[Improvement of vision in nursing home patients through eyeglasses]. / Visusverbetering door brilcorrectie bij verpleeghuispatiënten.

Adequate refraction correction may contribute to the quality of life of elderly persons who will be less dependent on care in daily life and will be less prone to fall. In nearly 20% of 102 nursing home residents binocular visual acuity improved with at least one line on the Snellen Chart by adjustment of refractive correction.

Histopathologic ocular examination after lensectomy in a Macacus rhesus monkey, an unexpected event of secondary glaucoma.

In a Macacus rhesus monkey an unilateral lensectomy was performed on the 15th day of life to study the emmetropization proces. During a period of 20.5 months refractional state, axial length, corneal dioptric power and intraocular pressure were measured in the aphakic and fellow eye. Results showed that axial elongation of the aphakic eye was larger in comparison to the phakic fellow eye. Histopathologic examination of the aphakic eye revealed glaucomatous changes due to obstruction in the anterior chamber angle.

A comparison of the incidence of the oculocardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in children.

UNLABELLED: We examined changes in the cardiorespiratory system of small children during surgical correction of strabismus with a laryngeal mask airway and spontaneous respiration with sevoflurane or halothane inhaled anesthesia. Fifty-one children, 1-7 yr old, having outpatient strabismus correction were randomized to sevoflurane (S) or halothane (H) in 66% nitrous oxide at 1.3 minimum alveolar concentration. Children breathed spontaneously through a laryngeal mask airway and were not pretreated with anticholinergics. The oculocardiac reflex (OCR), defined as a 20% decrease in heart rate (HR) from baseline, dysrhythmias, or sinoatrial arrest concomitant with ocular muscle traction occurred less frequently with sevoflurane than with halothane (S 38%, H79%, P = 0.009). The baseline HR was higher with sevoflurane (S 114 +/- 13 bpm, H 101 +/- 15 bpm, P = 0.002). The lowest HR occurred with halothane (S 95 +/- 22 bpm, H 73 +/- 19 bpm, P = 0.001). The incidence of dysrhythmias was higher in the halothane group (S 4%, H 42%, P = 0.004). Reductions in minute ventilation and PETCO(2) accompanied OCRs. Airway irritability was present with halothane only (S 0, H 3). Eleven children, of whom the majority had received halothane, required measures to correct SpO(2) < 95% or PETCO(2) > 60 mm Hg during maintenance anesthesia (S 11%, H 32%). Sevoflurane may be a more suitable anesthetic than halothane for operations involving traction on the ocular muscles with spontaneous respiration in children because of reduced incidence of OCR, airway irritability, and ventilatory disturbances. IMPLICATIONS: Some children experience a sudden slowing of the heart and impaired breathing when the surgeon pulls on the eye muscles during squint operations under anesthesia. Sevoflurane, a recently developed anesthetic vapor, may reduce this problem when compared with the established vapor halothane.

Retinopathy following measles, mumps, and rubella vaccination in an immuno-incompetent girl.

We describe a 4-year-old girl with subnormal visual acuity due to a bilateral retinopathy. The child had a history of encephalitis following MMR vaccination. Temporary retinopathy associated with measles, mumps, and rubella (MMR) vaccination has been described. Recently an idiopathic CD4+ T lymphocytopenia in the child was diagnosed. This cellular immunodeficiency supports our hypothesis of measles retinopathy after vaccination of an immuno-deficient child.

[Treatment of acute ethmoiditis according to a protocol based on clinical stage]. / Behandeling van acute etmoïditis volgens een protocol gebaseerd op het klinische stadium.

OBJECTIVE: To describe the results of application of a systematic treatment protocol, meant to reduce the risk of serious complications, when treating acute ethmoiditis. DESIGN: Prospective study. SETTING: Academic hospital of the 'Vrije Universiteit (VU)', Amsterdam, The Netherlands. METHOD: From January 1988 to March 1994, 25 children with acute ethmoiditis were admitted to the VU hospital. Eight of them had Chandler stage I, 8 stage II, 3 stage III, 3 stage IV and 3 stage V. The treatment protocol was stepwise, based on the Chandler stages and focused on intensive antibiotic treatment in combination with surgical drainage of the ethmoid complex and (or) the orbit. RESULTS: All children with ethmoiditis stages I-III were cured without rest symptoms. One patient with ethmoiditis stage IV and a pre-existent lymphatic leukaemia died of pulmonary complications of a massive fungal infection, 8 months after treatment. One patient with ethmoiditis stage V finally had permanent psychomotor retardation. CONCLUSION: The used treatment protocol offered the possibility to treat patients with acute ethmoiditis stepwise, depending on stage, with satisfying results. Especially the treatment result in patients with ethmoiditis stage V was good.

Ophthalmologic abnormalities in encephalocraniocutaneous lipomatosis.

Encephalocraniocutaneous lipomatosis (ECCL) is a sporadically occurring disorder that belongs to the group of neurocutaneous syndromes. Important characteristics of the case we present are: intracranial lipomas, a skull hamartoma, bilateral lipodermoids and jaw tumors (ossifying fibromas and compound odontomas). We propose four minimal criteria for the diagnosis of ECCL and review the ocular abnormalities reported to date.

A giant congenital orbital tumor: an unusual presentation of retinoblastoma.

We report a case of an unusual giant congenital tumor presenting in a newborn infant as a large exophytic mass emerging from the left orbit. After enucleation orbital recurrence developed within 14 days. No anti-tumor treatment was given and the child died at the age of 4 weeks. The histopathological and cytogenetical analysis of the tumor is presented. The tumor was diagnosed as a retinoblastoma but we could not exclude the possibility of a neuroblastoma.

Visually impaired children's visual characteristics and intelligence.

The results are presented of the mentally normal, visually impaired, Braille-educated population of Dutch and Dutch-speaking Belgian children on verbal and non-verbal tests of intelligence and school achievement. The children were aged between six and 15 years old. Their visual characteristics were strongly inter-related and correlated similarly with the test scores. Colour perception did not contribute to the intelligence test score variation after controlling for near visual acuity. Congenital blindness had a positive influence on verbal memory and a negative influence on spatial ability.

Ocular examination in nine-month-old infants with very low birthweights.

In the period 1980-1987 ocular examinations were performed on 185 infants with a very low birthweight (less than 1500 g) at the age of nine months corrected for the duration of pregnancy. The mean gestational age of the infants was 30 weeks, while the mean birthweight was 1160 g. The mean spherical refraction was 0.9 D (S.D. 1.3 D), the mean astigmatism was C-0.6 D (S.D. 1.0 D), while convergent strabismus was found in 10% of the patients. The purpose of the investigation was to see if there was a relation between spherical equivalent of refraction, astigmatism and strabismus on the one hand and 11 perinatal parameters and cerebral palsy diagnosed at the age of nine months on the other hand. Statistical analysis was performed with the Student t-test. No significant correlation between the findings of ocular examination and the perinatal parameters could be detected.

Ocular abnormalities in Patau syndrome (chromosome 13 trisomy syndrome).

The ocular pathology in eight patients with trisomy 13 (Patau syndrome) is discussed and compared with the undisturbed development of the eye.

Ocular pathology in trisomy 18. A histopathological report of three cases.

Ophthalmic histopathology is presented in three cases of trisomy 18. The children, who showed typical systemic anomalies, died in the first few days of life. In two cases the cornea was normal, while in one case hypercellularity of the stroma was found and Bowman's and Descemet's layers were absent. A minimal cataract was also present in two cases. Retinal folds were a common finding in the posterior region in all three cases. In one case, a partial coloboma of the optic disc was present in both eyes. In case 2, a pouch between the optic nerve and the dural sheath was considered to be a minimal developmental disturbance of the primitive epithelial papilla possibly representing an optic pit. The absence of pigment epithelium on the nasal disc border in case 3, also points to a deformity of the primitive papilla. The importance of the disc region in clinical and histopathological investigation is stressed.

Lens implantation in children.

Two objections to lens implantation in children are answered. After the second year of life the size and the strength of the implanted lens does not have to be changed any more. Long-term follow-up (more than ten years) of Binkhorst 2-platinum loop lenses in traumatic cataract gives indication of slight decrease in visual function. In view of this the indication for lens implantation has still to be very strict, although fewer complications are to be expected in the posterior chamber lenses.

A direct projection from the nucleus oculomotorius to the retina in rats.

The centrifugal projection to the eye has been studied in rats with anterograde and retrograde tracing techniques. As a retrograde tracer Nuclear Yellow (NY) was used. Following NY injections into the vitreous body of the eye, labeled neurons were exclusively found bilaterally in nucleus oculomotorius. The course and termination site of the retinopetal fibers were studied with the anterograde tracer Phaseolus vulgaris-leucoagglutinin (PHA-L). Iontophoretic injections of PHA-L in nucleus oculomotorius resulted in labeling of retinopetal fibers which reach the eye via the optic tract and optic nerve. Preterminal arborizations were found in the inner nuclear layer of the retina. In addition, labeled fibers have been observed which seem to terminate within the optic tract and optic nerve. It is suggested that the projection from the nucleus oculomotorius to the retina constitutes a link in the multisynaptic efferent pathway from the visual cortex to the eye, by which the visual cortex can influence the functioning of the retina.