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Biomedical subjects

Moshe Snir

Publications and source records attributed to Moshe Snir.

15 recordsLinked to original sources
PubMed2005

Ocular injury in children from exploding microwaved eggs.

PURPOSE: To report an ocular injury caused by exploding microwave-cooked eggs. DESIGN: Case reports. METHODS: Two children exposed to exploding microwaved eggs were examined for facial burns and ocular trauma. RESULTS: One patient sustained mild corneal epithelial damage in both eyes and eyelid burn, which were treated conservatively. The other, injured in the same event, had symblepharon and moderate keratopathy requiring intensive lysis. CONCLUSIONS: Physicians should be alerted to the potential risk of vision-threatening ocular injury from exploding microwaved foods, and the public should be educated not to cook eggs in microwave ovens.

Blast Injuries↗
PubMed2005

Clinical course and outcome of uveitis in children.

PURPOSE: We sought to evaluate the clinical course, complications, and visual outcome of pediatric uveitis. METHODS: Our sample included 38 consecutive children with uveitis treated between 1986 and 2002: 15 with idiopathic uveitis, 10 with Behcet disease, 9 with juvenile rheumatoid arthritis, 4 with other diagnoses. The last group was excluded from the analysis because of its small size. Appropriate ophthalmologic and laboratory examinations were obtained. Treatment consisted of topical, periocular, or systemic steroids with or without immunosuppression. RESULTS: Complications occurred in all 3 groups, although they tended to be more severe in the patients with juvenile rheumatoid arthritis. Visual acuity improved from presentation to final examination; the difference was statistically significant for the patients with idiopathic uveitis (P < 0.0005) and Behcet disease (P = 0.004). CONCLUSIONS: These findings support an intensive treatment approach to childhood uveitis. The visual prognosis is good even in patients with a severe clinical course.

Adolescent↗
PubMed2005

Combined rectus muscle transposition with posterior fixation sutures for the treatment of double-elevator palsy.

PURPOSE: To evaluate the surgical and functional results of full horizontal tendon rectus muscle transposition to the superior rectus (SR) insertion, augmented by posterior fixation sutures, in patients with double-elevator palsy (DEP). DESIGN: Retrospective nonconcurrent interventional comparative case series. PARTICIPANTS: Fourteen consecutive patients with DEP. INTERVENTION: Six patients treated for DEP by vertical transposition of the horizontal muscles to the SR insertion (Knapp procedure) were compared with 8 patients treated by the Knapp procedure combined with fixation of the transposed muscles to the sclera, adjacent to the SR, with nonabsorbable sutures. MAIN OUTCOME MEASURES: Postoperative ocular alignment, ductions, binocular functions, and rate of reoperation. RESULTS: Ocular deviation: Mean distance and near deviations decreased by 84% and 83%, respectively (P = 0.012), in the augmented-surgery group versus 48% and 47%, respectively (P = 0.03), in the standard-surgery group. Duction: Mean elevation deficiency in abduction and adduction improved by 64% and 65%, respectively (P = 0.01), in the augmented surgery group versus 42% and 55% (P = 0.02) in the standard group. Binocular functions: 3 patients (37%), all in the study group, gained binocular function. Reoperation was required in 5 patients (83.3%) in the control group. The difference in postoperative improvement between the groups was statistically significant for all 4 parameters. No postoperative complications or duction anomalies were observed during the follow-up period of 15.4 months (standard deviation, 5.5). CONCLUSIONS: The augmented Knapp procedure with superior posterior fixation suture is the preferred surgical treatment for patients with DEP. Its use in this series avoided the need for multiple surgeries on other extraocular muscles.

Child↗
PubMed2005

Full vertical rectus muscle transposition combined with medial posterior fixation sutures for patients with adduction deficiency.

PURPOSE: To compare the surgical and functional results of full tendon rectus muscle transposition to the medial rectus muscle augmented with posterior medial fixation sutures in patients with adduction deficiency (ADD) and Duane's syndrome type 2. DESIGN: Retrospective nonconcurrent interventional comparative case series. PARTICIPANTS: Twelve consecutive patients with ADD and Duane's syndrome type 2. INTERVENTIONS: Six patients treated by the full tendon rectus muscle transposition procedure alone were compared with 6 patients treated by the full tendon rectus muscle transposition combined with posterior medial fixation sutures. MAIN OUTCOME MEASURES: Postoperative ocular alignment, duction improvement, binocular functions, and reoperation. RESULTS: In the augmented surgery group, mean distance and near deviation decreased by 74.5% and 74%, respectively, versus 56% and 59%, respectively, in the control group (P = 0.007 and 0.02, between-group comparison for distance and near deviation, respectively). Mean duction improved in 73% of the study group compared with 52% of controls (P = 0.025). No postoperative complications or duction anomalies were observed during follow-up in the entire cohort; reoperation was needed in 1 patient in the study group and in all 6 patients in the control group. CONCLUSIONS: The augmented full vertical rectus muscle procedure is a beneficial surgical approach for patients with ADD and Duane's retraction syndrome type 2, reducing the need for multiple extraocular muscle surgery.

Abducens Nerve Diseases↗
PubMed2005

Ocular growth in premature infants conceived by in vitro fertilization versus natural conception.

PURPOSE: To evaluate the possible effect of in vitro fertilization (IVF) on early development of the eye in premature infants. METHODS: Biometric and keratometric values, intraocular pressure, and retinal vascular status were assessed in a cohort of 133 premature infants. These values were compared between premature infants conceived by IVF or naturally, and the relationship between these parameters and postconceptional age and weight at examination were evaluated. RESULTS: The sample consisted of 133 premature infants, 62 (46.6%) born by IVF and 71 (53.4%) by natural conception. Postconceptional age at examination was 28 to 46 weeks. In both groups, axial length, anterior chamber depth, and corneal radius correlated with the postconceptional age and weight at examination and followed a linear growth pattern. Lens thickness changed very slightly. The rate of retinal vascularization correlated with the postconceptional age as well. No correlation was found between intraocular pressure and corrected age or weight at examination. There was no difference between the study and control groups in any of the biometric or keratometric parameters or in intraocular pressure, according to two-way analysis of variance. CONCLUSIONS: IVF apparently does not affect early ocular growth, intraocular pressure, changes in corneal curvature, or retinal vascularization in premature infants. These findings may aid ophthalmologists in assessing ocular dimensions in this patient population.

Biometry↗
PubMed2004

Intravitreal injections of triamcinolone acetonide for severe vitritis in patients with incomplete Behcet's disease.

PURPOSE: To report our experience with intravitreal triamcinolone acetonide (IVTA) injections for the treatment of sight-threatening vitritis. DESIGN: Interventional case series. METHODS: Three patients with acute severe exacerbations of noninfectious panuveitis and vitritis were treated with IVTA injections alone or as an adjunct to systemic immunosuppressive agents. RESULTS: Rapid clearance of the vitreous inflammation with improvement in visual acuity was observed 1 to 2 weeks after injection. The effect lasted 2 to 6 months, with the shortest duration in the vitrectomized eye of Patient 1. Repeated injections were required in all patients. CONCLUSION: Intravitreal triamcinolone acetonide may be beneficial in selected cases of vitritis. This treatment modality has a rapid effect and may lower the use of systemic agents.

Acute Disease↗
PubMed2004

Intraocular pressure variations after diode laser photocoagulation for threshold retinopathy of prematurity.

PURPOSE: To investigate the intraocular pressure (IOP) variations occurring after indirect diode laser photocoagulation for threshold retinopathy of prematurity. DESIGN: Prospective, nonrandomized, comparative study. PARTICIPANTS: A study group-21 consecutive premature babies (42 eyes) undergoing diode laser photocoagulation for retinopathy of prematurity-and control groups-32 premature babies (64 eyes) undergoing retinal examination with or without scleral indentation. INTERVENTION: Intraocular pressure was measured with a portable electronic tonometer before, immediately after, and 1, 2, and 3 days after diode laser photocoagulation in the study group; before retinal examination in control group 1; and before and after retinal examination with scleral indentation in control group 2. MAIN OUTCOME MEASURE: Intraocular pressure after diode laser photocoagulation for threshold retinopathy of prematurity. RESULTS: Mean IOP in the study group rose from 15 mmHg (standard deviation [SD] = 4.1) before coagulation to 33.2 mmHg (SD = 7.8; range, 20-50) immediately after, and then dropped to 22.2 (SD = 5.2), 16.5 (SD = 3), and 14.5 mmHg (SD = 2.1) 1, 2, and 3 days later, respectively. All the changes were statistically significant at P<0.0001, except for the difference between days 2 and 3 (P = 0.096). Mean baseline IOPs were 16.3 mmHg (SD = 3.7) in control group 1 and 15.7 mmHg (SD = 2.3) in control group 2 (P = 0.84 between control group 1 and study group, and P = 0.32 between control group 2 and the study group). At termination of the retinal examination with scleral indentation (control group 2), IOP measured 15.1 mmHg (SD = 2.2) (P = 0.49 compared with baseline). CONCLUSIONS: Intraocular pressure may be significantly elevated after diode laser photocoagulation for retinopathy of prematurity. The mechanism and long-term clinical implications of this observation should be investigated.

Female↗
PubMed2004

Swedish interactive thresholding algorithm fast for following visual fields in prepubertal idiopathic intracranial hypertension.

OBJECTIVE: To examine the reliability of Swedish Interactive Thresholding Algorithm Fast (SITA Fast) visual fields (VFs) in prepubertal idiopathic intracranial hypertension (IIH) and to compare whether age, gender, or severity of visual outcome influenced the reliability of VF tests. DESIGN: Prospective, longitudinal cohort study. PARTICIPANTS: Twenty-six prepubertal children (<11 years of age; mean age, 7.2 years) with IIH. TESTING: Children were prospectively followed up using a child-oriented program, which included SITA Fast VF tests. Age, gender, and severity of visual outcome were correlated with reliability of performance on SITA Fast VFs using a 1-way analysis of variance, point-biserial correlation, and the chi-square test for independence of observation. MAIN OUTCOME MEASURES: Statistical analyses results that correlated the reliability of SITA Fast VFs with age, gender, and visual outcome. RESULTS: Three children were treated at the age of 2 years and were unable to perform automated VF tests. Four children were treated at the age of 4 years, 3 of whom were able to perform repeatable reliable SITA Fast VF tests. Forty-two eyes of 21 children had an average SITA Fast test time of 4.5 minutes for each eye, compared with 8 minutes using the Fastpac strategy. Age was not associated with reliability scores of SITA Fast tests (F = 0.971, not significant [ns]). Gender did not influence the reliability of SITA Fast VF tests (chi-square((1)) = 0.669, ns), nor did severity of visual outcome (chi-square((2)) = 3.348, ns). Visual deficits were observed in 55% of patients at presentation and in 27% of patients after resolution of papilledema. CONCLUSIONS: The SITA Fast VF tests can be performed from age 4 years and offer a reliable method for shortening test time. A child-oriented follow-up program, which entails a shortened testing time, may improve outcome in prepubertal IIH.

Algorithms↗
PubMed2003

Quantitative changes in botulinum toxin a treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm.

PURPOSE: To evaluate the quantitative changes in botulinum toxin A (BTA) treatment required over time to achieve relief for 3 to 4 months in patients with essential blepharospasm (EBS) and idiopathic hemifacial spasm (IHFS). DESIGN: Interventional case series. METHODS: In this retrospective longitudinal study in an institutional ophthalmologic outpatient clinic, data were retrieved from patient files and a comparison between patients with EBS and IHFS was performed. The patient population consisted of 27 patients, 17 with EBS and 10 with IHFS, who were treated for the first time with BTA injections and were followed up for 4 to 6 consecutive years. All patients initially received 12 or more courses of treatment with a lower dose ( 20 U). The main outcome measures were the shift in the dose-response relationship between the lower and higher doses and were analyzed with respect to four variables: average number of treatments, dosage, duration of therapy, and interval of symptomatic relief. RESULTS: In the EBS group the mean dose for each patient changed from 16.0 +/- 1.4 U (lower dose) to 24.2 +/- 1.4 U (higher dose). The shift occurred after a mean of 8.8 +/- 2.9 treatments per patient given for a mean of 33.5 +/- 13.3 months. The mean interval of relief was longer with the lower dose than with the higher dose (4.0 +/- 1.4 months vs 3.2 +/- 1.0 months, respectively). In the IHFS group, the mean dose / patient changed from 16.8 +/- 1.2 U to 25.0 +/- 1.8 U, and the switch occurred after a mean of 6.5 +/- 2.3 treatments given over a mean period of 23.8 +/- 6.6 months. The mean duration of treatment with the lower dose was shorter than with the higher dose. The interval of relief was similar for both dose ranges (3.8 +/- 10 months and 4.1 +/- 1.3 months, respectively). The IHFS group switched to the higher dose earlier, by both number and duration of treatments, than the EBS group. Only minor and transient side effects of treatment were observed in both groups. CONCLUSIONS: Botulinum toxin A is an effective and safe treatment for EBS and IHFS. The dose in our study was increased over time by 50% to achieve 3 to 4 months of symptomatic relief with minimal complications.

Aged↗
PubMed2003

Elevated intraocular pressure associated with steroid treatment for infantile spasms.

PURPOSE: To evaluate the ocular changes and medical and surgical therapy after high-dose systemic steroid treatment in babies with infantile spasm and hypsarrhythmia. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: In 5 of the 9 (55%) babies with infantile spasm exposed to systemic corticosteroid treatment, an increase in intraocular pressure (IOP) and optic disc cupping was observed. INTERVENTION: Ophthalmic examination under mild sedation was conducted 3 to 4 weeks after initiation of systemic therapy. Antiglaucoma treatment was given to the patients found to have high IOPs and cup-to-disc ratio changes. Routine follow-up was continued until systemic therapy was completed. MAIN OUTCOME MEASURES: Controlled IOP with a decrease in cupping damage after antiglaucoma therapy. RESULTS: Five patients required antiglaucoma treatment; one also underwent augmented trabeculectomy. Mean IOP decreased in this subgroup from 30.1 +/- 9.5 mmHg to 15.4 +/- 4.2 mmHg in the right eye (P = 0.043) and from 32.6 +/- 7.4 mmHg to 15.2 +/- 1.8 mmHg in the left eye (P = 0.043). Mean cup-to-disc ratio improved from 0.53 +/- 0.2 to 0.37 +/- 0.04 in the right eye (P = 0.06) and from 0.57 +/- 0.12 to 0.35 +/- 0.05 in the left eye (P = 0.042). CONCLUSIONS: The rapid onset of IOP and cup-to-disc ratio changes in patients with infantile spasm and hypsarrhythmia treated by high-dose corticosteroids necessitates early and intensive monitoring to prevent anatomic ocular damage and visual impairment in the future.

Administration, Oral↗
PubMed2003

Outcome of double-headed pterygium surgery.

PURPOSE: To evaluate the postoperative outcome and recurrence rate of bare sclera technique combined with intraoperative application of mitomycin C (MMC) 0.02% for 5 minutes in the treatment of primary and recurrent double-head pterygia. METHODS: A prospective, noncomparative interventional case series of 13 eyes in 13 patients with primary (n = 10) or recurrent double-head pterygia in one eye operated on by one surgeon (R.A.). They all had bare sclera excision combined with intraoperative application of MMC 0.02% for 5 minutes. All patients were followed postoperatively for recurrence of the lesion, aesthetic outcome, and incidence of eye complications. RESULTS: Mean follow-up was 36.3 +/- 3.8 months for the patients with primary and 28.4 +/- 2.7 months for the patients with recurrent double-head pterygia. There was only one recurrence in one of the three eyes in the group with recurrent pterygia (33.33%). The only significant complication observed was a pyogenic granuloma in two of the recurrent and one of the primary cases. CONCLUSIONS: The bare sclera technique combined with intraoperative MMC 0.02% for 5 minutes is an effective and safe procedure for double-head pterygia. This method can serve as a useful alternative to amniotic membrane transplantation in countries where the latter is not available and in patients in whom conjunctival autograft is not feasible.

Adult↗
PubMed2002

Tactile corneal reflex development in full-term babies.

OBJECTIVE: To evaluate the development of the tactile corneal reflex in healthy full-term babies. DESIGN: Prospective longitudinal comparative case series. PARTICIPANTS: One hundred and ninety-one babies aged 1 to 3 days examined in the nursery, and 200 babies aged 1 to 12 weeks examined in an orthopedic outpatient clinic. METHODS: The tactile corneal reflex was evaluated by three ophthalmologists using the Cochet-Bonnet esthesiometer. MAIN OUTCOME MEASURES: The probability of the presence of the tactile corneal reflex was calculated in relation to gestational age, postpartum age, postconceptional age, and birth weight. RESULTS: The proportion of children with tactile corneal reflex was expressed in a linear logistic model. We found that 10% of the babies had tactile corneal reflex in at least one eye at 2 days of age, 25% at 1 week, 50% at 3.5 weeks, 75% at 6 weeks, and 100% at 12 weeks. The postpartum age had a greater impact on the development of the tactile corneal reflex than the gestational age. The birth weight also had a statistically significant influence (P = 0.005, Wald's test). CONCLUSIONS: The tactile corneal reflex is present in only a minority of newborns and develops during the first 3 months of life. These results demonstrate that the tactile corneal reflex has a longitudinal neurologic development and is part of the normal neurologic maturation process.

Aging↗
PubMedDate not supplied

Decompensation of exodeviation after corneal refractive surgery for moderate to high myopia.

BACKGROUND AND OBJECTIVE: To evaluate strabismus and binocular decompensation of exodeviation and their surgical treatment following corneal refractive surgery. PATIENTS AND METHODS: A retrospective study of a noncomparative case series was conducted. Seven patients whose strabismus worsened after photorefractive keratectomy or laser in-situ keratomileusis for correction of myopia underwent orthoptic evaluation before and after refractive surgery, as well as after corrective strabismus surgery. The motor alignment and regaining of binocularity after strabismus surgery to correct the misalignment following refractive corneal surgery were evaluated and compared at three time points. RESULTS: After corneal refractive surgery, there was a deterioration in mean distance exodeviation from 7.1 +/- 5.2 to 25.7 +/- 10.1 prism diopters (PD) (P = .028) and in mean near exodeviation from 7.1 +/- 5.1 to 29.7 +/- 8.1 PD (P = .18), with loss of binocular function in 6 of the 7 patients. Following strabismus surgery, the mean distance exodeviation was reduced from 25.7 +/- 10.1 to 2.0 +/- 1.8 PD (P = .027) and the mean near exodeviation from 29.7 +/- 8.1 to 3.7 +/- 1.5 PD (P = .028). Five of the six patients regained binocular function. CONCLUSIONS: All at-risk patients with exophoria and exotropia should undergo a thorough orthoptic evaluation before corneal refractive surgery. Patients with ocular motility and misalignment problems should be warned preoperatively of the risk of decompensation of their strabismus.

Adult↗
PubMedDate not supplied

Indocyanine green angiography in high myopia.

BACKGROUND AND OBJECTIVE: To evaluate indocyanine green imaging of choroidal changes in pathologic myopia and to compare it with fluorescein angiography. PATIENTS AND METHODS: The angiograms of all consecutive patients with pathologic myopia photographed with confocal indocyanine green angiography using a scanning infrared laser or ophthalmoscope from March 1997 to December 1999 were reviewed. RESULTS: Twenty-one patients (35 eyes) were included. Indocyanine green angiography was performed in 35 eyes and immediate sequential fluorescein angiography and indocyanine green angiography in 25 eyes. The lacquer cracks were demonstrated to radiate from the disc, at the papillomacular bundle, through the macula, and around the macula. Lacquer cracks were identified in 89% and 28% of the eyes, respectively. Choroidal neovascularization (CNV) was demonstrated in 57% of eyes by indocyanine green angiography and in 56% by fluorescein angiography. All of the CNVs were classic and were located within 300 microm of the foveal center. Seventy percent of the CNVs were delineated in lacquer cracks by indocyanine green angiography. Overall, 124 lacquer cracks were identified by indocyanine green angiography and only 14 by fluorescein angiography. Lipids or serous detachment were not observed. Retinal hemorrhages were noted in 22% and 28% of eyes with indocyanine green angiography and fluorescein angiography, respectively. CONCLUSION: Confocal indocyanine green angiography offers better delineation of lacquer cracks and the localization of the CNV in lacquer cracks than does fluorescein angiography.

Choroidal Neovascularization↗