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Biomedical subjects

M J Greenwald

Publications and source records attributed to M J Greenwald.

At least 19 recordsLinked to original sources
PubMed1999

Hypobaric ocular trauma from a Popper.

We have observed 3 cases of ocular trauma in children that were caused by an atypical, hypobaric mechanism induced by a toy called a Popper. When we initially notified the United States Consumer Product Safety Commission in 1990, Poppers disappeared from store shelves. We are concerned that this potentially harmful toy is making a comeback in 1998 (Smilemakers Inc, Spartanburg, SC; June-July 1998 catalog, p. 57). In 1990, packaged poppers cautioned against applying to face or skin; we are not sure that such warnings accompany current Poppers.

Barotrauma↗
PubMed1996

Treatment of intraocular retinoblastoma with carboplatin and etoposide chemotherapy.

PURPOSE: Management of intraocular retinoblastoma was initiated with 2-drug chemotherapy in an effort to improve the rate of vision preservation and ocular salvage and to avoid or delay the use of external beam radiation treatment. METHODS: Six patients with intraocular retinoblastoma (five bilateral; one unilateral, 1 month old) received 6 to 7 monthly cycles of intravenously administered carboplatin and etoposide (VP-16) as primary treatment. No eyes were enucleated primarily. Twelve of the 33 discrete tumors in the 11 study eyes received prophylactic supplemental treatment with cryotherapy or laser hyperthermia. Response was documented with frequent eye examinations with the patient under general anesthesia and with repeated fundus photography. RESULTS: All eight larger tumors (> 10-mm diameter) underwent dramatic regression after treatment with chemotherapy alone, and six of these tumors ultimately became fully calcific. One larger tumor and two smaller tumors showed post-treatment growth, each within 2 months after completion of chemotherapy. Six larger tumors were observed without growth or further treatment for 7 to 21 months after completion of chemotherapy. Subretinal fluid resorbed completely in four of four eyes with extensive retinal detachment, and vitreous seeding diminished considerably in four of four eyes. In five eyes, intraocular disease recurrence at a distance from any initially observed tumor eventually required treatment with external beam radiation (three eyes) or enucleation (three eyes). Eight of 11 involved eyes were salvaged, including 5 of 8 with larger tumors and 4 of 4 with vitreous seeding; 4 retained eyes received no radiation exposure, including 3 with larger tumors and 1 with vitreous seeding. Good vision was preserved in six eyes, two of which were markedly improved after occlusion therapy for amblyopia. There was no extraocular disease recurrence and no serious harm from treatment during observation ranging from 12 to 40 months after diagnosis. CONCLUSION: Chemotherapy with carboplatin and etoposide shows promise as initial treatment for intraocular retinoblastoma. Further study is indicated to define its proper role in the management of this disease.

Antineoplastic Agents↗
PubMed1995

Principles and paradigms of pediatric cataract management.

Propensity for increased postoperative inflammation and capsular opacification, a refractive state that is constantly in a state of flux due to growth of the eye, difficulty in documenting anatomic and refractive changes due to poor compliance, and a tendency to develop amblyopia, makes management of cataract in the child different from that in the adult. The recent past has unraveled several caveats of pediatric cataract management-the importance of atraumatic surgery and complete removal of lens matter, benefits of in-the-bag intraocular lens (IOL) implantation, role of titrating IOL power to counter refractive changes due to growth of the eye, prudery of continuously following these eyes for early detection of aphakic glaucoma and benefits of some surgical innovations. Although these promise to significantly improve our management of pediatric cataract, their long-term benefits are yet to be determined. We will also have to harness newer techniques, especially in the areas of wound construction and capsule management, and will have to develop effective strategies for the refractive management of infantile aphakia.

Adult↗
PubMed1994

Ocular abnormalities associated with unilateral coronal synostosis.

Forty-five patients with premature fusion of one coronal suture were treated between June 1985 and June 1991. Thirty-three patients were evaluated with pre- and postoperative photographs, computed tomographic scans, and serial radiographs and were assessed by the ophthalmological and plastic surgical services before and after surgery. The patients' mean age was 11.5 +/- 3.2 months at the time of surgery. Two patients (6%) were noted to have facial abnormalities preoperatively. Seventeen patients (52%) exhibited a disorder of extraocular muscle function preoperatively. After craniofacial repair, 21% of patients exhibited a distinct change from their preoperative ocular examination. A substantial majority of patients with premature fusion of the unilateral coronal suture (72%) will present with an abnormal examination postoperatively. In addition, a significant percentage of these patients will exhibit a change in ophthalmological status after craniofacial surgery; therefore, surgery on the extraocular musculature should, in general, be deferred until after bony repositioning.

Cohort Studies↗
PubMed1993

Acne rosacea with keratitis in childhood.

We present three cases of acne rosacea keratitis that developed in childhood. All three children were prepubescent and demonstrated characteristic dermatologic findings involving the nose, cheeks, and/or chin. The patients had complained of ocular irritation for at least 6 months, and in one case symptoms were reported by the family to have occurred intermittently since age 4 years. All three children showed evidence of meibomian gland inflammation; two patients demonstrated bilateral keratitis, the third had only unilateral involvement. In each case, oral tetracycline hydrochloride or doxycycline hyclate was necessary to relieve symptoms. Rosacea keratitis should be considered in the differential diagnosis of chronic keratoconjunctivitis during childhood.

Administration, Oral↗
PubMed1993

Carboplatin-induced regression of an optic pathway tumor in a child with neurofibromatosis.

Optic pathway tumors are common in children with neurofibromatosis-1 (NF-1). The optimal management of these tumors is unknown, particularly when the optic chiasm and other brain structures are involved. We report the dramatic response to carboplatin in a 10-year-old girl with NF-1 and a progressive optic pathway tumor. Tumor shrinkage was accompanied by striking improvement in visual fields, return of color discrimination, and marked improvement in visual acuity. No significant toxicity was observed. One year following completion of chemotherapy the glioma remains as small or smaller than it was at the conclusion of therapy, and there has been no deterioration of vision. Carboplatin is a promising agent for the treatment of optic pathway tumors in children with NF-1.

Carboplatin↗
PubMed1992

Ocular and dermatologic manifestation of neurocutaneous syndromes.

The dermatologic and ophthalmologic manifestations of neurocutaneous syndromes are numerous and varied, but familiarity with them is essential to the clinician from any specialty who may have to deal with these disorders. Although many of their complications are unfortunately still difficult or impossible to treat effectively, there may be significant benefit to the patient from prompt detection of optic glioma in NF, retinal angiomas in VHL disease, and glaucoma in SWS. Recognition of characteristic lesions of skin and eye in individuals with mild expressions of NF and TS is essential for genetic counseling. For affected children and their parents, early diagnosis (based on sometimes subtle findings) and formulation of a complete and accurate prognosis can considerably ease the burden imposed by any of these conditions.

Eye Neoplasms↗
PubMed1991

Scleritis and Wegener's granulomatosis in children.

We treated two children with scleritis (one unilateral, one bilateral), in whom Wegener's granulomatosis was diagnosed on the basis of pathologic changes in respiratory tract mucosa. Both patients were girls, 13 and 14 years of age, respectively. One patient had otitis media and a nodular scleritis. Laboratory test results demonstrated an increased erythrocyte sedimentation rate and microscopic hematuria. A biopsy of the sinus confirmed the diagnosis of Wegener's granulomatosis. The second patient had fever, arthralgias, a nonproductive cough, and bilateral scleritis. Laboratory test results demonstrated an increased erythrocyte sedimentation rate, positive test results for rheumatoid factor, and bilateral pulmonary nodules on chest x-ray. Open-lung biopsy confirmed the diagnosis of Wegener's granulomatosis. Both patients responded well to treatment with a combination of prednisone and cyclophosphamide.

Adolescent↗
PubMed1989

Optic gliomas in children with neurofibromatosis type 1.

To determine the frequency and natural history of tumors of the optic nerves and chiasm in patients with neurofibromatosis type 1, we obtained computed tomographic scans of 65 children who had no known visual or ocular abnormalities before their initial evaluation. Optic gliomas were detected in 10 children (15%). The median age of children with gliomas was 4.3 years (mean 5.8 years, range 9 months to 21 years). Three children (30%) had isolated, unilateral tumors, three (30%) had bilateral tumors, and four (40%) had involvement of the optic chiasm and of one or both nerves. Definite abnormalities of vision were found in only two children (20%). Five additional children were referred to the clinic after evaluation of ophthalmologic complaints led to the diagnosis of neurofibromatosis type 1: three had unilateral exophthalmos and two had plexiform neurofibromas of the eyelid with associated glaucoma. Ipsilateral optic gliomas were found in all five children; one child also had a contralateral tumor. Optic gliomas are commonly identified in young children with neurofibromatosis type 1 who have no ocular or visual abnormalities. Optic nerve gliomas may be associated with plexiform neurofibromas of the eyelid and glaucoma.

Adolescent↗
PubMed1989

Management of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.

A retrospective analysis of 21 consecutive patients hospitalized with either Stevens-Johnson syndrome or toxic epidermal necrolysis was carried out to assess morbidity and mortality rates and to establish the value of a specific management practice. Fourteen children with Stevens-Johnson syndrome and seven with toxic epidermal necrolysis were cared for at the Children's Memorial Hospital, Chicago, between 1978 and 1988. All were managed in a well-staffed medical ward or, when necessary, in the pediatric intensive care unit. Supportive measures included reverse barrier isolation, intravenous fluids and nutritional support, meticulous skin care, early detection and treatment of infection, and daily ophthalmologic examination. No patient was treated with systemic steroids. The mortality rate was zero. Eye complications, consisting of dry eyes or mild chronic symblepharon, were the most significant long-term sequelae.

Adolescent↗
PubMed1989

Orbital roof fractures in childhood.

The authors documented 36 orbital roof fractures in 32 children over a 5-year period. With the aid of computed tomography (CT), 16 fractures were classified as isolated and 20 were found to be associated with more extensive damage to the skull. Isolated fractures typically occurred in younger children (mean age, 2.8 years) after relatively minor trauma, most often a fall from a height of less than 10 feet. Birth trauma was the cause in one case. Three fourths of the isolated fractures were linear; with extensive trauma, the orbital roof was usually comminuted. Upper eyelid hematoma characteristically developed hours after the traumatic event. There were no significant chronic disturbances of vision, motility, or lid function. Acute neurologic concerns were common, and two patients died, but full recovery was otherwise the rule. In two cases, late development of ocular pulsation led to CT demonstration of encephaloceles. Both of these children had comminuted roof fractures with displacement of bone fragments into the orbit. The authors conclude that fracture of the orbital roof is a common but frequently overlooked occurrence in childhood. Anatomic factors may account for differences in the effect of frontal impact at different ages.

Accidental Falls↗
PubMed1989

Orbital roof fractures in the pediatric population.

Twenty-three patients aged 3.3 +/- 1.6 years (mean +/- SD) presented between January of 1984 and September of 1987 with fronto-orbital trauma resulting in fractures of one (N = 20) or both (N = 3) orbital roofs. All patients had computed tomography (CT) with axial and coronal sections that revealed three fracture patterns of the orbital roof (nondisplaced, superiorly displaced, and inferiorly displaced fractures). Orbital dystopia was exhibited in 35 percent (N = 8) of the patients. Exophthalmos was noted in 61 percent (N = 14) of the patients. Only 30 percent of the patients (N = 7) sustained associated maxillofacial fractures. Eight percent of fractures exhibited orbital encephaloceles. All patients lacked frontal sinus pneumatization. The majority of children with orbital roof fractures do not exhibit concomitant facial fractures. CT utilizing both axial and coronal sections is valuable in defining the extent and pattern of the fracture as well as in identifying associated neurologic injuries. Large, displaced orbital roof fractures, which occurred in 3 of 13 patients with displaced fractures in our series, should undergo early reduction to avoid late development of encephalocele.

Child, Preschool↗
PubMed1988

Clinical suppression and amblyopia.

In individuals with abnormal binocular vision, such as strabismics and anisometropes, it is common for all or part of one eye's view to be suppressed so binocular confusion and diplopia are eliminated. We examined the relation between the depth of suppression (the amount by which the monocular contrast increment threshold for an eye was elevated by stimulation in the contralateral eye) and the degree of amblyopia (difference in monocular contrast thresholds for the two eyes). There was a significant negative correlation between suppression and amblyopia, so that clinical suppressors with no amblyopia exhibited deep suppression (ie, large threshold elevation) while observers with amblyopia exhibited weaker or no suppression. This negative correlation was found when the two eyes viewed orthogonally oriented contours as well as identically oriented contours. These results suggest that when an eye is amblyopic there is no longer a need for strong suppression of that eye by the contralateral eye.

Amblyopia↗