Bilateral vitreous hemorrhages in an infant with low fibrinogen levels.

The finding of retinal or vitreous hemorrhage in a child under age 3 years may cause significant controversy with regard to the etiology, because it raises the suspicion of nonaccidental injury. Blood dyscrasias have been documented to cause retinal and vitreous hemorrhages in adults and children, but they have rarely been reported to be the cause of retinal hemorrhages in neonates. We report on a patient with a low plasma fibrinogen level who had bilateral retinal hemorrhage that proceeded to vitreous hemorrhage. This subtle abnormality of the blood clotting cascade caused significant retinal and vitreous hemorrhage in a child without risk factors for abuse.

Diabetes mellitus and hearing loss.

A prospective hearing survey was performed in a sample of 102 diabetic patients. The hearing data were compared with the hearing thresholds of three control population groups. A significant difference was found in the average hearing thresholds between the diabetic patients and all of the three control populations. Diabetic patients have worse hearing threshold levels especially at low and mid frequencies (P < 0.001). There was also a correlation between the duration of diabetes and hearing loss. No significant correlation was found between the different stages of diabetic retinopathy and the degree of hearing loss.

Surgical correction of ptosis in ocular fibrosis syndrome.

The surgical management of ptosis is reported in seven patients suffering from the ocular fibrosis syndrome. Satisfactory results were obtained with bilateral Crawford type brow suspension with autologous fascia lata in six patients and bilateral Fox type brow suspension with stored fascia lata in a young child. As patients with ocular fibrosis syndrome usually exhibit little or no Bell's phenomenon, corneal exposure can become a problem after brow suspension. It was recommended that the lids are left just closed on the operating table at the end of the operation. None of the patients required a subsequent procedure to lower an overcorrection of the ptosis. The routine prescription of ocular lubricants for 2 months after ptosis correction is advocated. Urgent brow suspension in young children using non-autologous materials should only be considered if there is a risk of amblyopia.

Repair of an avulsed upper lid and partially severed lower lid.

We present a case in which trauma from a broken glass resulted in complete amputation of the upper lid and severe lacerations to the lower lid but with an intact and functioning globe. The avulsed upper lid was repaired as a composite autograft. The possible management of such an unusual case is discussed.

Natural history of retinopathy of prematurity.

Sixty-nine infants at risk of developing retinopathy of prematurity (ROP) were entered into a prospective study to assess the incidence and natural history of the disease. Seventeen infants developed ROP, and in six eyes the disease progressed to stage IV ROP. The natural regression of a pupillary membrane and physiological vitreous haze was not influenced by the onset of ROP. Progression from stage I to stage III was rapid and the rate was influenced by the zone affected. Congestion and tortuosity of vessels in the posterior pole always signified stage III ROP. Progression from stage III to stage IV ROP was slower; it was characterised by the development of vitreoretinopathy, signified by the sudden onset of a vitreous haze. Iris congestion associated with poor mydriasis may be a grave sign indicating imminent retinal detachment. Cicatricial ROP can be divided into retinal and vitreoretinal cicatricial disease directly related to the stage of active disease reached. ROP is characterised by its self limiting nature, but the stage at which it becomes inactive varies and will influence the final outcome.