A new computer program for mass screening of visual defects in preschool children.

AIMS: To test the effectiveness of a PC computer program for detecting vision disorders which could be used by non-trained personnel, and to determine the prevalence of visual impairment in a sample population of preschool children in the city of Beer-Sheba, Israel. METHODS: 292 preschool children, aged 4-6 years, were examined in the kindergarten setting, using the computer system and "gold standard" tests. Visual acuity and stereopsis were tested and compared using Snellen type symbol charts and random dot stereograms respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and kappa test were evaluated. A computer pseudo Worth four dot test was also performed but could not be compared with the standard Worth four dot test owing to the inability of many children to count. RESULTS: Agreement between computer and gold standard tests was 83% and 97.3% for visual acuity and stereopsis respectively. The sensitivity of the computer stereogram was only 50%, but it had a specificity of 98.9%, whereas the sensitivity and specificity of the visual acuity test were 81.5% and 83% respectively. The positive predictive value of both tests was about 63%. 27.7% of children tested had a visual acuity of 6/12 or less and stereopsis was absent in 28% using standard tests. Impairment of fusion was found in 5% of children using the computer pseudo Worth four dot test. CONCLUSIONS: The computer program was found to be stimulating, rapid, and easy to perform. The wide availability of computers in schools and at home allow it to be used as an additional screening tool by non-trained personnel, such as teachers and parents, but it is not a replacement for standard testing.

Medical rectus re-recession for unacceptable head-turn and esotropia in Duane's retraction syndrome.

Duane's syndrome is a condition in which the eye exhibits palsy during abduction, with retraction of the globe and narrowing of the palpebral fissure of the affected side during adduction. Two patients with this condition underwent re-recession of the medial rectus muscle, to a position of 13.5 mm from the limbus, to treat a cosmetically unacceptable head-turn and esotropia in the primary position. Postoperatively, improvement of the head-turn with good binocular single vision in the primary position was achieved in both cases.

Treatment of convergence insufficiency by single medial rectus muscle slanting resection.

A method of treatment of convergence insufficiency is described. The author describes three patients who underwent single medial rectus muscle slanting resection with successful alignment in all fields of gaze.

[Penetrating ocular injuries: an epidemiologic and retrospective study].

Penetrating injuries of the eye are an important cause of unilateral visual loss. We studied a series of 82 cases of penetrating injuries treated here from 1987 through 1993. The injuries were caused by sharp objects in 66% and blunt trauma in 6%. The prognosis after a penetrating injury is greatly influenced by the nature of the injury and the extent of the initial drainage. Among factors associated with an unfavorable visual outcome were diminished preoperative visual acuity and scleral wounds with dense vitreous hemorrhage.

Conjunctival closure in strabismus surgery: Vicryl versus fibrin glue.

Six patients undergoing bilateral symmetric strabismus surgery were enrolled in this study. For each subject, incisions were closed with Vicryl in one eye and glue in the other. The conjunctival closure with the Vicryl suture resulted in increased discomfort and inflammation during the early postoperative period compared with fibrin glue. However, the difference between the Vicryl and the glue disappeared after 14 days.

Silicone oil for complicated retinal detachment in the pediatric population.

We presented our results with silicone oil in vitreoretinal surgery in pediatric patients. The retinas reattached in 58% but corneal opacification occurred in 75% and glaucoma in 25%. Our results indicate that silicone oil should be considered in otherwise hopeless cases of retinal detachment surgery in children.

Treatment for 'A' or 'V' pattern esotropia by slanting muscle insertion.

BACKGROUND: Patients with 'A' or 'V' pattern esotropia without vertical muscle overaction have traditionally been treated with medial rectus recession and vertical transposition of the muscle insertions. METHOD: Seven cases are presented treated by slanting muscle insertions, whereby the lower margin of the medial rectus is preferentially recessed more than the upper margin in esotropia, and the upper margin is recessed more than the lower margin in A esotropia. RESULTS: All seven patients had their A or V patterns eliminated, with six achieving good alignment in all positions of gaze. CONCLUSION: The slanting muscle insertion should be considered as an alternative technique in all cases of A or V pattern esotropia.

[Retinopathy and serum uric acid in diabetics].

Low serum uric acid (UA) levels have been reported in diabetics. In a group followed for 15 years it was reported that low UA levels preceded the onset of diabetic retinopathy. We studied 95 consecutive diabetic clinic patients between July and September 1992. There was no significant difference in UA levels between those with or without retinopathy: 5.0 +/- 1.2 (SD) mg--vs. 5.3 +/- 1.3, respectively. Multiple regression analysis showed that higher UA levels were related independently to high body mass index (overweight, obesity), and male gender, but not to age, duration of diabetes, glycosylated hemoglobin, diabetic treatment or retinopathy.

A complex chromosome translocation resulting in deletion 11p and associated with uveal colobomata.

A boy with a complex chromosome rearrangement of chromosomes 3, 10, and 11 resulting in a deletion of the short arm of chromosome II is presented. The occurrence of uveal coloboma as an isolated congenital malformation might suggest a chromosomal site for this ocular anomaly in proximity to the aniridia locus.

The use of mitomycin in pterygium surgery.

We report on the use of mitomycin drops after the surgical removal of pterygiums in 70 patients. Our results justify the use of mitomycin as a standard postoperative procedure in preference to other treatments.

Optic disc coloboma associated with macular hole and retinal detachment.

A 15-year-old myopic girl had a retinal detachment associated with optic disc coloboma and a macular hole. The retinal detachment was treated successfully with vitrectomy, drainage of the subretinal fluid, and gas tamponade. The possibility of a macular hole should be investigated in myopic eyes with optic disc colobomas and retinal detachments. To the best of our knowledge, such a combination has not been described previously.

Senior's syndrome (hereditary renal retinal dysplasia) associated with cataracts.

Senior's syndrome includes nephronophthisis with retinitis pigmentosa. In our patient, there was a combination of bilateral retinitis pigmentosa, cataracts, nephronophthisis, osteomalacia, growth and mental retardation, arterial hypertension, and aortic insufficiency. This case was unusual because all the features of Senior's syndrome existed along with bilateral cataracts from childhood.

Medial rectus re-recession in undercorrected esotropia.

Conventional surgical management of surgically undercorrected esotropia includes bilateral lateral rectus resection, marginal myotomy, and Faden operation. During a 3-year period, 10 patients with surgically undercorrected esotropia had medial rectus re-recession 13.5 mm from the limbus. Successful binocular realignment (to 10 prism diopters or less residual binocular misalignment) was achieved in 9 of the 10 cases for both near and distance measurements.

Graves' orbitopathy and restrictive myopathy.

Restrictive myopathy in Graves' orbitopathy is a disabling disorder, difficult to treat, involving clinically the inferior and medial recti. Most patients do not return to the normal, premorbid state of muscular alignment and the goal of treatment is to reach binocular vision in the important directions of gaze--straight ahead (primary position) and downgaze (reading position). The treatment in the acute, congestive stage is optical, prisms or patching, or medical. The medical treatment principally consists of a course of oral or intravenous corticosteroid treatment, and in selected patients orbital irradiation can be of benefit. Surgery is performed on the euthyroid patient after the muscular imbalance has stabilized, usually six months from the onset of the disorder. The mainstay of therapy is a large recession of the involved muscles, if possible on an adjustable suture. Sometimes marginal myotomies are added to the muscle recession. A fadenoperation on the contralateral, minimally involved inferior rectus has been suggested as a means of increasing muscular alignment in both primary position and downgaze. Thorough evaluation of the course of the disease, and the benefit of different treatment modalities is possible only with long term follow-up.

Congenital insensitivity to pain with neuroparalytic keratitis.

Congenital insensitivity to pain is a well-defined entity in the group of sensory deficiency syndromes. To the best of our knowledge, unilateral neuroparalytic keratitis associated with congenital insensitivity to pain has not been reported. We report such a case to alert clinicians to this potentially blinding problem.