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Young MP, Ployprasith W, Brintz BJ, Rutar T. Refractive error in unilateral Duane syndrome. J AAPOS 2022; 26:247.e1-247.e5. [PMID: 36122873 DOI: 10.1016/j.jaapos.2022.07.008] [Citation(s) in RCA: 1] [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: 02/23/2022] [Revised: 07/06/2022] [Accepted: 07/16/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate whether chronic co-contraction of the medial and lateral rectus muscles leads to higher against-the-rule astigmatism in affected versus fellow eyes in Duane syndrome. METHODS A database of 4,103 patients of Dr. Arthur Jampolsky was queried for diagnosis of Duane syndrome. Inclusion criteria were unilateral Duane syndrome and complete data set. Refractive error was compared between Duane and fellow eyes. RESULTS A total of 84 patients with unilateral Duane syndrome were identified. The spherical equivalent of Duane eyes and fellow eyes was similar (0.4 vs. 0.2 [P = 0.14]). Mean cylinder power was higher in Duane eyes compared to fellow eyes (0.7 vs 0.4 [P = 0.0003]). There was modest evidence of more against-the-rule astigmatism in Duane eyes compared to fellow eyes (P = 0.04) but no difference for with-the-rule astigmatism (P = 0.83). Duane compared to fellow eyes were, however, significantly more likely to have oblique astigmatism (P = 0.004) or any astigmatism at all (P = 0.0005). CONCLUSIONS Duane eyes compared to fellow eyes had higher astigmatism that was more likely to be oblique. Our study lends support to the hypothesis that extraocular muscles may influence refractive error.
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Affiliation(s)
- Marielle P Young
- Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah.
| | | | - Ben J Brintz
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Tina Rutar
- Smith-Kettlewell Eye Research Institute, San Francisco, CA
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Saffren BD, Yassin SH, Geddie BE, de Faber JTHN, Blieden LS, Bhate M, Gamio S, Rutar T, Levin AV. Optic Nerve Aplasia. J Neuroophthalmol 2022; 42:e140-e146. [PMID: 33870948 DOI: 10.1097/wno.0000000000001246] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Optic nerve aplasia (ONA) is a rare ocular anomaly. We report ophthalmologic, systemic, and genetic findings in ONA. METHODS Patients were identified through an International Pediatric Ophthalmology listserv and from the practice of the senior author. Participating Listserv physicians completed a data collection sheet. Children of all ages were included. Neuroimaging findings were also recorded. RESULTS Nine cases of ONA are reported. Patients' ages ranged from 10 days to 2 years (median 9 months). Seven cases were bilateral. All patients had absence of the optic nerve and retinal vessels in the affected eye or eyes. Ophthalmologic findings included glaucoma, microcornea, persistent pupillary membrane, iris coloboma, aniridia, retinal dysplasia, retinal atrophy, chorioretinal coloboma, and persistent fetal vasculature. Systemic findings included facial dysmorphism, cardiac, genitourinary, skeletal, and developmental defects. A BCOR mutation was found in one patient. One patient had rudimentary optic nerves and chiasm on imaging. CONCLUSION ONA is a unilateral or bilateral condition that may be associated with anomalies of the anterior or posterior segment with or without systemic findings. Rudimentary optic nerve on neuroimaging in one case suggests that ONA is on the continuum of optic nerve hypoplasia.
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Affiliation(s)
- Brooke D Saffren
- Philadelphia College of Osteopathic Medicine (BDS), Philadelphia, Pennsylvania; Pediatric Ophthalmology and Ocular Genetics (BDS, SHY), Wills Eye Hospital, Philadelphia, Pennsylvania; Pediatric Ophthalmology (BEG), Helen DeVos Children's Hospital, Grand Rapids, Michigan; The Rotterdam Eye Hospital (JTHNF), Rotterdam, the Netherlands ; Cullen Eye Institute (LSB), Baylor College of Medicine, Houston, Texas; Department of Pediatric Ophthalmology (MB), LV Prasad Eye Institute, Hyderabad, India ; Ophthalmology Unit (SG), Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina ; Cataract and Laser Institute of Southern Oregon PC (TR), Medford, Oregon; Flaum Eye Institute and Golisano Children's Hospital (AVL), University of Rochester, New York, New York
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Simonsz HJ, Rutar T, Kraft S, Thiadens AA, Batstra MR, Verdijk RM, Loeffler KU, Kommerell G, Berg MSD, Schooneveld MJ, Drunen LC, Missotten L, Kolling GH, Tusscher MP, Morad Y, Nucci P, Olitsky SE, Kowal L, Eppinga HG, Duivenboden F, Schalij NE, Malacara Hernandez JJ. Endophthalmitis after strabismus surgery: incidence and outcome in relation to age, operated eye muscle, surgical technique, scleral perforation and immune state. Acta Ophthalmol 2021; 99:37-51. [PMID: 32533628 PMCID: PMC7891599 DOI: 10.1111/aos.14446] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Identify risk factors for endophthalmitis after strabismus surgery (EASS) and relate these to incidence and outcome. METHODS Ophthalmologists, who had operated, diagnosed or treated EASS, completed a case record form with 71 questions in six domains: Preoperative, Surgery, Perforation, Postoperative, Outcome and Experts' opinion. To estimate the age-specific incidence per number of strabismus operations in the Netherlands during 1994-2013, the age distribution of Dutch cases was compared with the age-specific rates of strabismus surgery in the Dutch Registry of Strabismus Operations and with population data. Exploratory data analysis was performed. The immune state was evaluated in six patients. Five enucleated eyes were studied histopathologically. RESULTS None of the 26 patients (27 eyes with EASS) were between 9 and 65 years old, except for one patient with retinal haemorrhage followed by endophthalmitis. In the Netherlands during 1994-2013, the rate of EASS was approximately one per 11 000 strabismus operations, but one per 4300 for children aged 0-3 and one per 1000 for patients 65 and older. Endophthalmitis was diagnosed on postoperative day 1-4 in children aged 0-3. In all 15 children aged 0-5, the 16 affected eyes were phthisical, eviscerated or enucleated. The involved eye muscle had been recessed in 25 of 27 cases. It was a medial rectus in 15 of 16 children aged 0-6. It was a lateral (6), inferior (2) or medial (1) rectus in elderly. Scleral perforation went unnoticed in all children (no record in three) and in two of seven elderly (no record in two). Histopathology showed transscleral scarring compatible with scleral perforation in four patients but, in a two-year-old girl who had EASS together with a transient medial rectus palsy, the sclera underneath the former suture tract was not perforated but did contain the long posterior ciliary artery. CONCLUSIONS Endophthalmitis after strabismus surgery (EASS) affects children and elderly, with a grave outcome in young children. It occurs after recession of the medial rectus muscle in children, and it may occur without scleral perforation. Age and perforation are key determinants that interact with other factors that determine the occurrence and fulminance of EASS.
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Affiliation(s)
- Huibert J. Simonsz
- Department of Ophthalmology Erasmus Medical Center Rotterdam the Netherlands
| | - Tina Rutar
- Department of Ophthalmology Cataract and Laser Institute of Southern Oregon Medford OR USA
| | - Stephen Kraft
- Ophthalmology & Vision Sciences University of Toronto Toronto ON Canada
| | | | - Manou R. Batstra
- Medical Immunology Reinier Haga Medical Diagnostic Center Delft the Netherlands
| | - Robert M. Verdijk
- Department of Pathology Erasmus Medical Center Rotterdam the Netherlands
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Rutar T, Youm J, Porco T, Tilton N, Muskat M, McNamara N, Wara D. Ophthalmic manifestations of perinatally acquired HIV in a US cohort of long-term survivors. Br J Ophthalmol 2014; 99:650-3. [PMID: 25416182 DOI: 10.1136/bjophthalmol-2014-305557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 05/19/2014] [Accepted: 11/02/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To determine the ophthalmic manifestations of HIV in a cohort of long-term survivors of perinatally acquired HIV. METHODS Twenty-two patients with perinatally acquired HIV who were aged ≥12 years were prospectively studied at a university clinic. They underwent complete ophthalmic examinations and fundus photography. Their medical histories, medications and CD4 counts were abstracted from the medical records. To evaluate for keratoconjunctivitis sicca, both HIV patients and 44 healthy controls (matched by age, gender and contact lens wear) underwent Schirmer testing and ocular surface staining. RESULTS Nine male and 13 female HIV patients with mean age of 16.6 years (SD, 3.4) were examined. Of the 22 HIV patients, 21 had been treated with highly active antiretroviral therapy (HAART). Only one patient had a CD4 count nadir of <200 cells/µL. The mean visual acuity of the eyes of the HIV subjects was 20/22 (SD, 1.6 lines). No patient had cytomegalovirus retinitis. Four of the 22 (18%) HIV patients had strabismus. HIV subjects and controls had similar rates of abnormal Schirmer (9% and 14%, p=0.62) and ocular staining scores (p=0.29). CONCLUSIONS In the post-HAART era, long-term survivors of perinatally acquired HIV exhibited little vision-threatening disease, but had a high prevalence of strabismus.
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Affiliation(s)
- Tina Rutar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Jiwon Youm
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Travis Porco
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA Francis I. Proctor Institute for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Nicole Tilton
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Mica Muskat
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Nancy McNamara
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA Francis I. Proctor Institute for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Diane Wara
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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Rutar T, Palmowski-Wolfe A, Harrad R, Brabyn J, Jampolsky A. Clinical problems in strabismus: the Smith-Kettlewell Eye Research Institute symposium. J AAPOS 2014; 18:385.e1-7. [PMID: 25173911 DOI: 10.1016/j.jaapos.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/28/2014] [Accepted: 04/30/2014] [Indexed: 10/24/2022]
Abstract
The Smith Kettlewell Eye Research Institute (SKERI), celebrating its 50th anniversary in 2014, hosted a symposium to identify the most pressing clinical problems in strabismus and binocular vision. Forty-five experts from around the world shared their perspectives at the San Francisco meeting, held November 6-9, 2012. Prior to the meeting, the organizers (TR, APW, RH, JB, AJ) asked attendees to identify the most pressing clinical problems in strabismus and to discuss them in a workshop-based format. The clinical problems were organized into the following six areas: (1) esotropias; (2) binocular vision: amblyopia, suppression, and diplopia; (3) intermittent exotropia; (4) "oblique dysfunctions"; (5) dissociated vertical deviation (DVD); and (6) new approaches to strabismus management. Herein we highlight of some of the clinical problems discussed at the meeting.
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Affiliation(s)
- Tina Rutar
- Smith Kettlewell Eye Research Institute, San Francisco, California; Cataract and Laser Institute, Medford, Oregon.
| | | | - Richard Harrad
- University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom
| | - John Brabyn
- Smith Kettlewell Eye Research Institute, San Francisco, California
| | - Arthur Jampolsky
- Smith Kettlewell Eye Research Institute, San Francisco, California
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Rutar T. Intentional monovision for long-standing diplopia. J Cataract Refract Surg 2013; 39:311. [PMID: 23332283 DOI: 10.1016/j.jcrs.2012.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Indexed: 11/18/2022]
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Affiliation(s)
- Elizabeth Shen
- University of California, San Francisco, School of Medicine, San Francisco, CA 94143, USA
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Ku TK, Naseri A, Han Y, Porco TC, Rutar T. Effect of Timing and Duration of Tamsulosin Exposure on Complications in Resident-Performed Phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2011; 42:416-22. [DOI: 10.3928/15428877-20110602-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 04/29/2011] [Indexed: 11/20/2022]
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Martel JN, Rutar T, Lujan BJ, de Alba Campomanes A. Chorioretinal architecture in Aicardi syndrome: an optical coherence tomography and fluorescein angiography study. J AAPOS 2011; 15:308-10. [PMID: 21777802 PMCID: PMC3142350 DOI: 10.1016/j.jaapos.2011.03.011] [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: 11/16/2010] [Revised: 02/27/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
Aicardi syndrome is a rare congenital disorder with a classic triad of infantile spasms, chorioretinal lacunae, and agenesis of the corpus callosum. We report the use of fluorescein angiography and spectral domain optical coherence tomography to examine the posterior segment structures in an 8-month-old girl with Aicardi syndrome. Most of the observed features correlated with previously published histopathological findings, but inner nuclear layer cysts have not been previously described. To our knowledge, this is the first study of the tomographic and angiographic chorioretinal features in vivo.
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Affiliation(s)
- Joseph N Martel
- Department of Ophthalmology, University of California-San Francisco, San Francisco, California 94143-0412, USA
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Huang S, Crawford JB, Rutar T. Pathological findings in poststrabismus surgery endophthalmitis. J AAPOS 2011; 15:98-100. [PMID: 21397817 DOI: 10.1016/j.jaapos.2010.11.018] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/23/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
Bacterial entry into the vitreous cavity via inadvertent scleral perforation is one postulated mechanism for poststrabismus surgery endophthalmitis. In a review of 746 cases, we identified 2 pediatric enucleation specimens related to complications of strabismus surgery. In both cases, the patients developed postoperative endophthalmitis and no light perception vision, and the eyes were enucleated when they became phthisical or painful. In both submitted cases, pathology showed a thick band of scar tissue emanating focally from the sclera into the vitreous. Although no needle tracts were visualized, pathological findings were consistent with scleral perforation.
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Affiliation(s)
- Susan Huang
- University of California San Francisco, San Francisco, CA 94143-0730, USA
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Haug S, Lakew T, Habtemariam G, Alemayehu W, Cevallos V, Zhou Z, House J, Ray K, Porco T, Rutar T, Keenan J, Lietman TM, Gaynor BD. The decline of pneumococcal resistance after cessation of mass antibiotic distributions for trachoma. Clin Infect Dis 2010; 51:571-4. [PMID: 20649409 DOI: 10.1086/655697] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
After 6 biannual mass distributions of oral azithromycin for trachoma in Ethiopian communities, 76.8% (95% confidence interval [CI], 66.3%-85.1%) of nasopharyngeal Streptococcus pneumoniae isolates from children aged 1-5 years were resistant to macrolides. Twelve and 24 months after the last azithromycin treatment, resistance decreased to 30.6% (95% CI, 18.8%-40.4%; P <.001 ) and 20.8% (95% CI, 12.7%-30.7%; P < .001), respectively. Macrolide resistance decreases after antibiotic pressure is removed.
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Affiliation(s)
- Sara Haug
- FI Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California 94143-0944, USA
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Abstract
OBJECTIVES To compare intraoperative complication rates and visual outcomes for patients treated and not treated with tamsulosin hydrochloride who underwent resident-performed phacoemulsification, and to determine whether the recognition of intraoperative floppy iris syndrome in 2005 affected the subsequent complication rates for tamsulosin-treated patients. METHODS This comparative retrospective cohort study included 101 tamsulosin-treated eyes and 404 non-tamsulosin-treated eyes from January 1, 1998, to August 31, 2008. Main outcome measures were major and minor complication rates and postoperative best-corrected visual acuity. Complication rates were compared between August 11, 1999, to December 31, 2005, and January 1, 2006, to September 3, 2008, for both tamsulosin-treated and non-tamsulosin-treated eyes. RESULTS The major complication rates were 3.0% for tamsulosin-treated eyes and 8.9% for non-tamsulosin-treated eyes (P = .08), while the minor complication rates were 24.8% and 12.1%, respectively (P = .002). Both groups had an equal likelihood of attaining better than 20/40 postoperative visual acuities (82.2% vs 82.9%, respectively; P = .85). Frequency of major complications between tamsulosin-treated and non-tamsulosin-treated eyes was 6.0% vs 15.8%, respectively (P = .09), from August 11, 1999, to December 31, 2005, compared with 0.0% vs 2.0%, respectively (P > .99), from January 1, 2006, to September 3, 2008. CONCLUSIONS Differences in the major complication rates for tamsulosin-treated and non-tamsulosin-treated eyes were not significant, whereas tamsulosin exposure was associated with a significant increase in minor complications. Both groups had similar, good postoperative visual outcomes. After 2005, a reduction in major complications was seen in both groups, attributed to programmatic changes in surgical education. Recognition of intraoperative floppy iris syndrome did not impart a significant additional protective effect in preventing major complications.
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Affiliation(s)
- Tina K Ku
- Department of Ophthalmology, University of California, USA
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Huang S, Crawford JB, Porco T, Rutar T. Clinicopathologic review of pediatric enucleations during the last 50 years. J AAPOS 2010; 14:328-33. [PMID: 20736124 DOI: 10.1016/j.jaapos.2010.05.006] [Citation(s) in RCA: 4] [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: 02/21/2010] [Revised: 05/13/2010] [Accepted: 05/18/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate diagnoses leading to enucleations in the pediatric age group over time. METHODS All pathology reports of enucleation specimens at the University of California-San Francisco eye pathology laboratory from children (ages 0 to 18 years) from 1960 to 2008 were reviewed. The main outcome measures were the frequency of pediatric enucleation specimens in each diagnostic category as compared with total pathological laboratory volume over time, and the age and gender distribution of histopathological diagnostic categories over time. RESULTS Specimens of 746 eyes from 729 pediatric patients were analyzed. Pediatric enucleated eyes constituted 2.7% of all specimens received at the pathology laboratory. The overall frequency of pediatric enucleation specimens did not change over time. Retinoblastoma specimens increased by a factor of 2.9 over time (p < 0.0001). The increase in retinoblastoma was offset by a decrease in nonretinoblastoma enucleations, which decreased by a factor of 3.8 between the 1960s and 2000s (p < 0.0001), driven by a decrease in enucleations caused by trauma (p < 0.0001). Beginning in the 1980s, pediatric enucleations caused by nonrhegmatogenous retinal detachment, nematode and non-nematode endophthalmitis, and congenital glaucoma decreased significantly. Retinoblastoma was the most common diagnosis overall (45%), in girls (60%), and in ages <5 years (78%). Trauma was the second most common diagnosis (32%) and the most common in boys (42%) and in children ages 6-12 (58%) and 13-18 (72%) years. CONCLUSIONS A decrease in pediatric nonretinoblastoma enucleations was observed over time, possibly attributable to better diagnostic capabilities, surgical techniques, and public health interventions. The increase in retinoblastoma enucleations over time was likely due to the result of institutional referral bias.
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Affiliation(s)
- Susan Huang
- Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California-San Francisco, 10 Koret Way, San Francisco, CA 94143, USA
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Abstract
Posterior subcapsular cataract is a well-known complication of corticosteroid treatment. While this association has not been established for adrenocorticotropic hormone (ACTH) treatment, similar side effects would be expected for the 2 drugs given the mechanism of ACTH, which stimulates glucocorticoid synthesis and secretion. The authors report 2 children who were treated with ACTH for infantile spasms who developed bilateral posterior subcapsular cataracts. The authors recommend that children treated with ACTH be referred promptly to a pediatric ophthalmologist as these young, often developmentally delayed children may not exhibit recognizable signs of visual loss. Prompt evaluation and treatment of cataracts in children is important to prevent permanent vision loss from deprivation amblyopia.
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Affiliation(s)
- Jennifer B Taylor
- Department of Ophthalmology, University of California, San Francisco, USA
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Rutar T, Schwartz D, Good W. Severe zone III retinopathy of prematurity in an infant with a birth weight of more than 1,500 grams. J Pediatr Ophthalmol Strabismus 2010; 47 Online:e1-3. [PMID: 21214144 DOI: 10.3928/01913913-20100510-06] [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: 01/07/2010] [Accepted: 02/24/2010] [Indexed: 11/20/2022]
Abstract
The authors report zone III stage 3 retinopathy of prematurity requiring treatment in a former 1,692-g 30 6/7-week twin cared for in a modern intensive care nursery. This case highlights the need for identifying biomarkers that increase the risk of severe retinopathy of prematurity so that screening guidelines can be optimized.
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Affiliation(s)
- Tina Rutar
- Department of Ophthalmology, University of California–San Francisco, San Francisco, California 94143, USA
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Hung S, Rutar T, Lin S, Wong IG. Severe Hypotony Associated With Parry-Romberg Syndrome. Ophthalmic Surg Lasers Imaging Retina 2010; 41:1-3. [PMID: 20337268 DOI: 10.3928/15428877-20100216-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2008] [Indexed: 02/28/2024]
Abstract
Parry-Romberg syndrome is a rare inflammatory disorder characterized by progressive hemifacial atrophy and ocular involvement. Two patients with Parry-Romberg syndrome who had mild heterochromic uveitis but developed profound ocular hypotony were evaluated. A 17-year-old girl and a 32-year-old woman with Parry-Romberg syndrome developed chronic uveitis with gradual worsening of intraocular pressure to 0 mm Hg. For the first time, ultrasound biomicrosopy found evidence of inflammation of the ipsilateral ciliary muscle in patients with hemifacial atrophy. The profound hypotony concomitant with ciliary body edema in two patients with Parry-Romberg syndrome provides a clue linking the systemic disease to the ocular findings.
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de Alba Campomanes AG, Rutar T, Crawford JB, Seiff S, Goodman D, Grenert J. Crystal-storing histiocytosis and crystalline keratopathy caused by monoclonal gammopathy of undetermined significance. Cornea 2010; 28:1081-4. [PMID: 19724196 DOI: 10.1097/ico.0b013e318199f73b] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to report the occurrence of crystalline keratopathy and of orbital infiltrative disease resulting from crystal-storing histiocytosis (CSH) in a patient with monoclonal gammopathy of undetermined significance. METHODS The authors conducted a review of a medical record and immunohistopathologic studies. RESULTS A 66-year-old man presented with a 3-year history of unilateral progressive ptosis, proptosis, and external ophthalmoplegia. Magnetic resonance imaging showed orbital fat expansion and extraocular muscle thickening with gadolinium enhancement. The patient also had bilateral crystalline keratopathy and had undergone penetrating keratoplasty in one eye. The urine and serum showed elevated levels of immunoglobulin, but the bone marrow aspirate was normal. The systemic evaluation was consistent with monoclonal gammopathy of undetermined significance. An orbital fat biopsy revealed histiocytes engorged with lambda light chain crystals. The corneal stroma also showed positive immunostaining for lambda light chains. The patient was diagnosed with orbital CSH and with lambda light chain crystalline keratopathy. CONCLUSIONS CSH is characterized by the accumulation of reactive histiocytes filled with immunoglobulin crystals in various tissues and is frequently associated with systemic hyperglobulinemic states. For unknown reasons, in this patient, a systemic immunologic disorder led to lambda light chain abnormalities with histiocyte infiltration of the orbit and corneal deposition. Although CSH is rare, it should be part of the differential diagnosis of orbital infiltrative disease with or without crystalline keratopathy.
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Lin P, Shankar SP, Duncan J, Slavotinek A, Stone EM, Rutar T. Retinal vascular abnormalities and dragged maculae in a carrier with a new NDP mutation (c.268delC) that caused severe Norrie disease in the proband. J AAPOS 2010; 14:93-6. [PMID: 20227630 DOI: 10.1016/j.jaapos.2009.11.012] [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: 07/20/2009] [Revised: 11/10/2009] [Accepted: 11/11/2009] [Indexed: 11/26/2022]
Abstract
Norrie disease (ND) is caused by mutations in the ND pseudoglioma (NDP) gene (MIM 300658) located at chromosome Xp11.4-p11.3. ND is characterized by abnormal retinal vascular development and vitreoretinal disorganization presenting at birth. Systemic manifestations include sensorineural deafness, progressive mental disorder, behavioral and psychological problems, growth failure, and seizures. Other vitreoretinopathies that are associated with NDP gene mutations include X-linked familial exudative vitreoretinopathy, Coats disease, persistent fetal vasculature, and retinopathy of prematurity. Phenotypic variability associated with NDP gene mutations has been well documented in affected male patients. However, there are limited data on signs in female carriers, with mild peripheral retinal abnormalities reported in both carrier and noncarrier females of families with NDP gene mutations. Here, we report a family harboring a single base-pair deletion, c.268delC, in the NDP gene causing a severe ND phenotype in the male proband and peripheral retinal vascular abnormalities with dragged maculae similar to those observed in familial exudative vitreoretinopathy in his carrier mother.
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Affiliation(s)
- Phoebe Lin
- Department of Ophthalmology, University of California, San Francisco, USA
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Abstract
Lemierre's syndrome is characterized by acute oropharyngeal infection with secondary internal jugular vein thrombophlebitis and subsequent metastatic infections. The anaerobe Fusobacterium necrophorum is the usual etiologic agent, although other microorganisms, including Streptococcus, Staphylococcus, Enterococcus, Bacteroides, and Lactobacilli, may be present alone or in combination with F. necrophorum. Common sites of metastatic infection include the lungs and joints. Thromboembolic complications, such as septic pulmonary embolism, persistent jugular vein occlusion, hepatic abscesses, and nephropathy, may occur. We report a case of Lemierre's syndrome in a 3-year-old Caucasian boy who subsequently presented with manifestations of a fourth (trochlear) nerve palsy.
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Affiliation(s)
- Seongmu Lee
- Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Yang JL, Hong KC, Schachter J, Moncada J, Lekew T, House JI, Zhou Z, Neuwelt MD, Rutar T, Halfpenny C, Shah N, Whitcher JP, Lietman TM. Detection ofChlamydia trachomatisOcular Infection in Trachoma-Endemic Communities by rRNA Amplification. ACTA ACUST UNITED AC 2009; 50:90-4. [DOI: 10.1167/iovs.08-2247] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Julius Schachter
- From the F. I. Proctor Foundation, the2Departments of Laboratory Medicine,
| | | | | | | | | | | | | | | | | | | | - Thomas M. Lietman
- From the F. I. Proctor Foundation, the4Ophthalmology, and5Epidemiology and Biostatistics, and the6Institute for Global Health, University of California San Francisco, San Francisco, California; and
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Rutar T, Hwang DG, Stamper RL. Acute angle-closure glaucoma due to iris transfixation of a subluxated posterior chamber intraocular lens–capsular bag complex. J Cataract Refract Surg 2007; 33:1662-3. [PMID: 17720091 DOI: 10.1016/j.jcrs.2007.05.014] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 05/07/2007] [Indexed: 10/22/2022]
Abstract
An 80-year-old woman with pseudoexfoliation syndrome developed subluxation of a posterior chamber intraocular lens (IOL)-capsular bag complex due to zonular rupture. She underwent a limited 25-gauge pars plana vitrectomy and iris transfixation of the subluxated IOL-capsule complex. The postoperative course was uneventful until the patient developed acute angle-closure glaucoma 3 weeks postoperatively. Ultrasound biomicroscopy confirmed pupillary block by the IOL-capsule complex. The patient was treated with intraocular pressure-lowering medications and a vitreous tap before a laser peripheral iridotomy could be performed successfully. The vision returned to normal, and the angle closure resolved. We recommend that a prophylactic surgical iridectomy be performed in patients with iris transfixation of a posterior chamber IOL-capsular bag complex.
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Affiliation(s)
- Tina Rutar
- Cornea Service, Department of Ophthalmology, University of California-San Francisco, San Francisco, California 94143, USA.
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Rutar T, Chambers HF, Crawford JB, Perdreau-Remington F, Zwick OM, Karr M, Diehn JJ, Cockerham KP. Ophthalmic Manifestations of Infections Caused by the USA300 Clone of Community-Associated Methicillin-Resistant Staphylococcus aureus. Ophthalmology 2006; 113:1455-62. [PMID: 16766029 DOI: 10.1016/j.ophtha.2006.03.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [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: 09/08/2005] [Revised: 03/19/2006] [Accepted: 03/19/2006] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the microbiological, clinical, and pathological characteristics of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA) infections of the eye and orbit. DESIGN Prospective case series. PARTICIPANTS Nine patients with CAMRSA infections of the eye and orbit were identified during a 6-month period at 2 tertiary care hospitals in San Francisco. METHODS Case identification was by prospective case selection and retrospective laboratory review of 549 MRSA cultures collected in the 2 hospitals. Ophthalmic microbial isolates were analyzed by pulsed-field gel electrophoresis and compared with a control CAMRSA clone (USA300). Clinical characteristics of patients infected with CAMRSA were reviewed, and all surgical specimens underwent pathological examination. MAIN OUTCOME MEASURES Pulsed-field gel electrophoresis banding patterns of MRSA isolates, antibiotic sensitivity profiles, patient demographics, systemic and ocular complications of infection, and posttreatment visual acuities. RESULTS Nine ophthalmic isolates were CAMRSA clone USA300. The infections included orbital cellulitis, endogenous endophthalmitis, panophthalmitis, lid abscesses, and septic venous thrombosis. Patients were treated with trimethoprim-sulfamethoxazole, rifampin, clindamycin, or vancomycin based on microbial sensitivity studies and severity of infection. Eight of the 9 patients had no history of hospitalization. Seven patients required hospitalization, 3 required surgery, and an additional 4 required invasive procedures. Eight patients had good visual outcomes, but 1 deteriorated to no light perception. Pathological analyses showed extensive necrosis in eyelid and orbital specimens, and disorganized atrophy bulbi in an enucleated eye. CONCLUSION The USA300 CAMRSA clone, which carries Panton-Valentine leukocidin genes, can cause aggressive infections of the eye and orbit in hospital-naive patients. Treatment of infections often required debridement of necrotic tissues in addition to non-beta-lactam class antibiotics. In communities where CAMRSA is prevalent, ophthalmologists should obtain microbial cultures and sensitivity studies to help guide antibiotic therapy for severe ophthalmic infections.
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Affiliation(s)
- Tina Rutar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143-0344, USA.
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Rutar T, Cockerham KP. Periorbital zygomycosis (mucormycosis) treated with posaconazole. Am J Ophthalmol 2006; 142:187-188. [PMID: 16815283 DOI: 10.1016/j.ajo.2006.02.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 12/15/2005] [Revised: 02/10/2006] [Accepted: 02/10/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To report on the successful treatment of periorbital zygomycosis (mucormycosis) with posaconazole, a broad-spectrum oral antifungal available for compassionate use. DESIGN Interventional case report. METHODS Review of a medical record. RESULTS A 22-year-old male undergoing induction chemotherapy for acute lymphoblastic leukemia presented with periorbital cellulitis attributable to Rhizopus. The patient was initially treated with liposomal amphotericin B, surgical debridement, and reversal of immune compromise. The patient was switched to posaconazole because of amphotericin side effects and lack of improvement. He took posaconazole for five months while undergoing additional cycles of chemotherapy. Despite recurrent profound neutropenia, the periorbital infection resolved, he tolerated reconstructive procedures, and he did not develop orbital invasion. His Rhizopus isolate was highly susceptible to posaconazole in vitro. CONCLUSIONS Drug toxicities can limit the use of amphotericin in some patients with zygomycosis. Posaconazole shows promise as an alternative antifungal agent in the treatment of periorbital zygomycosis.
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Affiliation(s)
- Tina Rutar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA.
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Wardell B, Marik PS, Piper D, Rutar T, Jorgensen EM, Bamber BA. Residues in the first transmembrane domain of the Caenorhabditis elegans GABA(A) receptor confer sensitivity to the neurosteroid pregnenolone sulfate. Br J Pharmacol 2006; 148:162-72. [PMID: 16547524 PMCID: PMC1617053 DOI: 10.1038/sj.bjp.0706719] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 01/20/2006] [Accepted: 01/25/2006] [Indexed: 12/28/2022] Open
Abstract
The GABA(A) receptor is a target of endogenous and synthetic neurosteroids. Little is known about the residues required for neurosteroid action on GABA(A) receptors. We have investigated pregnenolone sulfate (PS) inhibition of the Caenorhabditis elegans UNC-49 GABA receptor, a close homolog of the mammalian GABA(A) receptor. The UNC-49 locus encodes two GABA receptor subunits, UNC-49B and UNC-49C. UNC-49C is sensitive to PS but UNC-49B is not sensitive. By analyzing chimeric receptors and receptors containing site-directed mutations, we identified two regions required for PS inhibition. Four residues in the first transmembrane domain are required for the majority of the sensitivity to PS, but a charged extracellular residue at the end of the M2 helix also plays a role. Strikingly, mutation of one additional M1 residue reverses the effect of PS from an inhibitor to an enhancer of receptor function. Mutating the M1 domain had little effect on sensitivity to the inhibitor picrotoxin, suggesting that these residues may mediate neurosteroid action specifically, and not allosteric regulation in general.
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Affiliation(s)
- Bryan Wardell
- Department of Pharmacology and Toxicology, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, U.S.A
| | - Purba S Marik
- Department of Pharmacology and Toxicology, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, U.S.A
| | - David Piper
- Department of Physiology, University of Utah, 410 Chipeta Way, Salt Lake City, UT 84108, U.S.A
| | - Tina Rutar
- Department of Biology, University of Utah, 257 South, 1400E Salt Lake City, UT 84112, U.S.A
| | - Erik M Jorgensen
- Department of Biology, University of Utah, 257 South, 1400E Salt Lake City, UT 84112, U.S.A
| | - Bruce A Bamber
- Department of Pharmacology and Toxicology, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, U.S.A
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Rutar T, Zwick OM, Cockerham KP, Horton JC. Bilateral blindness from orbital cellulitis caused by community-acquired methicillin-resistant Staphylococcus aureus. Am J Ophthalmol 2005; 140:740-2. [PMID: 16226533 DOI: 10.1016/j.ajo.2005.03.076] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [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: 02/28/2005] [Revised: 03/29/2005] [Accepted: 03/29/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe bilateral blindness resulting from infection with community-acquired methicillin-resistant Staphylococcus aureus (MRSA). DESIGN Observational case report. METHODS A 44-year-old man developed proptosis, ptosis, ophthalmoplegia, and no light perception vision after attempting to lance a nasal pustule. A nasal culture grew MRSA. Imaging showed bilateral orbital cellulitis, pansinusitis, and cavernous sinus thrombosis. The right fundus showed severe ischemia, but the left fundus was essentially normal. RESULTS Despite initiation of appropriate antibiotics early in the course of infection, the patient lost sight in both eyes. Surgical drainage of the paranasal sinuses and use of intravenous corticosteroids and heparin led to the resolution of orbital cellulitis. CONCLUSIONS MRSA orbital cellulitis can progress to irreversible blindness despite antibiotic treatment. A new, community-acquired clone of this organism has exhibited increased potential for tissue invasion.
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Affiliation(s)
- Tina Rutar
- Beckman Vision Center, University of California San Francisco, San Francisco, California 94143-0730, USA
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Rutar T, Baldomar Salgueiro EJ, Maguire JH. Introduced Plasmodium vivax malaria in a Bolivian community at an elevation of 2,300 meters. Am J Trop Med Hyg 2004; 70:15-9. [PMID: 14971692] [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: 04/28/2023] Open
Abstract
Tuntunani, Bolivia, a community of 199 persons situated at an elevation of 2,300 meters, experienced its first malaria outbreak in 1998. Blood smears from 63 of 183 symptomatic residents were examined, and 52 showed Plasmodium vivax. An investigation two years later indicated that the epidemic resulted from introduced transmission, since persons of all ages and both sexes were infected, and there had been no travel to low-lying endemic areas in the five months preceding the epidemic. Treatment became available only two months into the epidemic, at which time 58% of the people had been ill for three weeks or longer. This outbreak demonstrates the vulnerability of highland populations with poor access to health care to introduced malaria.
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Affiliation(s)
- Tina Rutar
- Harvard Medical School, Boston, Massachusetts, USA.
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