Direct silicone intubation using Nunchaku-style tube (NST-DSI) to treat lacrimal passage obstruction.

PURPOSE: To confirm the usefulness of direct silicone intubation using a Nunchaku-style tube (NST-DSI) for the treatment of lacrimal passage obstruction. METHODS: Included in this retrospective study were 54 cases (45 patients) of adult-onset lacrimal passage obstruction on which NST-DSI was performed. The cases were subdivided into two groups: 29 cases of common canalicular obstruction (the canalicular obstruction group) and 25 cases of nasolacrimal duct obstruction (the duct obstruction group). RESULTS: At the final examination, irrigating fluid passed readily through the lacrimal passage in 39 (72.2%) of the 54 cases. Twenty-two cases (75.9%) were successful in the canalicular obstruction group (29 cases) whereas 17 cases (68.0%) were successful in the duct obstruction group (25 cases). CONCLUSION: NST-DSI is an effective alternative to treat both common canalicular obstruction and nasolacrimal duct obstruction. We regard NST-DSI as the first choice for the treatment of lacrimal passage obstruction.

Five years' experience with the Grating disc. A simplified method of evaluating vision in young children.

The Grating Disc (GD) is a simplified visual test designed for children 18 months to 4 approximately 5 years. Two hundred pediatric patients (103 males, 97 females; aged 5 months to > 6 years) participated in this study to determined how the GD visual acuity (VA) correlates with the Preferential Looking (PL) VA. Forty-six percent of the patients had varying degrees of retinopathy of prematurity. The PL acuity was determined using the up-and-down staircase procedure. To measure GD acuity, six GDs with vertical gratings equivalent to acuities of 20/1920 to 20/60 were used. The examiner presented one GD simultaneously with the homogeneous disc from 57 cm. The VA was determined by the finest GD that the child could differentiate from the homogeneous disc. The overall correlation between the PL and the GD acuities was very high (R2 = 0.861). One hundred twenty-eight patients (64.0%) had an acuity agreement within 0.5 octave and 178 (89.0%) patients were within 1.0 octave. When the PL acuity was > or = 20/100, the GD and PL acuities showed good agreement. When the PL acuity was poorer, the GD acuity was poorer than the PL acuity. Although the GD acuity tended to be lower than the PL acuity in severely visually impaired patients, the GD acuity agreed with the PL in most visual assessments of young children. GD testing could be a useful alternative when sophisticated assessment systems such as the PL are unavailable.

Comparison of preferential looking acuity and pattern reversal visual evoked response acuity in pediatric patients.

BACKGROUND: We compared the visual acuities obtained with preferential looking (PL), the most widely used method of pediatric vision assessment, with those obtained with the spatial frequency sweep pattern-reversal visual evoked response (SPVER). METHODS: Eighty patients (ages 1.5 months to 12 years) with various ocular pathologies participated in this study. The PL acuity was determined using the up-and-down staircase procedure. The PVER was recorded with the spatial frequency sweep method using 10 spatial frequencies; the acuity was determined by placing the best-fit regression line on the descending slope of the PVER amplitude-spatial frequency function toward the higher spatial frequency to the baseline. RESULTS: The PL acuities ranged from 20/25 to < 20/1600 (mean 20/155). The correlation between the two methods was good (r = 0.847). Fifty-six patients (70%) had an acuity agreement within 1.0 octave. When the PL acuity was > 20/128, it was on average better than the PVER acuity. When the PL acuity was lower, the PVER acuity was usually better. This tendency was marked when the visual acuities were very poor (y = 0.552x + 0.362). CONCLUSION: The methods correlate well, although there is a dissociation of acuities in the presence of very low vision. PVER may be a useful addition to PL in assessment of vision in infants and young children.

Spatial frequency sweep pattern reversal VER acuity vs Snellen visual acuity: effect of optical defocus.

The effect of artificially induced image defocusing on visual acuities (VAs) measured by spatial frequency sweep pattern reversal visual evoked response (SPVER) and Snellen measurement was studied in six normal subjects. The steady-state SPVER was recorded using vertical gratings of 10 different spatial frequencies ranging from 0.52 to 30.36 c/deg. The SPVER acuity was compared with Snellen acuity (SA) measured under the same conditions of optical defocus. With moderate defocusing [< + 1.0 diopter (D), VA > 20/40], the SPVER acuities were equal to or poorer than the SAs. With more defocus (> + 1.5 D, VA < 20/70), the SPVER acuities became better than the SAs. The discrepancies between the SA and SPVER acuities may be the result of the influence of the parafoveal area on the SPVER at lower visual acuity levels.

Correlating preferential looking visual acuity and visual behavior in severely visually handicapped children.

We developed a series of questions that reflects the functional abilities of severely visually handicapped children. The study population comprised 100 patients aged 30 to 60 months (mean 43.23), mostly afflicted with retinopathy of prematurity. Visual acuity was measured by preferential looking. Preferential looking acuities of the patients ranged from 20/25 (0.8) to 20/6400 (0.003) (mean 20/470 (0.04)). Ten activities were analyzed and correlated with preferential looking acuity. Among the selected visual activities, when children are not interested in television (p = 0.0001), toys (other than those that make sounds (p = 0.0001), and people (p = 0.001)), their preferential looking acuities were very low. For example, 73 out of 100 patients who were visually interested in television had preferential looking acuities (mean 20/245 (0.082)) that were significantly higher (p = 0.001) than 21 patients not interested in television (mean 20/2806 (0.007)). Patients with nystagmus (n = 79) had significantly lower preferential looking acuities (p = 0.0001) (mean 20/1114 (0.018)) than patients with no nystagmus (mean 20/57 (0.35)). When evaluating visual function in young, severely visually impaired patients, in addition to preferential looking testing, analyzing visual behavior within the environment is important to accurately evaluate their remaining visual abilities.

[Plasma fibrinopeptide A, fibrinopeptide B beta 15-42 and 4 other coagulation factors levels in patients with diabetic retinopathy].

Fibrinopeptide A (FPA), fibrinopeptide B beta 15-42 (FPB beta 15-42) and other coagulation factors (anti-thrombin III, thrombin-antithrombin complex, alpha 2-macroglobulin, plasmin inhibitor complex) were measured in the plasma of 101 patients with diabetes mellitus (DM). The levels in 80 healthy adults were also measured for comparative purposes. The mean levels of FPA, FPB beta 15-42 and the other 4 coagulation factors in the DM patients were significantly higher than in the controls (p < 0.05). The mean levels of FPA and FPB beta 15-42 in patients with diabetic retinopathy (DR) were higher than in those without DR, that is in those with proliferative diabetic retinopathy (PDR) higher than in those with simple diabetic retinopathy (SDR). In patients after panretinal photocoagulation (PRP), the mean level of FPA was higher and that of FPB beta 15-42 was lower than in patients before PRP. In the SDR group, the level of FPB beta 15-42 was significantly correlated with the progression of diabetic retinopathy. We suggest that there was a close correlation between plasma FPA and FPB beta 15-42 levels and activity or progression of disease, and that the investigation of these levels may be useful for the judging of prognosis or effect of therapies of diabetic retinopathy.