Ophthalmology
Journal Scan is the clinician's guide to the latest clinical research findings in the Archives of Ophthalmology, Ophthalmology, and other important journals of interest in ophthalmology. Short summaries of feature articles include links to the article abstracts. (Access to full-text articles usually requires registration at the specific journal's Web site.)
Vitreous Hemorrhage in Children
Spirn MJ, Lynn MJ, Hubbard GB III
Ophthalmology. 2006:113;848-852
The most common cause of spontaneous vitreous hemorrhage in adults is proliferative diabetic retinopathy. However, in children, the cause is not so clear-cut. A retrospective review of 168 children with spontaneous or traumatic vitreous hemorrhage was performed. Children with active retinopathy of prematurity were excluded from the analysis.
In children ages 9-18 years, the most common presenting symptom was decreased vision. In those younger than 9 years, strabismus was the most common presenting complaint. Trauma (both manifest and occult) was the most common cause of vitreous hemorrhage (73%). Twenty-seven percent of vitreous hemorrhage cases were spontaneous, with regressed retinopathy of prematurity the most common cause. Most cases of vitreous hemorrhage were unilateral (90.5%) vs bilateral (9.5%). The most common cause of bilateral vitreous hemorrhage is shaken baby syndrome. Most cases of vitreous hemorrhage were observed, and specific cases had specific interventions. For example, most cases of penetrating trauma required surgical intervention (82.6%), whereas pars planitis was frequently treated with cryotherapy or laser photocoagulation.
This study is important because although the causes for vitreous hemorrhage are manifold in children, trauma is the most common cause. Ophthalmologists may play a role in determining if a child is a victim of child abuse.
Abstract
http://www.medscape.com/medline/abstract/16650682
This program was supported by an independent educational grant from Genentech.
Early Versus Late Orbital Decompression in Graves' Orbitopathy: A Retrospective Study in 125 Patients
Baldeschi L, Wakelkamp IM, Lindeboom R, Prummel MF, Wiersinga WM
Ophthalmology. 2006:113;874-878
A mainstay of therapy for exophthalmos secondary to Graves' orbitopathy is bony decompression. Although surgery is usually delayed until stability of disease is obtained (unless compressive optic neuropathy is encountered), the duration of disease has not been analyzed as a factor of surgical outcomes. This study attempted to analyze the effect of duration of disease on 125 patients who underwent 3-wall coronal approach bony decompression for aesthetic rehabilitation without diplopia within 20 degrees of field of primary gaze.
Group 1 included 70 patients who had Graves disease for less than 4 years (average 2.2 years) and group 2 included 55 patients with orbitopathy for more than 4 years (average 9 years). Between the 2 groups there was no difference in preoperative immunosuppressive therapy, smoking, Hertels, or NOSPECS score. However, patients in group 1 had more extraocular muscle enlargement compared with that in group 2. Postoperative results were similar between both groups, including reduction of exophthalmos (4.5 vs 4.2 mm), reduction of lid retraction, and postoperative swelling. However, the rate of diplopia was worse in group 1 compared with that in group 2 (29% vs 13%).
The results of this study are interesting because they suggest that early rehabilitation may not be the best course of treatment of Graves' orbitopathy. Patients with disease of less than 4 years had larger extraocular muscle volume and higher rates of post-decompression diplopia in this study. However, this study is retrospective and therefore immunosuppressive use was not controlled. Furthermore, selection bias as to when patients were offered surgery could have affected the outcomes of this study. Finally, the coronal approach with a 3-wall decompression may be considered excessive by many surgeons for an average exophthalmos of 22 mm.
Abstract
http://www.medscape.com/medline/abstract/16530839