1/7. Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse.PURPOSE: To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome. methods: We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27--34 weeks and 790--1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding. RESULTS: Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (<1-2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance). CONCLUSIONS: In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/7. Acute retrolental fibroplasia.Three hundred eighty-four premature infants were examined by indirect ophthalmoscopy in a period of 38 months. Sixty-eight were found to have some degree of retrolental fibroplasia. Most pathologic changes resolved spontaneously to normal or near normal. A classification was formulated, based on peripheral vascular changes, to enable observers to interpret and quantitate the amount of disease present. The role of the ophtalmologist in the perinatal intensive care nursery is not to dictate the amount of oxygen administration during the acute phase of respiratory distress syndrome but to monitor peripheral fundus and posterior vascular changes of infants of low birth weight, or who have received oxygen, or both, at a time that is not detrimental to the health of the infant. To evaluate the possible indications and efficacy of surgical intervention, an understanding of the natural course of the disease process is mandatory.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/7. Nonhyperoxic retrolental fibroplasia.Retrolental fibroplasia (RLF) has most often been observed in preterm infants exposed to high ambient oxygen concentrations. This case report describes an infant near term who was never exposed to supplemental oxygen but in whom stage 4 RLF developed. The etiologic role of exchange transfusion is discussed.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/7. Closed vitrectomy for severe retrolental fibroplasia in the infant.Fifteen infants between the ages of 5 months and 2 years suffering from severe retrolental fibroplasia with near total and total retinal detachment and retrolental scar tissue formation were operated upon with closed vitrectomy. The surgical technique and the problems related to the smallness of the eye and the changes caused by RLF are discussed in detail. Seven retinas were reattached completely and one retina partially reattached. Vision was definitely improved, although the visual acuity was probably low.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/7. vitrectomy in infants and children with retinal detachments caused by cicatricial retrolental fibroplasia.Four infants and one child with retinal detachments from cicatricial retrolental fibroplasia involving traction judged too severe to be relieved by scleral buckling alone underwent lensectomy and vitrectomy. Three retinas were successfully reattached. Because of the incomplete development of the pars plana in infants and the manner in which peripheral retina is pulled anteriorly to a position near or in contact with the posterior lens capsule, entry through the pars plana can create iatrogenic tears in the peripheral retina or introduction of irrigation fluid under the retina. Our experience has shown that a small contact lens makes it possible to work in the posterior vitreous cavity through the limbal approach in these infants. The circumferential traction produced by the ring of fibrovascular proliferation behind the lens can be relieved and tractional bands running forward from the posterior pole can be cut. Fibrovascular proliferative tissue lying on the posterior pole, however, proved resistant to membrane peeling or dissection, and its severity seemed to determine the success or failure of the surgery.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/7. Modification of the UniVision lens for a low-vision bifocal user.BACKGROUND: A 5-year-old Hispanic male with an ocular history of retinopathy of prematurity was seen for an evaluation of his functional abilities and a determination of the possible treatment options for rehabilitation. The greatest concern was to provide the boy with the tools necessary to ensure success in the educational system. methods: A low-vision evaluation was performed and baseline information was obtained, including distance visual acuities, near visual acuities, visual fields and refractive error. This data was then used to determine if, in a classroom setting, the child would encounter any difficulties that could benefit from assistive optical devices or modifications of environment. RESULTS: The child demonstrated a large angle of head turn in order to eccentrically view to obtain his best visual acuity. His refractive error had no effect on this visual acuity at distance. Visual acuities taken at near demonstrated a working distance of 4 cm with preference to using the right eye. A gross confrontation field suggested a relatively full field in the right eye, but a temporal field loss in the left eye. CONCLUSIONS: A monocular bifocal system was prescribed for use in the classroom and at home when studying. The bifocal segment was a round 24 diopter aspheric lens, 22 mm in diameter, which was reshaped into a flat-top and adhered to a carrier lens. The carrier lens was ordered with 10 prism diopters base left in each eye. This system addressed both the large eccentric viewing position and the magnification necessary to alleviate the accommodative system.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
7/7. Prospective study of new zealand infants with birth weight less than 1500 g and screened for retinopathy of prematurity: visual outcome at age 7-8 years.AIM: To determine the visual outcome at 7-8 years in very low birth weight (VLBW: birth weight < 1500 g) infants screened for retinopathy of prematurity (ROP). methods: In 1986 all 413 VLBW infants admitted to neonatal units in new zealand were enrolled in a prospective study of acute ROP. Surviving infants were traced and assessed at a home visit. Visual assessment comprised examination for abnormal and range of eye movements, visual fields, distance and near visual acuity, stereopsis, and photorefraction. RESULTS: Of 338 infants surviving to discharge, 313 (93%) had been examined for acute ROP. ROP was present in 66 (21%: ROP ), absent in 247 (ROP-), with 25 not examined (NA). 298 children (96% survivors resident in new zealand: 91% all survivors) were assessed. Any visual problem occurred in 79% ROP and 60% ROP-/NA (p < 0.01). Distance visual acuity less than 4/10 in the worse eye occurred in 29% ROP and 15% ROP-/NA (p < 0.05); and in the better eye in 19% ROP and 5% ROP-/NA (p < 0.001). Any myopia in the worse eye occurred in 36% ROP and 18% ROP-/NA (p < 0.01); and in the better eye in 25% ROP and 11% ROP-/NA (p < 0.01). strabismus, including treated, occurred in 33% ROP and 19% ROP-/NA (p < 0.05). overall, 11% had astigmatism and 18% hypermetropia with no difference between the groups. CONCLUSION: In a population based study it was confirmed that VLBW is associated with an increased risk of visual problems at school age. A history of ROP is associated with an additional risk of poor outcome, including a near doubling of poor distance acuity, myopia, and strabismus.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |