Prevalence of Glaucoma Following Paediatric Cataract Surgery in an Australian Tertiary Referral Centre

Purpose

Secondary glaucoma following childhood cataract surgery remains the most common complication in the paediatric population. This study aimed to determine the incidence, time to progression and risk factors associated with the development of secondary glaucoma following childhood cataract surgery in a paediatric population. Outcome measures were the detection of secondary glaucoma, postoperative time frame to development of glaucoma and risk factors in its development.

Patients and Methods

A retrospective case series was conducted between 2003 and 2017 at a tertiary children's hospital in Sydney. The patient population included those 16 years or less of age who underwent congenital cataract extraction, with or without an intraocular lens implantation and who had been followed up for a minimum of six months following surgery. Patients were excluded if they had cataract aetiology other than congenital idiopathic cataract. Multivariate Cox Regression analysis was used to determine relevant risk factors.

Results

A total of 320 eyes in 216 patients were included in the study. Secondary glaucoma developed in 11.9% of eyes. In those that developed secondary glaucoma, the average time to onset from surgery was 3.2 years (median 2.75 years). The mean age of diagnosis of secondary glaucoma was 4.58 years (median 3.5 years, range 2.5 months to 13.23 years). Microcornea was the only adverse characteristic significantly associated with an increased risk of secondary glaucoma (HR 6.30, p 0.003).

Conclusion

Despite modern surgical techniques, glaucoma remains a significant long-term sequela in children following cataract surgery.

Panophthalmitis and Orbital Inflammation with Cavernous Sinus Thrombosis Following Cataract Surgery

Background

Panophthalmitis is a severe inflammation of the globe that can result as a rare complication of ophthalmic surgery. In severe cases, it may also be associated with orbital inflammation and cavernous sinus thrombosis.

Purpose

This case demonstrates a rare and life-threatening post-operative complication of cataract surgery. We also hope to highlight the importance of considering the relevant risk factors associated with developing potential infections after cataract surgery, including the use of corneal sutures, high-risk behaviours such as excessive eye-rubbing, and non-compliance with appointments and post-operative medications.

Case Report

We report the case of a 35-year-old female with severe autism and developmental delay who developed panophthalmitis, orbital inflammation and cavernous sinus thrombosis 6 weeks post cataract surgery. The likely cause was corneal suture-related microbial keratitis, and the patient required enucleation due to sepsis.

Conclusion

Post-surgical panophalmitis is a rapidly progressive disease that is not only sight- but life-threatening and demands urgent and intensive treatment. Consideration of early enucleation may be required to prevent deterioration in such patients.

Paediatric Horner Syndrome: How much further to investigate?

We report an infant with an early-onset Horner syndrome and normal urinary catecholamine levels. Further investigations with Nuclear medicine imaging with ¹²³I-MIBG (meta-iodo benzyl-guanidine) confirmed a right thoracic inlet mass consistent with a neuroblastoma, a tumor of neural crest origin. The authors emphasize the need for investigating idiopathic acquired pediatric Horner syndrome and the value of an MIBG scan as a diagnostic test for suspected neuroblastoma.

Community engagement in general practice: a qualitative study

BACKGROUND Community engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODS We conducted 20 distinct interviews with 31 key informants from general practice and the wider community. The interviews were semi-structured around key relevant topics and were analysed thematically. RESULTS Key themes identified from the interview transcripts included an understanding of 'community', examples of community engagement and the perceived benefits and barriers to community-engaged general practice. We particularly explored aspects of community engagement with Māori. CONCLUSIONS General practices in the study do not think in terms of communities, and they do not have a systematic framework for engagement. Although local champions have generated some great initiatives, most practices seemed to lack a conceptual framework for engagement: who to engage with, how to engage with them, and how to evaluate the results of the engagement.

Liquid Chromatographic Determination of Glyphosate Technical and Its Formulation: Collaborative Study

An HPLC method for the determination of glyphosate in formulation and technical samples has been subjected to a collaborative study with 12 laboratories participating. This method requires no sample pretreatment. Samples were dissolved in mobile phase, injected directly using a fixed-volume loop, and quantitated by an external standard technique. Compounds were separated on a strong anion exchange column with a water-methanol (96 + 4) mobile phase that was 0.0062M in KH2P04 and adjusted to pH 1.9 with 85% H3PO4, and detected with a variable wavelength UV detector at 195 nm. Calculations were made using peak areas. The collaborative study involved 3 pairs of matched samples with single determinations on each sample: Roundup herbicide, a technical intermediate, and technical glyphosate. The coefficients of variation for the 3 pairs were 1.70, 0.88, and 0.90%, respectively. The method has been adopted official first action.

Triadic Interactions in MIECHV: Relations to Home Visit Quality

Objectives This study was conducted to look inside home visits to examine active intervention ingredients used and their relations with ratings of home visit quality. In particular, triadic interactions that engage the home visitor, parent, and child together and provide a context for home visitors to facilitate parent-child interactions by observing, modeling and coaching behaviors that promote optimal child development were examined. Methods Observations were conducted to describe intervention activities (with the HVOF-R) and rate quality of home visit practices and engagement (with the HOVRS A+). Results Analyses revealed the majority of home visit time (71%) was spent in home visitor-parent interactions with only a small proportion of home visit time (17%) spent in triadic interactions and an even smaller proportion of time (2%) during which home visitors actively coached parent-child interactions. Amount of time spent in triadic interactions was related positively to quality ratings of home visit practices and engagement. Moreover, time spent coaching parent-child interactions uniquely predicted home visit quality after accounting for visit length and home visitor time spent observing and modeling. Conclusions for Practice Increasing the percentage of home visitors engage the parent and child in triadic interaction should be a focus for home visiting programs. Home visitors will likely need professional development and supervisory support to enhance their skills in coaching parent-child interactions during triadic interactions.

Correction to: Triadic Interactions in MIECHV: Relations to Home Visit Quality

The article "Triadic interactions in MIECHV: Relations to home visit quality", written by Carla A. Peterson, Kere Hughes-Belding, Neil Rowe, Liuran Fan, Melissa Walter, Leslie Dooley, Wen Wang and Chloe Steffensmeier, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 12 June 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 9 July 2018 to

A negative waveform in the scotopic response in a patient with phosphoglycerate kinase deficiency: a visual electrophysiology report

PURPOSE

Phosphoglycerate kinase (PGK) deficiency is an X-linked neurometabolic genetic disorder with variable systemic manifestations. So far, only one patient with retinal anomalies has been reported, but no visual electrophysiology findings were described. We report the first description of visual electrophysiology in a child with PGK deficiency. This provides further information for the site of involvement in the eye.

METHOD

A case history of a nine-year-old boy with PGK deficiency is reported.

RESULTS

This patient was diagnosed with PGK deficiency by screening soon after birth, as his mother was a known carrier of a PGK gene mutation. A bone marrow transplant was performed at the age of 9 months. He had two episodes of encephalopathy following the transplant but no acute episode of haemolysis. From the age of 6 years, his vision has been deteriorating. Visual electrophysiology results identified retinal involvement involving both rod and cone dysfunction. The visual evoked potential was normal.

CONCLUSIONS

Retinal dystrophy may be one of the clinical manifestations of phosphoglycerate kinase deficiency.

Visual manifestations of craniofrontonasal dysplasia

In this sample of craniofrontonasal dysplasia, a 44.4% prevalence of visual impairment was observed, with more than half being due to potentially correctable causes of visual loss, including amblyopia and anisometropia. High prevalences of strabismus (88.9%) and V-pattern (55.5%) in craniofrontonasal dysplasia were also demonstrated. All three patients who underwent strabismus surgery showed improvement in ocular alignment postoperatively. This group needs regular eye examinations to assess for visual impairment and provide timely intervention for modifiable causes of visual loss.

Prevalence and causes of visual impairment in craniosynostotic syndromes

BACKGROUND

To assess the prevalence and causes of visual impairment in patients with craniosynostotic syndromes of Apert, Crouzon, Pfeiffer, Saethre-Chotzen and craniofrontonasal dysplasia.

METHODS

The medical records of patients who attended the Craniofacial Clinic at two large paediatric hospitals in Sydney, Australia between 1983 and 2004 were retrospectively reviewed. Presenting visual acuity (VA) was assessed using tests appropriate to age and cognition: 'fix and follow' in infants (<18 months old), Teller card acuity in preverbal children (18 months to less than 3 years old), Kay picture test or Sheridan-Gardiner test in children aged between 3 and less than 6 years and Snellen chart in those aged 6 years or older. Visual impairment was defined as the inability to fix and follow or presenting VA < 6/12 in the better eye. Amblyopia was defined as a two-line difference in VA between both eyes in the absence of an organic eye disease.

RESULTS

Sixty-three patients with craniosynostotic syndromes were identified, of whom 55 had VA assessed at the first visit. Of these 55, 19 (35.5%) had bilateral visual impairment and 5 (9.1%) had unilateral visual impairment. Causes of visual impairment include amblyopia (16.7%), ametropia (25%), optic atrophy (16.7%) and exposure keratopathy (4.2%). Risk factors for amblyopia include strabismus (43.3%), astigmatism (> or =1.5 dioptres) (39.5%), hypermetropia (18.4%) and anisometropia (> or =1.5 dioptre difference between both eyes) (15.8%). Six of the 63 patients (9.5%) had papilloedema; those who were followed up showed gradual resolution of papilloedema following timely decompressive surgery.

CONCLUSIONS

A high prevalence of visual impairment in patients with craniosynostotic syndromes was found, almost half of them due to potentially correctable causes, including amblyopia and ametropia. Optic atrophy remains an important cause of visual impairment. Further studies are needed to assess the timing and efficacy of intervention for modifiable causes of visual loss in craniosynostotic syndromes.

Comparison of silastic and banked fascia lata in pediatric frontalis suspension

PURPOSE

To compare the use of Silastic and banked fascia lata in pediatric frontalis suspension surgery for functional success, ptosis recurrence, and infection and granuloma rates.

METHODS

This retrospective study analyzed the medical records of 72 patients who underwent 131 frontalis suspension operations using either Silastic or banked fascia lata during the past 12 years at Children's Hospital at Westmead, Sydney, Australia.

RESULTS

Functional success rates for primary frontalis suspension procedures were not significantly different for banked fascia lata and Silastic (60% versus 67.2%, respectively; P = .4666). Infection and granuloma rates also were not significantly different (7.1% for banked fascia lata versus 15.2% for Silastic; P = .1381). There was, however, a statistically significant difference between the two materials in ptosis recurrence (35.3% for banked fascia lata versus 13% for Silastic; P = .0062).

CONCLUSIONS

Silastic was significantly better than banked fascia lata in terms of ptosis recurrence. Both materials were comparable in terms of functional success after one procedure and in infection and granuloma rates. Given the conflicting evidence presented in the literature, large prospective studies are needed to compare the use of the most common synthetic materials with banked fascia lata in pediatric frontalis suspension.

Outcomes in persistent hyperplastic primary vitreous

AIMS

To report outcomes in cases of persistent hyperplastic primary vitreous (PHPV) and examine factors predictive of visual acuity in patients selected for surgery.

METHODS

Retrospective case series of 55 eyes in 50 patients presenting between 1990 and 2001 at the Children's Hospital, Westmead. 33 eyes underwent surgery aimed at visual rehabilitation.

RESULTS

In surgical patients, median age at surgery was 77 days, and median age at final follow up was 28 months. Six (18%) achieved a visual acuity at final follow up of 6/60 or better and eight (24%) achieved acuity of less than 6/60 to counting finger vision inclusive. Those undergoing surgery before 77 days were approximately 13 times more likely to obtain a visual acuity of counting fingers or better than those operated later (p = 0.01). Neither posterior segment PHPV nor post-surgical glaucoma was a significant predictor of outcome in this selected group.

CONCLUSION

Early surgery aimed at rehabilitation markedly improves the likelihood of useful visual outcome in selected eyes with PHPV.

Bimedial hang-back recession— outcomes and surgical response

AIM

To report outcomes and identify factors affecting surgical response for constant esotropia using 'hang-back' bimedial rectus recession.

STUDY TYPE

Retrospective case series analysis.

METHODS

Patients managed by a single surgeon over a 4-year study period were categorized into esotropia types: infantile, partially accommodative, nonaccommodative and secondary esotropia. Postoperative alignment was compared between types, and regression modelling used to examine factors predicting surgical response.

RESULTS

In all, 95% (18/19) of children with partially accommodative esotropia achieved postoperative deviation <15 prism dioptres from orthotropia, compared to 56% (15/27) of children with infantile esotropia, 69% (11/16) of children with non-accommodative esotropia and all (2/2) of those with secondary esotropia. Surgical response (Delta/mm recession performed) increased with the magnitude of both preoperative deviation (P<0.001) and anisometropia (P<0.001); the effect of deviation on surgical response was reduced by amblyopia (P=0.02). Age at surgery was statistically associated (P=0.002) but had negligible clinical effect on response.

CONCLUSIONS

Surgical response to hang-back recession may be partially predicted by preoperative factors.

How do plant waxes cause flies to slide? Experimental tests of wax-based trapping mechanisms in three pitfall carnivorous plants

The waxy surfaces of three carnivorous plants, Nepenthes ventrata (Nepenthaceae), Brocchinia reducta and Catopsis berteroniana (Bromeliaceae), were compared using scanning electron microscopy (SEM). Their effects on attachment and locomotion of the fly Calliphora vomitoria were studied. The waxy surface of N. ventrata is comprised of a heterogeneous layer from which only platelet-shaped crystalloids could be detached by brushing. In the two bromeliads, the crystalloids are thread-shaped and form a homogenous dense network, which was entirely removable from the epidermis. Experimental data showed that none of the flies was able to walk across any of the waxy surfaces and only a few were able to take off from those surfaces. Both the absence of sites for claw anchorage, especially in N. ventrata, and the wax itself were shown to contribute to the trapping ability of the plants. Only half of the flies quickly recovered their locomotion ability on a glass surface after 20 min of being tested on waxy plant surfaces. SEM observations revealed that the wax of C. berteroniana formed a powder of broken crystals on the tenent setae of the flies' pulvilli. In contrast, the waxes of B. reducta and N. ventrata appeared to have lost their crystal structure in contact with the tenent setae and formed an amorphous substance that adhered setae together. We hypothesize that wax interacts with adhesive fluids secreted by the fly pad and thereby prevents the tenent setae from functioning effectively.

Remodeling of the temporomandibular joint following mandibular distraction osteogenesis in the transverse dimension

Transverse mandibular distraction osteogenesis involves moving the osteotomized segments of the mandible in either a varus or valgus direction. This maneuver allows for widening of the bigonial distance or for a lateral shift of an asymmetric mandibular midline. During this process, a significant amount of torque is placed on the mandibular condyles, because they act as the pivot point for the mandibular translation. Although standard linear distraction osteogenesis induces transient, reversible changes in the temporomandibular joint, it is not known what effect the varus and valgus stresses of transverse distraction have on the temporomandibular joint. We therefore designed a study to document the temporomandibular joint changes following various degrees of transverse distraction. Bilateral transverse mandibular distraction was performed on 10 adult, female mongrel dogs using an external, multiplanar mandibular distraction device. The distraction protocol was as follows: (1) complete osteotomy at the angle of the mandible, (2) 5-day latency period, (3) distraction rate of 1 mm/day, (4) rhythm of one turn per day, (5) linear activation 16 to 30 mm bilaterally, and (6) 8-week consolidation period. A variety of varus and valgus distraction vectors were applied to the mandible only after 10 mm of initial linear distraction had been achieved. Posteroanterior and lateral cephalograms were performed throughout the entire process. Pre-distraction and post-consolidation computed tomographic scans were also performed. Changes in mandibular conformation, axis of rotation, temporomandibular joint structure, and glenoid fossa changes were directly assessed by evaluating the postmortem craniofacial skeleton. The findings were compared with those of normal, age-matched mongrel dog skulls. Significant remodeling changes were observed in the temporomandibular joints of all animals involved in the study. The mandibular condyles demonstrated varying degrees of flattening and erosion at all contact points with the craniofacial skeleton. In some cases, the condyle became part of the distraction regenerate process and was hypertrophied in all dimensions. The condyles were frequently displaced out of the glenoid fossa, particularly on the side in the direction of varus distraction. When the latter occurred, a new fossa was created on the undersurface of the zygomatic arch. Varying degrees of mandibular rotation in the sagittal plane were also observed, which led to abnormal torquing of the condyles in the coronal plane, depending on whether the axis of rotation occurred primarily around the condyle or around the distraction regenerate zone.In conclusion, transverse mandibular distraction is an effective means of producing a varus or valgus shift in the gonion relative to the midsagittal plane. However, unlike linear or angular mandibular distraction, transverse distraction has a multitude of nontransient effects on the temporomandibular joint. Therefore it must be emphasized that in clinical practice, transverse distraction should be used cautiously. One must also be aware that such a maneuver in distraction can have negative effects on the temporomandibular joint.

Growth restriction of cranial sutures in the fetal lamb causes deformational changes, not craniosynostosis

Newborns with in utero cranial vault molding can present with severe forms of plagiocephaly. Intrauterine constraint has been proposed as one cause for craniosynostosis. The purpose of this experiment was to investigate whether rigid plate fixation across a fetal cranial suture, representing a severe form of growth restriction in utero, would lead to cranial suture fusion in a fetal lamb model. Six fetal lambs at 85 to 95 days gestation (term = 145 days) underwent laparotomy, hysterotomy, fetal coronal scalp incision, and miniplate screw fixation across the right coronal suture in utero. Two unoperated twins and four unoperated age-matched lambs were used as controls (n = 12). Animals were killed at both 4 and 8 weeks postoperatively. Fetal head analysis consisted of gross examination, photography, basilar and lateral radiographs, and three-dimensional computed tomographic scans. Cranial suture analysis consisted of imaging by computed tomographic scan (axial and sagittal cuts) and histology of experimentally plated coronal sutures, contralateral nonplated coronal sutures and twin control coronal sutures. Gross examination, radiographs, and three-dimensional computed tomographic analysis of heads with cranial suture plating showed ipsilateral forehead flattening, contralateral forehead bossing, superiorly displaced ipsilateral orbital rim, anterolateral projection of ipsilateral malar eminence, and anterior position of the ipsilateral ear point compared with the contralateral side of the same animal and normal controls. There was no change in nasal root, chin point, or predentition occlusal plane. Although analysis of the plated coronal sutures by computed tomographic scans showed diminished width or even stenosis, the histology revealed narrowed but patent experimental coronal sutures at 4 and 8 weeks. Contralateral, nonplated coronal sutures were not only patent, but widened compared with normal control sutures. This finding may have represented compensatory changes in the contralateral coronal suture caused by growth restriction at the plated suture. These data demonstrate that intrauterine growth restriction across a cranial suture caused by compression plate fixation resulted in deformational skull changes, not craniosynostosis. In addition, these data strongly support a role for in utero positional molding secondary to growth restriction in the maternal pelvis as a cause for nonsynostotic plagiocephaly seen in newborns.

Computer-supported identification and intervention for diabetic patients at risk for amputation

We used the fully automated medical record system at Kaiser Permanente of Ohio to direct appropriate interventions to diabetic patients at risk for amputation. The computer identified all patients with a diagnosis of diabetes, reminded physicians, at the moment of care, of the need to enter the patient's risk status for amputation, and kept track of patients at medium or high risk for amputation who were due for an evaluation with education in the podiatry department. Two years and four months after activation of this reminder system, the risk level had been determined for 76% of the diabetic population (n = 10,000), and two thirds of those at medium or high risk had received the appropriate intervention. In patients in the medium and high risk groups, the risk ratio for amputation was 17.5.

Death of a dog attributed to the cyanobacterial (blue-green algal) hepatotoxin nodularin in South Africa

A bull terrier died after drinking water at the margin of Zeekoevlei near Cape Town. At the time, Zeekoevlei, a hypertrophic coastal lake, contained a bloom of the cyanobacteria Nodularia spumigena and Microcystis aeruginosa. The circumstances of the incident, clinical signs of poisoning and histopathology, which mainly revealed extensive liver damage, were consistent with cyanobacterial poisoning. The cyanobacterial bloom material contained 3.47 micrograms mg-1 dry weight of the pentapeptide hepatotoxin nodularin. It is inferred that the dog died of cyanobacterial hepatotoxicosis due to the ingestion of nodularin.

Comparative effects of endothelin (ET-1) and U46619 on human saphenous vein and gastroepiploic artery, sources of human autologous grafts

The effects of endothelin (ET-1) on smooth muscle contractile activity were investigated and compared in human saphenous vein and gastroepiploic artery, vessels frequently used in revascularization procedures. ET-1 contracted saphenous vein and gastroepiploic artery in a concentration-dependent manner. The peptide produced a greater maximal effect in the vein than in the artery and, in both preparations, ET-1 was less efficacious than U46619, an agent which mimics the actions of thromboxane A2 at the thromboxane A2/prostaglandin H2 receptor. The contractile response to ET-1 declined spontaneously at a more rapid rate in the artery than in the vein. The present data indicate that ET-1 has significant contractile activity in both vessels which are used for coronary arterial bypass surgery and suggest that although, a weaker vasoconstrictor than U46619, the peptide could induce vasospasm in both graft vessels.

Cervical screening with cervicography and the Papanicolaou smear in women with genital condylomata

Cervicography has been shown to be a very sensitive screening tool in the general population. Its value in screening a high-risk population was explored. One hundred five women seen with vulvar condylomata or a history thereof were offered a cervigram and Papanicolaou smear. Twelve patients had abnormal smears, whereas 53 had abnormal cervigrams. Colposcopically directed biopsies in the abnormal Papanicolaou group revealed cervical intraepithelial neoplasia (CIN) I in six patients and III in two. Cervicography-positive patients exhibited CIN I in 9 cases, II in 1 and III in 2. There was some overlap. Twelve patients had cervical condylomata without dysplasia. Cervicography, in addition to cervical cytology, should be considered for all women with vulvar condylomata.

Liquid Chromatographic Determination of Dicofol in Kelthane Formulations: Collaborative Study

A liquid chromatographic (LC) method was used to determine p,p'- and o,p'-isomers of dicofol AI (active ingredient) in Kelthane® EC and MF formulations. Samples are dissolved in methanol and AI components and impurities are separated on a high resolution C8 column in series with a short C18 guard column, with a methanol-water-acetic acid mobile phase. Cleaned samples are directly injected into the LC system and are monitored at 254 nm. Twelve collaborators submitted results on 5 samples. Using 95% confidence criteria, the average total standard deviation of the total AI across all samples was 2.82%. The method has been adopted official first action.

Pluripotential nature of mesotheliomata induced by inhalation of erionite in rats

Mesotheliomata can be induced more rapidly and more frequently by inhalation of erionite than by asbestos inhalation. Erionite-induced tumours have in general a similar ultrastructural appearance to inoculum-induced pleural and peritoneal mesotheliomata. Unusual features of these tumours were the presence of dense-cored vesicles and cells staining positively for neuron-specific enolase which indicated the presence of endocrine cells. In addition, one tumour showed differentiation towards bone-forming cells. The expression of both epithelial and mesodermal characteristics demonstrates the pluripotential nature of mesothelial cells under certain circumstances.