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Biomedical subjects

Abraham Spierer

Publications and source records attributed to Abraham Spierer.

15 recordsLinked to original sources
PubMed2006

Bilateral medial rectus muscle recession: results in children with developmental delay compared with normally developed children.

PURPOSE: We sought to compare bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay with the results in normal children. METHODS: A retrospective analysis of all the children that underwent standard BMR surgery for esotropia during a 10 year period was undertaken. The surgical results of children with developmental delay were compared with those of normal children. RESULTS: In the developmentally delayed group, the mean angle of esotropia before surgery was 53+/-12 PD, the mean amount of medial rectus recession was 5.4+/-0.56 mm, 0.84 mm less than the standard amount of recession, and at the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among the failures, 86% were undercorrected, only one patient developed consecutive exotropia after surgery. In the developmentally intact group, the mean angle of esotropia before surgery was 37.4+/-8 PD, the mean amount of medial rectus recession was 5.2+/-0.65 mm, and 94% achieved surgical success. Among surgical failures, we observed only a single case of overcorrection. CONCLUSION: A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession amount of the medial rectus muscles when compared with the developmentally normal children who received a standard amount of recession. The main reason for surgical failure in the developmentally delayed group, in a follow-up period of 2 years, was undercorrection of the angle of esotropia. It seems that decreasing the surgical table by a certain amount in children with developmental delay may lead to undercorrection. Therefore, we need to delineate the ideal amount of surgery in this unique group of individuals.

Child↗
PubMed2005

Vector analysis of high early postoperative astigmatism after congenital cataract surgery.

BACKGROUND: Corneal astigmatism is a well-documented finding after cataract surgery. Postoperative astigmatism is of greater importance in children than in adults, because of its adverse effect on vision development and the risk of amblyopia. The purpose of this study was to evaluate refractive outcomes in eyes- which had high early postoperative astigmatism after congenital cataract surgery. METHODS: We retrospectively reviewed the charts of 74 children (112 eyes), who underwent congenital cataract extraction with intraocular lens implantation, using limbal incision, scleral tunnel, or clear corneal incision. Thirty-two eyes of 28 children, aged 2 months to 11 years, had astigmatism of 3.0 diopters (D) or more when assessed 1 week after surgery. Changes in cylinder vector, spherical equivalent (SEQ) and defocus equivalent (DEQ) between 1 week and 5 months postoperatively were calculated for each group. RESULTS: Mean SEQ and DEQ were 0.7+/-3.5 D and 5.1+/-2.8 D, respectively, at 1 week postoperatively- and -0.2+/-3.4 D and 3.1+/-2.3 D, respectively, at 5 months postoperatively in the three groups. DEQ levels showed a significant reduction during the 5-month follow-up period (P<0.001). The mean astigmatism vector was 2.9+/-3.3 D x 93 degrees in all the three groups 1 week postoperatively- and 0.2+/-1.1 D x 153 degrees at 5 months after surgery. A significant change during 5-month follow-up in cylinder vector (P<0.02) and SEQ (P=0.01) was found after operations using scleral tunnel technique. CONCLUSION: Children- who underwent congenital cataract surgery by different surgical techniques showed a significant spontaneous reduction in DEQ values. A significant change in cylinder vector and SEQ was found after operations using scleral tunnel technique.

Astigmatism↗
PubMed2005

Strabismus in senile cataract patients.

PURPOSE: We sought to determine the prevalence of strabismus among patients with senile cataract. METHODS: Forty-seven consecutive patients who were scheduled for cataract surgery underwent complete eye examinations, including ocular alignment evaluation. Twenty-four normal adults of the same age range underwent also complete eye examinations and were used as a control group. All patients of the cataract group underwent unilateral cataract surgery. The angle of strabismus was measured by the prism and cover test or prism and corneal reflex test. RESULTS: Mean preoperative deviation of the study group was 17.8 +/- 9.7 prism diopters (PD) of exophoria/tropia. In this group, 70.2% had exophoria and 27.7% had exotropia. In the control group exophoria was found in 75% of the persons whereas none of them had any heterotropia. Mean deviation in the control group was 4.7 +/- 5.1 PD of exophoria. Postoperatively, the angle of exophoria/tropia improved to 12.8 +/- 8.5 PD, which was different from the preoperative measurements (P < 0.01). In this group 78.8% had exophoria and 19.1% had exotropia. CONCLUSIONS: Patients with cataract have greater tendency to develop exotropia or exophoria than noncataract persons of the same age. Cataract surgery improves the heterophoric status of these patients.

Aged↗
PubMed2004

Changes in astigmatism after congenital cataract surgery and intraocular lens implantation: a comparative study.

OBJECTIVE: To evaluate the postoperative changes in astigmatism in the pseudophakic eyes of children who underwent 1 of 3 different types of surgical incisions for congenital cataract extraction with intraocular lens implantation, and in whom astigmatism of at least 3 diopters (D) was recorded 1 week after the operation. METHODS: We retrospectively reviewed the medical records of all the children in our department who had undergone surgery for nontraumatic cataract between 1992 and 2001. Cataract surgery with intraocular lens implantation was performed using 1 of 3 types of surgical incisions: a limbal incision, a scleral tunnel, or a clear corneal incision allowing the use of a foldable intraocular lens. In 28 children (32 eyes) aged 2 months to 11 years (mean +/- SD, 4.7 +/- 3.4 years), astigmatism of 3 D or more was found when assessed 1 week after surgery. The refraction was measured and recorded again 3 months and 5 months after surgery. The paired t test was used to compare the outcome variables. MAIN OUTCOME MEASURES: Refractive error 1 week, 3 months, and 5 months after surgery. RESULTS: Mean +/- SD astigmatism 1 week postoperatively was 5.8 +/- 2.2 D, 5.1 +/- 2.1 D, and 4.0 +/- 1.3 D in groups 1, 2, and 3, respectively. Thereafter, the astigmatic component of the refractive error underwent a spontaneous decline, reaching mean +/- SD values of 0.9 +/- 1.0 D, 1.6 +/- 1.6 D, and 1.0 +/- 0.8 D, respectively, in the 3 groups 5 months after the operation. The difference between the mean values at 1 week and at 5 months in each group was statistically significant (P <.001 in group 1; P =.01 in group 2; and P<.001 in group 3). CONCLUSION: Children who underwent extraction of congenital cataract and intraocular lens implantation by different surgical techniques showed a significant spontaneous reduction in astigmatism postoperatively.

Astigmatism↗
PubMed2004

Refractive error in premature infants.

PURPOSE: To determine the incidence and the degree of refractive error between the ages of 2 weeks and 6 months in premature infants without retinopathy of prematurity and to seek a correlation between refractive error and age at examination, birth weight, or gestational age. SUBJECTS AND METHODS: In this observational cross-sectional study, eye refraction in 390 premature infants, with no ocular pathology, was measured by cycloplegic retinoscopy at the age of 2 weeks to 6 months. A correlation was sought between refractive error and perinatal variables. RESULTS: Of the 390 infants reviewed, 347 (89%) had a refractive error and 43 (11%) were emmetropic in both eyes. Most of the infants were hyperopic (76.8%). Myopia was observed in only 11.9%. Astigmatism was found in 24.4% of the infants. The mean age at examination was 2.1 +/- 1 months; the mean birth weight was 1639 +/- 444 g, and the mean gestational age at birth was 32.2 +/- 2.4 weeks. The mean spherical equivalent of refraction was +1.56 +/- 1.82 diopters (D) in the right eye and +1.55 +/- 1.78 D in the left eye. Refractive error was positively correlated with age at examination ( R = 0.16, P = 0.001). The mean refractive error was +1.24 D in infants aged 1 month or less and reached +2.50 D at the age of 4 to 6 months. Refractive error was not correlated with birth weight or gestational age. CONCLUSIONS: The incidence of refractive error in premature infants without retinopathy of prematurity in the first 6 months of life may be as high as 89%. Most of these infants are hyperopic. Eye refraction is correlated with age at examination, but not with birth weight or gestational age.

Birth Weight↗
PubMed2004

Primary congenital upper eyelid retraction in infants and children.

Four infants with unilateral or bilateral eyelid retraction were examined. A full clinical evaluation revealed no ocular or systemic pathology. In all cases, clinical examination, thyroid function tests, and neuroimaging of the brain and orbits revealed no underlying disease process. The eyelid retraction did not change over the follow-up period of 2 to 6 years. Unilateral or bilateral eyelid retraction in infants and children may be an isolated clinical entity without an associated underlying disease.

Congenital Abnormalities↗
PubMed2004

Spectacle use and reduced unaided vision in third grade students: a comparative study in different educational settings.

BACKGROUND: The development of myopia is influenced by hereditary factors, environmental factors and gene-environment interaction. Reading and near-work activity are associated with myopia and myopic progression. This study sought to determine and compare the prevalence of reduced unaided vision and spectacle use among third grade Israeli students from three different educational settings. METHOD: A sample of 917 students (mean age 8.5 years, range seven to 10 years) was drawn from the three Israeli educational streams: secular, Orthodox and ultra-Orthodox. Children in the ultra-Orthodox education pathway begin studying at the age of three years and their daily reading involves sustained near work with increased accommodative effort accompanied by head-rocking movements. Reduced distance vision was used to indicate the likely development of or an increase in the amount of myopia. Spectacle lenses were measured to determine the prevalence of myopia. RESULTS: Of the 917 students studied, 103 (11.2 per cent) wore spectacles (14.2 per cent of the males and eight per cent of the females); 82.5 per cent of those who wore spectacles were myopic. Males from ultra-Orthodox schools had the highest rate of reduced unaided vision (72.5 per cent) compared with males from secular schools (27.3 per cent), males from Orthodox schools (59.3 per cent) or with females from all three groups (average of 34.8 per cent, p < 0.0001, chi squared). Males had a higher rate of reduced unaided vision, especially in the Orthodox and ultra-Orthodox schools. CONCLUSIONS: Our study suggests that Jewish ultra-Orthodox males have a higher prevalence and degree of myopia. The study habits of young children, including exposure to prolonged near tasks, high accommodative demands and possibly optical defocus induced by body sway, may contribute to the development of myopia.

Accommodation, Ocular↗
PubMed2003

Presbyopia among normal individuals.

BACKGROUND: To define ocular variables that might affect the need for early use of reading glasses. METHODS: A retrospective, non-randomized clinical trial was conducted at an aero-medical center. The charts of 100 healthy male pilots who suffered from presbyopia were reviewed. All subjects had undergone a complete eye examination every year for 30 years. Ocular parameters measured at the ages of 20, 30, 40, 45, and 50 years were recorded. Individuals were divided into two groups: those who needed reading glasses at the age of 45 years or earlier (group 1) and those who had needed reading glasses after 45 years of age (group 2). RESULTS: Of all the ocular variables examined each year, two differed significantly between the two groups. Refraction at age 20 was 0.1+/- 0.3 D in group 1 and 0.0 +/- 0.3 D in group 2 ( P <0.05). Amplitude of accommodation at age 20 was 9.5 +/- 1.2 D in group 1 and 9.9 +/- 1.0 D in group 2 ( P <0.05). CONCLUSION: Hyperopia and low amplitude of accommodation at the age of 20 might predispose to early development of presbyopia in normal individuals.

Accommodation, Ocular↗
PubMed2003

Acute concomitant esotropia of adulthood.

PURPOSE: To identify the characteristics of adult patients who develop acute concomitant esotropia of adulthood. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Ten patients were included in this study. INTERVENTION: The charts of all adults with acute-onset concomitant esotropia who were examined at our institute between 1990 and 1997 were reviewed, and those who had developed the syndrome when they were older than the age of 16 years were included in this study. All participants underwent a complete ocular and physical examination, including brain and orbital computed tomography. MAIN OUTCOME MEASURES: Angle of esotropia, measured by the prism and cover test. RESULTS: The mean age +/- standard deviation at the time of the ocular and physical examination was 38 +/- 18.6 years (range, 18-70 years). The mean myopic error was -4.1 +/- 3.2 diopters (range, +2.0 to -8.5 diopters). Nine of the 10 patients were myopic. The mean angle of esotropia was 33.8 +/- 14.7 prism diopters (range, 18-60 prism diopters). The mean period of follow-up was 2.2 +/- 1.0 years (range, 1-4 years). After surgery, all patients were orthophoric or minimally esophoric, and in all of them, stereoacuity (measured by the Titmus stereofly test) was 40 arc seconds. CONCLUSIONS: In a well-defined group of adult patients with acute-onset concomitant esotropia, almost all were myopic, and all regained normal stereopsis after surgery. Acute concomitant esotropia of adulthood should probably be classified as a distinct subgroup of acute-onset esotropia.

Acute Disease↗
PubMedDate not supplied

Visual acuity in premature infants.

PURPOSE: To measure grating visual acuity in premature infants and compare it with that in full-term infants. METHODS: The visual acuity of 73 premature and 73 full-term infants was tested at 6 months of age by the Teller Acuity Card procedure. All premature infants had undergone indirect funduscopy for the detection of retinopathy of prematurity (ROP). Seven infants had developed ROP. The mean gestational age of the premature infants was 33 +/- 1.4 weeks as compared with 39.9 +/- 0.9 weeks in the full-term infants. The mean birth weights of the 2 groups were 1,906 +/- 412 and 3,244 +/- 420 g, respectively. RESULTS: Impaired binocular visual acuity was found in 53.4% of the premature infants, but in only 11% of the full-term infants (p < 0.0001). Impaired monocular visual acuity was found in 13.7% of the premature infants as compared with 2.7% of the full-term infants. Within the premature infant group, monocular visual acuity was impaired in 42.9% of those with ROP and in 10.6% of those without ROP (p = 0.0497). Pathological refraction was found in 33.3% of the prematures without ROP and in 14.3% of the prematures with ROP. This difference was not statistically significant. Visual acuity of preterm infants was not different from full-term infants when examined at 6 months of postconceptual age. CONCLUSIONS: Both monocular and binocular visual acuities as measured by the Teller Acuity Cards are worse in premature infants than in full-term infants at the same chronological age. Poor visual acuity in premature infants can be attributed mainly to immaturity of the visual system.

Birth Weight↗
PubMedDate not supplied

Changes in astigmatism after congenital cataract surgery and foldable intraocular lens implantation.

PURPOSE: To evaluate the changes in astigmatism after cataract extraction and implantation of a foldable intraocular lens (IOL) in children. Only eyes with astigmatism of 3.0 D or more were included in the study. METHODS: The charts of children who had undergone surgery for nontraumatic cataract using a foldable IOL were retrospectively reviewed. In 13 eyes with astigmatism of 3.0 D or more, the refraction was tested and recorded at 1 week, 3 months, and 5 months postoperatively. A paired t test was used to compare the variables. RESULTS: Mean astigmatism 1 week postoperatively was 4.7 +/- 1.9 D (range, 3.0-10.0 D). Thereafter, the astigmatic component of the refractive error underwent a spontaneous steady decline, reaching a mean value of 0.9 +/- 0.9 D (range, 0-2.25 D) 5 months after surgery. The difference between the mean values at 1 week and 5 months was statistically significant (P < .0001). CONCLUSION: Children who underwent congenital cataract surgery and IOL implantation showed a significant spontaneous reduction in astigmatism postoperatively.

Astigmatism↗
PubMedDate not supplied

Unilateral and bilateral lateral rectus recession in exotropia.

BACKGROUND AND OBJECTIVE: To evaluate the surgical results obtained by unilateral and bilateral lateral rectus recession for the correction of exotropia. PATIENTS AND METHODS: The charts of all patients with exotropia who were operated on at the Goldschleger Eye Institute at Sheba Medical Center during an 11-year period were retrospectively reviewed. Study participants all underwent a complete orthoptic and ocular examination. Twenty-five patients with moderate-angle exotropia underwent unilateral lateral rectus recession (group 1) and 38 patients with large-angle exotropia underwent bilateral lateral rectus recession (group 2). The angle of exotropia was measured by the prism and cover test. Moderate exotropia was defined as 25 prism diopters (PD) and large-angle exotropia as greater than 25 PD. RESULTS: The mean age at the time of the surgery was 10.0+/-5.2 years in group 1 and 8.5+/-8.0 years in group 2. The mean preoperative exotropia was 16.1+/-5.7 PD in group 1 and 29.6+/-14.4 PD in group 2. A mean postoperative exodeviation of 4.2+/-5.4 PD was found in group 1 and 5.8+/-13.6 PD in group 2. The success rate (deviation of < 10 PD) was 84% in group 1 and 74% in group 2. There was no incomitance in group 1. CONCLUSION: Unilateral lateral rectus recession is an effective surgical method for correcting moderate-angle exotropia with results similar to bilateral lateral rectus recession for larger exotropia angles.

Adolescent↗