussão Encefálica/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
J AAPOS ; 23(2): 86.e1-86.e7, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30885809

RESUMO

PURPOSE: To evaluate the effect of a computer-based training program-Massachusetts Eye & Ear ROP Trainer-on residents' knowledge of retinopathy of prematurity (ROP) management. METHODS: In this prospective, randomized study, ophthalmology residents from nine different training programs consented to participate. Those who completed the study were randomly assigned to either the Trainer or the control group. The ROP Trainer was created using clinical cases encompassing the stages of ROP in digital pictures and videos. It includes sections on screening decisions, examination techniques, and diagnosis, and a reference section with the expert video clips and a searchable image library. Subjects in the control group were asked to study standard print material on ROP. A pre- and post-test, consisting of theoretical and practical (diagnosis) questions, and a post-intervention satisfaction test were administered. Accuracy of ROP diagnosis was assessed. RESULTS: A total of 180 residents agreed to participate, of whom 60 completed the study. Residents in the Trainer group had statistically significant improvements (P = 0.003) in ROP knowledge and diagnostic ability (P = 0.005). Residents randomized to the Trainer group were more satisfied with the training materials than were those in the control group. There was no significant difference in improving knowledge by year of training, sex, or country. Considering all training levels, a statistically significant increase was observed in sensitivity for the diagnosis of preplus or worse, zone I or II, ROP stage, category, and aggressive posterior ROP in the Trainer group. CONCLUSIONS: In this study, the Trainer was shown to significantly improve ROP knowledge and diagnostic skills of residents, regardless of sex, year, of training, or country.


Assuntos
Competência Clínica/normas , Instrução por Computador/métodos , Internato e Residência/métodos , Oftalmologia/educação , Retinopatia da Prematuridade/diagnóstico , Retroalimentação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Massachusetts , Oftalmologia/normas , Estudos Prospectivos , Retinopatia da Prematuridade/terapia
19.
Am J Ophthalmol Case Rep ; 13: 16-19, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30505980

RESUMO

Purpose: Chromosome 22q11.2 micro-duplication syndrome (MDS), is a rare autosomal dominant condition, with a highly variable phenotype that ranges from unremarkable and asymptomatic, to fatal due to cardiovascular defects. Hypertelorism, downslanting palpebral fissures, superior displacement of the eyebrows, and ptosis are the most commonly reported ocular manifestations. Here, we report a newborn with bilateral exposure, entropion, and corneal ulceration related to 22q11.2 MDS. Observation: A newborn girl presented with bilateral upper eyelid entropion, bilateral lower eyelid ectropion, and lagophthalmos. She subsequently developed bilateral corneal ulcers. Topical antibacterial drops, bandage contact lenses, medroxyprogesterone 1%, and fluorometholone 0.1%, together with partial tarsorrhaphy and correction of eyelid malposition, were used to treat the ulcers and address the underlying issues of exposure and entropion. Genetic testing revealed chromosome 22q11.2.MDS; further evaluation revealed systemic manifestations of this syndrome. The ocular surface healed well with gradual improvement of corneal opacification as well as bilateral partial tarsorrhaphy. Conclusion and importance: This report is the first that describes a newborn with 22q11.2 MDS presenting with sight-threatening corneal ulceration. Entropion, ectropion, and lagophthalmos were identified and treated, allowing for healing of the corneal surface. Genetic testing revealed a syndrome not known to be associated with eyelid abnormalities and corneal ulceration, but with other important systemic and ocular implications. Bilateral partial tarsorrhaphy should not be excluded as a treatment option for infants who fail more conservative measures for the treatment of exposure.

20.
Pediatr Neurol ; 84: 49-52, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29859720

RESUMO

BACKGROUND: Posterior ischemic optic neuropathy results from ischemia of the retrobulbar aspect of the optic nerve. It presents as acute loss of vision without optic disc swelling. This is rare in children, with only seven cases reported to date. Neuroimaging is frequently used to aid in the diagnosis of acute visual complaints in children; however, none of the cases described to date delineate the neuroimaging findings of this entity in children. METHODS: We retrospectively reviewed the electronic medical record. RESULTS: We describe the MRI findings in a 10-month-old boy with posterior ischemic optic neuropathy after intraophthalmic artery injection of chemotherapy for retinoblastoma. CONCLUSIONS: As targeted therapies for retinoblastoma and other diseases amenable to intravascular treatment delivery are more frequently used, the risk of grave vision-related side effects increases. Posterior ischemic optic neuropathy should be considered in the differential diagnosis of any child presenting with acute loss of vision. Dedicated imaging of the orbits can elucidate specific findings that may aid in the diagnosis of this entity in children.


Assuntos
Infusões Intra-Arteriais/efeitos adversos , Artéria Oftálmica , Neuropatia Óptica Isquêmica , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Transtornos da Visão/etiologia , Antineoplásicos/administração & dosagem , Imagem de Difusão por Ressonância Magnética , Humanos , Lactente , Angiografia por Ressonância Magnética , Masculino , Artéria Oftálmica/diagnóstico por imagem , Artéria Oftálmica/lesões , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/diagnóstico por imagem , Neuropatia Óptica Isquêmica/etiologia
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