Visual function and ocular features in children and adolescents with attention deficit hyperactivity disorder, with and without treatment with stimulants

AIMS: To investigate visual function and ocular features in children with attention deficit hyperactivity disorder (AD/HD) and establish whether treatment with stimulants is reflected in functioning of the visual system. METHODS: Detailed ophthalmologic evaluations without and with stimulants were performed in 42 children (37 boys) with AD/HD, mean age 12 years, and compared with a reference group (ref; n=50; mean age 11.9 years; 44 boys). For a comparison between two groups, Mann-Whitney's U-test was used for ordered and continuous variables; for dichotomous variables, Fisher's exact test was used. For paired comparison (with and without treatment), sign test was used. RESULTS: In all, 83% had visual acuity of >0.8 (<0.1 logMAR) without treatment, 90% with stimulants (ref 98%; P=0.032 and n.s., respectively). Heterophoria was found in 29% without, and in 27% with, stimulants (ref 10%; P=0.038 and n.s., respectively) and subnormal stereovision (>60 s of arc) in 26% (ref 6%; P=0.016) without stimulants, and in 27%, with (P=0.014). Abnormal convergence (>6 cm or absent) was noted in 24% (ref 6%; P=0.031) without treatment and in 17%, with (n.s.). Astigmatism (> or =1.0 D) was observed in 24% (ref 6%; P=0.03), and signs of visuoperceptual problems in 21% (ref 2%; P=0.007). We found smaller optic discs (n=8/38) and neuroretinal rim areas (n=7/38) (P<0.0001) and decreased tortuosity of retinal arteries (n=6/34) (P=0.0002) than that of controls. CONCLUSIONS: Children with AD/HD had a high frequency of ophthalmologic findings, which were not significantly improved with stimulants. They presented subtle morphological changes of the optic nerve and retinal vasculature, indicating an early disturbance of the development of these structures.     

超声乳化联合房角分离术治疗白内障伴青光眼的疗效

目的:探讨超声乳化联合房角分离术治疗白内障伴青光眼的临床疗效.方法:以2014-04/2015-10我院收治的73例80眼闭角型青光眼伴白内障患者为研究对象,所有患眼均行晶状体超声乳化联合前房角分离术治疗.比较治疗前后的视力、眼压、前房深度、前房角分级和并发症,分析该术式的临床效果.结果:视力:术后1wk,1、2、6mo,1a平均视力均较术前提高,差异有统计学意义(P<0.05).眼压:术后1wk,1、2、6mo,1a平均眼压均较术前降低,差异有统计学意义(P<0.05).前房深度:术后1wk,1、2、6mo,1a前房深度平均值均较术前升高,差异有统计学意义(P<0.05).前房角分级:术后1wk,1、2、6mo,1a分级均较术前改善,差异有统计学意义(P<0.05).术后无严重并发症.结论:超声乳化联合房角分离术治疗白内障伴青光眼安全有效,可增加前房深度,改善前房角开放程度,并能提高视力和降低眼压.     

Treatment with betaxolol and placebo eyedrops in patients with glaucoma and reactive airway diseases

The study communicated here was designed to evaluate the absence of pulmonary beta-blockade as detected by a histamine provocation in betaxolol-treated patients suffering from open-angle glaucoma and coexisting obstructive airway disease. The study was a randomized, double-masked crossover trial, comparing betaxolol 0.5% ophthalmic solution and placebo. Ten patients (4 male, 6 female) were eligible by demonstrating baseline off-therapy IOP values exceeding 22 mmHg and a FEV1 value that was reduced by 15% to 20% following histamine provocation. After an appropriate washout period, baseline IOP and pulmonary function (FEV1, FVC) were tested. One drop of test medication (betaxolol or placebo) was instilled in both eyes; tonometry and a pulmonary function test were performed 90 minutes later. The patients then underwent a histamine provocation test. The concentration of histamine necessary to reduce FEV1 and FVC by 15% to 20% was recorded. The IOP was significantly reduced in patients treated with betaxolol, but not in those given placebo. FEV1 and FVC values 90 minutes after treatment with betaxolol or placebo were not significantly different from baseline values. After histamine provocation the FEV1 was, as expected, significantly decreased from baseline (15% to 20%) in both treatment groups. There was no statistical difference in the histamine concentration necessary to reduce the FEV1 by 15% to 20% between placebo (5.60 mg/ml) and betaxolol (5.25 mg/ml) treatments. This demonstrates that betaxolol has no pulmonary beta-blocking effect. Our study suggests that ophthalmic treatment with betaxolol in patients with glaucoma and obstructive airway disease enhances pulmonary safety due to the beta-1 cardioselective action of the drug.     

超声乳化术治疗闭角型青光眼合并白内障临床观察

目的 探讨白内障超声乳化折叠式人工晶状体植入术治疗闭角型青光眼的安全性和有效性。方法 38例(38眼)青光眼合并白内障患者，房角关闭小于1／2者单纯施行白内障超声乳化摘出及折叠式人工晶状体植入术，房角关闭大于1／2者施行角巩膜分开切口白内障超声乳化摘出及折叠式人工晶状体植入联合小梁切除术。结果 38例术后3个月眼压均控制在正常范围内，平均眼压为14．2mmHg，全部病例视力较术前提高，视力≥0．5者20眼(52．6％)．未发生严重并发症。结论 白内障超声乳化术在闭角型青光眼患者治疗中具有安全、视力恢复较好较快、降眼压效果确实、并发症少的优点。     

Migraine with and without headache

Transient visual and neurological episodes are relatively common and can occur for the first time in middle and old age. In many cases these transient events are migraine auras. An aura is a transient, stereotypical, visual or neurological episode usually lasting 4 to 60 minutes in duration. Migraine is usually, but not always, associated with headache and can be accompanied by systemic and autonomic symptoms. Diagnosis is dependent on International Headache Society criteria. The pathophysiology is believed to involve neurovascular mechanisms. There is a hereditary component to migraine. When migraine auras occur in the absence of headache they are termed acephalgic migraines. Late onset migraine accompaniment is an acephalgic migraine that presents in middle-aged and older adults. It is usually benign. Migraines can be mimicked by other more serious conditions. Most patients with a stable migraine pattern and normal neurological evaluation do not require further testing. Some patients with atypical presentation, older age, or suspected secondary causes need further investigation.     

Migraine with and without headache

Transient visual and neurological episodes are relatively common and can occur for the first time in middle and old age. In many cases these transient events are migraine auras. An aura is a transient, stereotypical, visual or neurological episode usually lasting 4 to 60 minutes in duration. Migraine is usually, but not always, associated with headache and can be accompanied by systemic and autonomic symptoms. Diagnosis is dependent on International Headache Society criteria. The pathophysiology is believed to involve neurovascular mechanisms. There is a hereditary component to migraine. When migraine auras occur in the absence of headache they are termed acephalgic migraines. Late onset migraine accompaniment is an acephalgic migraine that presents in middle-aged and older adults. It is usually benign. Migraines can be mimicked by other more serious conditions. Most patients with a stable migraine pattern and normal neurological evaluation do not require further testing. Some patients with atypical presentation, older age, or suspected secondary causes need further investigation.     

挫伤性眼球破裂的相关因素与视力预后的关系

目的　探讨眼球破裂伤的相关因素与视力预后的关系。方法　回顾 13 6例 13 6眼眼球破裂伤临床资料 ,对其相关因素与最终视力的关系作非参数检验及二元变量的相关性分析。结果　最初视力≤ 0 0 1与 >0 0 1组之间和伤口范围≤ 1象限与 >1象限组之间的最终视力差异有非常显著意义 (P <0 0 1)。伤口末端在角膜缘部、肌止端前、和肌止端后 3组间 ;伤口长度≤ 10mm、11～ 2 0mm、>2 0mm 3组间 ;眼内出血和眼内容脱失的轻、中、重 3组间的最终视力差异有非常显著意义 (P <0 0 1)。最终视力与最初视力 ,伤口范围、位置、长度 ,眼内出血及眼内容脱失程度相关。结论　眼球破裂伤的最初视力越差 ,伤口范围越大、越向后延伸、长度越长 ,伴眼内出血及眼内容脱失程度越重 ,其视力预后越差。     

Hyperhomocysteinemia in patients with diabetes mellitus with and without diabetic retinopathy

OBJECTIVE: To evaluate the prevalence of hyperhomocysteinaemia in diabetic patients with no diabetic retinopathy (no DR), with non-proliferative diabetic retinopathy (NPDR) and with proliferative diabetic retinopathy (PDR). RESEARCH DESIGN AND METHODS: This prospective, case-control study, included 179 diabetic patients and 156 age-matched controls with no diabetes and no history of ocular disease, who were undergoing routine physical checkups. Plasma homocysteine levels of all study participants were measured using high-performance liquid chromatography (HPLC). Hyperhomocysteinaemia was defined when homocysteine levels were higher than 15 micromol/l. RESULTS: The mean plasma homocysteine level was 11.75+-0.24 in the control group,13.46+0.74 in the no DR group, 14.56 + 0.64 in the NPDR group and 15.86 + 1.34 in the PDR group. Mean homocysteine levels were significantly elevated in the NPDR and PDR groups compared to the control group(P = 0.001 and <0.0001, respectively). The prevalence of hyperhomocysteinaemia was also higher in the NPDR and PDR groups compared to the control group (P = 0.032 and 0.011, respectively). No statistically significant difference was found between the no DR and the control group. CONCLUSIONS: Our findings suggest that hyperhomocysteinaemia may be associated with diabetic retinopathy and partially explain the increased risk of microvascular angiopathy occurring in these patients.     

不同切口白内障超声乳化联合青光眼小梁切除手术

目的 探讨经不同切口行白内障超声乳化联合青光眼小梁切除手术方法与手术效果分析。方法 分析2005年至2006年间我院开展的46例白内障合并闭角形青光眼患者，其中急性闭角型青光眼35例，慢性闭角型青光眼11例；经一切口行常规的白内障超声乳化摘除及折叠型人工晶状体值入，另一切口行常规的小梁切除手术：术后按常规处理。结果 术后一周视力〉0.3者28例。术后随访3到6个月，矫正视力〉0.5者34例，视力较差的原因主要是青光眼性视神经萎缩；眼压43例控制在21mmHg以下，3例经局部用降眼压药水后眼压控制在正常范围，并且滤过泡形成良好。结论 不同切口进行白内障超声乳化工晶状体植入联合小梁切除手术是治疗白内障合并闭角型青光眼较理想的方法，并且手术后视力恢复良好，眼压得到控制，滤过泡形成理想。     

Supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts

Elevated intraocular pressure (IOP) is a major risk factor for the development or progression of glaucoma. Lowering IOP is the only proven therapeutic approach to the management of glaucoma. IOP can be lowered by medication, laser treatment or surgery (1). Generally, instillation of IOP-lowering eye drops remains the first-line treatment because it enables the patients to avoid the potential risk of vision-threatening complications associated with filtering surgery such as blebitis, hypotony maculopathy, and endophthalmitis. However, topical anti-glaucoma treatment also has downsides such as drug-related adverse effects, ocular surface toxicity, and poor adherence. Moreover, medical treatment often fails to reduce IOP sufficiently enough to prevent glaucomatous progression. Despite the risks of complications, surgical treatment is recommended in such cases (2,3).     

Bilateral dacryoceles associated with bilateral alacrimia with punctal and canalicular agenesis

To report a rare case of a 19 year old female presenting with bilateral dacryocele and punctal and canalicular agenesis without epiphora. After clinical and radiological examination, the patient was found to have bilateral lacrimal gland agenesis as well. No other dental, otological or systemic abnormality suggestive of lacrimo-auricular-dento-digital syndrome was detected. She was managed with bilateral dacryocystectomy. Algorithm for managing such nonconventional lacrimal outflow dysgenesis based on presenting symptoms and co existing epiphora is proposed. Rationale of preferring lacrimal sac excision instead of dacryocystorhinostomy in this case is also discussed.     

Incidence and outcomes of lasik with diffuse lamellar keratitis treated with topical and oral corticosteroids

PURPOSE: To analyze the incidence and clinical outcomes of patients developing diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) treated with topical and oral corticosteroids. SETTING: Oregon Eye Institute, Eugene, Oregon, USA. METHODS: A retrospective analysis of the last consecutive 1000 LASIK cases was performed. Eyes developing stage 3 DLK or at risk for progressing to stage 3 were treated with a combination of high-dose prednisolone acetate 1% and oral prednisone and evaluated for corneal scarring, loss of best spectacle-corrected visual acuity (BSCVA), and deviation from the intended refractive outcome. RESULTS: Diffuse lamellar keratitis developed in 40 eyes (4%). It progressed to stage 3 in 7 eyes (17%). Oral and topical steroids were used in 22 eyes (55%). The mean variation from the desired refractive outcome was 0.14 diopter +/- 0.53 (SD). There were no instances of corneal scarring or permanent loss of BSCVA. No eye had interface irrigation. CONCLUSIONS: Treatment of severe DLK with high-dose topical and oral corticosteroids produced excellent results without flap lifting and interface irrigation.