Biomedical subjects

H C Fledelius

Publications and source records attributed to H C Fledelius.

At least 55 records · Page 3Linked to original sources

PubMed1993

[Retinopathy in premature infants].

Retinopathy of prematurity (ROP) is a complication of very preterm birth. The problem is relatively common in Denmark; although only 10 infants are blinded each year, this represents a high incidence in international comparison. The very complete Danish registry of the blind may be partly responsible. The incidence remains high due to the increased survival rate in very preterm infants. Although free oxygen radical injury most likely plays a central role, it is doubtful if reduction of supplementary oxygen under careful monitoring can reduce the risk of ROP. Unfortunately, the most preterm and most unstable infants, who are at highest risk of ROP, are also particularly exposed to hypoxia. It is possible that light increases the risk, even for other reasons it is recommended to reduce the intensity of light in the ward or to use eye pads, at least some of the time. There is no effective drug prevention, in particular there is no evidence that vitamin E is useful. Cryotherapy, however, in the acute phase of threshold disease (stage 3+), can reduce the risk of permanent loss of central vision from about 50% to 25%. Effective screening for ROP has become part of modern neonatology. Diagnosis as well as cryotherapy requires particular skill and experience.

Humans↗

PubMed1993

Autosomal recessive microcephaly, microcornea, congenital cataract, mental retardation, optic atrophy, and hypogenitalism. Micro syndrome.

Three affected children from an inbred family had microcornea, microcephaly, congenital cataract, severe mental retardation, retinal dystrophy, optic nerve atrophy, hypothalamic hypogenitalism, and agenesis of the corpus callosum. The disorder is presumably autosomal recessive; no identical syndrome has been described, but we consider syndromes with similar features.

Adolescent↗

PubMed1993

Retinopathy of prematurity in Frederiksborg County 1988-1990. A prospective investigation, an update.

A report is given of retinopathy of prematurity findings in a Danish county (pop. 342,000) for birth years 1988-90. Out of 12,116 liveborn infants 200 were followed with eye controls during (at least) the first 3 months. In 135 gestational age and/or birth weight were below 32 weeks/1750 g. Twenty-five had ROP stage 1-2 with uneventful regression. Out of 5 with at least stage 3 ROP 2 had spontaneous regression. Three had cryotherapy; two acquired unilateral blindness, one myopia of prematurity. As part of an ongoing prospective investigation the visual results denote progress as compared to the serious results from the preceding 6 years (6 blind children). For 1982-90 the pooled ROP blindness rate amounted to 18.7/100,000 liveborn, a frequency only to be surpassed by the neighbouring Copenhagen area. Considering correct timing of cryotherapy close observation of small premature infants is recommended. At present our screening limits are 32 weeks gestational age/1750 g birth weight.

Blindness↗

PubMed1993

Intraocular lens prediction and oculometric harmony. With special reference to skew ratios between axial length and corneal curvature radius.

The oculometric features have been analysed in two groups of cataract patients, each comprising 30 subjects. All had undergone ECCE and insertion of biconvex Rayner 2 Superflex posterior chamber IOL. Using Binkhorst and SRK II routinely, the groups were given by a good fit between methods (discrepancy between emmetropia predictions numerically < 1 D) and a poor fit (actual discrepancy range 1.6-4.1 D, all with the same sign, the lower values being predicted by Binkhorst). A certain overlapping between groups was found regarding axial length and corneal curvature radius, the ranges being 21.5-25.1/22.7-29.9 mm and 7.3-8.5/7.2-8.1 mm, respectively. In contrast there was no overlapping regarding the ratio between axial length and corneal curvature radius; the ranges were 2.80-3.05 and 3.06-3.90 in the two groups. Evaluating the actual prediction errors by the two methods (follow-up after at least 4 months), they did not primarily pertain to very short or very long eyes, as usually advanced. Skew ratios between axial length and corneal curvature appeared more decisive. Possible implications for the current IOL prediction formulas, including the newer generations, are discussed.

Adult↗

PubMed1993

Retinopathy of prematurity 1974-91. An analysis of the Danish Register for the Visually Impaired.

Registration of visual impairment is compulsory in Denmark for the age group 0-17 years. With birth years 1974-91 141 subjects were in the register with retinopathy of prematurity as basic disease, giving a frequency of 13.1 per 100 000 liveborn. Compared with other countries this is a high figure, and the trend over the period is a slight annual increase. Further analysing the data for trends in time the material was subdivided chronologically into thirds, each group comprising 47 subjects. Birth weight and gestational age showed a decline: median values in the three groups were 1250, 1100, and 960 g, and 30, 28, and 27 weeks, respectively. Associated CNS handicaps were recorded in 17, 38, and 34%. Visual impairment was serious in all groups, the median corrected acuity of the better eye being below 1/60. Geographically there was a striking shift towards a Copenhagen area preponderance of heavy ROP cases, with one of the two NICUs to account for the main part of registered cases in the most recent period.

Adolescent↗

PubMed1993

Very pre-term birth and visual impairment. A retrospective investigation of 411 infants of gestational age 30 weeks or less, 1983-89 Rigshospitalet, Copenhagen.

In a group of infants and children of very preterm delivery (gestational age 30 weeks or less, n = 411, Rigshospitalet Copenhagen 1983-89) 13 got blind due to retinopathy of prematurity (3.2%) while another 13 with sequelae retained useful vision of at least one eye. One child later acquired bilateral retinoblastoma, with a free interval of one year from a protracted course of ROP stage 2-3 eventually to regress. The 411 surviving subjects being recruited from a total of 515 of a similarly low gestational age, the survival rate in the 7-year period under study was just below 80%. No doubt, the high survival rate in this very pre-term group is of importance for the risk of developing retinopathy of prematurity, but the role of the ophthalmologist in controlling the infants is also emphasized. Generally, stricter observation schemes are recommended. Probably, the ROP frequency in the sample of 23.6% is an underestimate.

Blindness↗

PubMed1993

Eye surgery in severe retinopathy of prematurity. Experience from the Copenhagen University Eye Clinic of Rigshospitalet 1986-91, with emphasis on cryotherapy.

Data concerning observation of 40 pre-term infants referred to the Copenhagen University eye clinic 1986-91 for evaluation of ROP, predominantly of advanced stages, have been analysed. Twenty-one eyes in 13 subjects underwent cryotherapy at stage 3 (-4), on day 50-172 after delivery (median 72 days). Out of 19 eyes available for follow-up 10 obtained good of fair function; nine eyes ended with no L. Four subjects with ROP stage 4-5 at referral underwent vitrectomy and one trabeculectomy, all in eyes where surgery on beforehand was considered palliative or 'mainly experimental'. No indication for therapy was recorded in 22 infants; they mainly appeared for evaluation rather late in the course of ROP, to have the feasibility of reconstructive anatomy considered. The mean age of the infant at first discovery of ROP was 55 days when only stage 1-2 was found, 63 days when stage 3, and 69 days when at least stage 4 was described. Altogether, the range was 30-100 days. The inhomogeneity of the data is stressed. Though the possible benefit of earlier recognition cannot be proven, the investigation clearly indicates the need of uniform observation schedules nationwide and clearer indications for referral to the vitreo-retinal department.

Child, Preschool↗

PubMed1992

[Giant cell arteritis and vision complications. Illustrated by a 3-year study from hospitals in the county of Frederiksborg].

During the three-year period 1986-1988, 95 patients were referred to the county eye department on account of suspected giant cell arteritis (GCA = temporal arteritis/polymyalgia rheumatica). Among the 51 with GCA, nine had visual loss. Bilateral blindness occurred in one patient. Temporal artery biopsy was positive in 18 patients. Malignancies were found in two of the 44 patients in whom the GCA diagnosis was subsequently rejected. In the somatic hospitals of the county, a total of 263 GCA patients could be collected during the sampling period. Requests to the primary health service ophthalmologists revealed one further case with marked visual loss. A total of ten out of 264 patients visual loss associated with GCA denotes a lower ocular risk than traditionally presumed. The result is in agreement with previous Danish and Nordic investigations. Probably the low visual risk is related to a high diagnostic rate of GCA, given here by an annual hospital based incidence in the county of 1 per 1,000 of age 50+. Considering the number of cases diagnosed and treated outside hospital, the real incidence is even higher. Regarding visual loss, however, we feel that all known cases with serious reduction of sight due to recognized GCA have been included.

Adult↗

PubMed1992

Giant cell arteritis and visual loss. A 3-year retrospective hospital investigation in a Danish county.

An ophthalmic status is given for 95 consecutive patients referred from other departments of the Central County Hospital 1986-88 due to suspected giant cell arteritis. Eventually, the diagnosis was confirmed in 51/95 (18 had positive biopsy of the temporal artery; in 33 it was on clinical grounds). Nine of the 51 had significant visual loss, in one even as bilateral blindness. Generalized malignancies were found in 2 of the 44 with diagnosis other than giant cell arteritis. Retrospectively, in the same 3-year period a total of 263 cases of giant cell arteritis were registered in the somatic hospitals of the county (population 340,000). One further case with visual loss became known from requests to the primary health sector ophthalmologists. Between 3-4% were thus known to have significant visual loss, a result mainly in keeping with other Nordic clinical studies. Probably, the low figures of visual impairment are related to high diagnostic rates of giant cell arteritis, and to early treatment. Our hospital-based data of giant cell arteritis gave a calculated annual incidence of 1 per 1000 of those older than 50 years in the county, or 27/100,000 including all ages. The true county incidence would be even higher had it been possible to find and include the additional cases of giant cell arteritis who were diagnosed and treated in the primary health sector only.

Adult↗

PubMed1992

Pre-term delivery and the growth of the eye. An oculometric study of eye size around term-time.

Refraction and axial eye dimensions, evaluated by ultrasound measurements, were investigated in 101 pre-term infants and 25 full-term controls. Gestational ages in the pre-term group ranged from 25 to 34 weeks, birth weights from 728 to 2480 g. All were seen in the eye clinic due to risk of developing retinopathy of prematurity. Age at examination was 36-54 weeks (gestational/conceptional) in the pre-terms and 37.3-50 weeks in the term infants. Adjusted to a 40 weeks axial length value (based on an assumed average eye elongation of 0.14 mm per week) the term-values were similar, 17.02 and 17.03 mm in the two groups. Within the premature group, however, the 40-week adjusted axial lengths were shorter, the shorter the gestational age. The study demonstrated more foetal anterior segment proportions, with flatter anterior chambers and thicker, more spheroid lenses in the preterm infants. Probably this explains the early preponderance of myopia in that group, at feature eventually to disappear, and not to be confused with myopia of prematurity. As compared to the full-terms a correlational disturbance by pre-term delivery was further indicated by the absence of the usual correlation between axial length and refractive value.

Anthropometry↗

PubMed1992

An unusual ophthalmic tumour in a 5-year-old boy.

A rare tumour in a 5-year-old boy is presented and discussed. In time and location the story had two parts (Fig. 1): 1) a conjunctival granuloma at the nasal limbus of the right eye was surgically removed. 2) a few months later a huge lesion presented in the posterior segment of the same eye. Was it an ocular tumour with extension to the orbit or an orbital process with impression or invasion of the eye? Repeated surgical biopsies have indicated nodular scleritis of the posterior eye segment as the definitive diagnosis.

Child, Preschool↗

PubMed1991

Deletion mapping of a retinal cone-rod dystrophy: assignment to 18q211.

Deletion of 18q211 was observed in a mentally retarded young man with electrophysiologically demonstrated cone-rod dystrophy, present since childhood. He had hypogonadism and a central postsynaptic hearing impairment. This is the first case of a chromosome deletion in a patient with a cone-rod dystrophy. Three patients with more distal deletions on chromosome 18 did not present retinal dystrophies. We suggest that one of the loci for cone-rod dystrophy may be located on chromosome 18 at q211-213. Reports of similar findings will be necessary for confirmation of this assumption.

Abnormalities, Multiple↗

PubMed1990

Retinopathy of prematurity. Where to set screening limits? Recommendations based on two Danish surveys.

If all cases of serious ROP are to be detected, followed, and possibly treated, and the entire natural history of ROP to be recognized, screening limits should be set at no lower than gestational age 32 weeks and/or birthweight 1,750 g. These recommendations are based on the experience gained from two Danish surveys: cases registered as visually impaired (compulsory), from the whole country, covering the birth years 1971-88 (n = 142), and an epidemiological study from a Danish county comprising 411 infants considered at risk in 1982-1987; 63 infants developed ROP, eventually resulting in blindness in 6 of them.

Birth Weight↗

PubMed1990

Central vein thrombosis and topical dipivalyl epinephrine.

A report is given on an 83-year-old female who acquired central vein thrombosis in her seeing eye one day after having started topical medication with dipivalyl epinephrine for advanced glaucoma discovered in the other eye. From present knowledge about the effects of adrenergic eye drops on ocular blood circulation, it is difficult to suggest an association between the two events, which may be coincidental only.

Administration, Topical↗

PubMed1990

Retinopathy of prematurity. Clinical findings in a Danish County 1982-87.

The study includes all infants in a Danish county born 1982-87 considered at risk of acquiring retinopathy of prematurity (n = 411; 178 girls, 233 boys). 325 had birthweight (BW) less than or equal to 1750 g and/or gestational age (GA) less than or equal to 34 weeks. The remaining referrals were on account of functional immaturity/significant oxygen treatment (n = 86). With a median onset age of 6.5 weeks (range 5-9 weeks) ROP was recorded in 63 infants. A negative correlation (r = -0.34) between GA and ROP onset age suggested a later onset in the very immature infant. ROP appeared in 60% of those born at GA less than or equal to 28 weeks (n = 30) and in 50% of survivals with BW less than or equal to 1000 g (n = 20). With BW and GA beyond the limits of 32 weeks and 1750 g only 5 cases of ROP were observed. Out of the 14 infants with at least stage 3 ROP 6 became blind in both eyes after few months (GA at delivery 25-31 weeks/BW 920-1595 g). All considered, 57 of the 63 with ROP showed spontaneous regression, however, leaving myopia of prematurity in 8 subjects.

Blindness↗

PubMed1990

Ocular features other than retinopathy of prematurity in the pre-term infant.

218 premature infants born 1985-87 in Frederiksborg County were followed in the eye clinic, mainly due to the risk of developing retinopathy of prematurity (ROP). The median gestational age was 33 weeks, the median birth weight 1.750 g. ROP being analysed elsewhere, emphasis is on a) retinal haemorrhages (long-standing in 11) and vitreous bleeding (3 cases); b) the oval shape of the pre-term optic disc, considered a true finding and not merely an optical artifact; c) the pre-term presence of the optic disc cup, otherwise considered of about-term development; and d) refractive state, with myopia as a prevailing finding at post-conceptional ages shorter than 40 weeks. A shift towards hypermetropia became obvious after 2-3 months. Only 4 cases deserved the label myopia of prematurity, the criteria being early recording of ROP and persistent myopia (for more than 18-24 months).

Denmark↗

PubMed1990

Refraction in diabetics during metabolic dysregulation, acute or chronic. With special reference to the diabetic myopia concept.

The influence of diabetic dysregulation on refraction was analysed by a short-term and a long-term approach. a) Out of 15 patients admitted due to high blood sugars and followed over weeks, 11 showed refractive fluctuation of 1-6.5 D, in either direction-often with excess hypermetropia, while 4 appeared refractively stable. In those with refractive change a transient increase of lens thickness was suggested from ultrasound measurements. b) Diabetes control was evaluated retrospectively in 74 adult diabetics, mainly based on repeated 24 h urine glucose determinations over a 6-year period. As a group, those with low myopia did not score worse than those who had stayed emmetropic. Among the myopes, diabetes duration was longer in the subgroup where diabetes preceded myopia onset. - All considered, we found no support for dysregulation per se as an underlying factor behind the 'diabetic myopia' previously reported from our clinic.

Acute Disease↗

PubMed1990

An epidemiological study of disability in 4-year-old children from a birth cohort in Frederiksborg County, Denmark.

In an epidemiological study of a county cohort of 4,138 liveborn children, surveyed at age four, 45 had disability (1.1%). The following period prevalences from birth to age four in per mille were found: motor handicap 5.1, to include cerebral palsy 4.1, myelomeningocele and hydrocephalus 0.5, and metabolic disorders 0.5; severe mental retardation 2.9, mild 1.4, subnormality 2.7; epilepsy 4.6; severe visual defect 1.4; severe auditory defect 0.7. Perinatal damage alone was likely in only three children out of 45. Two thirds had a prenatal cause or a combination of prenatal and perinatal causes. Birth asphyxia seemed to be a rare cause of motor disability and mental retardation. Prematurity per se gave a risk of spastic diplegia, but not of mental retardation. Among the mentally retarded, half were light for gestational age, and in more than half, the damage occurred prenatally.

Cerebral Palsy↗