Ophthalmological Morbidity Research Articles

Актуальные проблемы эпидемиологии офтальмологической заболеваемости среди молодежи России и Центрального федерального округа.

Indicators of primary morbidity of the eyes and their appendages in adolescents aged 15–17 years and young people, in particular among students of higher educational institutions, increase annually due to increased visual stress as risk factors. The purpose of the work is to identify current problems in the epidemiology of ophthalmological morbidity among young people in the Russian Federation and the Central Federal District. Materials and methods. A theoretical analysis of the literature on the epidemiology of ophthalmic diseases in young people and a search for statistical data on the epidemiology of ophthalmic diseases was carried out. To assess the dynamics of epidemiological indicators, an increase calculation was carried out. Results. The increase in the incidence of visual organs in adolescents per 100 thousand children aged 15–17 years from 2000 to 2021 was +47.9%, and from 2018 to 2019 the increase in the incidence of myopia was +9.2%. In the structure of diseases for adolescents, it is pathologies of the visual organs that lead, and 40% of students have visual impairments, the detection of which increases by 3–7% annually, while the severity of myopia grows every year by 5–7%. The increase in morbidity of the eyes and adnexa in the Central Federal District for 2019–2021 was +57.5%, however, morbidity statistics do not consider the age distribution of diseases and their structure. The largest (+296.0 +110.1%) increase per 100 thousand population is observed for the Vladimir, Voronezh, Lipetsk, Ivanovo and Kaluga regions. It was revealed that in 2017, the incidence rate of eyes and their appendages in the Voronezh region over 10 years increased from 64.8 to 94.8 per 1000 students, 45.6% of students had impaired visual acuity. In the region, there is a staff shortage of ophthalmologists, insufficient coverage of preventive examinations and a low level of detection of patients at an early stage of disease. Conclusion. The epidemiology of eye diseases on the territory of the Russian Federation and its constituent entities in the young population has not been sufficiently studied. Improving regional analysis tools will help identify factors of variability in the epidemiology of eye diseases across the country’s regions. In regions with a high increase in ophthalmic morbidity, it is necessary to study in more detail the epidemiology of vision diseases in young people.

PREVALENCE OF THYROID EYE DISEASE IN PATIENTS WITH THYROID DYSFUNCTION IN A TERTIARY CARE HOSPITAL OF CENTRAL NEPAL

Background: Thyroid eye disease is the most common extra thyroidal manifestation of Graves’ disease. The pattern and prevalence of thyroid eye disease vary widely from a mild disorder characterized by dry eye symptoms and ocular irritation to a severe disfiguring form of orbitopathy. Thyroid eye disease is a frequently encountered Ophthalmological morbidity in Nepal and across the globe. The aim of this study was to ascertain the prevalence of thyroid eye disease in subjects with thyroid dysfunction in a tertiary care hospital in central Nepal.. Methods: This was a prospective cross-sectional study, conducted in Chitwan medical college Teaching hospital (CMCTH), department of Ophthalmology. Subjects presenting to Ophthalmology department or referred patients from different departments with thyroid dysfunction were enrolled in the study. The data thus collected was analyzed using SPSS version 26 and the data was presented as frequency and percentage. Results: Among 320 subjects screened for Thyroid eye disease prevalence, 106 (33.3%) were hyperthyroid, 207 (64.7%) were hypothyroid whereas, 7 (2.2%) were euthyroid. The prevalence of Thyroid eye disease was 40% and this was more prevalent among hypothyroid. Among the 320 patients with thyroid eye disease, 126 (39.4%), 95 (29.7%), 53 (16.6%), 24 (7.5%), 15 (4.7%), 5 (1.6%) and 2 (0.6%) had CAS score of 1,2,3,4,5,6 and 7 respectively. Similarly, NOSPECS score (American Thyroid Association) 243 (75.9%), 57 (17.8%), 1 (0.3%), 7 (2.2%), 8 (2.5%), 3(0.9%) and 1 (0.3%) were graded from 0-6 accordingly respectively. Conclusions: Thyroid eye disease was more prevalent in hypothyroid middle-aged females and the overall prevalence of Thyroid Eye disease was more in hypothyroid patients. Though sight threatening complications didn’t exist in our study, close workup by endocrinologist and ophthalmologist can decrease ocular morbidity.

Otorhinolaryngological spectrum of diseases leading to Ophthalmological presentation in eye out patient department: An overview

Orbital complications are not so uncommon in ENT diseases. Being an adjacent structure, orbit is commonly involved which can be further complicated by vision loss and intracranial spread of infection and sometimes mortality. In this scenario proper imaging and and newer generation antibiotics can be a game changer. The study aims to demonstrate Ophthalmological manifestations in relation to otorhinolaryngological diseases. This was a retrospective observational study conducted in Eye outpatient department of Regional Hospital, Himachal Pradesh for the period of 1 year from July 2022 to June 2023. In a retrospective investigation, 28 cases of ophthalmological symptoms with root cause of various ENT disorders, mostly paranasal tumour expansions, nasopharyngeal tumour, and nasal furunculosis, were examined in connection to their age, gender, clinical, radiological, and histopathological profile. The most dependable investigating tool was considered as CT scan. Accordingly medical and surgical treatment were adopted owing to location and disease nature. A good cooperation and follow up is needed between ophthalmologist and otolaryngologist to overcome this challenge. A total of 28 patients who met the eligibility criteria were enrolled in the study. Average age of presentation was 36.2 years with 17 males and 11 females. Proptosis was the most common orbital manifestation found in 32.4% cases (n=9). Lagopthalmos was found in 25% cases (n=7) and preseptal cellulitis was found in 14.28% cases (n=4). Orbital cellulitis and cavernous sinus thrombosis was found in 7.14% cases (n=2). Orbital apex syndrome was found in 3.57% cases (n=1). To save the patient from Ophthalmological morbidity and maybe mortality, a high index of suspicion of early orbital involvement by thorough ENT examination is required. A team effort consisting of ophthalmologist and otorhinolaryngologist, acting jointly is needed in order to identify the underlying disease process and provide the appropriate care.

Analysis of the dynamics and structure of morbidity of athletes of the national teams of Moscow based on the results of medical examination

Objective: The aim of the study was to analyze the structure and dynamics of morbidity of athletes, members of sports teams of the city of Moscow based on the results of an in-depth medical examination in the period 2017–2021.Materials and methods: The data of the medical examination of athletes, which took place at the Moscow scientific and Practical Center for Medical Rehabilitation, restorative and sports medicine, including instrumental, functional and laboratory studies from 2017 to 2021, were analyzed. In 2017, 15176 athletes were examined, in 2018 and 2019, 11200, in 2020, 10080 people and in 2021–11922 athletes.Results: The results of the study showed an increase in the proportion of amenorrhea within the triad of athletes, an increase in general therapeutic morbidity, diseases of the gastrointestinal tract, among which the proportion of secondary hyperbilirubinemia in 2021 increased 3 times compared to 2020, which, in our opinion, is also due to the impact of the pandemic and quarantine restrictions.The high prevalence of ophthalmological morbidity of athletes and changes in the cardiovascular system is shown. During 2017–2021, a change in the structure of cardiac morbidity was revealed in the form of an increase in the proportion of cardiac arrhythmias and hypertensive response to stress.An increase in the endocrine morbidity of athletes in 2021 was revealed due to an increase in the proportion of hypothyroidism and more frequent detection of hyperthyroidism, possibly related to the COVID-19 pandemic, which requires further research.There was also an increase in diseases of the skin and genitourinary system in athletes. Psychological problems of athletes increased during the observation period from 2017 to 2021. There was no significant dynamics of surgical and traumatological diseases, otolaryngological pathologу.Conclusion: The results of the study indicate the importance of regular full-fledged examination of athletes, identification of various functional disorders and diseases for their timely prevention and treatment in order to preserve the health of athletes and improve athletic performance.

Assessment of the pathogenesis of visual impairment naval specialists of the arctic zone of the russian federation during the polar night

Introduction. The climatogeographic conditions of the Arctic Zone of the Russian Federation are determined by the proximity to the North Pole of the Earth and are characterized by a number of certain cyclical changes that do not take place in the middle latitudes — the polar day and the polar night. The high-latitude location determines the long period of the polar night, lasting from 98 to 133 days. Being the hallmark of the Arctic, the polar night is an integral part of service in the Arctic region, it has an impact on every geographically involved person, without exception.Purpose of work. To assess the mechanisms of the pathogenesis of visual impairment that develop during the polar night in naval specialists.Materials and research methods. The study involved 92 people. The surveyed contingent is male contract servicemen of the Navy, aged from 21 to 45 years. The analysis of the morbidity structure according to the ophthalmological profile was carried out during the polar night from November 20, 2020 to January 20, 2021 using an epidemiological method of a case-control study. The assessment of unfavorable climatic and geographical factors of the Arctic region during the polar night was carried out by the method of analytical observation and data recording from November 20, 2020 to January 20, 2021 using the example of the Novaya Zemlya archipelago, Belushya Guba village. On the basis of an integral analysis of epidemiological indicators, climatogeographic and clinical and morphological observations, a pathophysiological assessment of diseases of the organ of vision, developing during the polar night in naval specialists, was carried out.Research results show a high level of ophthalmological morbidity during the polar night among naval specialists serving on the Novaya Zemlya archipelago.Conclusions. Climatogeographic factors of the Arctic region have a polyetiological effect on the formation of mechanisms of pathogenesis of disorders of visual functions that develop in naval specialists during the polar night.

A cross-sectional observational study to assess the prevalence and distribution of ophthalmological comorbidities among nursing personnel in a tertiary care hospital

Background: Higher incidence of ill health among the nurses may jeopardize the performance of any hospital. Irony of the situation is that despite being at the center of the healthcare delivery apparatus, there is a strong element of neglect about the health issues of the nursing community. Objectives: This study aims to observe and analyze the pattern of ophthalmological morbidity among nursing care personnel in a tertiary care hospital in eastern India. Materials and Methods: Five hundred and thirty nursing personnel at the tertiary care hospital underwent comprehensive ophthalmological examination and as and when required underwent ophthalmic investigations after eliciting proper history. Results: The mean age of the study population was 48.6 ± 0.8 years. The majority (86%) had mild or no visual impairment (P < 0.00, χ2: 51.8). The uncorrected refractive error was found to be the common cause of visual impairment (51%) among the study population. About 80% of the study population having visual impairment had reversible causes (P < 0.00, χ2: 37); 87% of the study population with visual impairment were not aware of their visual condition (P < 0.00, χ2: 54.8). Around 78% of the study population had not undergone comprehensive ophthalmological examination in the last 12 months (P < 0.00, χ2: 31.4). Conclusion: Regular comprehensive ophthalmological examination and necessary intervention can lead to prevention of visual impairment among the nursing personnel. This is essential for providing, maintaining, and escalating the level of patient care delivery in any tertiary care hospital.

Is Orbicularis Oculi Muscle Resection Necessary in Upper Blepharoplasty? A Systematic Review.

Our objective is to evaluate the evidence on the aesthetic effect and complications of skin-OOM strip resection compared to skin only upper blepharoplasty. A systematic search of EMBASE, PubMed, Cochrane and Google Scholar databases was performed using our search strategy through to 31 December 2019. Only comparative studies of the two upper blepharoplasty techniques were included. Three reviewers performed study selection process, data extraction, and quality assessment. A total of six articles were eligible for final inclusion. The included studies consist of two controlled retrospective cohorts and four small randomized controlled studies (RCT). Three of which, were double blinded. Those RCTs were assigned level 2 evidence due to small size and methodological limitations. The sample size of included was studies 407 in the two retrospective studies and 57 in the four RCTs. The outcomes showed that resection of OOM along with skin in upper blepharoplasty showed no difference in long-term aesthetic outcome when skin only procedure is performed. Muscle strip resection was associated with initially higher ophthalmological morbidity (edema, bruising, pain, dry eye, sluggish eye closure and lagopthalmos). Those resolved afew weeks later with conservative treatment. The resection of OOM along with skin in upper blepharoplasty showed no difference in long-term aesthetic outcome and was associated with initially higher ophthalmological morbidity compared to skin only procedure. While we are not suggesting that OOM resection is never required, the evidence strongly support its preservation during standard upper blepharoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

English

BACKGROUND Ocular injuries due to road traffic accidents (RTA) is one of the important causes of ophthalmological morbidity and cause of unilateral blindness. Some of the injuries also result in cosmetic disfigurement. Increased usage of vehicles for transport in recent times has increased the incidence of cases. The primary objective of this study was to understand the epidemiology and pattern of ocular trauma in RTA cases and their visual outcome. METHODS A total of 75 cases was included in the study following the inclusion and exclusion criteria. A detailed history was taken which included information regarding time, location, type and mechanism of injury, use of spectacles, car safety belts, and helmets. The time interval between injury and reporting was recorded. Test of visual acuity was done, ophthalmic examination included the examination of all patients with the slit lamp, 90 D examination, and indirect ophthalmoscopy were done. Ultrasound B scan was done in cases where unclear media prevented fundus examination. RESULTS Ecchymosis of the lids was the commonest type of ocular injury. Out of 15 eyelid laceration cases, 10 cases were with mild partial-thickness tears present and 5 had severe lid tears which required suturing. Most of the patients recovered with good vision in 6 months post-treatment and a few fair results. Analysis of variance (ANOVA) comparison between conservative management and surgical management at the end of 4 months post treatment was done. The P-values were &gt; 0.05 hence, not significant. It indicated that the outcomes were independent of the method of management adopted. CONCLUSIONS The incidence of RTAs is increasing due to an increase in the number of vehicles used by the public. Ocular injuries are more often seen in young men especially those driving two-wheelers without safety devices like helmets. Open globe injuries and cases with previous ocular problems have poor outcomes. KEYWORDS Ocular Trauma, Road Traffic Accidents [RTA], Visual Outcome

Mycoplasma Pneumoniae–Induced Rash and Mucositis: A Longitudinal Perspective and Proposed Management Criteria

To evaluate the natural history and ophthalmologic morbidity of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and propose a treatment algorithm. Retrospective, interventional case series. Retrospective chart review of all MIRM patients examined by the department of ophthalmology at a tertiary children's hospital. Diagnosis was established clinically concomitant with either positive Mycoplasma pneumoniae IgM or PCR testing from January 1, 2010, until December 31, 2019. The main outcome measures were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention. There were 15 patients (10 male and 5 female) aged 10.9 ± 4.2 years who had primary episodes of MIRM; of those, 4 had multiple episodes. All patients required topical steroid treatment, 3 required amniotic membrane transplantation, and 1 patient underwent placement of a sutureless biologic corneal badage device. There were no patients who suffered visual loss, but 1 was left with mild symblephara near the lateral canthus in each eye and 2 others had scarring of the eyelid margins and blepharitis. The ocular morbidity is significantly less in MIRM than in other closely related syndromes such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. However, these patients still require close observation and a low threshold for intervention to avoid permanent ophthalmic sequelae and possible blindness.

Two-Year Outcomes of Infants with Stage 2 or Higher Retinopathy of Prematurity: Results from a Large Multicenter Registry

To define the incidence of ophthalmologic morbidities in the first 2 years of life among infants diagnosed with stage 2 or higher retinopathy of prematurity (ROP). We prospectively enrolled premature infants with stage 2 or higher ROP. The infants were followed up for 2 years, and we report on data collected from outpatient ophthalmology and primary care visits. We enrolled 323 infants who met inclusion criteria, of which 112 (35%) received treatment with laser surgery (90) or bevacizumab (22). Two-year follow-up was available for 292 (90%) of the cohort. The most common ophthalmologic conditions at follow-up were hyperopia (35%), astigmatism (30%), strabismus (21.9%), myopia (19.2%), anisometropia (12%), and amblyopia (12%). Severe ophthalmologic morbidities such as retinal detachment and cataracts were rare, but occurred in both treated and untreated infants. Overall, 22.6% of the infants were wearing glasses at 2 years, including 8.5% of the untreated infants. Patients with stage 2 or higher ROP remain at significant risk for ophthalmological morbidity through 2 years of age. Infants with regression of subthreshold ROP who do not require treatment represent an underrecognized population at long-term ophthalmological risk. CLINICALTRIALS. NCT01559571.

Peculiarities of the organization and accessibility of ophthalmological assistance to the population of the Voronezh area taking into account the data on incidence and causal factors

Purpose of the study was to develop methods for predicting and optimizing the mechanisms for providing ophthalmological assistance to the population of the Voronezh Region based on a statistical analysis of the relationship between indicators of the state of ophthalmic health of the population, quality and accessibility of medical care.Materials and methods. The data on ophthalmological morbidity, resources of the ophthalmological service, outpatient and inpatient care provided to patients with ophthalmopathology were analyzed.Results. The article presents the results of the analysis of the main indicators of the activity of the ophthalmological service of the Voronezh region, based on the data of regional sectoral statistics of the Voronezh region in recent years. The problems of the personnel resource of the ophthalmological service, the effectiveness of the use of hospital beds, as well as problems of an administrative nature are discussed. On the basis of a systematic analysis of the incidence of the organ of vision, the prevalence and organization of medical care to the population, criteria are proposed for a quantitative and qualitative assessment of risk factors for the development of a pathology of the organ of sight. Based on the structural analysis of ophthalmologic morbidity, a complex of nonlinear prognostic models for the interaction of medical and social risk factors of ophthalmopathology with clinically established diseases of the organ of vision has been developed and tested. The developed regression model allowed us to separate the indicators by priority and to highlight the most significant ones. A logical prognostic model of dependence on disability based on existing risk factors has been formed.Conclusions. The clinical and epidemiological analysis helped to develop a regional target program to improve eye care for the population of the region and to outline the main measures to optimize the organization of eye care to the population of the Voronezh region in order to increase its availability and quality. Based on the results obtained, practical recommendations have been developed for improving medical and social care for patients with diseases of the organ of vision, taking into account the possibility of preventive measures in the early stages, to prevent the development of complications.

Ophthalmological outcomes of patients treated for pineal region tumors.

OBJECTIVE The ophthalmological outcomes of children treated for pineal tumors have received limited attention in the literature. METHODS This paper reviews the outcomes of 29 children treated for pineal and posterior third ventricular tumors in the contemporary era using chemotherapy, radiotherapy, and resection as defined by the histology and/or marker profile of the tumor. RESULTS At the time of diagnosis, all patients except 1 had hydrocephalus and all had ophthalmological involvement. Papilledema was found in 69% of patients. Seventy-five percent of patients had partial or complete Parinaud's syndrome, and diplopia or blurred vision was noted in the remaining patients. Visual acuity was impaired in 8 patients. Outcomes were dependent on the histology of the tumor and the treatment required. Those patients who did not requiring resection showed a lower rate of ophthalmological worsening during treatment and greater long-term improvement, in particular with respect to up-gaze palsy. Patients who underwent resection for postchemotherapy residual disease or primary resection showed greater worsening during treatment and lesser degrees of recovery. All patients with impaired visual acuity improved with treatment. CONCLUSIONS As the mortality of germ cell and other pineal tumors decreases, posttreatment morbidity remains, specifically that related to convergence nystagmus, accommodation, and diplopia. In addition to survival, ophthalmological morbidity should be reported in studies concerning the outcomes of treatment for pineal neoplasms.

The long-term outcome of extremely preterm (

Severe retinopathy of prematurity (ROP) is associated with an increased risk for ophthalmologic morbidity, but the long-term impact in other domains is less clear. The aim of the current study was to determine whether severe ROP was related to poorer visual, cognitive, and educational outcomes in a representative sample of EP adolescents, and whether this persisted after adjusting for confounding neonatal risk factors. One hundred and eighty extremely preterm (EP; <28weeks) adolescents (17-18years) were assessed on a range of neurodevelopmental measures, including visual processing, IQ, visual learning, visual-motor integration, and academic achievement. EP adolescents were grouped according to ROP status, (1) severe ROP (stage 3 or greater) in the worse eye; or (2) no or mild ROP and were compared on each outcome. Longitudinal data were compared at 2, 5, 8, and 17-18years for general cognitive outcome. The severe ROP group performed more poorly and had more impairments than the non-severe ROP group on measures of visual processing, visual-motor integration, visual learning, IQ, and some academic achievement tests at 17-18years of age. Group differences diminished after controlling for perinatal risk factors (severe white matter injury, post-natal corticosteroid, and surgery in the neonatal period), and only visual acuity scores remained significantly different between the groups. IQ scores remained consistently lower in the severe ROP group over time, but the magnitude reduced after adjusting for perinatal risk factors. Extremely preterm children with severe ROP are at increased risk for ongoing visual processing difficulties and lower IQ compared with EP peers without severe ROP. While severe ROP is a predictor of long-term impairments, this association is largely mediated by other neonatal risk factors.

Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: Surgical technique and visual outcome

Objectives The aim of this study was to evaluate visual outcome in patients with tuberculum sellae meningioma (TSM) treated microsurgically using the frontolateral or fronto-orbital approach and optic canal unroofing to resect tumor involvement of the optic canal. Methods Data from 67 patients with TSMs who underwent microsurgical treatment by a frontolateral approach ( n = 44) or fronto-orbital approach ( n = 23) between January 2002 and December 2008 were retrospectively collected and analyzed. Change in visual function was evaluated as the main outcome. Results Total tumor resection was achieved in 62 of 67 cases (92.4%). Postoperative, visual acuity was improved in 87 eyes (64.9%) and unchanged in 39 eyes (29.1%), and the optic nerve was therefore preserved in 126 of 134 eyes (94.0%). Visual field deficits were improved or stable in 65 eyes, no patient experienced worsening of vision in both eyes. There was no mortality in our series. Conclusions The frontolateral approach with microsurgical dissection of the Sylvian fissure provides quick access to TSMs, which can be resected safely and totally. Visual function is improved and neurological and ophthalmological morbidity is minimal. Optic nerve decompression by intradural clinoidectomy and optic canal unroofing is likely to increase the rate of reducing or eliminating preoperative visual symptoms.

Use of tumor necrosis factor inhibitors in uveitis

Use of tumor necrosis factor-alpha blocking agents to treat chronic pediatric uveitis is becoming recognized as an important therapeutic modality. This review summarizes the rationale for this use, highlighting new studies of these agents in pediatric uveitis. The majority of patients with pediatric uveitis either have idiopathic uveitis or uveitis associated with juvenile idiopathic arthritis. Ophthalmologic morbidity among these children is common. Most studies evaluating tumor necrosis factor-alpha blockade in pediatric uveitis are retrospective case series, with attendant limitations that are inherent to any retrospective study. Study of uveitis has been hampered by lack of standardization of disease and outcome measures, which has been addressed by uveitis experts with publication of consensus measures. Data to date suggest that tumor necrosis factor-alpha blockade is efficacious in refractory uveitis. Agents with direct tumor necrosis factor-alpha membrane receptor binding activity may be the most efficacious. There remain many unanswered questions in the treatment of pediatric uveitis, including optimal dosing regimen and long-term efficacy. Tumor necrosis factor-alpha blocking agents play an important role in the treatment of chronic pediatric uveitis. Prospective comparative studies are needed so that we may better understand this role.

How low can you go? Intracranial pressure, cerebral perfusion pressure, and respiratory obstruction in children with complex craniosynostosis

Elevated intracranial pressure (ICP) is a well-recognized complication affecting children suffering from complex forms of craniosynostosis. The effects of ICP, including those on vision, and the underlying mechanisms involved remain uncertain. The aim of this study was to examine the relationships among ICP, cerebral perfusion pressure (CPP), and the episodic alterations in respiratory obstruction that are common in children with craniosynostosis. Eleven children with complex craniosynostosis underwent monitoring overnight, including simultaneous recording of subdural ICP, arterial blood pressure (ABP), and a variety of respiratory parameters. Sleep status was also analyzed. Mean values were calculated for all variables, including ICP, CPP, and ABP, during both quiet and active sleep. Mean ICP during quiet sleep was elevated in five patients, borderline in three, and normal in three children. During active sleep, plateaus of high mean ICP were observed in all patients. Marked decreases in CPP were demonstrated during active sleep with absolute values as low as 14 mm Hg. During quiet sleep, the mean baseline CPP was 53.3 mm Hg (range 34-70 mm Hg). During active sleep, CPP fell to a mean of 32.6 mm Hg (range 23-52 mm Hg). All patients experienced obstructive breathing problems, including 10 with obstructive sleep apnea, the effects of which demonstrated a temporal relationship to the alterations in sleep status, ICP, and CPP. Elevations of ABP appeared modest and remained within the normal limits for age. The findings of this study indicate that ICP, CPP, and respiratory obstruction interact in a vicious cycle, an observation that helps explain the pattern of plateau waves of elevated ICP characteristic among children with complex forms of craniosynostosis. The data gathered in this series revealed levels of CPP considerably lower than those described previously in clinical reports. Such reductions in CPP most likely contribute to the neurological, cognitive, and ophthalmological morbidity from which these children suffer frequently; therefore, the results of this study have important implications for the management of children with complex forms of craniosynostosis as well as for our understanding of the control of cerebral blood flow in general.

Tuberculum Sellae Meningiomas: Microsurgical Anatomy and Surgical Technique

Despite Cushing's accurate description of the anatomic origin of tuberculum sellae meningiomas, many subsequent authors have included tumors originating from the neighboring sella region in this classification. This has led to difficulty in evaluating the surgical results and consensus for an optimal surgical technique. We think this confusion has arisen from Cushing's description of these tumors under the heading "suprasellar meningiomas," which referred to their distinctive clinical symptoms and not their anatomic origin. We describe the microsurgical anatomy and tumor growth patterns to reemphasize the original classification of Cushing's tuberculum sellae meningiomas. Additionally, we describe our surgical approach, which decreases the risk of injury to anterior visual pathways and anterior cerebral circulation arteries. During a 19-year period, 23 patients with meningiomas arising from the tuberculum and diaphragma sellae underwent craniotomies at New York University Medical Center. The tumor size ranged from 2 to 5 cm. All patients presented with symptoms of visual dysfunction; 15 were asymmetrical. Magnetic resonance imaging with and without gadolinium differentiated these tumors from other suprasellar tumors with a high degree of accuracy. All patients underwent a pterional transsylvian approach. Twenty patients had total tumor removal, and three had subtotal tumor removal. There was one regrowth in the subtotal tumor removal group. Patients were observed for a mean follow-up time of 9.3 years (range, 3.6-18.5 yr). Visual acuity improved in 55%, was unchanged in 26%, and worsened in 19% of patients. Two of the oldest patients died from pulmonary complications, resulting in a mortality rate of 8.7%. We think that tuberculum and diaphragma sellae meningiomas are anatomically indistinguishable and should be termed tuberculum sellae meningioma. A pterional craniotomy with microsurgical dissection of the sylvian fissure allows access to these tumors with minimal neurological and ophthalmological morbidity.

Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus

BACKGROUND/AIMS Prematurely born infants are known to have an increased rate of ophthalmological morbidity. The aim of the present study was to investigate visual acuity and ocular alignment in a...

A Protocol for Measuring Ophthalmologic Morbidity and Recovery After Cranial Base Surgery

Patients with cranial base tumors often have impairment in visual function, either due to the pathologic process itself or as a result of surgical treatment of the lesion. We conducted a pilot study in which we performed ophthalmologic evaluations on patients before and after cranial base surgery. The results of the study were used to develop a protocol and reporting form for longitudinal assessment of visual function in these patients. Use of the protocol and reporting form for the past 2(1/2) years has shown that they are easy for physicians to use and that the results provide a representative evaluation of the patient's ability to function visually in everyday life. The authors propose implementation of the protocol and reporting form as a means of collecting data for further research into visual function in patients with cranial base tumors.