RESUMEN
This survey of pediatric ophthalmic surgeons on analgesia for postoperative adult strabismus patients indicates that 65% prescribed acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs), and 12% to 16% prescribed opioids. Most surgeons reported reasonable control of pain regardless of analgesia. Acetaminophen and/or NSAIDs may adequately control pain, although certain circumstances may warrant opioid prescriptions. [J Pediatr Ophthalmol Strabismus. 2023;60(1):e5-e7.].
Asunto(s)
Analgesia , Estrabismo , Humanos , Adulto , Niño , Acetaminofén/uso terapéutico , Dolor/tratamiento farmacológico , Antiinflamatorios no Esteroideos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Estrabismo/cirugíaRESUMEN
ABSTRACT: The Muller muscle-conjunctival resection is a common technique used to treat blepharoptosis, but there is variability with the target surgical resection and expected postoperative outcomes measured by marginal reflex distance-1 (MRD1). A Levator-Mullerectomy is a novel surgical approach described by Morris et al to incorporate the levator palpebrae superioris in the same incision as the classic Muller muscle-conjunctival resection in the treatment of blepharoptosis. This a retrospective study of patients who underwent Levator-Mullerectomy for ptosis repair showing the clinical outcomes based on MRD1. Statistical analysis was performed using analysis of variance and a nonparametric Kruskal-Wallis test. One hundred-twelve eyes of 83 patients (29 bilateral cases) with a mean age 64.6 years (7-92 years) were included. The types and prevalence of blepharoptosis were involutional (83%), neurogenic (8.0%), traumatic (3.6%), apraxia (2.7%), and congenital (2.7%). There was no significant difference in clinical outcome based on type of blepharoptosis (P = 0.7). Target resection lengths of 8âmm, 10âmm, and 12âmm were compared with postoperative MRD1 change. The mean change in MRD 1 between 8âmm and 10âmm was found to be statistically significant (P = 0.001 for both) but was not statistically significant for the 12âmm resection (P = 0.8). In patients with blepharoptosis and a positive response to 2.5% phenylephrine can benefit from Levator-Mullerectomy with either an 8âmm or 10âmm resection. This novel surgical approach allows surgeons to produce a more predictable and consistent clinical outcome.
Asunto(s)
Blefaroplastia , Blefaroptosis , Blefaroptosis/cirugía , Conjuntiva/cirugía , Humanos , Persona de Mediana Edad , Músculos Oculomotores/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To determine the ocular complications in school-age children and adolescents surviving at least 1 year following allogeneic bone marrow transplantation. DESIGN: Retrospective cohort study. METHODS: In this institutional study, 162 patients (7-18 years old) met our inclusion criteria with a mean age of 13.4 years at bone marrow transplantation. Follow-up ranged from 13 months to 12 years (mean 4 years; median 3.2 years). Patient charts were screened for cataract formation, dry eye, and other anterior and posterior segment diseases. RESULTS: Cataract formation was noted in 57 patients. Univariate analysis showed that fractionated total body irradiation, race, and use of cytarabine significantly increased the incidence of cataract formation (P < 0.05). Multivariate analysis of significant variables showed that total body irradiation was a risk factor for cataract formation. Of the 57 patients (97 eyes) who developed cataracts after bone marrow transplantation, 4 patients (6 eyes) required cataract surgery. After surgery, all patients had visual acuities of 20/20 to 20/25. Of the 162 patients, 51 developed dry eyes. Univariate analysis showed that age at transplantation; steroid use, chronic graft-versus-host disease; use of fludarabine, melphalan, and thiotepa; and receiving no pre-transplantation conditioning regimen prior to bone marrow transplant significantly increased the risk of dry eye syndrome (P < 0.05). In multivariate analysis, chronic graft-versus-host disease was a significant risk factor for dry eye syndrome. CONCLUSIONS: Due to the high incidence of cataract formation and dry eye disease in this population, this study proposes these patients be screened using examinations by a pediatric or general ophthalmologist at least every year.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Oftalmopatías/etiología , Adolescente , Segmento Anterior del Ojo/patología , Catarata/diagnóstico , Catarata/etiología , Niño , Síndromes de Ojo Seco/diagnóstico , Síndromes de Ojo Seco/etiología , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/etiología , Enfermedades Hematológicas/terapia , Humanos , Masculino , Segmento Posterior del Ojo/patología , Estudios Retrospectivos , Factores de Riesgo , Trasplante Homólogo , Agudeza Visual , Irradiación Corporal Total/efectos adversosRESUMEN
PURPOSE: To investigate ocular complications associated with bone marrow transplant and associated continued maintenance therapy in a preschool population. METHODS: The medical records of patients <7 years of age were reviewed retrospectively. Patient charts were screened for cataract formation, dry eye, and other anterior and posterior segment disease. RESULTS: Of 270 cases reviewed, 91 met inclusion criteria. Mean age at diagnosis was 3.17 years. Average follow-up was 5.8 years (range, 1.9 months-14.1 years). Of the 91, 37 patients developed cataracts (35 bilaterally) over a 14-year period. Cumulative incidence corrected for competing event (death before cataract) for the study population was found to be 58.4% after 14 years. Univariate analysis for cataract formation showed statistical significance for total body irradiation dose, age at diagnosis, race, donor type (related vs unrelated), product type, diagnosis type, survival status, calcineurin inhibitor use, and bisulfan, cytarabine, and thiotepa use. Multivariate analysis for competing event (death), showed that total body irradiation dose was not statistically significant; however, when studied in a binary logistic regression model, total body irradiation dose was statistically significant. Notably, steroid use and presence of graft-versus-host disease did not show statistical significance for cataract development. No other ocular complication was found in sufficient quantities to allow statistical analyses. CONCLUSIONS: Due to the high incidence of cataract formation in this population, especially those enduring a treatment regimen with total body irradiation, we propose screening examinations by a pediatric or general ophthalmologist at least annually. We also urge a low threshold for treatment of dry eye syndrome.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Oftalmopatías/epidemiología , Segmento Anterior del Ojo/patología , Antineoplásicos/uso terapéutico , Terapia Conductista , Catarata/diagnóstico , Catarata/epidemiología , Catarata/etiología , Niño , Preescolar , Síndromes de Ojo Seco/diagnóstico , Síndromes de Ojo Seco/epidemiología , Síndromes de Ojo Seco/etiología , Oftalmopatías/diagnóstico , Oftalmopatías/etiología , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped , Humanos , Incidencia , Lactante , Masculino , Neoplasias/terapia , Examen Físico , Segmento Posterior del Ojo/patología , Estudios Retrospectivos , Factores de Riesgo , Trasplante Homólogo , Irradiación Corporal TotalRESUMEN
The aim of this study was to determine the factors that may predict failure of closed reduction and casting of diaphyseal forearm fractures in children. Demographic and radiographic data of children with closed reduction and casting of these fractures in the emergency department were evaluated. Of 174 patients with adequate follow-up to union, 19 (11%) required a repeat procedure. Risk factors for repeat reduction included translation of 50% or more in any plane, age more than 9 years, complete fracture of the radius, and follow-up angulation of the radius more than 15° on lateral radiographs or of the ulna more than 10° on anteroposterior radiographs.