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METHODS: Twelve children with IXT were recruited. Stereoacuity was assessed using the Frisby Davis Distance test and the Distance Randot test at distance, and the Frisby and Preschool Randot tests at near. Tests were repeated three or four times over the day, with at least two hours between assessments. The main outcome measure was variable stereoacuity defined as a change by two or more log levels between any two time points over the day. RESULTS: Variable stereoacuity at distance was found in five (42%) of 12 patients. Four (33%) of 12 patients demonstrated variable results using the Distance Randot test, three of whom also showed variable results using the Frisby Davis Distance test. One patient had variable results using the Frisby Davis Distance test only. Nine (75%) of 12 patients completed near stereoacuity testing; two (22%) of nine showed variable near stereoacuity. Two (22%) of nine showed variable results using the Preschool Randot test, one (11%) of whom also had variable results using the Frisby test. In some cases, stereoacuity changed from measurable stereoacuity on one assessment to nil on another. CONCLUSIONS: Nearly half of children with IXT show marked changes in stereoacuity over the course of a single day. When based on isolated measures, an apparent change in distance stereoacuity between visits should be interpreted with caution. DISSOCIATED HORIZONTAL DEVIATION AFTER SURGERY FOR INFANTILE ESOTROPIA Clinical Characteristics and Proposed Pathophysiologic Mechanisms Michael D Brodsky MD; Katherine J Fray CO Arch Ophthalmol 2007;125(12):1683-1692 The objective of this study was to examine the results of reversed fixation testing in patients who develop consecutive exotropia after surgery for infantile esotropia. Twenty-eight patients were included. The reversed fixation test was performed prospectively; all patients were also assessed for adduction weakness, latent nystagmus, dissociated vertical divergence, and neurologic disease. A positive reversed fixation test, indicating a presence of dissociated horizontal deviation, was found in 14 of 28 patients (50%) with consecutive exotropia. In patients with dissociated horizontal deviation, the exodeviation was usually smaller with the nonpreferred eye fixating than with the preferred eye fixating, and smaller with the preferred eye fixating than during periods of visual inattention or under general anesthesia. Dissociated horizontal deviation correlated with the findings of dissociated vertical divergence, but not with asymmetric adduction weakness, latent nystagmus, or neurologic disease. The authors conclude that dissociated horizontal deviation is a clinical expression of dissociated esotonus. The common clinical presentation of dissociated horizontal 14
deviation as an intermittent exodeviation of 1 eye results from the superimposition of a dissociated esotonus on a baseline exodeviation. Variability of Control in Intermittent Exotropia Ophthalmology 2008;115:371-376. Purpose: To assess the presence and degree of any change in control occurring over the course of day using a previously described 6-point clinical control scale. Design: A prospective case series of 25 patients with intermittent exotropia. Variability over 1 day was assessed comparing 3 or 4 assessments at least 2 hours apart. Results: Interobserver agreement was high. Change in control was defined as ≥2 levels. Twenty-four percent of patients tested twice within 5 minutes showed change in control. Of the 13 patients assessed over 1 day, 6 (46%), showed change in control. Conclusions: Control can vary throughout the day including phoric to tropic and vice versa. The worst level of control was not always later in the day. Reviewer’s Comments: A single assessment of control can not be relied upon to represent severity in an individual patient. Apparent worsening may in fact represent normal variability of control in intermittent exotropia. Comparing Methods of Quantifying Diplopia Sarah R. Hatt, David A. Leske, Jonathan M. Holmes Ophthalmology 2007;114:2316-2322 Purpose: Quantification of diplopia is important for describing severity of strabismus, measuring change over time, and reporting surgical outcomes. The cervical range of motion (CROM) method has been proposed as a simple, inexpensive alternative to the Goldmann perimeter for quantifying diplopia. Purpose of this study was to compare these 2 techniques. Methods: Seventy-six consecutive patients underwent diplopia assessment with the CROM method and Goldmann perimeter. Where CROM and Goldmann results were disparate, the medical record was reviewed independently by 2 clinicians. Results: Overall agreement between the 2 tests was good. The most frequent reason for worse diplopia using the Goldmann technique was poor ability to fuse or suppress compared with the real-world targets used in free space for the CROM method. Worse diplopia using the CROM method most often was the results of the deviation being present for distance only. Conclusions: In most cases, both provide equivalent measures of diplopia severity. The Goldmann method seems to overestimate diplopia in patients with fragile fusion or tenuous suppression. The CROM method maybe more representative of diplopia severity as experienced in every day life. 15
Page 1 and 2: What’s New and Important in Pedia
Page 3 and 4: ROP Retinopathy of Prematurity: the
Page 5 and 6: same diagnosis in 4 of 34 images (1
Page 7 and 8: PREMATURITY Perinatal care in the t
Page 9 and 10: STRABISMUS Causes and outcomes for
Page 11 and 12: METHODS: The medical records of all
Page 13: initial positive response to medica
Page 17 and 18: STRABISMUS SURGERY Unilateral reces
Page 19 and 20: The effect of topical tetracaine ey
Page 21 and 22: +/-0.08 and 0.34 +/-0.07 mm, for th
Page 23 and 24: THYROID Cigarette smoking and thyro
Page 25 and 26: excluding from the cataract group t
Page 27 and 28: Long-Term Results of Lensectomy in
Page 29 and 30: CATARACT SURGERY Pediatric anterior
Page 31 and 32: Suture-related complications after
Page 33 and 34: included vitrectomy, capsulotomy, c
Page 35 and 36: medication. At the last follow-up,
Page 37 and 38: REFRACTIVE ERROR / REFRACTIVE SURGE
Page 39 and 40: demonstrated a positive effect on t
Page 41 and 42: ANTERIOR SEGMENT Conjunctival Melan
Page 43 and 44: RESULTS: Directly after birth, corn
Page 45 and 46: and photophobia (80%). The children
Page 47 and 48: Validity and reliability of the Chi
Page 49 and 50: outcomes achieved at cessation of t
Page 51 and 52: METHODS: One hundred and thirteen c
Page 53 and 54: Verisyse intraocular lens implantat
Page 55 and 56: GENETICS Marfan syndrome: from mole
Page 57 and 58: Visual outcome of a cohort of child
Page 59 and 60: primarily affect the photoreceptors
Page 61 and 62: single morphogenetic anomaly in dev
Page 63 and 64: Three genome-wide association studi
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• Cafe-au-lait macules • Freckl
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Laryngeal and tracheal anomalies Po
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Treatment of retinoblastoma: Curren
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Secondary acute myeloid leukemia af
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one. Patients treated with radiatio
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Neuro-ophthalmological management o
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CONCLUSION: Canalicular involvement
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peripheral retinal vasculitis. The
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This article describes a 7-month-ol
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eference eyes. Photopic flash ERGs
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RESULTS: In models that adjusted fo
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ORBIT Porous orbital implants, wrap
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PLASTICS Conjunctival epithelial ch
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The authors conclude that lash ptos
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.03). SBP and DBP were significantl
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CONGENITAL INFECTION Congenital lym
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PEDIATRICS Visual Manifestations of
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controversial, ranging from one to
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SYSTEMIC Visual function and ocular
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Toxocara infection. Toxocara GWC an
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congenital cataracts. The retina wa
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Childhood blindness: a UK epidemiol
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safe and efficient procedure to cor
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