Visual acuity in preschool children: the Chapel Hill-Durham Day-Care Vision Study.

Between 1985 and 1987, 1362 preschool children attending 45 day-care centers in Chapel Hill and Durham, North Carolina had their visual acuities tested by matching HOTV opto-types. Study participants were comprised of 718 males and 644 females. Seven hundred eight were African Americans, 607 were white, and 47 were from other ethnic groups. The children's ages were 89 < 3 years, 496 = 3 years, 531 = 4 years, and 246 > 5 years old. Only 69 children (5.1%) were unable to have their visual acuity tested in both eyes. Although there was no association between testability and either race or gender, there was a strong association with age, with 65 of the 69 children (94.2%) not testable being < 4 years old. Further, there was a clear relationship between visual acuity and age. The 1293 participants (2586 eyes) whose visual acuity was measured successfully in both eyes revealed that 2471 eyes (95.4%) had visual acuities of 20/40 or better. There were significantly more African Americans (56 or 8.4%) than whites (23 or 4.0%) in the 20/40-1 to 20/100 category.

Endogenous Bacillus cereus panophthalmitis.

Over the past seven years we have treated three cases of drug abusers in whom endogenous Bacillus cereus endophthalmitis rapidly progressed to panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes fulminant in an explosive manner and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to Bacillus cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process.

Retrolental fibroplasia: a five-year experience in a tertiary perinatal center.

During a five-year period, 565 premature infants in a tertiary perinatal center were evaluated by binocular indirect ophthalmoscopy. One-hundred-ten infants had retinopathy of prematurity. Ten of these infants developed grade 5 cicatricial retrolental fibroplasia, whereas two fellow eyes remained stable at grade 2 retrolental fibroplasia. Surgical lensectomy and vitrectomy failed to improve vision or reattach the retina in any of those with grade 5 retrolental fibroplasia. In three operated eyes and two unoperated eyes secondary glaucomas developed. Five vitrectomized eyes are now known to have phthisis. The factors that modulate the transition from the benign, acute retinopathy of prematurity lesions to cicatrizing (scarring) lesions characteristic of retrolental fibroplasia remain unclear. Birth weight (less than 1000 g), multiple apneic episodes with concomitant ventilatory assistance with 100% oxygen, and inadvertent hyperoxemia during general anesthesia may be significant cicatrization factors.

Ocular sarcoidosis. A case-control study among black patients.

A case-control study was conducted to investigate possible environmental risk factors for ocular sarcoidosis. The factors studied were exposures to pine products and occupational histories of employment in the tobacco, lumber, and textile industries. The exposure histories of 29 female and 15 male cases, patients with newly diagnosed ocular sarcoidosis that were attending the Glaucoma/Uveitis Clinic of the North Carolina Memorial Hospital, were compared to those of 110 female and 28 male controls selected from out-patient clinics. Elevated risks for sarcoidosis were detected among those females that were exposed to burning pine or were employed in the tobacco industry. For males, positive associations were observed for chewing pine products and for employment in the lumber and textile industries. These preliminary data are consistent with incomplete phagocytic clearance of nonbiodegradable foreign bodies present within our environment that may become antigenic to the immunologically susceptible host. Confirmation of refutation of these hypotheses awaits additional clinical and epidemiological research within the sarcoidosis belt.

Infantile esotropia: results in the neurologic impaired and "normal" child at NCMH (six years).

Charts of all infantile esotropes who received their primary surgical procedure at the North Carolina Memorial Hospital, between February 1978 and June 1984 were reviewed. Neurologic problems (general and ocular) were identified in 29 of the 47 patients (61.7%) followed a minimum three months (mean = 25.0 +/- 2.9 mos). Frequent general neurologic problems were prematurity, hydrocephalus, mental retardation, cerebral palsy, meningomyelocele, intraventricular hemorrhage, and seizures (neonatal and/or postnatal). Abducens nerve palsy was the most common ocular neurologic impairment. Neurologic impaired esotropes were older (mean = 31.9 +/- 3.8 mos) than the "normal" group (mean = 17.0 +/- 3.3 mos) at the time of surgery. Recession/resection procedures were performed on 13 (44.8%) of the neurologically impaired and nine (50.0%) of the normal esotropes. Bimedial recessions were employed on 12 (41.4%) of the patients with neurologic problems and seven (38.8%) of the normal esotropes. Unilateral medial recessions and/or inferior oblique recessions were performed on six patients. At last follow-up, orthophoria (+/- 10 delta) was present in 16 (55.2%) neurologically impaired patients and 15 (83.3%) normal esotropes (p less than 0.05 by the normal deviate (z) test). Seven (24.1%) neurologically impaired patients had residual esotropia, while consecutive exotropia was present in six (20.7%) patients. Among normal esotropes, residual esotropia was found in one patient and consecutive exotropia in two (11.1%) patients. DVD's occurred in nine patients while four subjects developed a postoperative accommodative component.

Relative afferent pupillary defects in primary open-angle glaucoma--five years' experience.

Afferent pupillary defects may accompany asymmetric primary open-angle glaucoma, though the exact incidence has not been reported. Charts were reviewed on 89 patients attending the Glaucoma/Uveitis Clinic at the North Carolina Memorial Hospital in Chapel Hill, North Carolina over a five-year period. All patients had primary open-angle glaucoma diagnosed by: (1) increased ocular tensions (22 mmHg) in the presence of open-anterior-chamber angles and (2) optic-nerve cupping and atrophy compatible with (3) pressure-dependent, visual-field loss. No subjects with secondary glaucomas, primary-angle-closure glaucoma, or ocular hypertension are included.The presence of the relative afferent pupillary defect was noted in 21 of 89 patients (23 percent). Sixteen of 70 black patients had relative afferent pupillary defect in the more severely affected eye, while five of 19 white patients demonstrated afferent pupils. Other demographic characteristics of this population are described. Two typical primary-open-angle glaucoma patients are discussed to demonstrate comparable changes within the optic nerves and Goldmann visual fields. The presence of the relative afferent pupillary defect best correlates with asymmetric, visual-field loss in the more severely affected eye.

Clinicopathological correlation of a solitary choroidal tuberculoma.

In a 34-year-old black man with pulmonary tuberculosis, a rapidly enlarging choroidal tuberculoma progressed to larger size, despite appropriate systemic anti-tuberculous therapy. The eye harboring the tuberculoma became blind and painful, and was subsequently enucleated. Conventional staining of tissue sections revealed a choroidal granuloma without evidence of organisms, but tubercle bacilli were demonstrated by fluorescence microscopy.

Myofibroblasts in filtration operations.

Myofibroblast cells, involved with collagen production, bridge incisional sites after two filtration operations. These spindle-shaped cells appeared as early as the seventh postoperative day and progressively developed through day 14. Later reparative stages were characterized by collagen production, though myofibroblast were strikingly absent after day 14. These histopathologic data obtained from healthy cats suggest that contraction of wound sites in early post-operative period may be causative in cicatrization failures of standard filtration procedures.

Scanning electron microscopy of the ocular vasculature in retinopathy of prematurity.

Clinicoanatomopathologic correlations in a case of the retinopathy of prematurity are reported. A premature infant delivered at 28 weeks of gestation (weight, 900 g) was hospitalized for a number of health problems, including bronchopulmonary dysplasia and respiratory distress syndrome. Ophthalmic examination, at the age of 5 months, disclosed stage 1B retinopathy of prematurity. The patient died at the age of 161 days; both eyes were taken for scanning electron microscopy and histopathologic studies. Scanning electron microscopy findings included absence of retinal capillaries, anterior uveal neovascularization originating from the venous side, and a coincidental typical coloboma of the optic nerve and choriocapillaris. Histopathologic findings confirmed iris stromal neovascularization, showed retinal neovascularization with proliferation into the vitreous and avascular areas between the midperiphery and ora serrata.

Pterygium: clinical classification and management in Virgin Islands.

Three hundred (300) patients from the Caribbean area and Southeast United States were classified and evaluated for pterygium surgery. Each subject had the surgical excision performed by the same surgeon (ALA). Each was followed for a period of one year postoperatively while receiving topical vasoconstrictors and artificial tears only without steroids, thiotepa, or beta-irradiation. Attempts were made to predict the probability, incidence, and type of recurrence, in relation to specific risk factors identified in each individual preoperatively. Those subjects exposed to highest number risk factors seemed to correlate best with ptergia recurrence. Recurrences, which consisted of pterygium regrowths onto the cornea, were classified as active or passive. Nineteen recurrences occurred in this series, the majority being in the secondary group where more than five risk factors were present. Of 270 eyes classified as primary ptergia that were operated upon by wide excision and suture closure, there were 13 recurrences (5.0%).

Coats' disease: a study of 62 histologically confirmed cases.

We studied 62 eyes submitted to the Armed Forces Institute of Pathology (AFIP) from 1958 through 1980 that satisfied our criteria for the histologic diagnosis of Coats' disease. Our histopathologic definition of Coats' disease was the presence of a primary vascular lesion consisting of retinal telangiectasia with leakage of plasma to form intraretinal and subretinal exudates. In the cases we reviewed, Coats' disease occurred more frequently in boys, it usually affected only one eye, and was generally detected in the first decade of life. In 52 cases (79%) the clinical manifestations, strabismus and leukokoria, were thought to be caused by retinoblastoma. Angle closure glaucoma was present in 36 cases (58%). In all but one of the cases studied, the lesion was located peripheral to the equator. We further identified diffuse involvement of capillaries in the peripheral retina using trypsin-digest preparations. Associated histologic findings included: rubeosis iridis, cataract, vitreous neovascularization, and nodules resulting from fibrous metaplasia of the retinal pigment epithelium. These fibrous nodules typically occurred in the macular area and occasionally contained calcium or bone.