Low-trauma fractures and bone mineral density testing in adults with and without intellectual and developmental disabilities: a population study.

Individuals with intellectual and developmental disabilities (IDD) are at risk for low-trauma fractures. We investigated the rate of low-trauma fractures and the odds of BMD testing in adults with/without IDD. Adults with IDD were more likely to have a low-trauma fracture, but there was no difference in bone mineral density (BMD) testing rates. INTRODUCTION: Individuals with IDD are at increased risk for developing osteoporosis which contributes to high rates of low-trauma fracture. Low-trauma fractures can lead to significant pain and further decrease mobility. It is therefore important to effectively manage osteoporosis, for example, by monitoring BMD in persons with IDD. The objective of this study was to examine the rates of low-trauma fracture and BMD testing among a population-based cohort of people with IDD and compare them to those without IDD. METHODS: Using administrative data, we created a cohort of adults with IDD between the ages of 40 and 64. They were compared to a random 20 % sample of those without IDD. The number of low-trauma fractures and BMD tests in each group were determined for Ontario residents between April 1, 2009 and March 31, 2010. RESULTS: Adults with IDD were approximately three times more likely to experience a low-trauma fracture than adults without IDD. The largest disparity in prevalence of low-trauma fractures between those with and without IDD was for men, older adults (60-64 years old) and those living in rural or lower-income neighbourhoods. Post low-trauma fracture, there was no significant difference in the likelihood of receiving a BMD test between individuals with and without IDD. CONCLUSIONS: The findings of this study have a number of important implications related to early detection, prevention and proper management of osteoporosis and low-trauma fractures among persons with IDD.

Leptin suppresses food intake and body weight in corticosterone-replaced adrenalectomized rats.

Intracerebroventricular (ICV) injections of leptin decrease food intake and body weight while increasing energy expenditure. Some of these effects are reportedly enhanced in bilaterally adrenalectomized (ADX) rats. The purpose of the present experiment was to establish the time course of the suppression in body weight and food intake after an ICV injection of leptin. We wanted to establish the effect of varying doses of corticosterone (CORT) on body weight and food intake suppression by using separate groups of ADX, ADX and corticosterone-treated and sham-operated Sprague-Dawley rats. All rats were implanted with cholesterol pellets that varied in CORT content. During the same surgical session, all rats were fitted with a cannula in the lateral ventricle. After recovering from surgery, each rat was administered a 5- micro g ICV injection of leptin. ADX rats that were treated with CORT replacement lost more (P < 0.05) weight and took longer (P < 0.05) to return to baseline body weight than sham-operated controls. Leptin injection decreased food consumption to a greater extent (P < 0.05) in the ADX groups treated with CORT than in the sham-operated controls. Plasma insulin increased in a dose-dependent manner in the ADX rats as a function of CORT replacement. The higher of the two CORT replacement doses used in this experiment restored circulating CORT to levels observed in sham-operated controls. Contrary to earlier reports, physiological doses of CORT appear to enhance leptin-induced weight loss.

Complications of Mersilene sutures in penetrating keratoplasty.

BACKGROUND: After penetrating keratoplasty, many corneal surgeons adjust sutures to reduce astigmatism and then leave the sutures in place indefinitely. Nylon sutures can hydrolyze and break years after surgery. In a series of human penetrating keratoplasties, we studied the use of polyester (Mersilene) sutures that do not hydrolyze. METHODS: We performed two prospective studies of polyester (Mersilene) sutures in human penetrating keratoplasty done by one surgeon. Study I was a randomized comparison of combined running and interrupted Mersilene and nylon sutures in 45 consecutive eyes. Study II was a case series of single running Mersilene suture with postoperative adjustment of suture tension to manage astigmatism in 23 consecutive eyes. We evaluated the performance of the suture and the control of astigmatism. RESULTS: The interrupted running suture study demonstrated that interrupted Mersilene sutures were 5.5 times more likely to have handling-related complications than nylon interrupted sutures (p = .01); in addition, they were three times as likely to have tissue-related complications as nylon (p = .16). The running suture study demonstrated an unacceptable complication rate of 69% when Mersilene was used as a single adjustable running suture. At 6 months postoperatively, the median refractive astigmatism for the adjustable cases was 3.37 diopters (mean, 4.03 +/- 2.37 D). Eyes with significant suture-related complications were 2.85 times more likely to have greater than 4.00 D of refractive astigmatism than were eyes without suture-related complications. CONCLUSIONS: Mersilene is an undesirable suture for use in penetrating keratoplasty.

The relationship of visual acuity, refractive error, and pupil size after radial keratotomy.

To better define the relationship between residual refractive error, uncorrected visual acuity, and pupil diameter, we compared 42 eyes that had an eight-incision radial keratotomy according to the Prospective Evaluation of Radial Keratotomy Study protocol with 42 matched control eyes. The parameters measured were best corrected visual acuity, uncorrected visual acuity, and the change in cycloplegic refraction with enlarging pupil diameter. The best corrected visual acuity was 20/16 in both the radial keratotomy and control groups, but the variability (SD) was higher in the radial keratotomy group. The average uncorrected visual acuity was 0.35 (35%) better in the radial keratotomy group, but the variability was 1.77 times higher. Change in refraction with dilation occurred in 9% of the controls and 36% of the radial keratotomy patients, indicating a significant difference (P = .002). The change in refraction with dilation in the eyes with radial keratotomy was almost equally split between a hyperopic change (17%) and a myopic change (18%), which was much different than in the control eyes, only 2% of which changed in a hyperopic direction and 7% in a myopic direction. The radial keratotomy patients with a myopic change had the best uncorrected visual acuity, indicating that positive spherical aberration yielded the best aspherical surface for uncorrected visual acuity.

Reproducibility of normal corneal power measurements with a keratometer, photokeratoscope, and video imaging system.

To determine the reproducibility of currently available instruments for measuring corneal power, two investigators measured comparable locations on 18 normal human corneas using a keratometer (Bausch & Lomb, Rochester, NY), the Corneascope (Kera Corp, Santa Clara, Calif), and the Corneal Modeling System (Computed Anatomy Inc, New York, NY). (For the two keratoscopes, average powers around rings at comparable locations were used.) Comparisons made between instruments at the significance level of .05 indicated that the keratometer was more reproducible than the Corneal Modeling System and the Corneascope, and the Corneal Modeling System was more reproducible than the Corneascope. Of the 31 rings projected on the surface of each cornea by the Corneal Modeling System, rings 2 through 13 were read reasonably reproducibly in that 76% of the measurements on these rings differed by no more than 0.5 diopter. The Corneal Modeling System (software version 1.16) is 83% as reproducible as a keratometer reading at approximately the edge of the 3-mm central zone on normal human corneas and provides information about corneal topography in a more reproducible and visually useful manner than the other two instruments.

Inadequacy of a polyester (Mersilene) suture for the reduction of astigmatism after penetrating keratoplasty.

Through two prospective studies, we evaluated the use of polyester (Mersilene) sutures in penetrating keratoplasty. Study 1 was a randomized comparison of combined running and interrupted Mersilene and nylon sutures (n = 45). Study 2 was a case series of single running Mersilene with postoperative adjustment of suture tension to manage astigmatism (n = 23). Study 1 demonstrated that Mersilene interrupted sutures were 5.5 times more likely to have handling-related complications compared to nylon (P = 0.01); in addition, they were 3 times as likely to have tissue-related complications as nylon interrupted sutures (P = 0.16). Study 2 demonstrated a complication rate of 69% when Mersilene was used as a single adjustable running suture. At 6 months postoperatively, the median refractive astigmatism for the adjustable cases was 3.37 D (mean, 4.03 +/- 2.37 D). Eyes in Study 2 with significant suture-related complications were 2.85 times more likely to have greater than 4 D of refractive astigmatism than were eyes without suture-related complications. We concluded that Mersilene is an undesirable suture for use in penetrating keratoplasty.

Accuracy and precision of keratometry, photokeratoscopy, and corneal modeling on calibrated steel balls.

Surgical manipulation of corneal shape requires an accurate and precise method of measuring anterior corneal curvature from apex to limbus. We evaluated the accuracy and precision of the Bausch & Lomb Keratometer, Kera Corneascope, and Computed Anatomy Corneal Modeling System by measuring comparable locations on four calibrated steel test balls. The Keratometer and Corneal Modeling System were more accurate and precise than the Corneascope. No statistically significant difference was found between the Keratometer and Corneal Modeling System with respect to accuracy or precision. In addition, the accuracy and precision of all 31 rings of the Corneal Modeling System were studied. Rings 2 through 26 were read accurately and precisely within +/- 0.25 diopter on three of the four balls. Values on the steepest ball were within +/- 0.37 diopter.

Results of anterior segment reconstruction for aphakic and pseudophakic corneal edema.

The authors studied prospectively 59 eyes with corneal edema after cataract surgery that required reconstructive surgery; penetrating keratoplasty in 59 (100%), anterior vitrectomy in 42 (71%), intraocular lens removal or exchange in 33 (56%), gonioplasty in 32 (54%), and iridoplasty in 30 (51%). With an average follow-up of 9.9 months, the corneal transplant was clear in 56 eyes (95%). The corrected visual acuity was improved in 49 eyes (83%) and was the same in seven eyes (12%). Intraocular pressure was less than or equal to 21 mmHg in 47 eyes (80%) and 22 to 29 mmHg in nine eyes (15%). The peripheral anterior synechiae score was the same or improved in 56 eyes (95%). Cystoid macular edema was absent to mild in 52 eyes (88%). Anterior segment reconstruction improved both anatomic integrity and visual acuity of most eyes without increasing complications.

Ptosis associated with botulinum toxin treatment of strabismus and blepharospasm.

The incidence, severity, and duration of ptosis after botulinum neurotoxin type A (BAT) injections into extraocular or orbicularis muscles were reviewed retrospectively. Even though lid droop frequently complicated botulinum toxin treatment in this series, no loss of vision or permanent ptosis was encountered. Sixty-seven injections were completed in 44 patients between September 1982 and December 1983. The records were reviewed to determine the incidence of ptosis after these 67 injections. Information was not adequate to ascertain the presence or absence of ptosis after 10 injections. Some degree of ptosis developed after 30 (53%) of the 57 injections with adequate follow-up history. Marked ptosis occurred after 12 (21%) of the 57 injections. The posttreatment lid droop in these 12 cases was potentially visually significant. All cases of ptosis, which impinged on the visual axis, resolved to a level permitting undisturbed vision by eight weeks after toxin injection. The incidence of ptosis was similar in patients who received injections into their medial rectus muscles and in patients who received injections into their lateral rectus muscles. However, an increased incidence of marked ptosis may be associated with the injection of previously operated muscles. Toxin dosage, patient age, and quality of the electromyogram used to monitor the injection showed no statistically significant relationship to the ptosis.

Nasal-oropharyngoscopy: a simple test to evaluate lacrimal duct function in children.

Obstruction of the lacrimal drainage system is a common problem in pediatric ophthalmology. We describe a simple office test which allows the patency of the lacrimal drainage system to be visualized.

Visual evoked potential pattern generation, recording, and data analysis with a single microcomputer.

A single microcomputer is used to generate multiple sets of checkerboard patterns, simultaneously record EEG data for visual evoked potentials, and analyze the results by fast Fourier transform in very rapid sequence under operator control. This system permits efficient estimates of visual acuity in infants with ophthalmological and neuro-ophthalmological disease.