1
|
Janetos TM, Goldstein DA, Yeldandi A, Kurup SP, Bhat P. Multimodal imaging of an acute presentation of ocular histoplasmosis syndrome in an immunocompetent patient. Am J Ophthalmol Case Rep 2023; 32:101896. [PMID: 37546375 PMCID: PMC10400860 DOI: 10.1016/j.ajoc.2023.101896] [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: 02/26/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Presumed ocular histoplasmosis syndrome (POHS) is a posterior segment disorder that is usually subclinical unless choroidal neovascular membrane (CNVM) develops. It is thought to be the sequela of a prior systemic infection with Histoplasma capsulatum, and evidence supporting this association is based on epidemiologic, animal, and few enucleation studies. Acute presentation of chorioretinal involvement during an initial histoplasmosis systemic infection in immunocompetent patients is rarely reported, presumably due to the usual lack of or minimal symptoms of both the systemic and ocular disease. We report on an immunocompetent male with choroidal lesions detected during disseminated histoplasmosis infection and characterize the lesions using multimodal imaging. Observations A 17-year-old male presented when routine optometry screening detected two deep, yellowish-white lesions in the left fundus. Optical coherence tomography (OCT) imaging confirmed a choroidal mass with extension through Bruch's membrane into the subretinal space and a small amount of subretinal fluid. Fluorescein angiography was suggestive of CNVM. There were no clinical findings of intraocular inflammation, and the patient was initially lost to follow-up. Eight weeks after last follow-up, the patient presented to the emergency department with fatigue, mild respiratory symptoms, and abdominal pain for the last month. Imaging revealed a mediastinal mass with hilar extension and innumerable nodules throughout the lung and spleen. Serum Histoplasma IgM/IgG were positive, and biopsy of the mediastinal mass revealed Histoplasma organisms. The patient was treated with antifungals and discharged. The patient underwent an extensive immunologic evaluation while admitted, which did not reveal an underlying immunodeficiency. On last follow-up, the choroidal lesions were smaller and more consolidated, and the subretinal fluid had resolved. Conclusions and Importance We present a patient with choroidal lesions in the setting of disseminated systemic histoplasmosis infection and characterize a lesion using multimodal imaging. The presentation of acute chorioretinal lesions in the setting of biopsy proven systemic Histoplasma infection supports H. capsulatum as the etiology of POHS.
Collapse
Affiliation(s)
- Timothy M. Janetos
- Northwestern University Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
| | - Debra A. Goldstein
- Northwestern University Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
| | - Anjana Yeldandi
- Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, IL, USA
| | - Sudhi P. Kurup
- Northwestern University Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Pooja Bhat
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| |
Collapse
|
2
|
Summers AI, Morrison DG, Chandler DL, Henderson RJ, Chen AM, Leske DA, Walker KR, Li Z, Melia BM, Bitner DP, Kurup SP, Allen M, Phillips PH, Nash DL, Grigorian AP, Kraus CL, Miller AM, Titelbaum JR, Kraker RT, Holmes JM, Cotter SA. A Pilot Randomized Clinical Trial of Base-in Relieving Prism Spectacle Treatment of Intermittent Exotropia. Optom Vis Sci 2023; 100:432-443. [PMID: 37399233 PMCID: PMC10534203 DOI: 10.1097/opx.0000000000002039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 07/05/2023] Open
Abstract
SIGNIFICANCE This pilot randomized trial, the first to evaluate a specific base-in relieving prism treatment strategy for childhood intermittent exotropia, did not support proceeding to a full-scale clinical trial. Defining and measuring prism adaptation in children with intermittent exotropia are challenging and need further study. PURPOSE This study aimed to determine whether to proceed to a full-scale trial of relieving base-in prism spectacles versus refractive correction alone for children with intermittent exotropia. METHODS Children 3 years old to those younger than 13 years with distance intermittent exotropia control score of ≥2 points on the Intermittent Exotropia Office Control Scale (Strabismus 2006;14:147-150; 0 [phoria] to 5 [constant]), ≥1 episode of spontaneous exotropia, and 16 to 35∆ by prism-and-alternate-cover test, who did not fully prism adapt on a 30-minute in-office prism-adaptation test were randomized to base-in relieving prism (40% of the larger of distance and near exodeviations) or nonprism spectacles for 8 weeks. A priori criteria to conduct a full-scale trial were defined for the adjusted treatment group difference in mean distance control: "proceed" (≥0.75 points favoring prism), "uncertain" (>0 to <0.75 points favoring prism), or "do not proceed" (≥0 points favoring nonprism). RESULTS Fifty-seven children (mean age, 6.6 ± 2.2 years; mean baseline distance control, 3.5 points) received prism (n = 28) or nonprism (n = 29) spectacles. At 8 weeks, mean control values were 3.6 and 3.3 points in prism (n = 25) and nonprism (n = 25) groups, respectively, with an adjusted difference of 0.3 points (95% confidence interval, -0.5 to 1.1 points) favoring nonprism (meeting our a priori "do not proceed" criterion). CONCLUSIONS Base-in prism spectacles, equal to 40% of the larger of the exodeviations at distance or near, worn for 8 weeks by 3- to 12-year-old children with intermittent exotropia did not yield better distance control than refractive correction alone, with the confidence interval indicating that a favorable effect of 0.75 points or larger is unlikely. There was insufficient evidence to warrant a full-scale randomized trial.
Collapse
Affiliation(s)
| | | | | | | | - Angela M Chen
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | | | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | - Sudhi P Kurup
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Megan Allen
- Illinois College of Optometry, Chicago, Illinois
| | | | | | | | | | | | | | | | - Jonathan M Holmes
- University of Arizona-Tucson, Tucson, Arizona for the PEDIG Study Group
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| |
Collapse
|
3
|
Kim AB, Cheng BT, Chan KS, Kurup SP. Assessment of the Web Site Availability and Content of Pediatric Ophthalmology Fellowship Programs: A Cross-Sectional Nationwide Study. J Acad Ophthalmol (2017) 2023; 15:e75-e79. [PMID: 38737160 PMCID: PMC10804737 DOI: 10.1055/s-0043-1764474] [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] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/27/2022] [Indexed: 03/15/2023]
Abstract
Background Fellowship program Web sites are a crucial source of information for prospective pediatric ophthalmology applicants, especially in light of the restrictions on in-person interactions due to the coronavirus disease 2019 pandemic. Objective This study examined all pediatric ophthalmology fellowship Web sites for availability and presented recruitment and training content. Methods A full list of all pediatric ophthalmology and strabismus (POAS) fellowship programs were compiled from the Association of University Professors of Ophthalmology (AUPO) directory and the San Francisco Match (SFMatch) application listing. Each fellowship was queried by Google Internet search to identify the program's corresponding Web site. The content of Web sites was evaluated using 20 predetermined recruitment and training criteria. All data were collected in February 2022. Kruskal-Wallis and Mann-Whitney U tests were constructed to examine differences by geographic location, program size, number of teaching faculty, and affiliation with a top ophthalmology residency program. Results There were 45 pediatric ophthalmology fellowships identified from the AUPO and SFMatch. All pediatric ophthalmology fellowships had an available program Web site. However, there was significant variability in content, and the average Web site had approximately half of the evaluated criteria. POAS Web sites reported a greater number of recruitment criteria than program training criteria. There were no differences by program size, number of faculty, affiliation with a top residency program, or geographic location in the number of observed criteria. Conclusions This study provides data to drive efforts to improve pediatric ophthalmology fellowship Web sites. Pediatric ophthalmology fellowship Web sites are missing important information, and there are opportunities to improve program Web sites, regardless of program size, number of faculty, affiliation with a top residency, and geographic location. Informative, accurate Web sites may attract qualified candidates, and as a result, elevate the likelihood that interviewed candidates are well-suited to the program. As such, improvements to fellowship Web sites can streamline the application process and increase a program's success rate in the match.
Collapse
Affiliation(s)
- Anne B. Kim
- Department of Ophthalmology, Rush University Medical College, Chicago, Illinois
| | - Brian T. Cheng
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kyle S. Chan
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sudhi P. Kurup
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Ophthalmology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
4
|
Cheng BT, Laurenti KD, Kurup SP. Neonatal eyelid penetration from insertion of a fetal scalp electrode: a case report. BMC Pregnancy Childbirth 2022; 22:878. [DOI: 10.1186/s12884-022-05146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
A fetal scalp electrode (FSE), first described by Edward Hon in 1967, is an intrapartum monitoring device embedded directly into the fetal scalp for an accurate measure of fetal heart rate. Though use of an FSE is generally safe, complications can occur from misplacement, including ophthalmic injury.
Case presentation
Patient was a 28-year-old G6P5006 who presented for induction of labor at 39 weeks due to asymptomatic bilateral pulmonary embolism. Concerning findings on external fetal monitoring led to placement of a fetal scalp electrode for close monitoring. Upon delivery, the neonate was noted to have the FSE embedded in the left upper eyelid. Ophthalmology was consulted and could not rule out ocular injury on external examination at the bedside. Examination under anesthesia in the operating room demonstrated no penetration of the ocular globe, and the eyelid laceration was sutured. The laceration was well-healing at one-week follow-up with no further complications.
Conclusion
Facial or brow presentation during delivery is rare but may increase the risk for misplacement of an FSE. Ultrasound verification of vertex position is warranted immediately prior to placing an FSE for patients at higher risk of facial or brow presentation. Periorbital edema of neonates may protect against damage to deeper structures. However, Ophthalmology should be consulted to rule out ocular injury if the FSE is placed in the periocular region.
Collapse
|
5
|
Cheng BT, Kim AB, Nadimpalli S, Pineles SL, Kurup SP. Association of Pediatric Strabismus and Functional Impairment: A Cross-sectional Nationwide Analysis. J Pediatr Ophthalmol Strabismus 2022:1-9. [PMID: 36102269 DOI: 10.3928/01913913-20220728-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the association of childhood strabismus with functional limitation to identify particular domains of impairment. METHODS The authors analyzed 201 children ages 5 to 17 years with strabismus enrolled in the 1996-2015 Medical Expenditure Panel Surveys, representative annual surveys of the U.S. POPULATION Functional impairment was assessed using the Columbia Impairment Scale (CIS), a validated measure of behavioral and psychosocial functioning. A CIS score of 16 or greater defined clinically significant functional impairment. Multivariate regression models adjusted for age, sex, race, ethnicity, household income, geographic location, and insurance type were constructed to examine the association of strabismus diagnosis with overall impairment and individual domains of function. RESULTS Children diagnosed as having strabismus had higher rates of clinically significant functional impairment compared to those without strabismus (15.1% vs 9.1%, adjusted odds ratio [95% CI]: 1.82 [1.11 to 2.97], P = .02). Moreover, strabismus diagnosis was associated with higher rates of problems with getting along with their mother (1.70 [1.21 to 2.40], P = .003) and father (1.66 [1.16 to 2.38], P = .006), getting along with other children (1.67 [1.16 to 2.40], P = .006), behavior at home (1.94 [1.37 to 2.74], P = .0002), staying out of trouble (1.52 [1.04 to 2.23], P = .03), nervousness (1.49 [1.05 to 2.11], P = .02), and getting involved with sports and hobbies (1.55 [1.03 to 2.34], P = .04). CONCLUSIONS Childhood strabismus is associated with 1.8-fold greater odds of clinically significant functional impairment, with greater dysfunction in specific relationship and behavioral domains. Functional burden may be an important consideration in management decisions. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
Collapse
|
6
|
Repka MX, Dean TW, Kraker RT, Li Z, Yen KG, de Alba Campomanes AG, Young MP, Rahmani B, Haider KM, Whitehead GF, Lambert SR, Kurup SP, Kraus CL, Cotter SA, Holmes JM. Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years. JAMA Ophthalmol 2022; 140:269-276. [PMID: 35142808 PMCID: PMC8832311 DOI: 10.1001/jamaophthalmol.2021.6176] [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: 11/14/2022]
Abstract
IMPORTANCE Cataract is an important cause of visual impairment in children. Data from a large pediatric cataract surgery registry can provide real-world estimates of visual outcomes and the 5-year cumulative incidence of adverse events. OBJECTIVE To assess visual acuity (VA), incidence of complications and additional eye operations, and refractive error outcomes 5 years after pediatric lensectomy among children younger than 13 years. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used data from the Pediatric Eye Disease Investigator Group clinical research registry. From June 2012 to July 2015, 61 eye care practices in the US, Canada, and the UK enrolled children from birth to less than 13 years of age who had undergone lensectomy for any reason during the preceding 45 days. Data were collected from medical record reviews annually thereafter for 5 years until September 28, 2020. EXPOSURES Lensectomy with or without implantation of an intraocular lens (IOL). MAIN OUTCOMES AND MEASURES Best-corrected VA and refractive error were measured from 4 to 6 years after the initial lensectomy. Cox proportional hazards regression was used to assess the 5-year incidence of glaucoma or glaucoma suspect and additional eye operations. Factors were evaluated separately for unilateral and bilateral aphakia and pseudophakia. RESULTS A total of 994 children (1268 eyes) undergoing bilateral or unilateral lensectomy were included (504 [51%] male; median age, 3.6 years; range, 2 weeks to 12.9 years). Five years after the initial lensectomy, the median VA among 701 eyes with available VA data (55%) was 20/63 (range, 20/40 to 20/100) in 182 of 316 bilateral aphakic eyes (58%), 20/32 (range, 20/25 to 20/50) in 209 of 386 bilateral pseudophakic eyes (54%), 20/200 (range, 20/50 to 20/618) in 124 of 202 unilateral aphakic eyes (61%), and 20/65 (range, 20/32 to 20/230) in 186 of 364 unilateral pseudophakic eyes (51%). The 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI, 28%-59%) in participants with bilateral aphakia, 7% (95% CI, 1%-12%) in those with bilateral pseudophakia, 25% (95% CI, 15%-34%) in those with unilateral aphakia, and 17% (95% CI, 5%-28%) in those with unilateral pseudophakia. The most common additional eye surgery was clearing the visual axis, with a 5-year cumulative incidence of 13% (95% CI, 8%-17%) in participants with bilateral aphakia, 33% (95% CI, 26%-39%) in those with bilateral pseudophakia, 11% (95% CI, 6%-15%) in those with unilateral aphakia, and 34% (95% CI, 28%-39%) in those with unilateral pseudophakia. The median 5-year change in spherical equivalent refractive error was -8.38 D (IQR, -11.38 D to -2.75 D) among 89 bilateral aphakic eyes, -1.63 D (IQR, -3.13 D to -0.25 D) among 130 bilateral pseudophakic eyes, -10.75 D (IQR, -20.50 D to -4.50 D) among 43 unilateral aphakic eyes, and -1.94 D (IQR, -3.25 D to -0.69 D) among 112 unilateral pseudophakic eyes. CONCLUSIONS AND RELEVANCE In this cohort study, development of glaucoma or glaucoma suspect was common in children 5 years after lensectomy. Myopic shift was modest during the 5 years after placement of an intraocular lens, which should be factored into implant power selection. These results support frequent monitoring after pediatric cataract surgery to detect glaucoma, visual axis obscuration causing reduced vision, and refractive error.
Collapse
Affiliation(s)
| | | | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | | | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Kathryn M. Haider
- Opthalmology Department, Riley Hospital for Children, Indiana University, Indianapolis
| | | | - Scott R. Lambert
- Department of Ophthalmology, Stanford University, Palo Alto, California
| | - Sudhi P. Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Susan A. Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | - Jonathan M. Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson
| | | |
Collapse
|
7
|
Zhou Y, Shapiro MJ, Burton BK, Mets MB, Kurup SP. Case report: A case of Norrie disease due to deletion of the entire coding region of NDP gene. Am J Ophthalmol Case Rep 2021; 23:101151. [PMID: 34189345 PMCID: PMC8220341 DOI: 10.1016/j.ajoc.2021.101151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/16/2020] [Revised: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 10/24/2022] Open
Abstract
Purpose Norrie disease is a rare X-linked recessive vitreoretinopathy. Variants of the NDP gene are associated with this condition. This case reports aims to demonstrate the variations of clinical presentations and exam findings of this disease. Observations A retrospective chart review of the patient's ocular and systemic findings and imaging results was performed. The patient had received genetic testing, including mutational analysis of targeted genes associated with retrolental masses. The patient had a comprehensive eye exam for bilateral leukocoria, demonstrating large retrolental masses, anterior polar cataracts, stretched ciliary processes, and roving eye movements. B-scan ultrasonography and magnetic resonance imaging indicated total, funnel-shaped retinal detachments, which is a unique retinal configuration in Norrie disease. Genetic testing confirmed deletion of the coding region of all three exons in the NDP gene, which confirmed Norrie disease. He has not shown any extraocular involvement to date. Conclusions and Importance This is a case demonstrating the association between deletion of the coding region NDP gene and Norrie disease. The phenotypical variation of this disease warrants further studies of genotype-phenotype correlations and mutations of the NDP gene.
Collapse
Affiliation(s)
- Yujia Zhou
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA
| | - Michael J Shapiro
- Retina Consultants, Ltd., 2454 E Dempster St Ste 400, Des Plaines, IL, 60016, USA
| | - Barbara K Burton
- Division of Genetics, Birth Defects & Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 440, Chicago, IL, 60611, USA
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 440, Chicago, IL, 60611, USA
| |
Collapse
|
8
|
Abstract
AIM To investigate the impact of concussion on pupillary function in children by examining pupillometric parameters and assessing for differences in children reporting photosensitivity. METHODS Retrospective chart review was performed of pediatric patients referred for visual symptoms after concussion from 2017 to 2018 seen in a single academic outpatient clinic. Pupillometry data of 92 patients were included. Outcomes were compared to normative pediatric data from the same institution by 2-sample t tests. The association between photosensitivity and each outcome was assessed by use of linear mixed models with photosensitivity as a fixed effect and random patient effect. RESULTS Outcomes of 181 eyes in 92 concussion patients were averaged by patient and compared to normative values in scotopic conditions. Concussion patients had an average age of 13.8 ± 2.64 years. Average constriction velocity (P = .0008), maximum constriction velocity (P = .0012), and average dilation velocity (P = .0034) were faster in concussion patients, whereas 75% recovery times (P = .0027) was increased. Photosensitivity did not significantly affect measured pupillary responses. CONCLUSION Dynamic pupillary responses may be increased in pediatric concussion. Pupillometry may provide insight into the complex pathophysiological changes underlying pediatric concussion.
Collapse
Affiliation(s)
- Jerry Hsu
- Department of Ophthalmology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Jerry Hsu, MD and Magdalena Stec, OD are co-first authors of this article
| | - Magdalena Stec
- Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Jerry Hsu, MD and Magdalena Stec, OD are co-first authors of this article
| | - Hantamalala Ralay Ranaivo
- Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nina Srdanovic
- Division of Biostatistics, Department of Preventive Medicine, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sudhi P Kurup
- Department of Ophthalmology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
9
|
Sternfeld A, Taranum Basith SS, Kurup SP, Basti S. Secondary intraocular lens implantation using the flanged intrascleral fixation technique in pediatric aphakia: case series and review of literature. J AAPOS 2020; 24:286.e1-286.e6. [PMID: 33045378 DOI: 10.1016/j.jaapos.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/11/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present a pediatric case series in which the flanged intrascleral intraocular lens (IOL) fixation technique (Yamane technique) was used to correct aphakia. METHODS The surgical database of a single tertiary children's hospital was reviewed to identify all patients who underwent secondary IOL implantation by a single surgeon from May 2018 to January 2020. The medical records and operative reports of all patients operated on using the Yamane technique were reviewed retrospectively. Intra- and postoperative complications and pre- and postoperative vision and refraction were documented to assess outcomes. RESULTS A total of 12 eyes of 10 consecutive patients were included. Mean age at surgery was 10 ± 6 years. Indications for scleral fixation were ectopia lentis (secondary to Marfan syndrome [n = 3] or idiopathic [n = 1]), lens subluxation with intermittent pupillary block secondary to Weill- Marchesani syndrome (n = 2), early childhood lensectomy with insufficient residual capsular support (n = 5), and traumatic aphakia after an open globe (n = 1). Mean follow-up was 8 ± 5 months. No major intraoperative complications occurred. Postoperatively 1 patient required IOL repositioning 1 week after surgery. The location of one haptic was noted to be intrascleral but superficial in another patient, who did not require surgical intervention. The mean postoperative astigmatism was 2 ± 2 D. Good visual results were achieved in all eyes. CONCLUSIONS With slight modifications, the Yamane technique can be adapted to the pediatric eye. This technique has significant surgical and anatomic advantages and provides stable IOL fixation. Visual outcomes and adverse events compare favorably with older techniques.
Collapse
Affiliation(s)
- Amir Sternfeld
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States
| | | | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Surendra Basti
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States.
| |
Collapse
|
10
|
Zhou Y, Ryan ME, Mets MB, Yoon HH, Rahmani B, Kurup SP. Aplasia of the Optic Nerve: A Report of Seven Cases. Neuroophthalmology 2020; 44:332-338. [DOI: 10.1080/01658107.2019.1617320] [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: 10/26/2022] Open
Affiliation(s)
- Yujia Zhou
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Maura E. Ryan
- Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marilyn B. Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hawke H. Yoon
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sudhi P. Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
11
|
Esfandiari H, Prager A, Hassanpour K, Kurup SP, Mets-Halgrimson R, Yoon H, Zeid JL, Mets MB, Rahmani B. The Long-term Visual Outcomes of Primary Congenital Glaucoma. J Ophthalmic Vis Res 2020; 15:326-330. [PMID: 32864063 PMCID: PMC7431714 DOI: 10.18502/jovr.v15i3.7451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/02/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the long-term visual outcomes of ab externo trabeculotomy for primary congenital glaucoma (PCG) at a single pediatric ophthalmology center. Methods In this retrospective single-center case series, data from 63 eyes of 40 patients who underwent ab externo trabeculotomy between September 2006 and June 2018 were included. The data were analyzed for best corrected visual acuity (BCVA), stereopsis, and surgical success. Kaplan–Meier analysis was performed using the surgical success criteria defined as intraocular pressure (IOP) ≤ 21 mmHg and ≥ 20% below baseline without the need for additional glaucoma surgery. Results BCVA at the time of diagnosis was 0.37 ± 0.48 logMAR, which changed to 0.51 ± 0.56 logMAR at the final follow-up (P = 0.08). Twenty-five percent of patients had BCVA equal to or better than 20/40 at the final visit. The mean refraction at baseline was –4.78 ± 5.87 diopters, which changed to less myopic refraction of –2.90 ± 3.83 diopters at the final visit. Optical correction was prescribed in 66% of eyes at the final visit. The average final stereopsis was 395.33 sec of arc. The linear regression model showed a significant association between the surgery success rate and final BCVA as well as stereoacuity (P-values: 0.04 and 0.03, respectively). Intraocular pressure (IOP) decreased significantly from 29.79 ± 7.67 mmHg at baseline to 16.13 ± 3.41 mmHg at the final follow-up (P = 0.001). Conclusion Patients with PCG can achieve an acceptable visual acuity and stereoacuity, particularly in cases of timely intervention and close follow-up.
Collapse
Affiliation(s)
- Hamed Esfandiari
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Alisa Prager
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kiana Hassanpour
- Ophthalmic Research Center, Institutue for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Rebecca Mets-Halgrimson
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Hawke Yoon
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Janice Lasky Zeid
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| |
Collapse
|
12
|
Shah SS, Ranaivo HR, Mets-Halgrimson RB, Rychlik K, Kurup SP. Establishing a normative database for quantitative pupillometry in the pediatric population. BMC Ophthalmol 2020; 20:121. [PMID: 32216772 PMCID: PMC7098071 DOI: 10.1186/s12886-020-01389-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population in a clinical setting. METHODS Pupillometry was obtained prospectively for consecutive, normal patients < 18 years old being evaluated by Lurie Children's Ophthalmology. Quantitative data included maximum (MAX) and minimum (MIN) diameters, constriction percentage (CON), latency (LAT), average (ACV) and maximum (MCV) constriction velocities, average dilation velocity (ADV), and 75% recovery time (T75). Iris color was noted as light, intermediate, or dark. RESULTS 196 eyes of 101 participants (42.6% male, ages 1-17 years, average age 10.3 years) were analyzed. Mean MAX was 6.6 mm (5.1-8.1 mm 95% CI); MIN was 4.7 mm (3.1-6.1 mm 95% CI); CON was 30% (17-42 95% CI); LAT was 230 milliseconds (160-300 ms 95% CI); ACV was 3.70 mm/sec (2.21-5.18 mm/sec 95% CI); and ADV was 0.88 mm/sec (0.38-1.38 mm/sec 95% CI). Age had a positive correlation with MAX, MIN, and CON. 84.2 and 95.8% of participants showed resting pupil asymmetry of ≤0.5 mm and ≤ 1.0 mm, respectively. CONCLUSIONS Quantitative pupillometry can be a useful tool for screening pediatric patients. We sought to establish normative data in this group. We found males to have significantly greater MCV and CON than females (p < 0.05). Also, age had a positive correlation with MAX, MIN, and CON.
Collapse
Affiliation(s)
- Sanket S Shah
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rebecca B Mets-Halgrimson
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Karen Rychlik
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Sudhi P Kurup
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| |
Collapse
|
13
|
Abstract
Background: Congenital disorders of glycosylation (CDG) are a group of hereditary multisystem disorders characterized by hypoglycosylation of glycoproteins. CDG type I results in a defect in the assembly of lipid-linkedoligosaccharides or their transfer onto nascent glycoproteins. Ocular abnormalities are common in CDG, but there is no report of detailed ophthalmologic evaluation in patients with CDG type Ig in the literature.Materials and Methods: Retrospective chart review of a case of CDG type Ig with novel variant in the associated gene: ALG12.Results: In addition to typical systemic findings of CDG, our case was found to have exotropia, bilateralcataracts, and retinitis pigmentosa with extinguished electroretinography in photopic and scotopic conditions.Conclusions: We hope to extend the understanding of ALG12-related CDG type Ig with these ophthalmologic observations.
Collapse
Affiliation(s)
- Hamed Esfandiari
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine H Kim
- Division of Genetics, Birth Defects & Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
14
|
Esfandiari H, Basith SST, Kurup SP, Mets-Halgrimson R, Hassanpour K, Yoon H, Zeid JL, Mets MB, Tanna AP, Rahmani B. Long-term surgical outcomes of ab externo trabeculotomy in the management of primary congenital glaucoma. J AAPOS 2019; 23:222.e1-222.e5. [PMID: 31251972 DOI: 10.1016/j.jaapos.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/25/2019] [Revised: 05/07/2019] [Accepted: 05/11/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze the long-term results of ab externo trabeculotomy with a Harms trabeculotome at a single, tertiary care pediatric hospital. METHODS The medical records of pediatric patients operated on between September 2006 and June 2018 were reviewed retrospectively. Kaplan-Meier analysis was performed, with success defined as postoperative intraocular pressure (IOP) of ≤21 mm Hg, >20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio. RESULTS A total of 63 eyes of 40 patients were included. The cumulative probability of success rate was 83% at 3 months, 76% at 6, 73% at 12, 72% at 18, and 65% at final visit. Presentation within 3 months of life was associated with a less favorable outcome. Thirty-five eyes (56%) underwent repeat trabeculotomy to treat a different area of the trabecular meshwork because of inadequately controlled IOP after the first session. Of those who needed another session of trabeculotomy, the final success rate was 60.2%. IOP significantly decreased from 29.79 ± 7.67 mm Hg at baseline to 16.13 ± 3.41 mm Hg by final follow-up (P = 0.001). Patients were followed for an average of 85.74 ± 32.95 months. IOP and success rates remained stable 18 months after surgery. CONCLUSIONS In our patient cohort, ab externo trabeculotomy was associated with good long-term results. More extensive trabeculotomy (ie, more than one procedure) was associated with better long-term success rates.
Collapse
Affiliation(s)
- Hamed Esfandiari
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States.
| | - Syeda Sumara Taranum Basith
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Rebecca Mets-Halgrimson
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Kiana Hassanpour
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hawke Yoon
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Janice Lasky Zeid
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Angelo P Tanna
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States
| |
Collapse
|
15
|
Kinori M, Jagannathan N, Langguth AM, Sasso MA, Mets MB, Rahmani B, Yoon H, Mets-Halgrimson R, Kurup SP, Zeid JL. Pediatric Nd:YAG laser capsulotomy in the operating room: review of 87 cases. Int J Ophthalmol 2019; 12:779-783. [PMID: 31131236 DOI: 10.18240/ijo.2019.05.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/09/2018] [Accepted: 12/25/2018] [Indexed: 02/03/2023] Open
Abstract
AIM To report a large series of children having Nd:YAG laser capsulotomy in the operating room using the lateral decubitus position. METHODS Medical records of children who underwent Nd:YAG laser capsulotomy in the operating room at Ann & Robert H. Lurie Children's Hospital of Chicago between September 2008 and April 2017 were reviewed. Induction of general anesthesia and intubation was performed in the supine position after which the patient was placed in lateral decubitus position. The Nd:YAG laser capsulotomy was performed using a standard protocol. At the completion of the procedure, the patient was turned back into the supine position and extubated. RESULTS This study included 87 eyes of 60 patients. Patient's age ranged from 1 to 18y (mean 6.4±4.1y). In most cases (84/87, 97%), the procedure was performed under general anesthesia. In all cases, good focus on the membrane was achieved, and the procedure was performed successfully. There were no intraoperative ocular or anesthesia-related complications. CONCLUSION When performing Nd:YAG laser capsulotomy in the operating room, the lateral decubitus position allows an easy and safe approach without the risk of potentially devastating complications that have been associated with the previously described sitting and prone positions.
Collapse
Affiliation(s)
- Michael Kinori
- The Goldschleger Eye Institute, Sheba Medical Center, Tel HaShomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 52621, Israel
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States
| | - Anne M Langguth
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Marjorie A Sasso
- Department of Surgical Services, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Hawke Yoon
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Rebecca Mets-Halgrimson
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Janice L Zeid
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, United States.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| |
Collapse
|
16
|
Hassan S, Rahmani B, Rastatter JC, Jaju AI, Kurup SP. Trauma-associated Pott's puffy tumor: an ophthalmologic perspective. Orbit 2019; 39:38-40. [PMID: 30773962 DOI: 10.1080/01676830.2019.1573909] [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] [Indexed: 10/27/2022]
Abstract
Pott's puffy tumor is a significant complication of frontal sinusitis that leads to frontal bone osteomyelitis and can be associated with frontal swelling, subperiosteal abscess, and intracranial abscess. It may be associated with antecedent trauma and typically presents in adolescents. Orbital involvement is rarely reported. We describe the case of a 15-year-old male who presented after blunt facial trauma with orbital hematoma and developed Pott's puffy tumor with orbital cellulitis and subperiosteal abscess. Management required a collaborative, multidisciplinary effort that yielded a good outcome.
Collapse
Affiliation(s)
- Shahzeb Hassan
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey C Rastatter
- Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alok I Jaju
- Division of Neuroradiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
17
|
Abstract
BACKGROUND Previous studies of partially accommodative esotropia (PAET) have assessed factors requiring surgery and alignment outcomes. The purpose of the present study was to additionally evaluate stereoacuity in patients who required surgery for their nonaccommodative component. METHODS The medical records of consecutive patients with PAET who underwent bilateral medial rectus recession from April 1990 to July 2010 to treat the nonaccommodative component were reviewed retrospectively. Preoperative data included visual acuity, stereoacuity, cycloplegic refraction, deviation at distance and near, and age at surgery. The primary outcomes were stereoacuity and alignment. RESULTS A total of 84 patients were included. Stereopsis by the Titmus StereoTest was demonstrated in 51 (61%) by the final visit. The average follow-up time was 4.4 ± 2.8 years (range, 0.8-11.0 years). Fine stereopsis (100 arcsec or better) was appreciated in 29 patients (35%, 57% of those with stereopsis). Of those with residual esotropia, 11 (50%) demonstrated stereopsis, and 7 (32%) appreciated fine stereoacuity. No exotropic patient had stereopsis. There was a statistically significant correlation between age at time of surgery and stereopsis at 1 year (ρ = 0.233; P = 0.033) but not at the final visit (ρ = 0.106, P = 0.34). Of the 84 patients, 56 (67%) had a favorable alignment (within 10Δ of orthotropia) at the final visit; 22 (26%) had residual esotropia; and 6 (7%) had consecutive exotropia. CONCLUSIONS In this subset of esotropic patients who required surgery for their nonaccommodative component, favorable sensory outcomes can be achieved. Furthermore, favorable stereoacuity can be found even when there is a residual esodeviation.
Collapse
Affiliation(s)
- Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Heath W Barto
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Gihyun Myung
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
18
|
Kinori M, Schwartzstein H, Zeid JL, Kurup SP, Mets MB. Congenital lymphocytic choriomeningitis virus-an underdiagnosed fetal teratogen. J AAPOS 2018; 22:79-81.e1. [PMID: 29274373 DOI: 10.1016/j.jaapos.2017.08.011] [Citation(s) in RCA: 9] [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: 08/18/2016] [Revised: 07/19/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
Abstract
Congenital lymphocytic choriomeningitis virus (LCMV) infection is associated with high mortality and morbidity. Although the number of cases reported in the literature has been increasing, it might still be clinically an underdiagnosed human fetal teratogen. We report 2 more cases of serologically proven congenital LCMV infection. One case presented with Aicardi-like syndrome features. Since congenital LCMV infection may mimic Aicardi syndrome, serologic testing should be considered in the workup of patients with Aicardi syndrome to rule out LCMV infection.
Collapse
Affiliation(s)
- Michael Kinori
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Hal Schwartzstein
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Janice Lasky Zeid
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudhi P Kurup
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Marilyn B Mets
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| |
Collapse
|
19
|
Shah SS, Kurup SP, Ralay Ranaivo H, Mets-Halgrimson RB, Mets MB. Pupillary manifestations of Marfan syndrome: from the Marfan eye consortium of Chicago. Ophthalmic Genet 2018; 39:297-299. [DOI: 10.1080/13816810.2018.1424207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sanket S. Shah
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sudhi P. Kurup
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | - Rebecca B. Mets-Halgrimson
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Marilyn B. Mets
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
20
|
Zhou Y, Wojcik A, Sanders VR, Rahmani B, Kurup SP. Ocular findings in a patient with oculofaciocardiodental (OFCD) syndrome and a novel BCOR pathogenic variant. Int Ophthalmol 2017; 38:2677-2682. [PMID: 29058245 DOI: 10.1007/s10792-017-0754-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 07/20/2017] [Accepted: 10/16/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE To report a case of OFCD associated with a de novo BCOR pathogenic variant and highlight the ocular findings and possible mechanisms. METHODS A retrospective chart review of the patient's ocular and systemic findings was performed. The patient underwent diagnostic whole exome sequencing (WES). RESULTS The patient had a comprehensive eye exam in infancy demonstrating bilateral congenital cataracts consisting of posterior lenticonus with a posterior cortical opacity. She also had blepharoptosis with a hooded appearance and retinal pigment hypertrophy of the inferior retina bilaterally. Systemic findings include atrial septal defect, patent ductus arteriosus, congenital clubfoot, syndactyly, tethered cord, and laryngeal cleft. WES identified a de novo heterozygous R1136X pathogenic variant in the BCOR gene. CONCLUSION The typical ocular manifestation of OFCD syndrome is congenital cataracts, which can have a significant impact on visual development and so should be considered in patients with multiple medical issues that may fit the diagnosis. A comprehensive eye exam in these patients is thus warranted.
Collapse
Affiliation(s)
- Yujia Zhou
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 70, Chicago, IL, 60611, USA.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Antonina Wojcik
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 70, Chicago, IL, 60611, USA.,Division of Genetics Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Victoria R Sanders
- Division of Genetics Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 70, Chicago, IL, 60611, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 70, Chicago, IL, 60611, USA. .,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
21
|
Kinori M, Simon SS, Kurup SP, Mets-Halgrimson R, Jampol LM, Zeid JL. Idiopathic bilateral central artery occlusion in a young woman. J AAPOS 2017; 21:418-420.e1. [PMID: 28844751 DOI: 10.1016/j.jaapos.2017.04.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/14/2017] [Accepted: 04/20/2017] [Indexed: 11/26/2022]
Abstract
Central retinal artery occlusion (CRAO) is uncommon among children and young adults. Bilateral CRAO before the age of 18 years are extremely rare. We present a case of an idiopathic bilateral CRAO in a young healthy female.
Collapse
Affiliation(s)
- Michael Kinori
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Shira S Simon
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudhi P Kurup
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rebecca Mets-Halgrimson
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lee M Jampol
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Janice Lasky Zeid
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| |
Collapse
|
22
|
Affiliation(s)
- WanWan Xu
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
23
|
Xu W, Kurup SP, Fawzi AA, Durbin MK, Maumenee IH, Mets MB. Comparative data on SD-OCT for the retinal nerve fiber layer and retinal macular thickness in a large cohort with Marfan syndrome. Ophthalmic Genet 2017; 38:34-38. [PMID: 28095089 DOI: 10.1080/13816810.2016.1275017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/20/2022]
Abstract
PURPOSE To report the distribution of macular and optic nerve topography in the eyes of individuals with Marfan syndrome aged 8-56 years using spectral domain optical coherence tomography (SD-OCT). METHODS Thirty-three patients with Marfan syndrome underwent a full eye examination including slit-lamp biomicroscopy, indirect ophthalmoscopy, and axial length measurement; and SD-OCT measurements of the retinal nerve fiber layer (RNFL) and macular thickness. RESULTS For patients between the ages of 8 and 12 years, the average RNFL thickness is 98 ± 9 μm, the vertical cup to disc (C:D) ratio is 0.50 ± 0.10, the central subfield thickness (CST) is 274 ± 38 μm, and the macular volume is 10.3 ± 0.6 mm3. For patients between the ages of 13 and 17 years, the average RNFL is 86 ± 16 μm, the vertical C:D ratio is 0.35 ± 0.20, the CST is 259 ± 15 μm, and the macular volume is 10.1 ± 0.5 mm3. For patients 18 years or older, the average RNFL is 89 ± 12 μm, the vertical C:D ratio is 0.46 ± 0.18, the CST is 262 ± 20 μm, and the macular volume is 10.2 ± 0.4 mm3. When the average RNFL data are compared to a normative, age-adjusted database, 6 of 33 (18%) were thinner than the 5% limit. CONCLUSION This study reports the distribution of SD-OCT data for patients with Marfan syndrome. Compared to a normative database, 18% of eyes with Marfan syndrome had RNFL thickness < 5% of the population.
Collapse
Affiliation(s)
- WanWan Xu
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA.,b Division of Ophthalmology , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois , USA
| | - Sudhi P Kurup
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA.,b Division of Ophthalmology , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois , USA
| | - Amani A Fawzi
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA
| | - Mary K Durbin
- c Carl Zeiss Meditec, Inc ., Dublin , California , USA
| | - Irene H Maumenee
- d Department of Ophthalmology and Visual Sciences , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Marilyn B Mets
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA.,b Division of Ophthalmology , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois , USA
| |
Collapse
|
24
|
Abstract
In this preliminary survey, coprologic examination of six different captive snake species housed in three different herpetariums of Kerala state was conducted from July 2005 to January 2006, to study the prevalence of endoparasites. Of the 25 snakes examined, 22 (88%) were found infected. On the basis of morphology and morphometry, Capillaria spp. (72%), strongyle (28%), spirurid (20%), Strongyloides/Rhabdias spp. (16%), ascarid (12%), pseudophyllidean tapeworm (8%), acanthocephalan (4%) and pentastomid (12%) ova were identified. The occurrence of ova of Hymenolepis spp. as pseudoparasite was also noticed.
Collapse
Affiliation(s)
- S Radhakrishnan
- Division of Pathology, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India.
| | | | | |
Collapse
|
25
|
Kurup SP, Azhahianambi P, Ghosh S. Effect of surface area to weight ratio of egg masses on the hatchability of Boophilus microplus eggs. J Vector Borne Dis 2008; 45:164-169. [PMID: 18592846] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND & OBJECTIVES On global basis, ticks transmit a number of pathogens than any other arthropod vector, and are among the most important vectors of diseases affecting humans, livestock and companion animals. Control of the vector has been focused on integrated management involving strategic use of insecticides, use of vaccines, use of herbal acaricides and breed resistance. It has been established that tick vaccine is working on limiting the egg laying potentiality and subsequent hatchability of the ticks fed on immunized animals. To generate entomological data following immunization of animals against ticks an experiment was conducted to establish the role of water content in egg masses for successful hatching into larvae. METHODS Different size and shape of egg masses of Boophilus microplus, Izatnagar isolate were obtained by manipulating the egg laying process. The weight of the egg masses was measured, keeping their integrity and surface areas of respective egg masses were calculated with the aid of computer software. Larvae hatched from the respective egg masses were counted individually. RESULTS It is clear that, with an increase in the exposed surface area of the cylindrical egg mass per unit weight, there is a reduction in the number of larvae hatched out. Also, the spherical egg masses significantly (0.026 at 95% confidence level) yielded more larvae per unit weight in comparison to the cylindrical egg masses. INTERPRETATION & CONCLUSION It has been established that the larval count yielded from an egg mass is more or less dependent on the surface area : weight ratio of the respective egg masses rather than on either the surface area alone or weight of the egg mass alone.
Collapse
Affiliation(s)
- S P Kurup
- Entomology Laboratory, Division of Parasitology, Indian Veterinary Research Institute, Izatnagar, India
| | | | | |
Collapse
|
26
|
Cook RW, Thompson TB, Kurup SP, Jardetzky TS, Woodruff TK. Structural basis for a functional antagonist in the transforming growth factor beta superfamily. J Biol Chem 2005; 280:40177-86. [PMID: 16186117 DOI: 10.1074/jbc.m504591200] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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] [Indexed: 11/06/2022] Open
Abstract
Within the transforming growth factor beta superfamily, the agonist-antagonist relationship between activin and inhibin is unique and critical to integrated reproductive function. Activin acts in the pituitary to stimulate follicle-stimulating hormone, and is antagonized by endocrine acting, gonadally derived inhibin. We have undertaken a mutational analysis of the activin betaA subunit to determine the precise structural aspects that contribute to inhibin antagonism of activin. By substituting specific amino acid residues in the activin betaA subunit with similarly aligned amino acids from the alpha subunit, we have pinpointed the residues required for activin receptor binding and activity, as well as for inhibin antagonism of activin through its receptors. Additionally, we have identified an activin mutant with a higher affinity for the activin type I receptor that provides structural evidence for the evolution of ligand-receptor interactions within the transforming growth factor beta superfamily.
Collapse
Affiliation(s)
- Robert W Cook
- Department of Neurobiology and Physiology, Northwestern University, Evanston, Illinois 60208, USA
| | | | | | | | | |
Collapse
|