The impact of orthodontic treatment on the quality of life in adolescents: a case-control study

The aim of this case-controlled study was to assess the effect of orthodontic treatment on the quality of life of Brazilian adolescents. Two hundred and seventy-nine 'cases' (106 males and 173 females) and 558 controls (246 males and 312 females) were randomly selected from 15- to 16-year-old adolescents attending all secondary schools in Bauru, S?o Paulo, Brazil. A case was defined as having at least one condition-specific impact (CSI) attributed to malocclusion during the previous 6 months, based on the Oral Impact on Daily Performances index. Conversely, a control was defined as having no CSI attributed to malocclusion during the same period. Adolescents were also clinically examined for orthodontic treatment need using the Index of Orthodontic Treatment Need (IOTN) and asked about previous orthodontic treatment. Binary logistic regression was used for statistical analysis. Females and adolescents with a definite normative orthodontic treatment need were more likely to report CSI than males and adolescents with no normative need [odds ratio (OR) = 1.48, 95 per cent confidence interval (CI) = 1.08-2.02 and OR = 2.02, 95 per cent CI = 2.09-4.47, respectively], whereas adolescents with a history of orthodontic treatment were less likely to report CSI than their counterparts (OR = 0.15, 95 per cent CI = 0.07-0.31). Furthermore, there was an interaction between a history of orthodontic treatment and the current level of normative need. Brazilian adolescents with a history of orthodontic treatment were less likely to have physical, psychological, and social impacts on their daily performances associated with malocclusion than those with no history of orthodontics. Gender was a confounding factor, whereas current level of normative orthodontic treatment need was an effect modifier. Prospective studies are needed to corroborate the present findings.     

Panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab for high‐risk proliferative diabetic retinopathy

Purpose: To evaluate the effects of panretinal photocoagulation (PRP) compared with PRP plus intravitreal injection of 0.5 mg of ranibizumab (IVR) in patients with high‐risk proliferative diabetic retinopathy (PDR). Methods: Prospective study included patients with high‐risk PDR and no prior laser treatment randomly assigned to receive PRP (PRP group) or PRP plus IVR (PRPplus group). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session in the PRPplus group. Standardized ophthalmic evaluations including best‐corrected visual acuity (BCVA) measured according to the methods used in the Early Treatment Diabetic Retinopathy Study (BCVA), fluorescein angiography to measure area of fluorescein leakage (FLA) and optical coherence tomography (OCT) for the assessment of central subfield macular thickness (CSMT), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). Results: Twenty‐nine of 40 patients (n = 29 eyes) completed the 48‐week study follow‐up period. At baseline, mean ± SE FLA (mm²) was 9.0 ± 1.3 and 11.7 ± 1.3 (p = 0.1502); BCVA (logMAR) was 0.31 ± 0.05 and 0.27 ± 0.06 (p = 0.6645); and CSMT (μm) was 216.3 ± 10.7 and 249.4 ± 36.1 (p = 0.3925), in the PRP and PRPplus groups, respectively. There was a significant (p < 0.05) FLA reduction at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48 (PRP = 2.9 ± 1.3 mm²; PRPplus = 5.8 ± 1.3 mm²; p = 0.0291). Best‐corrected visual acuity worsening was observed at 16, 32 and 48 weeks after treatment in the PRP group (p < 0.05), while no significant BCVA changes were observed in the PRPplus group. A significant CSMT increase was observed in the PRP group at all study visits, while a significant decrease in CSMT was observed in the PRPplus group at week 16, and no significant difference in CSMT from baseline was observed at weeks 32 and 48. Conclusions: Intravitreal ranibizumab after PRP was associated with a larger reduction in FLA at week 48 compared with PRP alone in eyes with high‐risk PDR, and the adjunctive use of IVR appears to protect against the modest visual acuity loss and macular swelling observed in eyes treated with PRP alone.     

The relationship between two types of upper eyelid movements: saccades and pursuit

PURPOSE: To establish the relationship between upper eyelid saccades and upper eyelid pursuit movements. METHODS: Upper eyelid saccades and periodic sinusoidal upper eyelid pursuit movements were recorded in a sample of controls and patients with Graves upper eyelid retraction. A video-computerized system was used to register both types of movements that accompanied 60 degrees of eye rotation across the upper and lower hemifields. The forced harmonic oscillator model was used to fit saccadic and pursuit movements. RESULTS: Mean mid-pupil eyelid distance for the Graves patients (6.6 +/- 1.1 mm) was significantly higher than for the controls (4.6 +/- 0.8 mm; t = 7.18; P < 0.00001). Despite the difference in the upper eyelid resting position, saccades and pursuit eyelid movements of both groups were extremely well fitted by underdamped solutions and steady forced solutions of the harmonic oscillator model, respectively. For the controls, the amplitude of the pursuit movements was well correlated with the upward and downward saccades. The amplitude of the eyelid movements of the Graves patients (saccades and pursuit) was significantly reduced compared with that of the controls. CONCLUSIONS: Saccadic and pursuit movements of the upper eyelid can be described by the harmonic oscillator model. In healthy subjects and Graves patients, the amplitude of pursuit lid movements is correlated to the saccade amplitude. Pursuit eyelid movements are more difficult to register than saccades, and their measurements do not allow clear separation of the relaxation and contraction properties of the upper eyelid retractors.     

Retinal safety of a new fluoroquinolone,pradofloxacin, in cats: assessment with electroretinography

Purpose To investigate the safety of a new fluoroquinolone, pradofloxacin, on the cat retina using electroretinogram. Methods Ganzfeld ERGs were recorded in 40 cats treated orally for 23 days in 4 groups: CTRL (n = 9): placebo-vehicle; PRADO30 (n = 10): pradofloxacin 30 mg/kg/day; PRADO50 (n = 14): pradofloxacin 50 mg/kg/day; and ENRO30 (n = 7): enrofloxacin at toxic doses of 30 mg/kg/day. ERG was performed before treatment and once weekly during the treatment period. An extended ISCEV protocol with addition of 8 steps of increasing luminance in dark adapted condition was carried out to assess: V _max (saturated scotopic b-wave amplitude) and k (luminance inducing V _max/2). OCT and retinal histological changes were also investigated. Results Pradofloxacin showed no effects in respect to rod b-wave, V _max, k and maximum scotopic a-wave (P > 0.05). Oscillatory potentials, cone ERG and flicker were also unaltered (P > 0.05). Rod b-wave was undetectable after treatment in ENRO30 group, V _max was reduced to 10.5% of the baseline (P < 0.05), accompanied by an increase of k by 1 log cd s/m2 (P < 0.05). Oscillatory potentials, cone b-wave amplitude and 30 Hz flicker amplitude were reduced to 8.3%, 58.9% and 37.4% of the baseline, respectively (P < 0.05). Effects were also seen in OCT and retinal histology starting within one week after the start of treatment and thereafter remaining stable. Conclusion Pradofloxacin at 6 and 10 times the recommended doses was shown to have no retinal toxic effects in cats, neither on rod or cone function with ERG.     

Parafoveal letter recognition at reduced contrast in normal aging and in patients with risk factors for AMD

Background  Patients with early age-related maculopathy (ARM) do not necessarily show obvious morphological signs or functional impairment. Many have good visual acuity, yet complain of decreased visual performance. The aim of this study was to investigate the aging effects on performance of parafoveal letter recognition at reduced contrast, and defects caused by early ARM and normal fellow eyes of patients with unilateral age-related macular degeneration (nfAMD). Methods  Testing of the central visual field (8° radius) was performed by the Macular Mapping Test (MMT) using recognition of letters in 40 parafoveal target locations at four contrast levels (5, 10, 25 and 100%). Effects of aging were investigated in 64 healthy subjects aged 23 to 76 years (CTRL). In addition, 39 eyes (minimum visual acuity of 0.63;20/30) from 39 patients with either no visible signs of ARM, while the fellow eye had advanced age-related macular degeneration (nfAMD; n = 12), or early signs of ARM (eARM; n = 27) were examined. Performance was expressed summarily as a “field score” (FS). Results  Performance in the MMT begins to decline linearly with age in normal subjects from the age of 50 and 54 years on, at 5% and 10% contrast respectively. The differentiation between patients and CTRLs was enhanced if FS at 5% was analyzed along with FS at 10% contrast. In 8/12 patients from group nfAMD and in 18/27 from group eARM, the FS was statistically significantly lower than in the CTRL group in at least one of the lower contrast levels. Conclusion  Using parafoveal test locations, a recognition task and diminished contrast increases the chance of early detection of functional defects due to eARM or nfAMD and can differentiate them from those due to aging alone. Gesa Astrid Hahn and Andre Messias share first authorship     

Eccentric fixation in Stargardt's disease assessed by Tübingen perimetry

PURPOSE: To measure eccentric fixation characteristics in visual fields of patients with Stargardt's disease. METHODS: The positions of fixation loci (FL) in the visual field were determined by Tübingen perimetry (TP), using the position of the blind spots in 173 patients. Altogether, 669 visual fields were measured at baseline and during follow-up. Twenty patients were also examined by scanning laser ophthalmoscope (SLO). RESULTS: Ninety-five of 173 patients showed a ring scotoma with central fixation in at least one test, which could persist for up to 18.8 years. The median age for a 50% chance of the development of eccentric fixation was 23.6 years. One hundred four patients (203 eyes) used eccentric fixation in at least one eye; in 154 eyes, the FL was placed below the scotoma and in 33 eyes to the left of it, in 11 to the right of it, and in 5 above it. Once the FL was chosen, it remained within the same visual field area at subsequent tests, varying on average by 1.76 degrees. Compared with SLO results, the mean distance between FL and PRL was 1.90 degrees. CONCLUSIONS: It is possible to determine the position of the FL by perimetry with sufficient accuracy if the blind spot is well delimited. Stargardt patients can keep central fixation for different time intervals before changing to an eccentric FL. Most of them show an FL below the central scotoma, which is considered favorable for horizontal reading.     

A relapse of paratyphoid fever after treatment with ciprofloxacin in a child with congenital biliary atresia

This report describes a relapse of Salmonella paratyphi B infection in a child with biliary atresia, following 2 weeks of treatment with ciprofloxacin. The recrudescence was complicated by the development of osteomyelitis and was treated with chloramphenicol, trimethoprim, ceftriaxone and ampicillin in succession.