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Sharieff JA, Fong JW, Parikh RN, Siatkowski RM. Anomalous Superior Oblique Tendon in Brown Syndrome. J Neuroophthalmol 2024:00041327-990000000-00575. [PMID: 38358823 DOI: 10.1097/wno.0000000000002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Jibran A Sharieff
- Department of Ophthalmology (JAS, RMS), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Ophthalmology and Visual Sciences (RNP), University of Iowa, Iowa City, Iowa; and Department of Ophthalmology (JWF), Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
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Hussain ZS, Heath MT, Ding K, Michael Siatkowski R. Characteristics associated with blindness or visual impairment within the adolescent demographic: a national cohort analysis. J AAPOS 2023; 27:333.e1-333.e7. [PMID: 37918705 DOI: 10.1016/j.jaapos.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Psychosocial metrics associated with self-reported blindness or visual impairment for adolescents in the National Survey of Drug Use and Health (NSDUH) have not been fully characterized. This retrospective cohort analysis of the latest NSDUH aimed to determine novel characteristics associated with self-reported visual loss among adolescents in the United States. METHODS Data from the NSDUH2020, a publicly available, federally validated database, were analyzed. Self-reported severe visual impairment or blindness was defined as being truly blind or having serious difficulty seeing even when wearing corrective lenses (s-rSVI). Inclusion criteria were all cases of s-rSVI in adolescents aged 12-17 years. NSDUH weights were used to accommodate complex survey design, nonresponse rates, and population variance. Weighted percentages, asymptotic two-sided Rao-Scott χ2 analyses, and multivariable logistic regression were performed. Statistical significance was considered reached at P < 0.05. RESULTS A total of 5,667 adolescents aged 12-17 years were surveyed, and s-rSVI occurred in 236 cases (weighted percentage, 3.48%). Within our final multivariable risk model, characteristics associated with increased odds of s-rSVI were female sex, Asian and Latino race/ethnicity (relative to non-Hispanic White), and self-reported serious difficulty hearing and concentrating (all P < 0.05). CONCLUSIONS This national retrospective cohort analysis highlights risk factors associated with s-rSVI for adolescents within the 2020 NSDUH. Clinicians and policymakers should consider at-risk demographics for s-rSVI during development and enhancement of screening programs, population health initiatives, and healthcare policy issues.
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Affiliation(s)
- Zain S Hussain
- Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma, Oklahoma City; University of Medicine and Health Sciences, Basseterre, St. Kitts
| | - Michael T Heath
- Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma, Oklahoma City
| | - Kai Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - R Michael Siatkowski
- Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma, Oklahoma City.
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O'Brien JC, Melson AT, Bryant JC, Ding K, Farris BK, Siatkowski RM. Surgical outcomes following strabismus surgery for abducens nerve palsy. J AAPOS 2023; 27:142.e1-142.e6. [PMID: 37179001 DOI: 10.1016/j.jaapos.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To assess ocular alignment outcomes and their stability for patients who underwent strabismus surgery for abducens nerve palsy and to identify preoperative patient variables that predict surgical success or repeated surgeries. METHODS We retrospectively reviewed the medical records of patients diagnosed with abducens nerve palsy and who subsequently underwent strabismus surgery. RESULTS A total of 209 patients (386 procedures) were included. The mean number of surgeries for patients was 1.9 ± 1.4. Success was achieved after a single surgery for 112 patients (53.6%), and success was achieved for an additional 42 patients, for a total of 154 patients (73.7%), following all surgeries. Preoperative abduction deficit severity was the only variable predictive of surgical success, with mild deficits having the highest odds of both initial success (OR = 5.555; CI, 2.722-11.336) and final success (OR = 5.294; 95% CI, 1.931-14.512). When analyzing survival time until additional surgery, the median survival was 406 days; abduction deficit severity, older age, other coincidental motility abnormalities, greater magnitude esotropia, and surgical technique were predictive of repeat surgical incidence. CONCLUSIONS In our patient cohort, preoperative abduction deficit was an important predictor of both surgical success and repeat surgical incidence for abducens nerve palsy. Older patient age, additional motility abnormalities, and greater amounts of baseline strabismus were also associated with greater likelihood of multiple surgeries.
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Affiliation(s)
- James C O'Brien
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City.
| | - Andrew T Melson
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City
| | - Juliana C Bryant
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City
| | - Kai Ding
- University of Oklahoma Department of Biostatistics and Epidemiology, Oklahoma City
| | - Bradley K Farris
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City
| | - R Michael Siatkowski
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City
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Aggarwal S, Wisely CE, Syed M, Siatkowski RM, Challa P. Learning From the 2021 Ophthalmology Match: Virtual Residency Matching During the COVID-19 Pandemic. J Grad Med Educ 2022; 14:674-679. [PMID: 36591419 PMCID: PMC9765913 DOI: 10.4300/jgme-d-22-00186.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/20/2022] [Accepted: 10/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The effect of virtual interviews on residency match outcomes during the COVID-19 pandemic is unknown. Examining the ophthalmology match may help inform all specialties undergoing virtual interviews. OBJECTIVE To determine the impact of allopathic applicant match characteristics in the first year of the virtual residency Match process. METHODS Using the Association of University Professors of Ophthalmology match database, a retrospective review was conducted of all allopathic applicants to ophthalmology residency programs in the United States from the 2016 through the 2021 match cycles. Demographic information, interview numbers, and match outcomes were compared between the 2016-2020 (in-person) and 2021 (virtual) cycles. RESULTS A total of 3343 allopathic applicants were analyzed. Applicants in the 2021 Match applied to significantly more programs than 2016-2020 applicants did (78.7±23.6 vs 73.1±22.7, P<.001). Among matched and unmatched applicants, there was no significant difference in the number of interviews granted or completed. There was a significant reduction in the match rate between the 2016-2020 and 2021 Match cycles (81.3% vs 76.6%, P=.0009). A subanalysis of applicants who went to medical schools with ophthalmology residency programs (N=2308) found that the home institution match rate was significantly higher for the 2021 Match compared to the aggregate 2016-2020 Matches (26.1% vs 20.6%, respectively, P=.015). CONCLUSIONS Significantly more applicants to ophthalmology residency programs matched at their home institutions in the 2021 virtual match cycle compared to the previous 5 years without influencing the interview numbers granted and attended.
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Affiliation(s)
- Sahil Aggarwal
- Sahil Aggarwal, MD, is Chief Resident, PGY-4, Duke Eye Center
| | - C. Ellis Wisely
- C. Ellis Wisely, MD, MBA, is Assistant Professor, Cornea and Refractive Surgery, Duke Eye Center, and Site Director, Ophthalmology Resident Service, Durham VA Medical Center
| | - Misha Syed
- Misha Syed, MD, MEHP, is Assistant Dean for Educational Affairs, Vice Chair for Academic Affairs, and Residency Program Director, Ophthalmology, The University of Texas Medical Branch at Galveston Department of Ophthalmology and Visual Sciences, and Member, Association of University Professors of Ophthalmology
| | - R. Michael Siatkowski
- R. Michael Siatkowski, MD, is CEO, Chair, and Professor, Dean McGee Eye Institute, The University of Oklahoma, and Member, Association of University Professors of Ophthalmology
| | - Pratap Challa
- Pratap Challa, MD, is Professor and Residency Program Director, Duke Eye Center, and Member, Association of University Professors of Ophthalmology
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Fong JW, Hahn-Parrott LA, Siatkowski RM. Evaluation and Management of Symptomatic Vertical Strabismus and Diplopia. J Binocul Vis Ocul Motil 2022; 72:226-229. [PMID: 36279479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The evaluation and management of vertical strabismus is more challenging and nuanced than that of horizontal strabismus. Vertical strabismus often results from a variety of restrictive or paretic causes, which can be further characterized as either acquired or congenital. In some cases, identifying the correct etiology of the strabismus can mean uncovering a potentially life-threatening condition, such as a brain tumor or stroke. The keys to identifying the correct diagnosis are, first and foremost, a careful history, and secondly, a detailed examination. The characteristics, etiologies, and evaluation of vertical strabismus will be reviewed here.
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Affiliation(s)
- Joseph W Fong
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Laurie A Hahn-Parrott
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Hartnett ME, Wallace DK, Dean TW, Li Z, Boente CS, Dosunmu EO, Freedman SF, Golden RP, Kong L, Prakalapakorn SG, Repka MX, Smith LE, Wang H, Kraker RT, Cotter SA, Holmes JM, Rhodes JE, Rogers DL, Bremer DL, Jordan CO, McGregor ML, Reem RE, Maletic SA, McMillin MC, Tobe Miller R, Bind JE, Leary JA, Mhaskar RM, Stiltner TL, Yang MB, Gray ME, Motley WW, Schwartz TL, Cobb P, Hirsch P, Reed M, Lagory D, Topmiller S, Coats DK, Bhatt AR, Demny AB, Bui VK, Lynds JL, McCartney TP, Vanderveen DK, Mantagos JS, Wu C, Yoon G, Goldstein S, Winter T, Anzaldi R, Smith HA, Haider KM, Hynes EA, Allard M, Head A, Morse D, Siatkowski RM, Collinge JE, Satnes KJ, Blunt MH, Taylor KD, Dries DC, Hoffman RO, Farnsworth KJ, Sorenson S, Austin DS, Beck RW, Boyle NM, Connelly PL, Conner CL, Chandler DL, Donahue Q, Fimbel BP, Henderson RJ, Hercinovic A, Hoepner JE, Kaplon JD, Ortiz G, Robinson JL, Stutz KM, Sutherland DR, Toro DO, Woodard VC, Wu R, Everett DF, Astle WF, Birch EE, Chen AM, Enyedi LB, Erzurum SA, Lambert SR, Lee KA, Manh VA, Manny RE, Silver JL, Weise KK, Verderber LC, Diener-West M, Baker JD, Davis BR, Phelps DL, Poff SW, Saunders RA, Tychsen L, Hartnett ME, Wallace DK, Dean TW, Li Z, Boente CS, Dosunmu EO, Freedman SF, Golden RP, Kong L, Prakalapakorn SG, Repka MX, Smith LE, Wang H, Kraker RT, Cotter SA, Holmes JM. Plasma Levels of Bevacizumab and Vascular Endothelial Growth Factor After Low-Dose Bevacizumab Treatment for Retinopathy of Prematurity in Infants. JAMA Ophthalmol 2022; 140:337-344. [PMID: 35446359 PMCID: PMC8895318 DOI: 10.1001/jamaophthalmol.2022.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Intravitreal bevacizumab effectively treats severe retinopathy of prematurity (ROP), but it enters the bloodstream and may reduce serum vascular endothelial growth factor (VEGF), potentially causing detrimental effects on developing organs in the premature infant. Objective To evaluate the association of intravitreal bevacizumab with plasma bevacizumab and VEGF concentrations at 2 and 4 weeks after predefined, de-escalating doses of intravitreal bevacizumab were administered to infants with severe ROP. Design, Setting, and Participants This phase 1 dose de-escalation case series study was conducted at 10 US hospitals of ophthalmology institutions from May 21, 2015, to May 7, 2019. Blood samples were collected 2 and 4 weeks after intravitreal bevacizumab injection. Participants included 83 premature infants with type 1 ROP in 1 or both eyes and no previous ROP treatment. Data were analyzed from April 2017 to August 2021. Interventions Study eyes received a single bevacizumab injection of 0.250 mg, 0.125 mg, 0.063 mg, 0.031 mg, 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg. When the fellow eye required treatment, one dose higher was administered. Total dose administered at baseline was defined as the sum of doses given to each eye within 3 days of initial study-eye injection. Main Outcomes and Measures Plasma bevacizumab concentration at 2 and 4 weeks after injection and the percentage change in plasma VEGF concentrations from pretreatment levels. Results A total of 83 infants (mean [SD] age, 25 [2] weeks; 48 boys [58%]) were included in this study. Higher doses of bevacizumab administered at baseline were associated with higher plasma bevacizumab concentrations at 2 weeks (ρ, 0.53; 95% CI, 0.31-0.70) and 4 weeks (ρ, 0.44; 95% CI, 0.18-0.64). Plasma VEGF concentrations decreased by 50% or more from pretreatment levels in 40 of 66 infants (61%) at 2 weeks and 31 of 61 infants (51%) at 4 weeks, but no association was observed between the total dose of bevacizumab administered at baseline and percentage change in plasma VEGF concentrations 2 weeks (ρ, -0.04; 95% CI, -0.28 to 0.20) or 4 weeks (ρ, -0.17; 95% CI, -0.41 to 0.08) after injection. Conclusions and Relevance Results of this phase 1 dose de-escalation case series study revealed that bevacizumab doses as low as 0.002 mg were associated with reduced plasma VEGF levels for most infants at 2 and 4 weeks after intravitreal administration; however, no association was observed between total bevacizumab dose administered and reductions in plasma VEGF levels from preinjection to 2 weeks or 4 weeks. Additional studies are needed to evaluate the long-term effects of low-dose bevacizumab on neurodevelopment and retinal structure.
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Affiliation(s)
| | | | | | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Eniolami O Dosunmu
- Cincinnati Children's Hospital Medical Center, Abrahamson Pediatric Eye Institute, Cincinnati, Ohio.,Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Lingkun Kong
- Texas Tech University Health Science Center, Lubbock
| | | | | | - Lois E Smith
- Boston Children's Hospital, Boston, Massachusetts
| | - Haibo Wang
- John A. Moran Eye Center, Salt Lake City, Utah
| | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
| | - Jonathan M Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson
| | - James E. Rhodes
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David L. Rogers
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Don L. Bremer
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Rachel E. Reem
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Sara Ann Maletic
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Jill E. Bind
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Julie A. Leary
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Michael B. Yang
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Michael E. Gray
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Patricia Cobb
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Patricia Hirsch
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Melissa Reed
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Denise Lagory
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Steven Topmiller
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David K. Coats
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Amit R. Bhatt
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Ann B. Demny
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Vanessa K. Bui
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | | | - Carolyn Wu
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Grace Yoon
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Tamar Winter
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Rocco Anzaldi
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Heather A. Smith
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Melissa Allard
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Annette Head
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David Morse
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Kelli J. Satnes
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Kaci D. Taylor
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David C. Dries
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Susan Sorenson
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Roy W. Beck
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Nicole M. Boyle
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - Quayleen Donahue
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Brooke P. Fimbel
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Amra Hercinovic
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - James E. Hoepner
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Joseph D. Kaplon
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Gillaine Ortiz
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - David O. Toro
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Rui Wu
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - William F. Astle
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Eileen E. Birch
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Angela M. Chen
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Laura B. Enyedi
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - S. Ayse Erzurum
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Scott R. Lambert
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Katherine A. Lee
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Vivian A. Manh
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Ruth E. Manny
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Jayne L. Silver
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - John D. Baker
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Barry R. Davis
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Dale L. Phelps
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Stephen W. Poff
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Lawrence Tychsen
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Eniolami O. Dosunmu
- Cincinnati Children’s Hospital Medical Center, Abrahamson Pediatric Eye Institute, Cincinnati, Ohio
- Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Lingkun Kong
- Texas Tech University Health Science Center, Lubbock
| | | | | | | | - Haibo Wang
- John A. Moran Eye Center, Salt Lake City, Utah
| | | | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
| | - Jonathan M. Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson
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Melson A, O'Brien J, Kutteh M, Siatkowski RM. A case of brain hamartoma in a child leading to compressive optic neuropathy mimicking amblyopia. J AAPOS 2021; 25:360-362. [PMID: 34597780 DOI: 10.1016/j.jaapos.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/13/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
Hamartomas are benign neoplastic malformations characterized by disorganized growths of tissue in their native location. They may grow in numerous sites throughout the body. We report the case of a 3-year-old boy with unilateral compressive optic neuropathy caused by a brain hamartoma that mimicked strabismic amblyopia. To our knowledge, this is the first case report in the literature of prechiasmal optic nerve compression from a brain hamartoma without ipsilateral bony defect or encephalocele.
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Affiliation(s)
- Andrew Melson
- Department of Ophthalmology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
| | - James O'Brien
- Department of Ophthalmology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Michael Kutteh
- Department of Ophthalmology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - R Michael Siatkowski
- Department of Ophthalmology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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Gudgel BM, Melson AT, Dvorak J, Ding K, Siatkowski RM. Correlation of Ophthalmology Residency Application Characteristics with Subsequent Performance in Residency. Journal of Academic Ophthalmology 2021. [DOI: 10.1055/s-0041-1733932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Purpose Only from reviewing applications, it is difficult to identify which applicants will be successful ophthalmology residents. The change of the USMLE Step 1 scoring to “Pass/Fail” removes another quantitative metric. We aimed to identify application attributes correlated with successful residency performance. This study also used artificial intelligence (AI) to evaluate letters of recommendation (LOR), the Dean's letter (MSPE), and personal statement (PS).
Design Retrospective analysis of application characteristics versus residency performance was conducted.
Participants Residents who graduated from the Dean McGee Eye Institute/University of Oklahoma Ophthalmology residency from 2004 to 2019 were included in this study.
Methods Thirty-four attributes were recorded from each application. Residents were subjectively ranked into tertiles and top and bottom deciles based on residency performance by faculty present during their training. The Ophthalmic Knowledge Assessment Program (OKAP) examination scores were used as an objective performance metric. Analysis was performed to identify associations between application attributes and tertile/decile ranking. Additional analysis used AI and natural language processing to evaluate applicant LORs, MSPE, and PS.
Main Outcome Measures Characteristics from residency applications that correlate with resident performance were the primary outcome of this study.
Results Fifty-five residents and 21 faculty members were included. A grade of “A” or “Honors” in the obstetrics/gynecology (OB/GYN) clerkship and the presence of a home ophthalmology department were associated with ranking in the top tertile but not the top decile. Mean core clerkship grades, medical school ranking in the top 25 U.S. News and World Report (USNWR) primary care rankings, and postgraduate year (PGY)-2 and PGY-3 OKAP scores were predictive of being ranked in both the top tertile and the top decile. USMLE scores, alpha-omega-alpha (AOA) status, and number of publications did not correlate with subjective resident performance. AI analysis of LORs, MSPE, and PS did not identify any text features that correlated with resident performance.
Conclusions Many metrics traditionally felt to be predictive of residency success (USMLE scores, AOA status, and research) did not predict resident success in our study. We did confirm the importance of core clerkship grades and medical school ranking. Objective measures of success such as PGY-2 and PGY-3 OKAP scores were associated with high subjective ranking.
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Affiliation(s)
- Brett M. Gudgel
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Andrew T. Melson
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Justin Dvorak
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Kai Ding
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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Wallace DK, Kraker RT, Freedman SF, Crouch ER, Bhatt AR, Hartnett ME, Yang MB, Rogers DL, Hutchinson AK, VanderVeen DK, Haider KM, Siatkowski RM, Dean TW, Beck RW, Repka MX, Smith LE, Good WV, Kong L, Cotter SA, Holmes JM. Short-term Outcomes After Very Low-Dose Intravitreous Bevacizumab for Retinopathy of Prematurity. JAMA Ophthalmol 2021; 138:698-701. [PMID: 32324197 DOI: 10.1001/jamaophthalmol.2020.0334] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Intravitreous bevacizumab (0.25 mg to 0.625 mg) is commonly used to treat type 1 retinopathy of prematurity (ROP), but there are concerns about systemic toxicity, particularly the risk of neurodevelopmental delay. A much lower dose may be effective for ROP while reducing systemic risk. Previously, after testing doses of 0.25 mg to 0.031 mg, doses as low as 0.031 mg were found to be effective in small cohorts of infants. Objective To find the lowest dose of intravitreous bevacizumab effective for severe ROP. Design, Setting, and Participants Between April 2017 and May 2019, 59 premature infants with type 1 ROP in 1 or both eyes were enrolled in a masked, multicenter, dose de-escalation study. In cohorts of 10 to 14 infants, 1 eye per infant received 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg of intravitreous bevacizumab. Diluted bevacizumab was prepared by individual research pharmacies and delivered using 300-µL syringes with 5/16-inch, 30-guage fixed needles. Analysis began July 2019. Interventions Bevacizumab intravitreous injections at 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg. Main Outcomes and Measures Success was defined as improvement by 4 days postinjection and no recurrence of type 1 ROP or severe neovascularization requiring additional treatment within 4 weeks. Results Fifty-five of 59 enrolled infants had 4-week outcomes completed; the mean (SD) birth weight was 664 (258) g, and the mean (SD) gestational age was 24.8 (1.6) weeks. A successful 4-week outcome was achieved for 13 of 13 eyes (100%) receiving 0.016 mg, 9 of 9 eyes (100%) receiving 0.008 mg, 9 of 10 eyes (90%) receiving 0.004 mg, but only 17 of 23 eyes (74%) receiving 0.002 mg. Conclusions and Relevance These data suggest that 0.004 mg may be the lowest dose of bevacizumab effective for ROP. Further investigation is warranted to confirm effectiveness of very low-dose intravitreous bevacizumab and its effect on plasma vascular endothelial growth factor levels and peripheral retinal vascularization.
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Affiliation(s)
- David K Wallace
- Indiana University Department of Ophthalmology, Indianapolis
| | | | | | | | | | | | - Michael B Yang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Lois E Smith
- Emory University School of Medicine, Atlanta, Georgia
| | - William V Good
- Smith-Kettlewell Eye Research Institute, San Francisco, California
| | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
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Rodrigo-Rey S, Gutiérrez-Ortiz C, Muñoz S, Ortiz-Castillo JV, Siatkowski RM. What did he eat? Surv Ophthalmol 2020; 66:892-896. [PMID: 33010288 PMCID: PMC7526636 DOI: 10.1016/j.survophthal.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 10/28/2022]
Abstract
A 13-year-old boy reported acute horizontal binocular diplopia and headache. Ten days before these symptoms he suffered from a gastrointestinal infection. Ophthalmological examination revealed bilateral ophthalmoparesis and diffuse hyporeflexia. Magnetic resonance imaging of the brain was normal. Lumbar puncture revealed albumin-cytological dissociation. There were no anti-GQ1b antibodies, but serum anti-GM1 antibodies were detected. He received intravenous immunoglobulins and had fully recovered two weeks later. Miller Fisher syndrome and its atypical variants are uncommon in childhood; nevertheless, they should be considered in the differential diagnosis of bilateral acute ophthalmoparesis.
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Affiliation(s)
- Sara Rodrigo-Rey
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Consuelo Gutiérrez-Ortiz
- Glaucoma and Neuro-ophthalmology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Silvia Muñoz
- Ophthalmology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
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Abstract
A 13-year-old girl presented with a 5-day history of fever and cough followed by new-onset oral ulcers and conjunctival injection. Clinical examination revealed bilateral 360-degree subconjunctival hemorrhages, which later evolved to corneal epithelial defects, pseudo-membrane formation, and extensive oral mucosal ulceration. Mycoplasma pneumoniae serum IgG and IgM were positive. Treatment with topical prednisolone acetate, moxifloxacin, preservative-free artificial tears, and erythromycin ointment was initiated. A self-retaining amniotic membrane was placed. The ocular and oral lesions resolved within 2 weeks of treatment, and the patient's vision returned to baseline. Mycoplasma-induced rash and mucositis is a newly defined entity that mainly affects children and has a favorable prognosis with early detection and treatment.
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Affiliation(s)
- Haoxing D Jin
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Rhea L Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Jin HD, O'Brien JC, Siatkowski RM. Suprasellar arachnoid cyst causing reversible junctional scotoma. Am J Ophthalmol Case Rep 2020; 18:100720. [PMID: 32382687 PMCID: PMC7200211 DOI: 10.1016/j.ajoc.2020.100720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/19/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Haoxing D. Jin
- Corresponding author. Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd., Oklahoma City, OK, USA.
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Rogers KA, Wilson AA, Wyckoff MA, Siatkowski RM. Computer-Based Quality Improvement for Management of Functionally Monocular Patients. Ophthalmology 2019; 127:138-139. [PMID: 31514972 DOI: 10.1016/j.ophtha.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/04/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kyle A Rogers
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma.
| | - Andrew A Wilson
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma
| | - Mark A Wyckoff
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma
| | - R Michael Siatkowski
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma
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Siatkowski RM. Truth, Transparency, and Teaching. JAMA Ophthalmol 2019; 137:1052-1053. [DOI: 10.1001/jamaophthalmol.2019.1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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Gong D, Winn BJ, Beal CJ, Blomquist PH, Chen RW, Culican SM, Dagi Glass LR, Domeracki GF, Goshe JM, Jones JK, Khouri AS, Legault GL, Martin TJ, Mitchell KT, Naseri A, Oetting TA, Olson JH, Pettey JH, Reinoso MA, Reynolds AL, Siatkowski RM, SooHoo JR, Sun G, Syed MF, Tao JP, Taravati P, WuDunn D, Al-Aswad LA. Gender Differences in Case Volume Among Ophthalmology Residents. JAMA Ophthalmol 2019; 137:1015-1020. [PMID: 31318390 DOI: 10.1001/jamaophthalmol.2019.2427] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P < .001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P < .001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P < .001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P = .81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P < .001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P < .001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P = .11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P = .008). Conclusions and Relevance Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study.
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Affiliation(s)
- Dan Gong
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Bryan J Winn
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Casey J Beal
- Department of Ophthalmology, University of Florida, Gainesville
| | - Preston H Blomquist
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
| | - Royce W Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Gary F Domeracki
- Department of Ophthalmology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - Jeremy K Jones
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Albert S Khouri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
| | | | - Timothy J Martin
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kelly T Mitchell
- Department of Ophthalmology & Visual Sciences, Texas Tech University Health Sciences Center, Lubbock
| | - Ayman Naseri
- Department of Ophthalmology, University of California, San Francisco
| | - Thomas A Oetting
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Joshua H Olson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Maria A Reinoso
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans
| | - Andrew L Reynolds
- Ross Eye Institute, University at Buffalo Jacobs School of Medicine, Buffalo, New York
| | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Misha F Syed
- Ophthalmology and Visual Science, University of Texas Medical Branch, Galveston
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine
| | - Parisa Taravati
- Department of Ophthalmology, University of Washington, Seattle
| | - Darrell WuDunn
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis
| | - Lama A Al-Aswad
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.,Department of Ophthalmology, New York University School of Medicine, NYU Langone Health, New York, New York
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Abstract
A healthy 7-year-old girl underwent a routine eye examination and was referred for unilateral, left optic nerve swelling. Best-corrected visual acuity in the affected eye was 20/20 with full Ishihara color plates and no relative afferent pupillary defect. Initial extensive workup was normal for any cause of unilateral disk swelling. When the patient returned a few years later with decreased vision, a thickened, gray-white preretinal tissue with surrounding retinal contraction and a surrounding charcoal gray lesion had developed in her optic nerve. Spectral-domain optical coherence tomography over the optic nerve demonstrated distortion of the inner retinal architecture, a dense epiretinal membrane, and high internal reflectivity. Clinical examination and imaging revealed a diagnosis of combined hamartoma of the retina and retinal pigment epithelium.
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Affiliation(s)
- Danny A Mammo
- Department of Ophthalmology and Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Michael S Lee
- Department of Ophthalmology and Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.
| | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute/University of Oklahoma, Oklahoma City, Oklahoma, USA
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Venincasa VD, Bugg V, Dvorak J, Ding K, Bhatti F, Siatkowski RM. Temporal Profile of Retinopathy of Prematurity in Extremely Premature Compared to Premature Infants. J Pediatr Ophthalmol Strabismus 2019; 56:116-123. [PMID: 30889266 DOI: 10.3928/01913913-20190205-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 01/07/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the time course of retinopathy of prematurity (ROP) in premature (≥ 28 to 34 weeks' gestational age) and extremely premature (< 28 weeks' gestational age) infants. METHODS This study was a retrospective single-center chart review that included 582 eyes (122 premature, 464 extremely premature) of 299 infants (65 premature, 234 extremely premature) diagnosed as having ROP who were born between January 1, 2010, and December 31, 2015. Data collected were analyzed with shared frailty models, chi-square, and Fisher's exact tests. RESULTS Extremely premature infants were diagnosed as having ROP earlier than premature infants at 33.6 weeks (95% CI [confidence interval]: 33.4 to 33.9) versus 36.0 weeks (95% CI: 34.7 to 36.4, P < .0001). The time from diagnosis to spontaneous regression was more than 4 weeks longer for extremely premature infants than premature infants with stage 1 ROP (82.0 vs 50.0 days, P < .0001), and more than 6 weeks longer for extremely premature infants than premature infants with stage 2 ROP (99 vs 55 days, P < .0001). Extremely premature infants had more bilateral ROP (96.6% vs 87.1%, P < .01) and were three times more likely to require treatment than premature infants (29.7% vs 9.9%, P < .0001). On average, infants who required treatment weighed 137 grams less at birth (P < .0001) and gained 37.7 grams less per week than infants who underwent spontaneous regression (P < .0001). CONCLUSIONS Extremely premature infants developed ROP earlier, had more bilateral ROP, took longer to achieve spontaneous regression, and required treatment more often than premature infants. Infants who required treatment had a lower birth weight and rate of weight gain than infants who underwent spontaneous regression. [J Pediatr Ophthalmol Strabismus. 2019;56(2):116-123.].
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18
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Strickland A, Baker CM, Siatkowski RM, Mapstone TB. Divergence insufficiency alleviated by posterior fossa decompression with duraplasty in a patient with Chiari type 1.5 malformation. J Neurosurg Pediatr 2018; 22:504-507. [PMID: 30095345 DOI: 10.3171/2018.5.peds1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/22/2018] [Indexed: 11/06/2022]
Abstract
The authors present a case of Chiari type 1.5 malformation with the uncommon presenting symptoms of esotropia and diplopia due to divergence insufficiency in a 12-year-old girl. Imaging at initial diagnosis revealed cerebellar herniation with extension of the tonsils to the C2 vertebral body, a retroflexed odontoid, and a small cervical syrinx. The patient was initially treated with an uncomplicated Chiari malformation decompression without dural opening. Repeat imaging revealed an adequate decompression. Three months postoperatively the patient's diplopia recurred and she underwent repeat posterior fossa decompression with dural opening and duraplasty. Following repeat decompression with dural opening and duraplasty, the patient's diplopia had not recurred by the 2-year follow-up.https://thejns.org/doi/abs/10.3171/2018.5.PEDS1886.
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Affiliation(s)
- Allison Strickland
- 1Department of Neurosurgery, University of Oklahoma Health Sciences Center; and
| | - Cordell M Baker
- 1Department of Neurosurgery, University of Oklahoma Health Sciences Center; and
| | - R Michael Siatkowski
- 2Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Timothy B Mapstone
- 1Department of Neurosurgery, University of Oklahoma Health Sciences Center; and
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Siatkowski RM, Mian SI, Culican SM, Green LK, Sun G, Waxman EL, Wayman LL, Stoner J, Chen X, Feldon S. Probability of Success in the Ophthalmology Residency Match: Three-Year Outcomes Analysis of San Francisco Matching Program Data. J Acad Ophthalmol 2018; 10:e150-e157. [PMID: 30662977 DOI: 10.1055/s-0038-1673675] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective To develop a probability model of matching into a US ophthalmology residency program using San Francisco Matching Program (SF Match) data. Design Retrospective data analysis of de-identified application and matching data. Participants Registrants for the 2013, 2014, and 2015 ophthalmology residency matches conducted by the SF Match. Methods Descriptive statistics of candidates, comparison of continuous and categorical variables between matched and nonmatched candidates, and linear regression modeling were performed. A recursive partitioning method was used to create a probability of matching algorithm. Main Outcome Measures Probability of successfully matching based on quantifiable candidate characteristics. Results Over the 3-year period, 1,959 individuals submitted an average of 64 applications and received a mean of nine interview invitations. The overall match rate was 71%, with 78% matching at one of their top five choices. Successful matches were more likely to occur in US medical school graduates (78% vs 20%, p < 0.001) and applicants on their first attempt (76% vs 29%, p < 0.001). The association between matching and number of programs applied became negative with > 48 applications. Probability of matching was "high" (> 80%) among US graduates with a step 1 United States Medical Licensing Examination (USMLE)score>243(regardless of number of programs applied to), a step 1 USMLE score of 231 to 243 who applied to at least 30 programs, and first-time applicants with a step 1 score >232. No international medical graduates or repeat applicants had a "high" probability of matching. Conclusions Although advice must be individualized for each candidate, applicants for ophthalmology residency who fall into a "high" probability of matching group are likely to be successful with applications to 45 or fewer programs. Applying to 80 or more programs should be considered for international medical graduates and/or applicants who are previously unmatched. Modification of the match application data form may allow more detailed analysis of variables such as Alpha Omega Alpha or Gold Humanism Honor Society membership, research activity, and composite evaluation on a standardized letter of recommendation.
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Affiliation(s)
- R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Laura K Green
- Krieger Eye Institute, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Evan L Waxman
- Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura L Wayman
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Xi Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Steven Feldon
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Dannelley JF, Johnson PN, Anderson MP, Oestreich K, Siatkowski RM, Miller JL. Assessment of Outcomes With a Sedation Protocol During Laser Photocoagulation in Preterm Infants With Retinopathy of Prematurity. J Pediatr Pharmacol Ther 2018; 23:410-416. [PMID: 30429696 PMCID: PMC6213621 DOI: 10.5863/1551-6776-23.5.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the success of a sedation protocol of fentanyl and midazolam infusions for infants undergoing laser photocoagulation for retinopathy of prematurity. METHODS This retrospective study included infants receiving a sedation protocol for laser photocoagulation during a 4-year period. The primary objective was protocol success, defined as completion without interruption, absence of protocol dose deviations, and absence of interventions. Secondary objectives compared outcomes between those with and without opioid/benzodiazepine exposure. A logistic regression was used to assess the effect of prior opioid/benzodiazepine exposure on requirement for fentanyl infusion increases. RESULTS Twenty-six infants were included. Seven (26.9%) had protocol success. Sixteen (61.5%) had protocol success, excluding dose deviations. Seventeen (65.4%) experienced ≥1 cardiopulmonary adverse events. Photocoagulation was completed in all cases. CONCLUSIONS Most achieved protocol success, when eliminating dosing deviations. These data indicate that flexibility is needed in fentanyl and midazolam infusion titration, based on clinical response.
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21
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Miller JL, Johnson PN, Harkey K, Siatkowski RM. Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity. J Pediatr Pharmacol Ther 2018; 23:34-40. [PMID: 29491750 PMCID: PMC5823490 DOI: 10.5863/1551-6776-23.1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study describes outcomes of intravenous (IV) analgesics and sedatives for bedside intravitreal bevacizumab injections for retinopathy of prematurity. METHODS This retrospective study included infants receiving intravitreal bevacizumab injections between January 2012 and May 2016. Infants were excluded if bevacizumab was administered under general anesthesia or for incomplete records. Data collection included demographics, sedation and analgesia regimen, and cardiopulmonary adverse events (AEs). The primary objective was to identify the median doses of the IV analgesics and sedatives. The secondary objectives included the number of patients with cardiopulmonary AEs and those with procedure success, defined as procedure completion without interruption and absence of interventions. RESULTS Fifteen infants were included. Fourteen (93.3%) were initiated on a fentanyl infusion at a median of 2 mcg/kg/hr (IQR, 2-3.6), and 12 (80%) received midazolam infusions at a median of 0.06 mg/kg/hr. All patients received at least 1 IV neuromuscular blocker dose just prior to the procedure. Only 2 patients (13.3%) required an increase in their fentanyl or midazolam infusions. Procedure success was achieved in 13 patients (86.7%). Five patients (33.3%) experienced 1 cardiopulmonary AE. One patient (6.7%) had a delay in the procedure, and 1 patient (6.7%) required naloxone. Despite this, the procedure was completed in all patients. CONCLUSIONS Most received fentanyl and midazolam infusions with a dose of vecuronium just prior to the procedure. Thirteen (86.7%) met the criteria for procedure success. One-third experienced a cardiopulmonary AE. Future studies are needed to identify the optimal agents and route of administration for this procedure.
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22
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Wallace DK, Kraker RT, Freedman SF, Crouch ER, Hutchinson AK, Bhatt AR, Rogers DL, Yang MB, Haider KM, VanderVeen DK, Siatkowski RM, Dean TW, Beck RW, Repka MX, Smith LE, Good WV, Hartnett ME, Kong L, Holmes JM. Assessment of Lower Doses of Intravitreous Bevacizumab for Retinopathy of Prematurity: A Phase 1 Dosing Study. JAMA Ophthalmol 2017; 135:654-656. [PMID: 28448664 DOI: 10.1001/jamaophthalmol.2017.1055] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Intravitreous bevacizumab (0.25 to 0.625 mg) is increasingly used to treat type 1 retinopathy of prematurity (ROP), but there remain concerns about systemic toxicity. A much lower dose may be effective while reducing systemic risk. Objective To find a dose of intravitreous bevacizumab that was lower than previously used for severe ROP, was effective in this study, and could be tested in future larger studies. Design, Setting, and Participants Between May 2015 and September 2016, 61 premature infants with type 1 ROP in 1 or both eyes were enrolled in a masked, multicenter, phase 1 dose de-escalation study. One eye of 10 to 14 infants received 0.25 mg of intravitreous bevacizumab. If successful, the dose was reduced for the next group of infants (to 0.125 mg, then 0.063 mg, and finally 0.031 mg). Diluted bevacizumab was delivered using 300 µL syringes with 5/16-inch, 30-gauge fixed needles. Interventions Bevacizumab injections at 0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg. Main Outcomes and Measures Success was defined as improvement in preinjection plus disease or zone I stage 3 ROP by 5 days after injection or sooner, and no recurrence of type 1 ROP or severe neovascularization requiring additional treatment within 4 weeks. Results Fifty-eight of 61 enrolled infants had 4-week outcomes completed; mean birth weight was 709 g and mean gestational age was 24.9 weeks. Success was achieved in 11 of 11 eyes at 0.25 mg, 14 of 14 eyes at 0.125 mg, 21 of 24 eyes at 0.063 mg, and 9 of 9 eyes at 0.031 mg. Conclusions and Relevance A dose of bevacizumab as low as 0.031 mg was effective in 9 of 9 eyes in this phase 1 study and warrants further investigation. Identifying a lower effective dose of bevacizumab may reduce the risk for neurodevelopmental disability or detrimental effects on other organs.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael B Yang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Lois E Smith
- Boston Children's Hospital, Boston, Massachusetts
| | - William V Good
- Smith-Kettlewell Eye Research Institute, San Francisco, California
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Bitner DP, Adesina OOO, Ding K, Farris BK, Michael Siatkowski R. Comparison of Objective and Subjective Techniques of Strabismus Measurement in Adults With Normal Retinal Correspondence. J Pediatr Ophthalmol Strabismus 2017; 54:216-220. [PMID: 28510769 DOI: 10.3928/01913913-20170322-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/10/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Accurate measurement of strabismus is vital to proper diagnosis and treatment. Objective and subjective measurement techniques can be used. The authors hypothesized that subjective measurement techniques would measure larger deviations than objective ones. METHODS Adults with strabismus, visual acuity greater than 20/50 in each eye, and normal retinal correspondence were measured in primary gaze at distance and near using the alternate prism and cover test and the red glass test. RESULTS Seventy-three patients were prospectively enrolled. Objective mean deviations were 9.1 (distance horizontal), 5.1 (distance vertical), 10.0 (near horizontal), and 2.6 (near vertical) prism diopters (PD). Subjective mean deviations were 10.2 (distance horizontal), 6.8 (distance vertical), 12.2 (near horizontal), and 3.2 (near vertical) PD. Subjective measurements were larger by a statistically significant margin and were more likely to show the presence of a vertical deviation not measured objectively (19 occurrences vs 2 at near, P = .008; 15 occurrences vs 0 at distance, P = .004). The measured deviations were within 5 PD horizontally and 3 PD vertically most of the time (range: 66.7% to 83.6%). CONCLUSIONS The red glass test was more likely to measure a larger deviation at distance and near and to identify a vertical deviation not seen objectively at both distance and near. The mean difference between the tests was usually not large enough to affect surgical treatment, but could potentially result in different amounts of prescribed prism for patients treated optically. [J Pediatr Ophthalmol Strabismus. 2017;54(4):216-220.].
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Siatkowski RM. Excellence in Ophthalmology: Continuous Certification. Ophthalmology 2017; 123:S25-9. [PMID: 27549998 DOI: 10.1016/j.ophtha.2016.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022] Open
Abstract
Over the course of a century, American medical specialty boards including the American Board of Ophthalmology (ABO) have developed significant expertise in assessing physician competence on completion of postgraduate training and, more recently, in defining appropriate criteria for continuous learning and quality improvement in practicing physicians. This article explores why maintaining career-long excellence is an evolving challenge, but one that is at the heart of the ABO's mission to protect the public by improving patient care.
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Affiliation(s)
- R Michael Siatkowski
- American Board of Ophthalmology, Bala Cynwyd, Pennsylvania; Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma.
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Quinn GE, Ying GS, Repka MX, Siatkowski RM, Hoffman R, Mills MD, Morrison D, Daniel E, Baumritter A, Hildebrand PL, Schron EB, Ells AL, Wade K, Kemper AR. Timely implementation of a retinopathy of prematurity telemedicine system. J AAPOS 2016; 20:425-430.e1. [PMID: 27651231 PMCID: PMC5086263 DOI: 10.1016/j.jaapos.2016.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the feasibility of a retinopathy of prematurity (ROP) telemedicine evaluation system of providing timely feedback to a neonatal intensive care unit (NICU) with at-risk premature infants. METHODS This was a prospective observational study of premature infants with birth weights of <1251 g in five NICUs in the United States. Infants scheduled for clinically indicated ROP evaluations underwent indirect ophthalmoscopic examinations and digital imaging on the same day. Imaging was performed by nonphysician retinal imagers. Times required were determined from obtaining digital images of both eyes to submission via web-based system to a secure server for grading by trained readers at a central reading center to sending back grading results to the clinical center. RESULTS A total of 1,642 image sets of eyes of 292 infants were obtained, from 823 imaging sessions. The mean turnaround time from submission of image sets of both eyes to return of the grading results to the clinical center was 10.1 ± 11.3 hours (standard deviation), with a median of 12.0 hours (1st quartile, 0.9 hours; 3rd quartile, 16 hours). Overall, 95.5% of gradings (95% CI, 93.9%-96.7%) were returned within 24 hours. Subgroup analyses found, for image sets submitted to the reading center before 2 p.m. Eastern Standard Time, median time to report was 1.7 hours (1st quartile, 0.7 hours; 3rd quartile, 15.5 hours) compared with those submitted after 2pm (median, 14.1 hours; 1st quartile, 11.2, hours; 3rd quartile, 16.3 hours). CONCLUSIONS An ROP telemedicine approach can provide timely feedback to the NICU regarding the detection of potentially serious ROP and thus referral to an ophthalmologist for examination and consideration of treatment.
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Affiliation(s)
- Graham E Quinn
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Robert Hoffman
- Department of Ophthalmology, University of Utah, Salt Lake City
| | - Monte D Mills
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David Morrison
- Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee
| | - Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Agnieshka Baumritter
- Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Anna L Ells
- Department of Ophthalmology, University of Calgary, Canada
| | - Kelly Wade
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alex R Kemper
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Abstract
Purpose To report a case of polymicrobial keratitis caused by Panotea agglomerans, Escherichia vulneris and coagulase-negative Staphylococcus in a patient who cleaned their extended wear contact lenses with only tap water for 2 weeks. Methods Case report. Results An adult presented with a painful red eye after wearing the same contact lenses for two weeks. The patient admitted to taking the contacts out in the evening and cleaning them with tap water before reapplying them in the morning. Exam revealed a 2.5 mm paracentral corneal ulcer in the left eye. Culture results from corneal scrapings were positive for P. agglomerans, E. vulneris and coagulase-negative Staphylococcus. Conclusions This is the first report of P. agglomerans and E. vulneris keratitis in association with contact lens wear. Both strains of P. agglomerans and E. vulneris were pansensitive to all tested antibiotics.
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Affiliation(s)
- Vincent D. Venincasa
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Dean McGee Eye Institute, 608 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
- Corresponding author.
| | - Michelle Callegan
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Dean McGee Eye Institute, 608 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave, Oklahoma City, OK 73104, USA
| | - Roger A. Astley
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Dean McGee Eye Institute, 608 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
| | - R. Michael Siatkowski
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Dean McGee Eye Institute, 608 Stanton L Young Blvd, Oklahoma City, OK 73104, USA
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Motley WW, Golnik KC, Anteby I, Atilla H, Gole GA, Murillo C, Olitsky SE, Pilling RF, Reddy AR, Sharma P, Siatkowski RM, Yadarola MB. Validity of ophthalmology surgical competency assessment rubric for strabismus surgery in resident training. J AAPOS 2016; 20:184-5. [PMID: 27079603 DOI: 10.1016/j.jaapos.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/16/2015] [Accepted: 12/31/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED The Accreditation Council for Graduate Medical Education (ACGME) requires US residency programs to assess ophthalmology residents for competency in 6 core areas. Ophthalmic surgical skills are currently part of the ACGME "Patient Care" competency, although some have advocated for a seventh competency, "Surgical Skills." The Ophthalmology Surgical Competency Assessment Rubric for Strabismus Surgery in Resident Training ( OSCAR Strabismus) tool was designed to aid in the assessment of surgical skills using procedure specific behavioral anchors. The present study evaluated inter-rater agreement of the OSCAR Strabismus tool in the assessment of resident performance. OSCAR Strabismus evaluations of resident surgical strabismus cases were performed by a multinational group of faculty strabismus surgeons. Cronbach α statistical analysis of the completed evaluations revealed high inter-rater agreement, indicating the OSCAR Strabismus is a reliable tool to facilitate assessment of resident strabismus surgical skills.
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Affiliation(s)
- W Walker Motley
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Ophthalmology, University of Cincinnati, Cincinnati, OH.
| | - Karl C Golnik
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH; Cincinnati Eye Institute, Cincinnati, OH
| | | | - Huban Atilla
- Department of Ophthalmology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Glen A Gole
- University of Queensland, Brisbane, Queensland
| | - Claudia Murillo
- Strabismus Department, Instituto de Oftalmologia Fundación Conde de Valenciana, México
| | | | - Rachel F Pilling
- Department of Ophthalmology, Bradford Royal Infirmary, Bradford, UK
| | - Aravind R Reddy
- Department of Ophthalmology, Royal Aberdeen Children's Hospital and University of Aberdeen, Aberdeen, Scotland
| | - Pradeep Sharma
- RP Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Maria B Yadarola
- Department of Pediatric Ophthalmology and Adult Strabismus, Centro de Ojos Romagosa, Cordoba, Argentina
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Kinori M, Ben Simon GJ, Zehavi-Dorin T, Robbins SL, Siatkowski RM. Ptosis Shmosis. Surv Ophthalmol 2016; 62:237-240. [PMID: 26921808 DOI: 10.1016/j.survophthal.2016.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
A 10-year-old girl presented with painless unilateral left upper lid ptosis. A nontender hard mass was palpated in the left upper lid. Blood smear was compatible with the diagnosis of leukemia. The cause of ptosis was now thought to be a mass composed of myeloid blast cells (myeloid sarcoma).
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Affiliation(s)
- Michael Kinori
- Ratner Children's Eye Center at the Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, USA; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Ramat Gan, Israel; Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.
| | - Guy J Ben Simon
- The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Ramat Gan, Israel; Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Tzukit Zehavi-Dorin
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Shira L Robbins
- Ratner Children's Eye Center at the Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - R Michael Siatkowski
- Dean McGhee Eye Institute, Department of Ophthalmology, University of Oklahoma, Oklahoma City, Oklahoma, USA
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Sussenbach EC, Siatkowski RM, Ding K, Yanovitch TL. Pediatric Ophthalmologists' Experiences With Abusive Head Trauma. J Pediatr Ophthalmol Strabismus 2016; 53:25-8. [PMID: 26835999 DOI: 10.3928/01913913-20160113-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/28/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To estimate the number of cases of abusive head trauma seen by pediatric ophthalmologists and analyze factors associated with physician subpoenas and court testimonies. METHODS Pediatric ophthalmologists were surveyed about their experiences with abusive head trauma. The survey was sent to 875 active members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). RESULTS The response rate was 15% (132 surveys). The median pediatric ophthalmologist is consulted 10.0 (interquartile range [IQR] = 4.0 to 19.0) times per year to evaluate patients for abusive head trauma and sees 2.5 (IQR = 1.0 to 6.0) patients with probable abusive head trauma each year. Pediatric ophthalmologists were equally likely to be subpoenaed (4.6% vs 4.8%, P = .84) or to testify (1.9% vs 1.7%, P = .79) whether they did or did not perform retinal photography. Physicians were equally likely to be subpoenaed (4.8% vs 7.1%, P = .92) or to testify (2.2% vs 0.0%, P = .17) whether a child abuse team was involved in patient care or not. Geographic location had no statistical significance on how frequently pediatric ophthalmologists were subpoenaed (P = .17) or testified in court (P = .12). When a pediatric ophthalmologist was subpoenaed to court, the median number of missed clinic days was 1.0 (IQR = 1.0 to 2.0), with an estimated cost of $3,000 (IQR = $1,750 to $4,750) in lost revenue. CONCLUSIONS Obtaining retinal imaging, having a child abuse team, and geographic location had no significant relationship with how often pediatric ophthalmologists were subpoenaed or testified in court.
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Adler E, Ding K, Siatkowski RM. Factors related to strabismus decompensation after a period of prolonged postoperative stability. J AAPOS 2014; 18:50-5. [PMID: 24568983 DOI: 10.1016/j.jaapos.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify factors associated with late decompensation of horizontal strabismus after a period of prolonged (>12 months) postoperative stability. METHODS Charts from all pediatric horizontal strabismus surgical cases from 1999 to 2009 were reviewed. Patients with a distance or near alignment of <10(Δ) at the first visit >12 months following surgery were included. The primary outcome was time from surgery to strabismus decompensation. Multiple variables were analyzed using the Cox proportional hazards model. RESULTS A total of 185 cases were included. Mean age at surgery was 5.1 years and mean follow-up was 62.2 months. Late decompensation rate was 31%; of these, 54% underwent reoperation. Using two different models, a higher risk of decompensation was associated with both the presence of preoperative oblique dysfunction (P = 0.023/0.002) and larger distance/near deviations at the first >12 months postoperative visit (P = 0.033/0.012). CONCLUSIONS Worsening of alignment >12 months after horizontal strabismus surgery occurs in almost one-third of patients. Preoperative oblique dysfunction is associated with long-term instability, possibly because it is a surrogate for sensory torsion and poor fusion. Additionally, larger distance and near deviations at >12 months after surgery were each associated with late decompensation. The rate of decompensation for patients with deviations of 0(Δ) to <4(Δ) was less than those with deviations of 4(Δ) to <8(Δ) and >8(Δ), suggesting that the biologic behavior of all deviations within the monofixation range (0(Δ) to 8(Δ)) is not uniform.
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Affiliation(s)
- Eldad Adler
- Department of Ophthalmology, University of Oklahoma/Dean McGee Eye Institute, Oklahoma City, Oklahoma
| | - Kai Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - R Michael Siatkowski
- Department of Ophthalmology, University of Oklahoma/Dean McGee Eye Institute, Oklahoma City, Oklahoma.
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Abstract
In 1933, famed aviator Wiley Post (1898-1935) was the first pilot to fly around the world solo. In addition, during one of his many stratospheric flights, he discovered the jet stream. What makes his accomplishments even more remarkable is that he did this monocularly, having lost his left eye from traumatic endophthalmitis following an oil rig accident. He underwent a period of self-imposed visual training to maximize his depth perception, and then accomplished what no one had before.
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Affiliation(s)
- Yasser M Elshatory
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma.
| | - R Michael Siatkowski
- Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, Oklahoma
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Siatkowski RM, Good WV, Summers CG, Quinn GE, Tung B. Clinical characteristics of children with severe visual impairment but favorable retinal structural outcomes from the Early Treatment for Retinopathy of Prematurity (ETROP) study. J AAPOS 2013; 17:129-34. [PMID: 23522948 PMCID: PMC4381920 DOI: 10.1016/j.jaapos.2012.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/28/2012] [Accepted: 10/29/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe visual function and associated characteristics at the 6-year examination in children enrolled in the Early Treatment for Retinopathy of Prematurity Study who had unfavorable visual outcomes despite favorable structural outcomes in one or both eyes. METHODS The clinical examination records of children completing the 6-year follow-up examination were retrospectively reviewed. Eligible subjects were those with visual acuity of ≤20/200 in each eye (where recordable) and a normal fundus or straightening of the temporal retinal vessels with or without macular ectopia in at least one eye. Data regarding visual function, retinal structure, presence of nystagmus, optic atrophy, optic disk cupping, seizures/shunts, and Functional Independence Measure for Children (ie, WeeFIM: pediatric functional independence measure) developmental test scores were reviewed. RESULTS Of 342 participants who completed the 6-year examination, 39 (11%) met inclusion criteria. Of these, 29 (74%) had normal retinal structure, 18 (46%) had optic atrophy, and 3 (8%) had increased cupping of the optic disk in at least one eye. Latent and/or manifest nystagmus occurred in 30 children (77%). The presence of nystagmus was not related to the presence of optic atrophy. Of the 39 children, 28 (72%) had a below-normal WeeFIM score. CONCLUSIONS In 25 participants (7%) completing the 6-year examination, cortical visual impairment was considered the primary cause of visual loss. The remainder likely had components of both anterior and posterior visual pathway disease. Clinical synthesis of ocular anatomy and visual and neurologic function is required to determine the etiology of poor vision in these children.
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Affiliation(s)
- R Michael Siatkowski
- Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma, Oklahoma City, Oklahoma 73104, USA.
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Tlucek PS, Grace SF, Anderson MP, Siatkowski RM. Effect of the oxygen saturation target on clinical characteristics of early- versus late-onset retinopathy of prematurity. J AAPOS 2012; 16:70-4. [PMID: 22370669 DOI: 10.1016/j.jaapos.2011.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/01/2011] [Accepted: 10/12/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between postmenstrual age of onset of retinopathy of prematurity (ROP) and the need for treatment, while examining the effects of two different neonatal oxygen saturation protocols on this relationship. METHODS A retrospective chart review was conducted for eligible inborn infants born before and after the institution of a new oxygen protocol adjusting target oxygen saturation from 90%-99% to 85%-93%. Early versus late-onset ROP was defined as first presence of any stage disease on examination at <36 versus ≥ 36 weeks' postmenstrual age, respectively. RESULTS The median birth weight/postmentrual age of infants was 840 g per 26.1 weeks (early-onset ROP) versus 952.5 g per 28 weeks (late-onset ROP; P < 0.01 vs P < 0.01). ROP developed in 119 of 369 (32.2%) of high oxygen target infants, and 100 of 373 (26.8%) infants in the low-target group (P = 0.11). Cumulatively, 35 of 144 (24.3%) of early-onset and 8 of 69 (11.6%) of late-onset patients required treatment (P = 0.03). Maximal severity of disease after treatment, including retinal detachment frequency, was similar in early- and late-onset patients, independent of the oxygen protocol (P = 1.00). CONCLUSIONS The clinical behavior of type 1 ROP is similar in early-and late-onset disease, regardless of oxygen saturation targets. Type 1 ROP disease occurred in 11.6% of patients with late-onset ROP.
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Affiliation(s)
- Paul S Tlucek
- Dean A. McGee Eye Institute, Oklahoma City, Oklahoma 73104, USA
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Siatkowski RM. The decompensated monofixation syndrome (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 2011; 109:232-250. [PMID: 22253490 PMCID: PMC3259678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To describe the clinical features and response to treatment of patients with decompensated monofixation syndrome (MFS) and to propose a hypothesis for a decompensation mechanism in such patients. METHODS Fourteen adults with MFS who had been symptomatically stable for a mean duration of 25 years developed diplopia in the absence of neurologic or orbital disease. After retrospective chart review, they underwent detailed orthoptic testing. Results from this cross-sectional analysis were compared with similar data from 16 control subjects with stable MFS. RESULTS Compared to stable MFS patients, decompensated subjects had significantly poorer horizontal fusional amplitudes but greater torsional fusional amplitudes; they were also more likely to have a small vertical strabismus and to have received initial treatment later. Stable subjects, however, also had subnormal horizontal as well as torsional fusional amplitudes. There was no difference between groups with respect to refractive error, amblyopia, type or prior treatment of strabismus, stereoacuity, or angle of deviation. After treatment, all patients regained monofixational alignment, but up to one-third had continued diplopia. Symptoms recurred in two patients whose treatment was initially successful. CONCLUSIONS Patients with MFS lose fusional amplitudes over time. In some cases this results in development of sensory torsion with secondary decompensation and diplopia. The rate of decompensation averages 7% per year from ages 20 to 70. Treatment for decompensation offers excellent motor results, but sensory symptoms may persist and recurrent symptoms may develop. Monitoring and maintenance of fusional vergence amplitudes should be part of the routine care for patients with MFS.
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Affiliation(s)
- R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
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Siatkowski RM, Yanovitch TL, Ash JD, Moreau A. The effects of D-penicillamine on a murine model of oxygen-induced retinopathy. J AAPOS 2011; 15:370-3. [PMID: 21907121 PMCID: PMC3644968 DOI: 10.1016/j.jaapos.2011.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 01/25/2023]
Abstract
PURPOSE To determine the effect of intraperitoneal and intravitreal D-penicillamine (DPA) on retinal neovascularization in a murine model of oxygen-induced retinopathy. METHODS On postnatal day 7, 16 mice were injected intraperitoneally with 300 mg/kg/day DPA for 3 days followed by 50 mg/kg/day for 7 days. A different group of 7 mice were injected intraperitoneally with 600 mg/kg/day DPA for 3 days followed by 100 mg/kg/day for 7 days. A third group of 14 mice were injected with 1,500 mg/kg/day DPA for 2 days; a control cohort of 17 mice received intraperitoneal phosphate-buffered saline (PBS). An additional 15 mice underwent intravitreal injection of 1 μL of 100 mg/mL DPA in the right eye and 1 μL PBS intravitreally in the left eye as a control. All groups were placed in a 75% oxygen chamber for 7 days then room air for 3 days before being sacrificed and enucleated. The retinas were stained and flat-mounted to determine the severity of retinal neovascularization by quantifying neovascular buds. RESULTS After intraperitoneal injection, the mean number of glomeruli and tubules was similar in the DPA and PBS groups (P = 1.0), regardless of DPA dosage. The dosage of 1,500 mg/kg/day proved to be uniformly lethal. After intravitreal injections, the mean number of glomeruli (P = 0.16) and tubules (P = 0.7) were similar in the DPA and PBS groups. CONCLUSIONS Neither intraperitoneal nor intravitreal injection of DPA inhibits retinal neovascularization in a murine model of oxygen-induced retinopathy.
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Siatkowski RM, Rhoades ED. Vision screening in Oklahoma public schools--the first 3 years (2007-2010). J Okla State Med Assoc 2011; 104:301-302. [PMID: 22013867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- R Michael Siatkowski
- Community and Family Health Services, Oklahoma State Department of Health, 1000 NE 10th St., Oklahoma City, OK 73117-1299, USA
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Capo H, Repka MX, Edmond JC, Drack AV, Blumenfeld L, Siatkowski RM. Optic nerve abnormalities in children: a practical approach. J AAPOS 2011; 15:281-90. [PMID: 21683634 DOI: 10.1016/j.jaapos.2011.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
Evaluation of children with optic nerve abnormalities is challenging. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, and genetic testing are helpful in the diagnosis and management of these patients. Importantly, many optic nerve problems are not isolated but occur in association with systemic and central nervous system anomalies. The ophthalmologist thus plays a critical role in recognizing patients who warrant systemic and neurologic assessment.
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Affiliation(s)
- Hilda Capo
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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Abstract
A 12-year-old girl presented with painless decreased vision in the left eye. Dilated fundus examination was consistent with Wyburn-Mason syndrome, and subsequent neuroimaging demonstrated a retro-orbital arteriovenous malformation. The etiology of the vision loss is discussed, as well as management options of Wyburn-Mason syndrome.
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Affiliation(s)
- Paul S Tlucek
- Dean McGee Eye Institute, Oklahoma City, OK 73104, USA
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Tlucek PS, Corff KE, Bright BC, Bedwell SM, Sekar KC, Siatkowski RM. Effect of decreasing target oxygen saturation on retinopathy of prematurity. J AAPOS 2010; 14:406-11. [PMID: 21035066 DOI: 10.1016/j.jaapos.2010.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 06/27/2010] [Accepted: 06/30/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The authors of previous studies suggest that the oxygenation status of premature infants contributes to the development of retinopathy of prematurity (ROP). In this study we compared the incidence and severity of ROP before and after institution of a new neonatal intensive care unit oxygen protocol. METHODS A retrospective chart review was performed of all eligible inborn patients screened for ROP during the 2 years immediately before (Group 1) to and the 2 years after (Group 2) the initiation of a new oxygen protocol. In the new protocol, target oxygen saturation was adjusted from 90%-99% to 85%-93%. Treatment criteria adhered to Early Treatment for Retinopathy of Prematurity guidelines for the study's duration. RESULTS There were 387 infants in Group 1 and 386 infants in Group 2 (descriptive statistics adjusted for correlation due to multiple births). Mean birth weights (BWs) and gestational ages were 1,194 g and 29.2 weeks (ranges, 525-2,085 g; 23 2/7-39 6/7 weeks) for Group 1 and 1,139 g and 28.9 weeks (ranges, 520-2,500 g; 22 6/7-35 3/7 weeks) for Group 2 (p = 0.02/0.10). ROP developed in 32.7% of infants in Group 1 and 27.8% in Group 2 (p = 0.17). The incidence of ROP requiring treatment was 19.9% in Group 1 and 20.5% in Group 2 (p = 0.91). Subanalysis of infants with BW ≤ 1,000g (Group 1, n = 119; Group 2, n = 141) revealed ROP incidence of 75.1% versus 57.1%, respectively (p < 0.01); treatable disease occurred in 37.5% and 21.9% of affected infants (p = 0.19). CONCLUSIONS Lowering target oxygen saturation for inborn premature infants was associated with decreased incidence of ROP only in infants with BW ≤ 1,000 g. Severity of disease, including need for treatment, was similar in both groups.
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Affiliation(s)
- Paul S Tlucek
- The Children's Hospital of Oklahoma and Dean A. McGee Eye Institute, Oklahoma City, Oklahoma, USA
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Waller ER, Siatkowski RM, Pardo G. Abnormal Eye Movements Due to Radiographically Silent Ischaemia as a Presenting Sign of Antiphospholipid Syndrome. Neuroophthalmology 2008. [DOI: 10.1080/01658100801952558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kiblinger GD, Wallace BS, Hines M, Siatkowski RM. Spasmus Nutans-Like Nystagmus is Often Associated With Underlying Ocular, Intracranial, or Systemic Abnormalities. J Neuroophthalmol 2007; 27:118-22. [PMID: 17548996 DOI: 10.1097/wno.0b013e318067b59f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is uncertainty as to whether spasmus nutans (SN) is an isolated idiopathic entity or whether there are underlying conditions that could cause or be associated with the nystagmus. We undertook this study to determine the frequency of ocular, intracranial, and systemic conditions in patients with nystagmus having characteristics of SN. METHODS We performed a chart review of 22 consecutive patients examined from 2000 through 2005 at the Dean McGee Eye Institute and Children' Hospital of Oklahoma with nystagmus consistent with SN. We collected information related to gender, age at presentation and age at final visit, visual acuity, refractive error, laterality of nystagmus, presence of head nodding and torticollis, pattern of strabismus, neuroimaging and electroretinography results, and other associated clinical findings. RESULTS Visual acuity was reduced in 75% of eyes at presentation and 58% of eyes at last visit. Eight patients had significant refractive error. Seven patients had strabismus. Two patients had chiasmal gliomas. Four patients had cone or rod/cone dystrophy. Only three patients had no associated ocular, intracranial, or systemic conditions. CONCLUSIONS A substantial proportion of patients presenting with SN-like nystagmus have important underlying ocular, intracranial, or systemic abnormalities that may require evaluation and management.
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Yanovitch TL, Siatkowski RM, McCaffree M, Corff KE. Retinopathy of prematurity in infants with birth weight>or=1250 grams-incidence, severity, and screening guideline cost-analysis. J AAPOS 2006; 10:128-34. [PMID: 16678747 DOI: 10.1016/j.jaapos.2005.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 08/05/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the incidence and severity of retinopathy of prematurity (ROP) in infants with birth weight (BW) 1250 to 1800 g, to examine the influence of systemic conditions on the development of ROP in this population, and to evaluate the cost-effectiveness of various screening guidelines. METHODS We reviewed records from 259 consecutive infants with BW 1250 to 1800 g who were screened for ROP over a 3-year period. Extracted data included presence and severity of ROP, and the following potential risk factors (RF) for ROP development: sepsis, meningitis, necrotizing enterocolitis, intraventricular hemorrhage greater than stage I, pneumothorax, direct bilirubin>2 mg/dl, central line placement, antibiotic treatment>14 days, greater than seven red blood cell (RBC) transfusions, and mechanical ventilation>96 hours. RESULTS The overall incidence of ROP in this population was 4.2%. Two infants had stage 3 ROP, one with plus disease. Infants with stage 3 ROP had significantly lower BW (1299 versus 1484 g, P=0.013) and gestational age (GA) (28 versus 31 weeks, P=0.002) than those with no ROP. No infant with BW>1500 g developed treatable ROP. Conditions that best predicted ROP development in the 1501 to 1800 g BW group were sepsis, ventilation >96 hours, antibiotic use >14 days, RBC transfusions greater than seven units, and central line placement (P=0.001, P=0.001, P=0.012, P=0.014 and P=0.035, respectively). All infants with BW>1500 g who developed ROP had greater than or equal to two of these RF. CONCLUSIONS All cases of high-risk ROP would have been identified by current screening guidelines. Modified screening criteria of infants with (1) BW<or=1500 g or (2) BW 1501 to 2000 g and greater than or equal to two significant RF results in a $587.85 benefit per infant screened.
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Affiliation(s)
- Tammy L Yanovitch
- University of Oklahoma, Department of Ophthalmology, Dean A. McGee Eye Institute, Oklahoma City, OK 73104, USA
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Lim SA, Siatkowski RM, Farris BK. Functional visual loss in adults and children patient characteristics, management, and outcomes. Ophthalmology 2005; 112:1821-8. [PMID: 16140382 DOI: 10.1016/j.ophtha.2005.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 05/06/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the characteristics of functional visual loss (FVL) in adults and children. DESIGN Retrospective chart review. PARTICIPANTS One hundred forty patients diagnosed with FVL over a 5-year period. METHODS Medical records of these patients were reviewed and data analyzed using statistical software. OUTCOME Demographics, underlying organic and psychiatric disease, concomitant psychosocial events, and resolution rates were studied. RESULTS Functional visual loss, with or without functional overlay, was initially diagnosed in 140 patients and was, in retrospect, a correct diagnosis in 138. There were 56 (40.6%) children and 82 (59.4%) adults (mean age, 13.4 and 40.0 years). The gender ratio, incidence of concomitant psychosocial events, incidence of functional overlay, prevalence of migraine or facial pain, and proportion referred for counseling were similar in the 2 groups. Concomitant psychosocial events were primarily social in children and related to trauma in adults. Thirty-two (39.0%) adults had a history of psychiatric illness, versus 10 (17.9%) children (P = 0.008). Symptoms were bilateral in 65.0% of cases. Functional visual loss manifested as visual acuity (VA) loss only occurred in 26.1% of patients, FVL manifested as visual field (VF) loss only was present in 28.3% of patients, and FVL with loss of both VA and VF occurred in 45.6% of patients. There was no significant difference in children versus adults in the proportion of VA, VF, or both being affected. Functional visual loss with coexistent organic disease (functional overlay) was present in 16.7% of patients. Follow-up information was available for 26.1% of patients. Normalization of any one parameter occurred in 58.3% of patients and was more likely in children. Three patients (2.2%) originally felt to have solely functional disease were subsequently diagnosed with organic disease. CONCLUSION Functional visual loss is most common in teenagers, is typically bilateral, and involves both VA and VF. Normal VA was proven half the time at initial consultation. At all ages, patients were predominantly female, and one fifth had migraine, facial pain, or coexistent organic pathology. Concomitant psychosocial events were mainly social in children and related to trauma in adults. Psychiatric disease was twice as likely in adults. Normalization of visual function occurred in a majority of patients. Early-onset macular dystrophies and hereditary optic neuropathies may be misdiagnosed as FVL.
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Affiliation(s)
- Su Ann Lim
- Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73104, USA
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Davitt BV, Dobson V, Good WV, Hardy RJ, Quinn GE, Siatkowski RM, Summers CG, Tung B. Prevalence of myopia at 9 months in infants with high-risk prethreshold retinopathy of prematurity. Ophthalmology 2005; 112:1564-8. [PMID: 16023214 DOI: 10.1016/j.ophtha.2005.03.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Accepted: 03/17/2005] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To examine the prevalence of myopia and high myopia at 9 months corrected age in premature infants who participated in the multicenter randomized trial of Early Treatment for Retinopathy of Prematurity (ETROP). DESIGN Randomized, controlled clinical trial. PARTICIPANTS Four hundred one infants with birth weights of <1251 g in whom prethreshold ROP developed in one or both eyes and who were determined to have a significant risk (> or =15%) of poor structural outcomes without treatment, based on the risk management for ROP program. INTERVENTION Infants with bilateral high-risk prethreshold ROP (n = 317) had 1 eye randomized to early treatment, and the fellow eye was managed conventionally. In asymmetric cases (n = 84), the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management (control). Eyes randomized to early treatment at high-risk prethreshold ROP and eyes randomized to conventional management in which threshold ROP developed received peripheral retinal photocoagulation or cryotherapy. Conventionally managed eyes in which threshold ROP did not develop were observed. Cycloplegic retinoscopy data were obtained at 9 months corrected age from 321 eyes treated early and 307 eyes managed conventionally. MAIN OUTCOME MEASURES Prevalence of myopic (spherical equivalent > or = 0.25 diopters [D]) and highly myopic (> or =5.00 D) eyes in each group. RESULTS The prevalence of myopia (64.5% vs. 69.4%; P = 0.06) and high myopia (25.5% vs. 28.3%; P = 0.20) was similar between eyes treated at high-risk prethreshold and high-risk prethreshold eyes managed conventionally. Among high-risk eyes managed conventionally, the prevalence of myopia (78.2% vs. 53.3%) and high myopia (37.6% vs. 11.2%) was higher when threshold ROP developed than when regression without treatment occurred. Among eyes treated at high-risk prethreshold ROP, the prevalence of myopia (93.3% vs. 91.7% vs. 60.6%) and of high myopia (53.3% vs. 33.3% vs. 20.8%) was higher in eyes with abnormal angle of temporal retinal vessels or macular ectopia than in eyes with no retinal residua. This also held true for conventionally managed eyes. CONCLUSIONS Early treatment at high-risk prethreshold did not place eyes at greater risk of myopia and high myopia than did conventional management of eyes with high-risk prethreshold ROP.
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Affiliation(s)
- Bradley V Davitt
- Department of Ophthalmology, Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA.
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Abstract
PURPOSE We sought to determine whether visual field abnormalities occur in infants with deformational posterior plagiocephaly and to assess whether there is a relationship between the severity and laterality of visual field abnormalities with the severity and laterality of skull deformity. METHODS A retrospective chart review was performed on 40 consecutive infants with deformational posterior plagiocephaly. Each was tested with standardized binocular arc perimetry in the horizontal plane. Sixteen patients also had 3-dimensional computed tomography of the skull. Hemifield asymmetry of >/=20 degrees and/or a decrease in hemifield values by >/=20 degrees from established normal patients was considered abnormal. Visual field data from study patients was plotted against previously published normative data. Graphs comparing visual field defects and laterality to cranial asymmetry also were generated. RESULTS Thirty-five percent of infants with deformational posterior plagiocephaly had constriction of one or both hemifields by at least 20 degrees from established normal patients. Hemifield asymmetry of 20 degrees or more was found in 17.5% of infants tested. There was a significant difference in the worse hemifield values measured in each patient and the standard visual fields obtained from normative data ( P = 0.036). There was no correlation between the laterality of the visual fields to the laterality of the defects. A correlation between severity of hemifield constriction and % asymmetry on computed tomography was noted ( P = 0.209). CONCLUSIONS Deformational posterior plagiocephaly may affect visual field development but neither the laterality nor the severity of skull deformity is predictive of the severity of visual field defects.
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Abstract
Trisomy 8 mosaicism can present with a wide variety of systemic and ophthalmologic manifestations. We report a patient with an extinguished electroretinogram and diffuse retinal pigment epithelial abnormalities suggestive of a rod-cone dystrophy, which has not been previously reported in association with trisomy 8. A finding that has been described in several patients with trisomy 8 is a central corneal opacity, but there are no data regarding the natural history of this finding; the corneal opacity in our patient spontaneously improved. This case expands the clinical spectrum of this rare entity.
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Affiliation(s)
- Donald U Stone
- Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City 73104, USA
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Abstract
Progressive hemifacial atrophy in Parry-Romberg syndrome is associated with a wide variety of ophthalmologic findings. Progressive visual loss, especially in the first decade, is rare in this condition. We present a young girl originally felt to have linear scleroderma and anisometropic amblyopia, who was eventually diagnosed with Parry-Romberg syndrome as the cause of her cutaneous and ophthalmologic findings.
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Affiliation(s)
- Thomas A Finley
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
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