Browse Health
Emergency Physician, Family Practitioner, Primary Care Doctor
21 years of experience
Accepting new patients

Education ?

Medical School Score Rankings
Emory University (1989)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Board of Emergency Medicine
American Board of Family Medicine

Affiliations ?

Dr. Donahue is affiliated with 3 hospitals.

Hospital Affilations

  • Memorial Hospital Central
  • Memorial Hospital North
  • Mayo Clinic - Arizona
    13400 E Shea Blvd, Scottsdale, AZ 85259
  • Publications & Research

    Dr. Donahue has contributed to 51 publications.
    Title Longitudinal Follow-up of Hypermetropic Children Identified During Preschool Vision Screening.
    Date November 2010
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    Early childhood hypermetropia is an important risk factor for the development of amblyopia and esotropia. Understanding the natural history of these complications aids in management decisions.

    Title Prevalence of Refractive Error.
    Date August 2010
    Journal Ophthalmology
    Title A-pattern Strabismus with Overdepression in Adduction: a Special Type of Bilateral Skew Deviation?
    Date June 2010
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    Skew deviation is an acquired vertical ocular misalignment caused by damage to the prenuclear vestibular inputs to the ocular motor nuclei. A-pattern strabismus often has bilaterally symmetric vertical incomitance and overdepression in adduction (superior oblique overaction) and can be associated with developmental delay, cerebral palsy, hydrocephalus, spina bifida, or posterior fossa or other brainstem disease. The purpose of this study is to describe the ocular motility and torsion findings in patients with A-pattern strabismus and bilateral overdepression in adduction (superior oblique muscle overaction) and to propose a possible brainstem mechanism underlying these observations.

    Title Amblyopia Therapy in Children Identified by Photoscreening.
    Date February 2010
    Journal Ophthalmology
    Excerpt

    To determine the efficacy of amblyopia treatment in children identified through a community photoscreening program.

    Title The Relationship Between Preoperative Alignment Stability and Postoperative Motor Outcomes in Children with Esotropia.
    Date November 2009
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    To examine the effect of preoperative alignment stability on postoperative motor outcomes in children who underwent surgery for esotropia.

    Title Correlation of Sonographic Measurements of the Internal Jugular Vein with Central Venous Pressure.
    Date September 2009
    Journal The American Journal of Emergency Medicine
    Excerpt

    Determination of volume status is crucial in treating acutely ill patients. This study examined bedside ultrasonography of the internal jugular vein (IJV) to predict central venous pressure (CVP). Ultrasonography was performed on 34 nonventilated patients with monitored CVPs. The IJV was measured during the respiratory cycle and with the patient in different positions. Mean IJV diameter in patients with CVP less than 10 cm H2O was 7.0 mm (95% confidence interval [CI], 5.7-8.3) vs 12.5 mm (95% CI, 11.2-13.8) in patients with CVP of 10 cm H2O and greater. Measurement of end expiratory diameter with the patient supine had the highest correlation coefficient: 0.82 (95% CI). There was strong agreement among ultrasonographers: correlation coefficient, 0.92 (95% CI). This pilot study shows promise that ultrasonography of the IJV can be a noninvasive tool to predict CVP. Measurement of end expiratory diameter in supine patients exhibited a high correlation to CVP.

    Title Corneal Ulceration Due to Vitamin A Deficiency in Zellweger Syndrome.
    Date September 2009
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    We report a case of vitamin A deficiency and secondary corneal ulcer in an infant with Zellweger syndrome. A 7-month-old infant with failure to thrive and malnutrition developed a corneal ulcer. Fortified antibiotic eye drops were administered without improvement. Vitamin A deficiency was suspected and confirmed. Supplementation with oral vitamin A decreased corneal opacification. Zellweger syndrome was later diagnosed. Vitamin A deficiency should be considered in the differential diagnosis of nonhealing corneal ulcers in children, especially those with systemic syndromes and failure to thrive.

    Title The Age-dependent Effect of Anisometropia Magnitude on Anisometropic Amblyopia Severity.
    Date August 2008
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    INTRODUCTION: Anisometropia is an important cause of amblyopia. The relationship between anisometropia depth and amblyopia magnitude is not well characterized, as previous studies have been limited to patients identified because of their amblyopia. We analyzed results from anisometropic patients identified with photoscreening to eliminate this selection bias. METHODS: We performed a retrospective observational study of preschool children with anisometropia >1.0 D identified during a statewide photoscreening program. Nine hundred seventy-four children with anisometropia were detected over a 9-year period. Visual acuity, cycloplegic refraction data, and patient age from a formal follow-up examination were analyzed. Effect of anisometropia magnitude on amblyopia was measured by ordinal logistic regression, taking age into account. RESULTS: Six hundred forty (65.7%) children had amblyopia > or =2 lines. Three hundred sixty-four (37.4%) had > or =4 lines amblyopia. There was a statistically significant increase in risk of amblyopia with increasing magnitude of anisometropia. Calculated odds ratios for amblyopia with maximal meridional anisometropia of > or =2 to <4 D compared with >1 to <2 D was 2.13 (95% CI [1.63, 2.78], p < 1 x 10(-7)), and 2.34 (95% CI [1.67, 3.28], p < 1 x 10(-6)) when comparing > or =4 D to > or =2 to <4 D. Odds ratios for spherical equivalent anisometropia were also highly statistically significant. CONCLUSIONS: Children with higher magnitudes of anisometropia had higher prevalence and greater depth of amblyopia. Older children had an increased risk of amblyopia compared with younger children for moderate levels of anisometropia. Low magnitude anisometropia in young children may not predispose to amblyopia; these findings have implications for vision screening criteria at various ages.

    Title Phakic Iols in Children.
    Date March 2008
    Journal Ophthalmology
    Title Exotropia and Face Turn in Children with Homonymous Hemianopia.
    Date March 2008
    Journal Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-ophthalmology Society
    Excerpt

    Four children developed homonymous hemianopia, exotropia with the deviating eye pointing in the direction of the field defect, and a face turn toward the side of the defect following complete third cranial nerve palsy after brain tumor resection, an in utero middle cerebral artery infarction, nonaccidental head trauma, and a hemispherectomy for an intractable seizure disorder. We present evidence that the exotropia and face turn are part of an adaptive mechanism to increase the useful visual field.

    Title Cortical Visual Impairment: Etiology, Associated Findings, and Prognosis in a Tertiary Care Setting.
    Date August 2007
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    PURPOSE: To evaluate the etiology, prognosis, and associated neurological and ophthalmologic findings of children with cortical visual impairment (CVI) at a tertiary care referral facility. METHODS: Records from patients visiting the Vanderbilt University Pediatric Ophthalmology Center during 2002 to 2005 were reviewed, and 98 patients were identified with an International Classification of Disease (9th ed.) coding of CVI (377.75). The charts were reviewed to assess presenting symptoms. The clinic and imaging notes were correlated with visual function (graded on a scale of I to VI). RESULTS: The most common etiologies were perinatal hypoxia (35%), prematurity (29%), hydrocephalus (19%), structural central nervous system abnormalities (11%), and seizures (10%). Many children (69%) had multiple etiologies. Associated ophthalmic abnormalities included esotropia (19%), exotropia (40%), nystagmus (21%), and optic atrophy (42%). Significant refractive error (> +3.00 D or < -2.00 D) was common (20%). Associated neurological findings included seizures (60%), cerebral palsy (37%), periventricular leukomalacia (12%), hemiparesis (21%), and hearing loss (11%). Fifty-three percent of children initially diagnosed with CVI were followed for a period of 0.5 to 10 years. Forty percent of the patients showed no improvement in visual function; 34% had minimal improvement, and 17% had mild improvement. Only 6% of the patients had significant improvement in visual function. Eight patients had fixing and following or better acuity at last follow-up. CONCLUSIONS: The major risk factors for CVI are perinatal hypoxia, premature birth, and hydrocephalus. Most patients have associated serious neurological and ophthalmologic abnormalities. While many patients have some recovery in vision acuity, most never see well. Patients with the most improvement in visual function were those having better initial acuity.

    Title Treatment of Strabismic Amblyopia with Refractive Correction.
    Date June 2007
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To report data on the response of previously untreated strabismic amblyopia to spectacle correction. DESIGN: Prospective, interventional case series. METHODS: Twelve patients with previously untreated strabismic amblyopia were prescribed spectacles and examined at five-week intervals until visual acuity was not improved from the prior visit. RESULTS: Amblyopic eye acuity improved by 2 lines or more from spectacle-corrected baseline acuity in nine of the 12 patients (75%), resolving in three (interocular difference <or=1 line). Mean change from baseline to maximum improvement was 2.2 +/- 1.8 lines. Improvement continued for up to 25 weeks. CONCLUSIONS: These results support the suggestion from a prior study that strabismic amblyopia can improve and even resolve with spectacle correction alone. Larger studies with concurrent controls are needed to confirm or refute these findings.

    Title Assessing Adherence to Evidence-based Guidelines for the Diagnosis and Management of Uncomplicated Urinary Tract Infection.
    Date March 2007
    Journal Mayo Clinic Proceedings. Mayo Clinic
    Excerpt

    OBJECTIVE: To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined. RESULTS: Of 228 patients, 68 (30%) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84%) and 52 (76%) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38%). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coil was sensitive to SMX-TMP in 33 (94%) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients. CONCLUSION: Only 30% of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25% received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.

    Title Compared Value of Amblyopia Detection.
    Date August 2006
    Journal Binocular Vision & Strabismus Quarterly
    Title The Yield and Challenges of Charitable State-wide Photoscreening.
    Date August 2006
    Journal Binocular Vision & Strabismus Quarterly
    Excerpt

    INTRODUCTION: State-wide cooperative programs for pediatric vision screening utilizing the MTI photoscreener and centralized interpretation were established in Alaska (The Alaska Blind Child Discovery, ABCD) and in Tennessee (Tennessee Lions Outreach). METHODS: Details of setup, implementation and interpretation of the state-wide MTI photoscreening programs are compared through 2002. The absolute numbers of children screened and the breakdown in interpretation categories are presented. RESULTS: ABCD screened 14,000 children while Tennessee Lions screened 100,800. Similarities between ABCD and Tennessee programs were funded by Lions Clubs and other charitable and public health organizations, community screening and each had coordinated centralized image interpretation and notification. The programs differed by clinic focus (Tennessee Lions organized pre-schools while ABCD used village and community health fairs and schools), parent notification (Tennessee Lions communicated through pre- schools and ABCD mailed directly to parents), and image interpretation (Tennessee used VOIC age-based and pupil-size crescents while ABCD used "delta-center crescent"). Predictive value positive was 73% for Tennessee and 89% for ABCD. Tennessee achieved better followup on referrals after a specific coordinator was employed. Image interpretation breakdown for ABCD: Tennessee Lions Outreach were anisometropia (29%:34%), high hyperopia (33%:16%), astigmatism (18%:30%), strabismus (7%:15%), myopia (5%:2%), cataract (0.7%:0.2%). Two state-wide programs detected 3216 amblyopic children at a charity borne-cost of 1.5 million dollars. If the parents persisted with appropriate amblyopia therapy, the expected societal value was estimated at 17 million dollars. Lacking societal mandate and funding, these concerted charitable efforts only achieved a community penetration rate of 10% to 14%. CONCLUSION: National adoption of preschool vision screening by a method with similar or even better validity and cost effectiveness as MTI photoscreening, ideally in the pediatric medical home, is warranted.

    Title Treatment of Anisometropic Amblyopia in Children with Refractive Correction.
    Date June 2006
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: To evaluate the effectiveness of refractive correction alone for the treatment of untreated anisometropic amblyopia in children 3 to <7 years old. DESIGN: Prospective, multicenter, noncomparative intervention. PARTICIPANTS: Eighty-four children 3 to <7 years old with untreated anisometropic amblyopia ranging from 20/40 to 20/250. METHODS: Optimal refractive correction was provided, and visual acuity (VA) was measured with the new spectacle correction at baseline and at 5-week intervals until VA stabilized or amblyopia resolved. MAIN OUTCOME MEASURES: Maximum improvement in best-corrected VA in the amblyopic eye and proportion of children whose amblyopia resolved (interocular difference of < or =1 line) with refractive correction alone. RESULTS: Amblyopia improved with optical correction by > or =2 lines in 77% of the patients and resolved in 27%. Improvement took up to 30 weeks for stabilization criteria to be met. After stabilization, additional improvement occurred with spectacles alone in 21 of 34 patients observed in a control group of a subsequent randomized trial, with amblyopia resolving in 6. Treatment outcome was not related to age, but was related to better baseline VA and lesser amounts of anisometropia. CONCLUSION: Refractive correction alone improves VA in many cases and results in resolution of amblyopia in at least one third of 3- to <7-year-old children with untreated anisometropic amblyopia. Although most cases of resolution occur with moderate (20/40-20/100) amblyopia, the average 3-line improvement in VA resulting from treatment with spectacles may lessen the burden of subsequent amblyopia therapy for those with denser levels of amblyopia.

    Title A Randomized Trial to Evaluate 2 Hours of Daily Patching for Strabismic and Anisometropic Amblyopia in Children.
    Date June 2006
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: To compare 2 hours of daily patching (combined with 1 hour of concurrent near visual activities) with a control group of spectacle wear alone (if needed) for treatment of moderate to severe amblyopia in children 3 to 7 years old. DESIGN: Prospective randomized multicenter clinical trial (46 sites). PARTICIPANTS: One hundred eighty children 3 to 7 years old with best-corrected amblyopic-eye visual acuity (VA) of 20/40 to 20/400 associated with strabismus, anisometropia, or both who had worn optimal refractive correction (if needed) for at least 16 weeks or for 2 consecutive visits without improvement. INTERVENTION: Randomization either to 2 hours of daily patching with 1 hour of near visual activities or to spectacles alone (if needed). Patients were continued on the randomized treatment (or no treatment) until no further improvement was noted. MAIN OUTCOME MEASURE: Best-corrected VA in the amblyopic eye after 5 weeks. RESULTS: Improvement in VA of the amblyopic eye from baseline to 5 weeks averaged 1.1 lines in the patching group and 0.5 lines in the control group (P = 0.006), and improvement from baseline to best measured VA at any visit averaged 2.2 lines in the patching group and 1.3 lines in the control group (P<0.001). CONCLUSION: After a period of treatment with spectacles, 2 hours of daily patching combined with 1 hour of near visual activities modestly improves moderate to severe amblyopia in children 3 to 7 years old.

    Title Lions Clubs International Foundation Core Four Photoscreening: Results from 17 Programs and 400,000 Preschool Children.
    Date April 2006
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.

    Title Three-muscle Surgery for Infantile Esotropia in Children Younger Than Age 2 Years.
    Date August 2005
    Journal Journal of Pediatric Ophthalmology and Strabismus
    Excerpt

    PURPOSE: To review the long-term outcome of infants undergoing three-muscle surgery for infantile esotropia. PATIENTS AND METHODS: Surgical records of 10 patients with esotropia > or = 55 prism diopters (PD) who underwent three-muscle surgery for large-angle infantile esotropia were reviewed. Outcome measures included over- or undercorrection, need for additional surgery, and amount of deviation at last follow-up. RESULTS: Mean age at initial surgery was 13 months. Mean preoperative deviation was 62.5 PD of esotropia. A single surgery was associated with satisfactory horizontal alignment in only three (30%) patients at last follow-up (mean, 37.1 months; range, 8-70 months). Esotropia was undercorrected in one (10%) and overcorrected in six (60%) patients, all of whom required additional surgery. One patient with satisfactory horizontal alignment required an additional procedure to correct a right hypertropia causing a left face turn. CONCLUSIONS: In contrast to older children and adults, three-muscle surgery may be inappropriate for infants with large-angle esotropia due to a large overcorrection rate. This controversy may benefit from a prospective study.

    Title Korean Kindergarten Vision Screen Programme.
    Date May 2005
    Journal The British Journal of Ophthalmology
    Title Hyperopia: How Do We Define Abnormal?
    Date January 2005
    Journal Archives of Ophthalmology
    Title Strabismus Surgery for Adults: a Report by the American Academy of Ophthalmology.
    Date June 2004
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: To describe the effectiveness and safety of surgical treatment of adult patients with strabismus, and to review the reported functional benefits and complications of strabismus surgery for adults. METHODS: A literature search was conducted in September 2001. It was repeated and updated in April 2003, with retrieval of relevant citations. Panel members reviewed the articles and rated them according to their relevance to the topic and methodology. RESULTS: The literature search identified 49 reports that describe the surgical treatment of strabismus in adult patients and meet predetermined review criteria. Of these reports, 2 were of randomized controlled trials, and 1 addressed the primary objective of this review. In this randomized study of adults with strabismus, direct comparison of surgical correction with botulinum toxin A chemodenervation indicated that surgical treatment was superior to botulinum toxin A in realigning the eyes (76.9% vs. 29.4%, P = 0.027). Several large case series of adults with strabismus (level III evidence) with successful surgical realignment rates of 68% to 85% have been reported. Functional benefits of surgical treatment are reported in many patients. These include elimination of diplopia, development of binocular fusion, expansion of binocular visual fields, and improvement of head position. Surgical complications, including new, postoperative diplopia (1%-14%) or scleral perforation (0.8%-1.8%), occur in a minority of patients. Unplanned reoperations (subsequent strabismus procedures that were not anticipated as part of a staged treatment) were needed in up to 21% of patients in large case series of comitant strabismus, and in up to 50% of patients with thyroid ophthalmopathy. CONCLUSIONS: Despite the paucity of level I evidence from randomized controlled trials, the existing literature suggests that surgical treatment of adults with strabismus is safe and effective in improving ocular alignment. In many cases it improves visual function, based largely on level III evidence. Risks include unplanned reoperation, postoperative diplopia, and scleral perforation. Additional level I studies of surgical treatment of adult patients would help to document the effectiveness and substantiate the safety of this treatment.

    Title Intraocular Lens Implantation During Infancy: Perceptions of Parents and the American Association for Pediatric Ophthalmology and Strabismus Members.
    Date March 2004
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

    Title Screening with Photoscreening Photographs.
    Date March 2004
    Journal Ophthalmology
    Title Preschool Vision Screening: What Should We Be Detecting and How Should We Report It? Uniform Guidelines for Reporting Results of Preschool Vision Screening Studies.
    Date January 2004
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Title Sensitivity of Photoscreening to Detect High-magnitude Amblyogenic Factors.
    Date July 2002
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    PURPOSE: To determine the sensitivity of a unique pupil-size based set of referral criteria of the MTI PhotoScreener(Medical Technology and Innovations, Inc, Cedar Falls, Iowa) to detect high magnitude refractive error. METHODS: The photoscreening photographs of 949 preschool children previously analyzed were reevaluated with the new referral criteria. The original photographs had been obtained from pediatricians' offices and public health and Women, Infants, and Children's (WIC) clinics. The results of this analysis were compared with the gold standard clinical examination and cycloplegic refraction. Sensitivities were calculated for amblyogenic factors based on the magnitude of the refractive error. RESULTS: For 26 patients with anisometropia, the sensitivity to detect anisometropia increased from 46% for +1.25 or greater spherical interocular difference to 100% for +2.50 spherical intraocular difference. For 36 patients with hypermetropia in at least 1 meridian ranging from +3.75 to +7.50 D, sensitivity increased from 53% to detect +3.75 D or greater to 70% for +5.00 D or greater. The sensitivity to detect hypermetropia of +5.75 D or greater was 100%. These criteria detected 82% of patients with astigmatism greater than or equal to +3.00 D, and 100% of patients with astigmatism greater than +3.50 D. CONCLUSION: It is crucial that screening programs avoid over-referrals caused by high false-positive screening rates. The sensitivity of our new criteria increases with higher magnitude refractive error; patients with moderate and severe amblyogenic factors are almost never missed. While the sensitivity to detect lower magnitude refractive error is poor, the amblyogenic impact of such errors remains to be determined.

    Title Age-based Refinement of Referral Criteria for Photoscreening.
    Date December 2001
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: To evaluate examination results from preschool children referred from photoscreening, and to adjust referral criteria for suspected astigmatism. DESIGN: Cross-sectional study and noncomparative case series. PARTICIPANTS: Thirty-one thousand fifty-three preschool children. METHODS: Analysis of (1) referral rate and unreadable photograph rate for all children screened, (2) examination results and treatment plan for all children referred for suspected astigmatism, and (3) examination results and treatment for all referred children aged less than 1 year. MAIN OUTCOME MEASURES: Referral rate, unreadable photograph rate, predictive value positive, treatment plan. RESULTS: The referral rate dropped from 7.8% for children 6 to 11 months to 5.3% for all other ages. The unreadable photograph rate declined exponentially from 12.1% for children aged 6 to 11 months to 1.1% for children aged 4 years. The predictive value positive of a photoscreen referral for all children in the 6- to 11-month age group was 30%, and only 12 of the 94 referred children were treated. The predictive value positive for children less than 1 year of age referred with suspected astigmatism was even lower (25%), and only one child in this age group was treated. The predictive value positive increased with age, and a higher percentage of older children were treated. For children at least 3 years old referred for suspected astigmatism, the predictive value positive was 67% when the examination was performed by a pediatric ophthalmologist. Strabismus, anisometropia, and high hypermetropia were diagnosed in such patients age 2 and older but never in younger children. CONCLUSIONS: Children less than 1 year of age have a much lower pass rate from photoscreening than do older children because of a higher referral rate and higher unreadable rate in this age group. When these children are examined, significant pathosis is usually absent, and intervention is rarely initiated. Most children age 2 and older who are referred for suspected astigmatism have a high likelihood of significant pathosis. It is probably unnecessary to examine children less than age 2 when their photoscreening suggests only astigmatism; conversely, referrals should still be provided for these children when their screening suggests other potentially amblyogenic factors.

    Title Skew Deviation and Inferior Oblique Palsy.
    Date December 2001
    Journal American Journal of Ophthalmology
    Excerpt

    To describe ocular motility and neuro-ophthalmologic findings in six patients with an ocular tilt reaction (OTR) that mimicked an inferior oblique palsy (IOP).

    Title Screening for Amblyopia in Preverbal Children: Improved Grading Criteria for Hyperopia.
    Date October 2001
    Journal Ophthalmology
    Title Screening for Amblyogenic Factors Using a Volunteer Lay Network and the Mti Photoscreener. Initial Results from 15,000 Preschool Children in a Statewide Effort.
    Date September 2000
    Journal Ophthalmology
    Excerpt

    PURPOSE: To describe the results from a statewide preschool vision screening program using the MTI PhotoScreener (Medical Technology and Innovations, Inc., Cedar Falls, IA). DESIGN: Cross-sectional study. PARTICIPANTS: A total of 15,059 children aged 6 to 47 months enrolled in childcare and preschool settings throughout the state of Tennessee. METHODS: Volunteers from local Lions Clubs took photoscreening photographs of children in a statewide effort. Photographs were interpreted at the Vanderbilt Ophthalmic Photography Reading Center using predetermined criteria. Children who failed the screening were referred to community ophthalmologists or optometrists who performed a comprehensive evaluation and forwarded the results to the authors. MAIN OUTCOME MEASURES: Referral rate, unreadable rate, and predictive value positive (PVP). RESULTS: During the 2 years of the screening program, 15,059 children were screened in 850 screenings. The screening referred 1013 children (6.7%), and 704 photographs (4.7%) were unreadable. Children who failed the screening had a significant abnormality (strabismus, anisometropia, high hypermetropia, high astigmatism, or high myopia) in 320 of the 531 cases where adequate follow-up results were reported. The PVP ranged from 84% when a diagnosis of strabismus was suggested by the photoscreen reading to 41% for astigmatism. Despite intense attention to follow-up, many children who failed the screening never received a formal eye examination. CONCLUSIONS: The MTI PhotoScreener can be used by volunteers to screen preschool children and can have a high PVP in organized settings, provided that meticulous attention is paid to photograph interpretation and quality control. The PVP of the MTI PhotoScreener depends on the diagnosis suggested when the photograph is read. Significant obstacles exist in obtaining care for those who fail screening.

    Title Isolated Trochlear Nerve Palsy in Patients with Multiple Sclerosis.
    Date August 2000
    Journal Neurology
    Title Baerveldt Implant Surgery in the Treatment of Advanced Childhood Glaucoma.
    Date November 1999
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    BACKGROUND: The efficacy of Baerveldt implant (Pharmacia & Upjohn, Inc., Kalamazoo, Mich.) surgery in the treatment of advanced childhood glaucoma is unknown. METHODS: We reviewed the results of 23 consecutive 350 mm Baerveldt implants in 20 eyes of 17 children. Results were classified as follows: (1) success; no further reoperation, no decrease in vision, and intraocular pressure at last follow-up less than 21 mm Hg with no medications; (2) qualified success; medication necessary to bring intraocular pressure to less than 21 mm Hg or complication not associated with tube failure; and (3) failure; intraocular pressure >20 mm Hg, tube failure complication or reoperation causing tube removal, phthisis, or enucleation. RESULTS: Original glaucoma types were bilateral aphakic (five), unilateral aphakic or persistent hyperplastic primary vitreous (four), primary infantile (four), juvenile (three), secondary(two), Peter syndrome (one), and Lowe syndrome (one). Patients had undergone a mean of 2.8 previous intraocular procedures. Mean preoperative intraocular pressure was 33.6 mm Hg; average number of preoperative glaucoma medications was 3.0. Mean follow-up was 19 months (range, 6 to 32 months). Eight procedures were considered successful (mean intraocular pressure 15.5 mm Hg), six were qualified successes (mean number of medications 0.8; mean intraocular pressure 16 mm Hg), and nine failed. Two eyes in the qualified success group do not have useful vision as a result of complications. Complications included retinal detachment (five), corneal decompensation (five), corneal graft rejection in five of six grafts; dislocated tubes (three), and recurrent uveitis (two). One of these eyes is phthisic and one has been enucleated. Only two of nine procedures in eyes with a history of one or no previous intraocular operations failed,whereas seven of 13 procedures in eyes with a history of three or more previous procedures failed. Only seven of 13 procedures in aphakic eyes were successes or qualified successes, whereas seven of 10 procedures in phakic eyes had good results. CONCLUSION: Baerveldt implants can produce good short-term results, especially in phakic eyes. Aphakic eyes and eyes that have undergone multiple procedures are at a much higher risk for devastating complications.

    Title Comparison of 24-2 and 30-2 Perimetry in Glaucomatous and Nonglaucomatous Optic Neuropathies.
    Date August 1999
    Journal Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-ophthalmology Society
    Excerpt

    OBJECTIVE: To determine whether the 24-2 Humphrey visual field (HVF) (Humphrey, San Leandro, CA) strategy provides information comparable to that provided by the 30-2 strategy in patients with optic nerve disease. METHODS: In part A of the study, an occluder device was designed to cover the additional outer 22 points tested in the 30-2 strategy of 187 HVFs from neuro-ophthalmology patients with nonglaucomatous optic neuropathy and 206 HVFs from patients with glaucoma. This device converted the gray scale and probability plots of the 30-2 HVF to a 24-2 field. Fields were initially read using the occluder and then were read in a masked manner without the occluder and compared. In part B, 15 healthy volunteers performed both 30-2 and 24-2 HVFs. Testing time and global indices were compared. Ninety-five percent of the fields in the neuro-ophthalmology patients, 96% of the fields in patients under observation for suspected glaucoma, 98% of the fields in patients with ocular hypertension, and 100% of the fields in patients with glaucoma were read similarly with the 24-2 and 30-2 strategies. In the few cases in which a discrepancy was noted between the 24-2 and the 30-2 fields, appropriate clinical management would not have been compromised by using the 24-2 strategy. Most of these cases were in patients with idiopathic intracranial hypertension and very subtle nerve fiber bundle defects. The 24-2 strategy had a significantly lower pattern standard deviation (P < 0.01) and corrected pattern standard deviation (P = 0.05) than did the 30-2 strategy. In addition, the 24-2 strategy shortened the standard threshold testing time by 28% in normal volunteers (P < 0.0001 ). CONCLUSIONS: In most cases, the 24-2 testing strategy provides information comparable to that provided by the 30-2 strategy in a shorter time and with less variability. A 30-2 HVF may be warranted in patients under observation for evolving idiopathic intracranial hypertension.

    Title Visual Field Defects After Temporal Lobe Resection: a Prospective Quantitative Analysis.
    Date August 1999
    Journal Neurology
    Excerpt

    OBJECTIVE: To evaluate and quantify prospectively visual field changes in patients undergoing temporal lobe resections for intractable epilepsy. BACKGROUND: Visual field abnormalities occur after temporal lobe resections for epilepsy; however, we have not encountered published reports using automated static visual field analysis. METHODS: Humphrey visual fields (program 30-2) were obtained before and after partial temporal lobe resection in 32 consecutive patients with intractable epilepsy. A quantitative point-by-point analysis was made in the affected superior quadrant, and the defects were averaged for the whole patient group. RESULTS: Thirty-one patients developed a visual field defect, but none was aware of the defect. The points nearest fixation were relatively spared. The defects were greatest in the sector closest to the vertical meridian in the eye ipsilateral to the resection. The ipsilateral and contralateral mean field defects also differed in both topography and depth. A significant correlation was found between the extent of lateral temporal lobe resection and the degree of the defect in the contralateral eye. CONCLUSIONS: There are differences in the shape and depth of the ipsilateral and the contralateral field defects not previously reported. These findings demonstrate that certain fibers from the ipsilateral eye travel more anteriorly and laterally in Meyer's loop, and support the hypothesis that visual field defects due to anterior retrogeniculate lesions are relatively incongruous because of anatomic differences in the afferent pathways. Automated perimetry is a sensitive method of evaluating and quantifying visual field defects.

    Title Tonic Ocular Tilt Reaction Simulating a Superior Oblique Palsy: Diagnostic Confusion with the 3-step Test.
    Date March 1999
    Journal Archives of Ophthalmology
    Excerpt

    The tonic ocular tilt reaction (OTR) consists of vertical divergence of the eyes (skew deviation), bilateral conjugate ocular torsion, and paradoxical head tilt. The head and superior pole of both eyes are rotated toward the hypotropic eye.

    Title Automated Perimetry in Amblyopia: a Generalized Depression.
    Date March 1999
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To quantitate the visual field abnormalities associated with amblyopia. METHODS: In a prospective study, 37 amblyopic patients (11 anisometropic, 13 strabismic, 9 combination, 4 deprivation) performed automated perimetry in each eye using the Humphrey 30-2 program. Primary outcome measures were foveal threshold, mean deviation, and average threshold. RESULTS: When the probability plots were examined, 21 visual fields in amblyopic eyes were normal, 8 had central scotomas, and 7 had diffuse depressions. No focal defects other than mild central scotomas were seen. However, the foveal threshold of amblyopic eyes was decreased by an average of 7.2 +/- 8.0 dB (P < .0001) compared with fellow eyes; intereye differences in mean deviation (3.2 +/- 5.4 dB; P < .001) and average threshold (2.9 +/- 5.3 dB; P < .005) were also seen. This decrease in sensitivity for the amblyopic eye occurred for all types of amblyopia. The depression in threshold was greatest at the fovea but was detectable and significant at all eccentricities of the 30-degree field. The average threshold in the amblyopic eye was highly correlated with visual acuity (r = .839; P < .001). CONCLUSIONS: Although automated visual fields in amblyopic eyes typically appear normal, all four types of amblyopia are associated with a generalized depression of light sensitivity, which is proportionately greatest at the fovea and highly correlated with visual acuity loss. In general, amblyopia is not associated with any area of focal loss of threshold light sensitivity. If a focal defect is present in the visual field of the amblyopic eye, organic causes of visual loss should be suspected. The Humphrey visual field analyzer STATPAC program (Allergan-Humphrey, Inc, San Leandro, California) may artifactually transform small and generalized full-field depressions in a manner that makes them appear to be isolated central defects.

    Title The Decreasing Incidence and Severity of Retinopathy of Prematurity.
    Date March 1999
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    PURPOSE: We sought to determine whether the incidence of retinopathy of prematurity (ROP) at our institution has changed since the Cryo-ROP recruitment period 10 years ago. METHODS: We determined the incidences of threshold ROP, prethreshold ROP, less-than-prethreshold ROP, and no disease for each of 3 birth weight classes (<750 g, 750 to 999 g, and 1000 to 1250 g) of infants born between July 1, 1995, and June 30, 1996, and cared for in the Vanderbilt Neonatal Intensive Care Unit. We then compared these with the rates from our institution during the Cryo-ROP study recruitment period (January 1, 1986, to November 30, 1987). RESULTS: The current incidence and severity of ROP have decreased substantially overall and for each weight group compared with the 1986-87 incidence (P < .001, Cochran-Mantel-Haenszel test). The incidence of "any ROP" decreased by 27% for infants with birth weights less than 750 g, by 51% for infants 750 to 999 g, and by 71% for infants 1000 to 1250 g. The incidence of "prethreshold or greater ROP" decreased by 70% for the 750 to 999 g and 77% for the 1000 to 1250 g weight groups. Although the decrease in "prethreshold or greater ROP" was not as dramatic (25%) for the infants less than 750 g, only 1 infant (10%) progressed to threshold disease in this group, whereas 7 (47%) did in 1986-87. The incidence of threshold ROP decreased by 84% for infants less than 750 g and by 66% for infants 750 to 999 g. No infant with birthweight greater than 999 g progressed to threshold ROP. CONCLUSIONS: The incidence of all levels of ROP has decreased substantially for all infants with birth weights less than 1251 g at Vanderbilt University Medical Center during the past decade. Putative factors responsible for this decrease may include surfactant use, continuous pulse oximetry, aggressive use of antenatal steroids, and improved neonatal nutritional support.

    Title Automated Pupil Perimetry in Amblyopia: Generalized Depression in the Involved Eye.
    Date December 1997
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: This study was designed to determine whether the relative afferent pupillary defects observed commonly in amblyopic eyes are associated with a uniform depression of the pupillary light reflex throughout the visual field or solely by a focal decrease in pupillary response near fixation. DESIGN: The authors used pupil perimetry to evaluate the contraction amplitude of the pupil in response to focal light stimuli at 76 points throughout the 30 degrees field in each eye of 28 patients with amblyopia. The "pupil fields" were recorded using a computerized infrared pupillograph linked to a Humphrey Field Analyzer, so that the pupil contraction could be recorded in response to perimetric light stimuli. PARTICIPANTS: Nine patients had strabismic amblyopia, ten had anisometropia, six had a combination of anisometropia and strabismus, and three had deprivation amblyopia due to monocular congenital cataract. MAIN OUTCOME MEASURES: Mean pupillary contraction amplitude for the entire field and focal amplitudes at each tested location were compared. Mixed-model analysis of variance was used to assess effects of perimetry location, type of amblyopia, and interaction effects. RESULTS: The overall average of all the pupil contractions throughout the 30 degrees field was less for the amblyopic eye compared with that of the fellow eye. This decrease in focal pupil response for amblyopic eyes was present in each type of amblyopia and was greatest for deprivation amblyopia. The contraction amplitude was depressed diffusely throughout the pupil field and showed neither focal deficits nor a selective depression about fixation. CONCLUSION: Amblyopia produces a global depression of focal pupillary responses across the entire 30 degrees field.

    Title Intraocular Candidiasis in Candidemic Patients.
    Date July 1997
    Journal European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
    Title Common Ocular Infections. A Prescriber's Guide.
    Date January 1997
    Journal Drugs
    Excerpt

    While most ocular infections are benign, others can be associated with devastating visual consequences. Most patients present with either ocular discharge, visual symptoms or a red or painful eye. The primary care physician is usually the first to evaluate these patients. We have separated ocular infections into 3 groups. Infections affecting the cornea and conjunctiva often present with eye pain and a red eye; noninfectious aetiologies can have a similar presentation. Infections inside the eye (endophthalmitis) often have devastating consequences. They usually occur following penetrating ocular trauma or after intraocular surgery. Prompt referral to an ophthalmologist is crucial. Infections in the soft tissue surrounding the eye (ocular adnexa and orbit) can involve the eye indirectly and can spread from the orbit into the brain. The purpose of this article is to review ocular infections and current opinion regarding treatment. A general guideline should be that the approach to treatment be governed by the severity of symptoms and the magnitude of possible consequences. Mild external infections can be typically treated empirically. Severe conjunctivitis, and any corneal infection, require aggressive management, often including cultures and broad spectrum antibiotics; cultures are often used to guide treatment. Devastating vision loss can occur, even with aggressive management. Preseptal cellulitis in adults and older children can be managed conservatively with oral antibiotics if the orbit and optic nerve are not involved and the patient is otherwise healthy. Orbital or optic nerve involvement, on the other hand, demands orbital imaging and more aggressive intervention. Patients who have had recent surgery are at risk for developing endophthalmitis. Complaints of pain or a red eye must be taken very seriously. These patients must be considered to have an intraocular infection until it can be ruled out, and should be aggressively managed by a physician trained in eye diseases and surgery.

    Title False-negative Hydroxyamphetamine (paredrine) Test in Acute Horner's Syndrome.
    Date December 1996
    Journal American Journal of Ophthalmology
    Excerpt

    To describe a false-negative hydroxyamphetamine test.

    Title Hourglass-shaped Visual Fields As a Sign of Bilateral Lateral Geniculate Myelinolysis.
    Date March 1995
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE/METHODS: Bilateral visual field defects resembling an hourglass could be produced by bilateral lateral geniculate lesions. We recently encountered such deficits in a 37-year-old woman after an episode of central pontine myelinolysis. RESULTS/CONCLUSIONS: Automated static perimetry demonstrated the congruous visual field defects to involve both halves of the visual field. They were confirmed with kinetic perimetry, and they remained stable for four years. Magnetic resonance imaging demonstrated enhancing lesions characteristic of myelinolysis in each lateral geniculate.

    Title Evaluation of Vitrectomy Machines As a Source of False-positive Culture Contamination in Endophthalmitis.
    Date February 1995
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: We sought to determine whether a venturi-aspiration vitrectomy machine could contaminate a vitrectomy culture. METHODS: Ninety vitrectomies were simulated in a hospital operating room and were cultured with standard techniques. An additional 90 control specimens were cultured in the exact same manner, but the vitrectomy machine was not used. Instead, the control specimens were placed directly into a sterile vitrectomy cassette. Contamination rates in the two groups were compared. RESULTS: Contamination occurred in four of 90 vitrectomy-simulation cultures and in three of 90 control cultures. This difference in contamination rate was not statistically significant. CONCLUSIONS: Although the result of a culture of the vitrectomy effluent can be false-positive, the source of contamination is not likely to be the vitrectomy machine.

    Title Intraocular Candidiasis in Patients with Candidemia. Clinical Implications Derived from a Prospective Multicenter Study.
    Date August 1994
    Journal Ophthalmology
    Excerpt

    PURPOSE: Intraocular infection caused by Candida species can have devastating visual consequences. With the emergence of Candida as a major nosocomial pathogen, the authors investigated the prevalence of ocular lesions in patients with candidemia and evaluated risk factors for eye involvement. METHODS: This study is a prospective, multicentered, observational design. One hundred eighteen patients with candidemia were evaluated by the infectious disease service and received indirect ophthalmologic examination within 72 hours of a reported positive blood culture. Ocular findings were classified on the basis of objective, pre-determined criteria. Candida chorioretinitis was defined as the presence of focal, white, infiltrative chorioretinal lesions without vitreal involvement. Candida endophthalmitis was defined as chorioretinitis with extension into the vitreous or intravitreal "fluff balls." RESULTS: In contrast to previous studies of patients with candidemia citing prevalence rates of endophthalmitis approaching 40%, no patients were shown to have endophthalmitis. Candida chorioretinitis was seen in 9% of the patients, all of whom received antifungal agents. The observation that chorioretinitis never progressed to endophthalmitis suggests that systemic antifungal agents provided adequate ocular therapy. Risk factors for Candida chorioretinitis include fungemia with Candida albicans (versus nonalbicans species), multiple positive blood cultures, visual symptoms, and immunosuppression. Twenty percent of patients had nonspecific ocular lesions not directly related to infection. CONCLUSION: Patients with candidemia who have the risk factors noted above warrant formal ophthalmologic examination.

    Title Interferon Treatment of Srnv.
    Date May 1994
    Journal Ophthalmology
    Title Empiric Treatment of Endophthalmitis. Are Aminoglycosides Necessary?
    Date February 1994
    Journal Archives of Ophthalmology
    Excerpt

    To reevaluate the necessity of empiric gram-negative therapy for postoperative endophthalmitis based on the recognition of aminoglycoside-induced toxic effects.

    Title Broad-spectrum Möbius Syndrome Associated with a 1;11 Chromosome Translocation.
    Date September 1993
    Journal Ophthalmic Paediatrics and Genetics
    Excerpt

    The authors report a case of Möbius syndrome with Poland syndrome, cleft palate, dextrocardia, mandibular hypoplasia, and multiple areas of diffuse brain volume loss. Karyotype demonstrated a t(1;11)(p22;p13) translocation in the patient and his phenotypically normal father and brother. This case extends the spectrum of congenital disorders that are associated with Möbius syndrome and raises the possibility of genetic heterogeneity for the Möbius disorder.

    Title Vitreous Cultures in Suspected Endophthalmitis. Biopsy or Vitrectomy?
    Date May 1993
    Journal Ophthalmology
    Excerpt

    BACKGROUND: Isolation of bacteria from vitreous biopsy often guides therapy in suspected endophthalmitis. Therapeutic vitrectomy provides an additional source of culture material. The authors compared the ability of these two techniques to isolate organisms from patients with acute endophthalmitis. METHODS: In a large ophthalmic microbiology laboratory during a 4-year period, the authors analyzed 206 microbial culture results from patients with suspected endophthalmitis. RESULTS: Two hundred six cases were evaluated. While cultures of vitreous biopsy specimens obtained using a needle and syringe were positive in 91 (53.8%) of 169 patients, culturing the contents of the vitrectomy cassettes produced positive cultures in 29 (74.8%) of 39 patients. Both techniques were performed on 23 patients. Vitreous biopsy allowed isolation of the causative organism in 43% of these patients, whereas vitrectomy was 76% successful. Both comparisons were significant at the P < 0.01 level. No positive vitreous biopsy cultures had associated negative vitrectomy cultures. CONCLUSION: Culturing the contents of the vitrectomy cassette significantly increases the likelihood of obtaining a positive culture compared with merely culturing a vitreous biopsy.

    Title Intraconjunctival Cavitary Inclusions of Silicone Oil Complicating Retinal Detachment Repair.
    Date December 1992
    Journal American Journal of Ophthalmology
    Title Response of Igf-1 to Nutritional Support in Malnourished Hospital Patients: a Possible Indicator of Short-term Changes in Nutritional Status.
    Date December 1989
    Journal The American Journal of Clinical Nutrition
    Excerpt

    IGF-1 is a circulating growth factor with hepatic release dependent on nutritional status. To determine if IGF-1 could be a useful nutritional index, 15 malnourished patients were assessed during nutritional support. Patients with protein or protein-calorie malnutrition had lower IGF-1 (39 +/- 7 micrograms/L) than did patients with calorie-only malnutrition (109 +/- 25 micrograms/L, p less than 0.005); transferrin concentrations did not differ between the two groups. Nutritional supplementation produced an increase in IGF-1 (123 +/- 32 micrograms/L, p less than 0.005); the relative increase in IGF-1 (264 +/- 62%, p less than 0.001) exceeded increases in albumin or transferrin (9 +/- 6% and 59 +/- 16%, NS and p less than 0.005, respectively). Reduction or termination of support was followed by a decrease in IGF-1 to 59 +/- 9% of peak values (p less than 0.001) but neither albumin nor transferrin decreased significantly. Changes in IGF-1 were correlated with nitrogen balance (r = 0.45, p less than 0.005). The strong relationship between IGF-1 and nutritional status suggests that IGF-1 determinations may be useful in guiding nutritional therapy in patients whose nitrogen balance is difficult to assess.

    Title Absence of All Cyclovertical Extraocular Muscles in a Child Who Has Apert Syndrome.
    Date
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    A 6-month-old patient with Apert syndrome underwent strabismus surgery for a hypertropic eye. At surgery, the patient was found to have agenesis of all four cyclovertical muscles in one eye. Further investigation by computed tomography demonstrated absence of all four cyclovertical muscles in the fellow eye as well. A transposition procedure corrected the strabismus. While isolated aberrant or missing extraocular muscles are well documented in patients with craniofacial syndromes, bilateral absence of all four cyclovertical muscles, as demonstrated in this patient, poses unique treatment challenges.

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