C R Whitfill | PubMed Health

PubMed2000

Avoidance and treatment of retinopathy of prematurity.

Retinopathy of prematurity is a blinding eye disease of premature infants. It is increasing in incidence as more babies of lower birth weights survive. Although in the 1940s and 1950s the major predisposing factor was high oxygen exposure, the main risk factor now is birth weight less than 1,000 g. Retinopathy of prematurity can be classified into several distinct stages, which progress in a typical manner. Once the stage of threshold is reached, the eye has a 50% chance of becoming blind. At this stage, laser peripheral retinal photo ablation or peripheral cryo ablation may cause the neovascularization to regress and preserve vision. The treatment is not effective in all cases, however, and a large number of children continue to become blind each year because of this devastating disease. New microsurgical techniques such as lens-sparing vitrectomy and modified scleral buckle for tiny eyes have improved the outcome for some children. Prevention is the best hope to eradicate blindness caused by this disorder, and manipulations of the metabolic and neonatal intensive care unit environment are currently being studied.

Cryotherapy↗

PubMedDate not supplied

Early-onset accommodative esotropia.

PURPOSE: To determine the frequency of accommodative esotropia with onset by 6 months of age; to determine if the presence or absence of characteristics usually associated with infantile esotropia can help in the diagnosis; and to determine if antiaccommodative therapy is adequate treatment for the esotropia. METHODS: The charts of 100 patients with infantile esotropia, seen over a 2-year period (September 1995 to September 1997), were reviewed. We identified those with at least 2.25 diopters (D) of hyperopia and determined the presence of large angle esotropia (> 30 to 40 prism diopters [delta]), amblyopia, inferior oblique overaction, dissociated vertical deviation, latent nystagmus, and cross-fixation. The success of antiaccommodative therapy, if attempted, was also evaluated. RESULTS: Of 100 patients with infantile esotropia, 15 (15%) were found to have at least +2.25 D. This represented 8% of all patients with accommodative esotropia seen over the same time period. The average age at initial examination was 21 months, although the reported age of onset in all cases was 6 months or less. Two had surgery before presenting to our institute. Eleven of 13 (84%) had 40 delta or less. Six (40%) of the 15 had amblyopia, 5 (33%) had inferior oblique overaction, 3 (20%) had dissociated vertical deviation, 1 (7%) had latent nystagmus, and 4 (27%) had cross-fixation. Of the 13, 7 were given glasses initially, with 3 being fully corrected. Six were not given glasses, all had surgery, and all were given glasses postoperatively for a residual esotropia. CONCLUSION: Fifteen percent of infantile esotropia patients and 8% of accommodative esotropia patients have infantile accommodative esotropia. Other characteristics of infantile esotropia may be present, but are less frequent, and at least 40% are fully corrected with spectacles indicating that when the hyperopia is 2.25 D or greater, antiaccommodative therapy should be instituted before surgery.

Accommodation, Ocular↗