PubMed Health⌕ Search

Biomedical subjects

P G Steinkuller

Publications and source records attributed to P G Steinkuller.

At least 19 recordsLinked to original sources
PubMed2000

Threshold retinopathy of prematurity in neonates less than 25 weeks' estimated gestational age.

INTRODUCTION: The survival rate of extremely premature infants has increased. No recent study has investigated the characteristics of retinopathy of prematurity (ROP) or the incidence of threshold ROP in the most severely premature infants. We undertook this study to determine the risk of developing ROP and threshold ROP in the growing sub-population of infants <25 weeks' estimated gestational age (EGA). METHODS: A retrospective review of infants born before the 25th week of gestation between the years 1994 and 1997 was performed. Of 49 infants examined (97 eyes), 42 were born in the 24th week of gestation and 7 were born in the 23rd week. Mean follow-up was 6.3 months (range, 2.5-37 months). Ophthalmology screening examinations were initiated at 5 weeks of age and continued until the infants were no longer at risk for serious ROP. RESULTS: ROP developed in all (97) eyes. Thirty-nine of 97 (40%) eyes in 20 of 49 (41%) infants developed threshold ROP, diagnosed at a mean post-conceptional age of 34 weeks. Thirteen (13%) eyes of 7 (14%) patients developed prethreshold disease and regressed without treatment. CONCLUSION: There is an increased incidence of threshold disease in infants </=25 weeks' EGA compared with children of greater EGA. Threshold disease may occur at an earlier post-conceptional age in this subgroup of neonates.

Gestational Age↗
PubMed1999

Therapeutic outcomes of cryotherapy versus transpupillary diode laser photocoagulation for threshold retinopathy of prematurity.

INTRODUCTION: We undertook this study to compare the clinical outcomes in patients treated for threshold retinopathy of prematurity (ROP) with transpupillary diode laser photocoagulation versus transscleral cryotherapy. METHODS: A retrospective chart review was performed of patients treated for threshold ROP at our institution between 1988 and 1997. Cryotherapy was used to treat patients before 1992, and diode laser was used thereafter. One hundred fifteen eyes of 63 patients underwent cryotherapy, and 130 eyes of 70 patients underwent laser treatment. Because strong concordance exists between fellow eyes treated for ROP, statistical analysis was done for right eye outcomes only. Demographics, short-term complications, and treatment parameters were compared on the entire cohort of patients. Structural outcomes were compared between a group of 79 cryotreated eyes (39 OD, 40 OS) and a group of 113 laser-treated eyes (56 OD, 57 OS). Mean cycloplegic refraction was compared between a group of 38 cryotreated eyes (18 OD, 20 OS) and a group of 90 laser-treated eyes (46 OD, 44 OS). Visual acuity for preverbal and nonverbal children was estimated and converted to a Snellen visual acuity equivalent. Geometric mean visual acuity was then compared between a group of 44 cryotreated eyes (22 OD, 22 OS) and a group of 92 laser-treated eyes (47 OD, 45 OS). Patients were included in each outcome analysis if adequate documentation was present in the patient record. RESULTS: Demographics and short-term complications were not significantly different between the 2 groups. In the statistical group, 22 of 39 right eyes (56.4%) in the cryotherapy group versus 49 of 56 right eyes (87.5%) in the laser group had resolution of ROP after treatment (P = .0008). Mean spherical equivalent cycloplegic refraction at 12 months of age and over the follow-up period was not significantly different between the cryotherapy and laser groups. Estimated geometric mean visual acuity in the cryotherapy group was 20/103 and in the laser group was 20/49 at 12 months of age (P= .0099). CONCLUSIONS: Diode laser photocoagulation was associated with a better long-term structural outcome and visual acuity compared with cryotherapy for the treatment of threshold ROP. Refractive error was not significantly different between the 2 groups over an equivalent follow-up period.

Child, Preschool↗
PubMed1999

Incidence of presumed cytomegalovirus retinitis in HIV-infected pediatric patients.

INTRODUCTION: Large population studies of adult patients suggest an incidence of cytomegalovirus (CMV) retinitis as high as 19% to 20% as a late complication of adult HIV infection. We conducted this prospective study of a large cohort of HIV-infected children to determine the incidence of CMV retinitis in HIV-infected children. METHODS: From January 1984 to August 1997, 173 HIV-infected children were followed up for an average of 55.3 months (13-164 months). The patients were seen in the Department of Pediatrics at least once every 6 months. Ophthalmologic examinations were initiated when a patient's CD4 count dropped below 50 or sooner if required for ophthalmologic or other indications. Ophthalmologic examination was then repeated every 6 months. RESULTS: A total of 116 (67%) of 173 patients underwent ophthalmologic examination. Four (3.4%) of 116 patients had CMV retinitis at a mean time of 17.3 months (8-38 months) after their CD4 counts dropped below 20. None of the 4 patients with CMV retinitis had subjective visual complaints despite advanced retinitis. Three patients had bilateral and 1 patient had unilateral CMV retinitis. CONCLUSIONS: CMV retinitis occurred infrequently in HIV-infected pediatric patients and was diagnosed only in patients with a CD4 count below 20. Routine ophthalmologic screening examinations may not be necessary in pediatric patients until the CD4 count is below 20. Because children may not complain of decreased vision, at-risk children should undergo frequent ophthalmologic examination.

AIDS-Related Opportunistic Infections↗
PubMed1999

Optic neuritis in children: clinical features and visual outcome.

BACKGROUND: The purpose of this paper is to study the clinical spectrum of pediatric optic neuritis. We evaluated the presenting features, neuroimaging findings, cerebrospinal fluid abnormalities, associated systemic disease, and visual outcome in patients with this condition. METHODS: A retrospective analysis was performed on all patients who came to Baylor College of Medicine with optic neuritis during a 6-year period from 1991 to 1997. The degree of initial visual loss, subsequent visual recovery, and associated disease were reviewed. Magnetic resonance images and cerebrospinal fluid findings were also analyzed. RESULTS: Twenty-five patients (39 eyes) 21 months of age to 18 years of age were included in the study, with a mean follow-up of 11 months. Fourteen patients (56%) had bilateral optic neuritis, and 11 patients (44%) had unilateral disease. Thirty-three of 39 eyes (84%) had visual acuity of 20/200 or less at presentation. Twenty-one of 25 patients (84%) were given intravenous methylprednisolone (10 to 30 mg/kg/day). Thirty of 39 eyes (76%) recovered 20/40 visual acuity or better. Three of 39 eyes (7%) recovered vision in the 20/50 to 20/100 range. Six of 39 eyes (15%) recovered vision of 20/200 or less. Twenty-three of 25 patients (92%) underwent magnetic resonance imaging of the brain. A normal magnetic resonance image of the brain was associated with recovery of 20/40 or better visual acuity in 6 of 6 affected eyes (100%). Seven patients were 6 years of age or younger at presentation. Six of 7 (85%) had bilateral disease, and 12 of 13 (92%) affected eyes recovered 20/40 visual acuity or better. Eighteen patients were 7 years of age or older at presentation. Eight of 18 (44%) had bilateral disease, and 10 of 18 patients (56%) had unilateral disease. Eighteen of 26 affected eyes (50%) recovered 20/40 visual acuity or better. CONCLUSION: Pediatric optic neuritis is usually associated with visual recovery; however, a significant number (22%) remain visually disabled. A normal magnetic resonance image of the brain may be associated with a better outcome. Younger patients are more likely to have bilateral disease and a better visual prognosis.

Adolescent↗
PubMed1999

Childhood blindness.

PURPOSE: The objective of this study was to summarize available data regarding pediatric blinding diseases worldwide and to present the most up-to-date information on childhood blindness in the United States. METHODS: We obtained data from a complete search of the world literature and from direct contact with each of the schools for the blind in the United States. RESULTS: Five percent of worldwide blindness involves children younger than 15 years of age; in developing countries 50% of the population is in this age group. By World Health Organization criteria, there are 1.5 million children worldwide who are blind: 1.0 million in Asia, 0.3 million in Africa, 0.1 million in Latin America, and 0.1 million in the rest of the world. There are marked differences in the causes of pediatric blindness in different regions, apparently based on socioeconomic factors. In developing countries, 30% to 72% of such blindness is avoidable, 9% to 58% is preventable, and 14% to 31% is treatable. The leading cause is corneal opacification caused by a combination of measles, xerophthalmia, and the use of traditional eye medicine. There is no national registry of the blind in the United States, and most of the schools for the blind do not keep data regarding the cause of blindness in their students. From those schools that do have this information, the top 3 causes are cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia. There has been a significant increase in both cortical vision loss and retinopathy of prematurity in the past 10 years. CONCLUSIONS: There are marked regional differences in the prevalence and causes of pediatric blindness, apparently based on socioeconomic factors that limit prevention and treatment schemes. In the United States the 3 leading causes of pediatric blindness are cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia. There is a need for more complete and more uniform data based on the established World Health Organization reporting format.

Adolescent↗
PubMed1998

Early-onset refractive accommodative esotropia.

INTRODUCTION: We studied the natural history of pure refractive accommodative esotropia after spectacle correction in patients with onset before 1 year old to determine whether their outcomes and characteristics were different from those of patients with more typical age at onset of refractive accommodative esotropia. METHODS: We retrospectively reviewed the charts of 17 children with onset of refractive accommodative esotropia before 1 year old. Records of 26 children with onset after 2 years old were reviewed as controls. RESULTS: The mean ages at diagnosis were 9 months and 48 months for the study and control groups, respectively. All 17 study patients and all 26 control patients were initially well aligned with spectacles at distance and near. Follow-up averaged 34 months for study patients and 41 months for control patients. Three study patients (17.6%) and 1 control patient (3.8%) had eventual deterioration and required strabismus surgery (P = .28). None of the study patients developed amblyopia, whereas 42% of control patients did (P = .001). Seven of 15 (47%) of the study patients with known birth history were born prematurely, whereas only 3 of 24 (12%) control patients were born prematurely (P = .03). CONCLUSIONS: Refractive accommodative esotropia was diagnosed at as early as and age 4 months. Prematurity appeared to be a risk factor. Amblyopia was not detected in any patient with early-onset refractive accommodative esotropia. Treatment with full hyperopic spectacle correction led to long-term stable alignment, with relatively few patients requiring surgery.

Accommodation, Ocular↗
PubMed1998

Ocular medications in children.

Many ocular medications are used by pediatricians or ophthalmologists caring for pediatric patients. Topical antibiotics are commonly prescribed for bacterial conjunctivitis, nasolacrimal duct obstructions, and ophthalmia neonatorum. Many new antiallergy eye drops are now available for the treatment of seasonal (hay fever) conjunctivitis. Dilating eye drops and antiglaucoma medications are generally used or prescribed by ophthalmologists, but pediatricians must be aware of their potentially serious systemic side effects. Before initiating treatment, physicians should evaluate the risks and benefits of ophthalmic medications, establish minimum dosages necessary to achieve a therapeutic benefit, and monitor children for local and systemic side effects.

Anti-Allergic Agents↗
PubMed1997

Congenital malignant teratoid neoplasm of the eye and orbit: a case report and review of the literature.

BACKGROUND: Medulloepithelioma is a tumor of the primitive medullary epithelium overlying the ciliary body. Most become evident early in life, and they may be malignant, although distant metastases are rare. The purpose of this report is to describe a unique case of congenital malignant teratoid neoplasm of the eye and orbit. METHOD: A patient with a congenital malignant teratoid tumor of the eye and orbit is described, and a detailed histopathologic study of the ocular findings with a review of the literature is presented. RESULTS: Histopathologic study showed that the lesion was a malignant teratoid neoplasm with a large orbital extension. Several intracranial structural abnormalities were identified. CONCLUSION: The tumor described herein must be added to the differential diagnosis of congenital orbital masses. The clinician should be alert to the association of this lesion with complex intracranial abnormalities.

Diagnosis, Differential↗
PubMed1991

Congenital dacryocele. A collaborative review.

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21% of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage.

Child, Preschool↗
PubMed1987

Primary eye care in rural sub-Saharan Africa.

Primary eye care in rural sub-Saharan Africa is reviewed. In the context of eye care delivered by village health workers (VHW's) living in and supported by the community, such a system of health care does not exist in Africa today. There are no VHW's, and primary health care is currently a matter of experimentation and conjecture only. However, most basic eye care is rendered by non-ophthalmologists; such care consists of screening, treatment of infections and inflammations, and in some cases, cataract surgery. Lower levels of non-ophthalmic general health workers are being tasked to promote measures to prevent trachoma and xerophthalmia/nutritional blindness by intervention at the village level. Preliminary results of such programs are encouraging, and warrant further evaluation and expansion.

Africa↗
PubMed1983

Ocular needs in Africa: increasing priorities and shrinking resources.

Current demands for ophthalmic treatment services in Africa far outstrip available resources, especially in terms of ophthalmic surgeons. With a few exceptions, the gross national product per capita in African countries is less than US $500. Even in those petroleum economies where the figure is considerably higher, the wealth is grossly inequitably distributed. In a continent whose population is expected to double within 20 years, this means that the ratio of trained health worker to population is expected to become much greater rapidly. The money needed to expand the corps of specially trained health workers at a rate matching the expected population growth rate is non-existent. About 1% of the African population is blind. The three major causes are cataract, trachoma and glaucoma. These involve specific age groups of the population. Cataract, which causes roughly 40% of all blindness, mostly affects the over-60s. This group comprises 5% of the population. Glaucoma occurs mostly over the age of 40, i.e. in about 20% of the population. The trachoma 'reservoir', from which chronic re-infections arise, is the under-15 group, an alarming 42% of the population. The prevalence of trachoma is inversely related to access to safe water, a commodity generally available to less than half of the people in Africa, and especially limited in rural areas. Finally, nutritional blindness and its associated high-mortality protein energy malnutrition (PEM) affects the under-five segment, about 18% of the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1983

Cataract: the leading cause of blindness and vision loss in Africa.

Senile cataract is a non-preventable disease of aging, having its biggest impact in the over-60 age group. Published clinic and hospital data, population-based surveys and World Health Organization estimates indicate that 1.2% of the entire population of Africa is blind, and that cataract causes 36% of this blindness. Ocular disease and ophthalmic manpower status questionnaires mailed to every African country in 1982 by the International Eye Foundation support these contentions, and further demonstrate that cataract is the biggest single cause of blindness on the continent. Taking the population of Africa as a whole, this means that 6,000,000 people are blind, and that 2,000,000 of them are blind due to cataract. As this form of blindness is so closely related to aging, an estimate of the annual incidence of the condition can be made. One method is to use the formula I = P/D, where I = annual incidence, P = overall prevalence and D = duration of the condition. A 5-year survival has come to be a commonly used estimate in developing world epidemiology for the longevity of a person who becomes blind due to senile onset cataracts. In Africa then, I = P/D = 2,000,000/5 = 400,000 people blinded annually by cataract. An alternate method for this computation is to multiply the number of people entering the 60 and above age group annually by 0.08. This factor is derived from knowing the prevalence of cataract blindness in this age group, the life expectancy on becoming 60, and the number of people turning 60 annually. This gives an annual incidence of 160,000 and would signify that the development of cataract blindness does not reduce longevity. Follow-up prevalence surveys in the same population group will tell us which method (if either) is correct. The average number of cataract operations done annually by each ophthalmologist in Africa is surprisingly low, 120. The two most cost-effective ways of raising the number of cases done are: (1) shorten the average hospital stay, and (2) train more ophthalmic clinical officers to perform cataract surgery.

Africa↗
PubMed1983

Nutritional blindness in Africa.

Nutritional blindness is loss of useful vision resulting from vitamin deficiency. A malnutrition Xerophthalmia means all the ocular manifestations of inadequate metabolism of vitamin A, nutritional blindness being the end result of the most severe cases. The estimated overall prevalence of nutritional blindness in Africa is very low, below the WHO levels of significance, although isolated clusters of locally high prevalence exist, usually in arid, sparsely-populated regions. The peak age group affected is 2-year olds, with most nutritional blindness having its effect before age 6 years. Xerophthalmia may be considered as a serious side effect of protein-energy malnutrition (PEM). When associated with corneal sequelae of xerophthalmia, PEM has an estimated overall mortality of 50%. Intervention programs, therefore, are more appropriately aimed at the broader condition of life-threatening PEM than at the specifically vision-threatening problem of xerophthalmia. Parameters of significant prevalence detection are discussed, and the relative merits of different forms of vitamin A-specific intervention programs are weighed.

Africa↗
PubMed1983

Surgical treatment of open angle glaucoma is preferable to medical management in Africa.

Primary open angle glaucoma is the third leading cause of blindness in Africa, causing roughly 16% of all blindness and thereby involving approx. 800,000 people on the continent. The overall prevalence and age-group breakdown of the disease is similar to that in industrialized countries, involving almost exclusively people over 40, and rising steadily thereafter with age. Factors such as a generally asymptomatic disease, definitely symptomatic medical treatment, the high cost of drugs and their irregular availability, difficulties in obtaining adequate long term chronic follow-up, and poor patient understanding of the disease all combine to make medical therapy of this condition unacceptable in Africa. Modern surgical techniques are safe, effective, and comparatively cost effective in the treatment of glaucoma. Early surgery is therefore recommended whenever possible.

Africa↗
PubMed1983

Visual disability and blindness secondary to refractive errors in Africa.

Optical defects of the light-focusing apparatus of the eye are called errors of refraction. They are responsible for 13% of all significant vision loss in Kenya, ranking third of all causes, after cataract and trachoma. As the overall prevalence of such visual impairment in the Country is 3.7%, roughly 0.5% of the population can be said to need spectacles to obtain normal vision. The comparable figure for secondary school children in Nigeria has been found to be 2.4%. In addition, patients require special spectacles after cataract surgery to obtain adequate vision; without such spectacles these patients are still 'blind' by World Health Organization criteria. These glasses can be obtained through mission societies and various charitable organizations for a little as $5 per pair, and can be manufactured locally with available ophthalmic manpower and technology. Alternatives to spectacles such as contact lenses, intra-ocular lenses and Kerato-refractive surgery are not suitable for use in developing Countries.

Africa↗
PubMed1982

Medullary proprioceptive neurons from extraocular muscles in the pigeon identified with horseradish peroxidase.

Three to five microliters of 50% HRP in saline was injected along a central axis into one of the 6 extraocular muscles in each of 18 adult pigeons. The brain was fixed and serially sectioned 16-20 h postinjection and the HRP reacted with tetramethylbenzidine (TMB). HRP-labeled proprioceptive neurons were located in the ipsilateral nucleus descendens nervi trigemini (TTD) for all muscle injections. The labeled neurons were further subdivided into two groups based on size and shape. In each experiment the number of labeled proprioceptive cells relative to the number of labeled motoneurons ranged between 4.9 and 15.5%. There were no labeled cells in the trigeminal mesencephalic nucleus or contralateral TTD. The study suggests that at least partial afferent (proprioceptive) innervation of the extraocular muscles in the pigeon derived from neurons in the ipsilateral TTD.

Animals↗