What's new AAPOS 2008 - The Private Eye Clinic

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Optical Treatment of Amblyopia in Astigmatic Children - The Sensitive Period for Successful Treatment Erin M. Harvey, Velma Dobson, Candice E. Clifford-Donaldson, Joseph M. Miller Ophthalmology 2007;114:2293-2301 Objective: Compare the effectiveness of eyeglass treatment of astigmatism-related amblyopia in children younger than 8 years versus children 8 years of age and older for short and long treatment intervals. Design: Prospective interventional comparative case-control study. Intervention: Eyeglass correction of refractive error, prescribed for full-time wear in astigmatic children. Results: Astigmatic children had significantly reduced mean best-corrected visual acuity at baseline compared to nonastigmatic children. Astigmats showed significantly great improvement in mean best visual acuity, than the nonastigmatic children over the 6-week interval. No additional treatment effect was observed between 6 weeks and 1 year. Treatment effectiveness was not dependent on age group and was not influenced by previous eyeglass treatment. Despite significant improvement, mean best-corrected visual acuity in astigmatic children remain significantly poorer. Reviewer’s Comments: This study provides strong evidence that children older than 7 years do respond to eyeglass treatment of astigmatism-related amblyopia. The effect of the randomized trial of patching regimens for treatment of moderate amblyopia on pediatric ophthalmologists: 3-year outcome. Jaffe T, Levin A. J AAPOS 2007 Oct 11(5); 469 The purpose was to determine if the recommendations of patching regimens based on the PEDIG amblyopia study results have been adopted by pediatric ophthalmologists. An e-mail questionnaire was sent to 560 AAPOS members and 20 % (107) responded. Fifty-five percent had decreased their patching regimens somewhat but the majority still patch more than 2 hrs and there was not a significant increase in prescribing near visual tasks during patching. 54
GENETICS Marfan syndrome: from molecular pathogenesis to clinical treatment. Ramirez F, Dietz HC. Curr Opin Genet Dev. 2007 Jun; 17(3):252-8. Epub 2007 Apr 27. This is an excellent review article. He reviews that MFS is caused by mutations in fibrillin-1, the major constituent of extracellular microfibrils. Fibrillin-1 mutations perturb local TFGB signaling, in addition to impairing tissue integrity. Additionally Dietz reviews a new syndrome with overlapping Marfan syndrome-like manifestations that is caused by mutations in TGFB receptors 1 and II. Loeys-Dietz syndrome is an autosomal dominant disorder with both unique and marfan syndrome-like manifestations, such as aortic root aneurysm, aneurysms and dissections throughout the arterial tree, and generalized arterial tortuosity. He states that they TGFB signaling pathway is now considered an attractive target to counteract aneurysm progression in MFS, using traditional pharmacological means of therapy. TGFB involvement in MFS helps to conceptualize the origin of clinical variability by providing a number of candidate modifiers that are part of the TGFB signaling network. The genes encoding regulators and effectors of TGFB signaling have emerged as attractive candidates for the sites of mutations causing phenotypes that overlap with MFS or Loeys-Dietz syndrome. The definition of MFS has changed from a structural disorder of the connective tissue to a developmental abnormality with broad and complex effects on the morphogenesis and function of multiple organ systems. Marfan syndrome: Clinical diagnosis and management. Dean JC. Eur J Hum Genet 2007 Jul; 15(7):724-33. Epub 2007 May 9. This is a superb review article, very practical. The clinical diagnosis of MFS is made using the Ghent nosolgy, which will unequivocally diagnose or exclude MFS in 86% of cases. The penetrance of the some features is age dependent, so the nosolgy must be used with caution in children. Molecular testing may be helpful in this context. He specifically addresses sports in the MFS patient: they should avoid high intensity static exercise, but can participate in lower intensity dynamic exercise. Contact sports are not advised to protect the aorta and the lens of the eye, and scuba diving should be avoided because of the increased risk of pneumothorax. The diagnosis of MFS requires a multidisciplinary team approach in view of its multisystem effects and phenotypic variability. 55
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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 and 14: initial positive response to medica
Page 15 and 16: deviation as an intermittent exodev
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: Verisyse intraocular lens implantat
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
Page 65 and 66: • Cafe-au-lait macules • Freckl
Page 67 and 68: Laryngeal and tracheal anomalies Po
Page 69 and 70: Treatment of retinoblastoma: Curren
Page 71 and 72: Secondary acute myeloid leukemia af
Page 73 and 74: one. Patients treated with radiatio
Page 75 and 76: Neuro-ophthalmological management o
Page 77 and 78: CONCLUSION: Canalicular involvement
Page 79 and 80: peripheral retinal vasculitis. The
Page 81 and 82: This article describes a 7-month-ol
Page 83 and 84: eference eyes. Photopic flash ERGs
Page 85 and 86: RESULTS: In models that adjusted fo
Page 87 and 88: ORBIT Porous orbital implants, wrap
Page 89 and 90: PLASTICS Conjunctival epithelial ch
Page 91 and 92: The authors conclude that lash ptos
Page 93 and 94: .03). SBP and DBP were significantl
Page 95 and 96: CONGENITAL INFECTION Congenital lym
Page 97 and 98: PEDIATRICS Visual Manifestations of
Page 99 and 100: controversial, ranging from one to
Page 101 and 102: SYSTEMIC Visual function and ocular
Page 103 and 104: Toxocara infection. Toxocara GWC an
Page 105 and 106:
congenital cataracts. The retina wa
Page 107 and 108:
Childhood blindness: a UK epidemiol
Page 109:
safe and efficient procedure to cor
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