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1.
J Formos Med Assoc ; 112(8): 445-53, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24016609

ABSTRACT

BACKGROUND/PURPOSE: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. This retrospective study investigated ROP, including incidence, demographic information,risk factors, treatments, and refractive outcomes, in southern Taiwan over a 10-year period. METHODS: The authors retrieved the National Cheng Kung University Hospital database between the years 2000 and 2009 for newborns with a gestational age less than 32 weeks and/or with a birth weight less than 1500 g who had been screened for ROP. We recorded sex, birth weight, gestational age, in-hospital versus out-of-hospital birth, paternal and maternal ages, whether there were multiple gestations, parity, Apgar scores, length of hospital stay, risk factors, presence and severity of ROP and whether it was treated, and refraction at the last visit. Regression analyses were performed to identify risk factors for ROP. RESULTS: A total of 503 live births were included. ROP was identified in 190 (37.8%) and met criteria for treatment in 59 (11.7%).ROP was diagnosed as stage 1, 2, 3, 4, and 5 in 61 (12.1%), 36 (7.2%), 81 (16.1%), 11 (2.2%), and 1 (0.2%) infant, respectively. Lower birth weight and younger gestational age were risk factors for greater severity of ROP (p < 0.001). Of the 167 with extremely low birth weight (<1000 g), 118 (70.7%) had ROP and 49 (29.3%) required treatment. On univariate analysis, low birth weight, younger gestational age, and risk factors such as respiratory distress syndrome, chronic lung disease, patent ductus arteriosus, surfactant usage, indomethacin usage, sepsis, upper gastrointestinal bleeding, blood transfusion, and necrotizing enterocolitis were associated with ROP. Multivariate logistic regression analysis showed that only lower birth weight was a significant and independent risk factor for ROP. Myopia (76%)and anisometropia (28%)were common in advanced ROP. CONCLUSION: Low birth weight is a major risk factor for ROP. Infants with extremely low birth weight had a higher risk of severe ROP. Common ocular sequelae of advanced ROP were myopia and anisometropia.


Subject(s)
Retinopathy of Prematurity/etiology , Birth Weight , Female , Gestational Age , Humans , Infant, Newborn , Logistic Models , Male , Retinopathy of Prematurity/epidemiology , Retrospective Studies , Risk Factors , Taiwan/epidemiology , Tertiary Care Centers
2.
J AAPOS ; 16(1): 80-2, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22370671

ABSTRACT

A 74-year-old woman with high myopia presented with a rapid-onset, large-angle esotropia consistent with myopic strabismus fixus, or fallen eye syndrome. We treated the patient with combined bilateral disinsertion of the medial rectus muscles and resection of the right lateral rectus muscle with bilateral repositioning of the displaced superior and lateral rectus muscles toward their normal anatomic positions using a polytetrafluoroethylene (Gore-Tex) sling. The eyes were held in the orthotropic position for 7 days after surgery using nylon traction sutures. After 7 months of follow-up, the patient remained orthotropic at distance with a residual esotropia of 12(Δ) at near and a persistent limitation of elevation.


Subject(s)
Esotropia/surgery , Myopia/surgery , Oculomotor Muscles/surgery , Polytetrafluoroethylene/therapeutic use , Suture Techniques , Sutures , Aged , Esotropia/complications , Female , Humans , Myopia/complications , Treatment Outcome
3.
Cornea ; 31(4): 442-6, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22236786

ABSTRACT

PURPOSE: To study the safety and efficacy of treating early-stage Acanthamoeba keratitis (AK) with 20% alcohol-assisted epithelial debridement. METHODS: Four consecutive patients (2 wearing orthokeratology lenses and 2 wearing soft contact lenses) presented with pseudodendrites, radial keratoneuritis, and epithelial irregularities. Using a technique similar to laser-assisted subepithelial keratomileusis, we performed alcohol-assisted full-thickness debridement of the corneal epithelium and sent portions for smears, histopathologic and ultrastructural examinations, and culture for evidence of Acanthamoeba. Patients were then started on topical propamidine isethionate and 0.02% polyhexamethylene biguanide. RESULTS: Immediately after debridement, minimal underlying anterior stromal infiltrate or haze was seen. Dosages of antiamoebic agents were tapered as corneal defects reepithelialized (in 1-3 weeks) with no evidence of post-debridement corneal infection. At the final follow-up, 1 cornea was transparent and the other 3 corneas had very faint subepithelial haze. Cultures of all epithelial debridement specimens yielded Acanthamoeba trophozoites and cysts, and histopathologic and electron microscopic examinations revealed Acanthamoeba organisms within corneal epithelial layers. CONCLUSIONS: Alcohol-assisted epithelial debridement facilitates detachment of the full-thickness corneal epithelial layer in a controlled manner and seems to be effective in the treatment of early-stage AK. Unlike the fragile fragmented specimens obtained by mechanical scraping without alcohol soaking, epithelial sheets detached easily and the architectures were well preserved, permitting histopathologic and ultrastructural examinations. Most importantly, 20% alcohol-assisted epithelial debridement did not prevent culturing of Acanthamoeba from the removed epithelial specimens.


Subject(s)
Acanthamoeba Keratitis/drug therapy , Acanthamoeba Keratitis/surgery , Antiprotozoal Agents/therapeutic use , Debridement , Ethanol/administration & dosage , Adolescent , Adult , Animals , Benzamidines/therapeutic use , Combined Modality Therapy , Drug Therapy, Combination , Epithelium, Corneal/drug effects , Female , Humans , Hydroxymercuribenzoates/therapeutic use , Male , Visual Acuity/physiology , Young Adult
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