Evaluation of intralesional propranolol for periocular capillary hemangioma

Ahmed Awadein, Mohamed A FakhryCairo University Faculty of Medicine, Cairo, EgyptBackground: The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangioma.Methods: A prospective study was performed in 22 consecutive patients with periocular hemangioma. Twelve patients underwent intralesional propranolol injection and ten patients underwent intralesional triamcinolone injection. The size of the lesion was measured serially every week during the first month, every 2 weeks for the second month, and then monthly for another 2 months. The refractive error and degree of ptosis if present were measured before injection and at the end of the study.Results: There was reduction in the size of hemangioma, astigmatic error, and degree of ptosis in both groups. The difference in outcome between both groups was not statistically significant. Rebound growth occurred in 25% of the propranolol group and 30% of the steroid group but responded to reinjection. No adverse effects were reported during or after intralesional propranolol injection.Conclusion: Intralesional propranolol injection is an alternative and effective method for treatment of infantile periocular hemangioma.Keywords: propranolol, intralesional, periocular capillary hemangiom

Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial

Background: Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or 2 – 4 h and delayed or 24 h postoperative suture adjustment in adult patients undergoing strabismus surgery. Methods: An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment 2 – 4 h postoperatively, and the delayed group, with suture adjustment 24 h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at 1 and 3 months and the success rate at 3 months postoperatively were compared. Results: Forty-five (90%) patients completed the follow-up, including 23 (92%) in the early adjustment group and 22 (88%) in the delayed adjustment group, with a mean (standard deviation) age of 25.6 (9.5) years and a male-to-female ratio of 46.7:53.3. Thirty patients (66.7%) had exotropia, and 15 (33.3%) patients had esotropia. Both groups had comparable baseline characteristics (all P > 0.05). The mean pain scores during adjustment did not differ significantly between groups (P > 0.05). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the 1- and 3-month follow-ups (all P > 0.05). The success rate in the early adjustment group was slightly higher (87.0% versus 63.6%), but the difference was not statistically significant (P > 0.05). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > 0.05). Conclusions: Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment

Long-term visual and treatment outcomes of whole-population pre-school visual screening (PSVS) in children:a longitudinal, retrospective, population-based cohort study

BACKGROUND: This study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances. METHODS: Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances. RESULTS: The proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p < 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p < 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01–4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99–7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29–10.07, p < 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49–4.66, p < 0.001) than those from better home circumstances. CONCLUSIONS: Orthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes

Optimizing the performance of the V0+ detector of the Fast Interaction Trigger (FIT) for the ALICE detector upgrade

Shutdown (2019-2020) vor. Die LHC-Luminosität und -Kollisionsrate wird ab 2021 die Design-Parameter des vorliegenden ALICE Detektors erheblich übersteigen. Darüber hinaus wird die Einführung eines neuen Myon Forward Trackers (MFT) das Platzangebot für die aktualisierten Trigger-Detektoren erheblich verringern. Zur Einhaltung dieser Bedingungen wurde ein Fast Interaction Trigger (FIT) entwickelt. Der FIT-Detektor besteht aus zwei Subdetektor-Systemen: T0+ und V0+. Der T0+ Detektor besteht aus zwei Anordnungen von Quarz-Radiatoren mit MCP-PMT-Sensoren, die auf den Interaktionspunkt gerichtet sind. Der V0+ Detektor besteht aus Kunststoff Szintillator Scheibensegmenten, Glasfaser-Bündel und Photosensoren. In dieser Arbeit konzentrieren wir uns auf den V0+ Detektor. Der V0+ Detektor erfordert hohe Effizienz, hohen Dynamikbereich (1-500) Partikel, Strahlunghärte und muss kompatibel sein mit einem 25 ns Abstand der Teilchenschauer und 1-2 MHz Interaktionsrate für pp-Kollisionen im neuen LHC-Betrieb; unter Beibehaltung der zeitlichen Auflösung von etwa 200 ps für ein einzelnes Teilchen. Um diesen technischen Herausforderungen gerecht zu werden, ist eine strikte fortlaufende F&E Arbeit erforderlich. Diese Arbeit konzentriert sich auf Optimierung des Szintillator Materials, die Wahl der Photosensoren (SiPM, Finemesh PMT und MCP-PMT), die Gestaltung der Glasfaser-Bündel, sowie die Ausleseelektronik."The ALICE Collaboration is preparing a major detector upgrade for the second LHC shutdown (2019-2020). The LHC luminosity and collision rate from 2021 onwards will exceed the parameters of the current ALICE forward trigger detectors. Moreover, the upcoming installation of a new Muon Forward Tracker will reduce the space for the upgraded trigger detector from one side. These conditions urge the need of a new design.The Fast Interaction Trigger (FIT) has been designed to replace the current ALICE forward trigger detector. The FIT will be the primary forward trigger and it will provide minimum bias trigger, multiplicity trigger, centrality, beam-gas event rejection, collision time for the Time of Flight detector (TOF), offline multiplicity and event plane determination". The FIT detector comprises of two subdetector systems, T0+ and V0+. The T0+ consists of two arrays of quartz radiators coupled to MCP-PMT sensors facing the interaction point. The V0+ detector is composed of a disk of plastic scintillator segments, optical fiber bundles, and photosensors. In this contribution, we will focus on the V0+ detector. The V0+ detector requires high efficiency, high dynamic range (1 - 500) particles, radiation hardness and must be compatible with 25 ns bunch spacing and ∼ 1-2 MHz interaction rate for pp collisions of the new LHC operation, while keeping the time resolution of about 200 ps for a single particle. In order to fulfill these technical challenges, a rigorous R&D work is ongoing. This thesis is focusing on optimization of scintillator material, the choice of photosensors (SiPM, Fine-mesh PMT, and MCP-PMT), the design of the optical fiber bundles and the readout electronics as well

Spectacle measurements versus contact lens measurements of the angle of deviation in myopic patients with strabismus

Purpose To compare the measurements of the angle of deviation through spectacles versus contact lenses and with the theoretically calculated angle. Patients and methods A total of 20 patients with comitant strabismus, more than 20 PD with spectacles, associated with bilateral myopia (spherical equivalent >1 D in both eyes) were included. Angle of deviation was measured using prism and cover test with spectacles and with contact lenses fitted according to the cycloplegic refraction and refined by subjective refraction. Agreements between the measurements obtained with contact lenses and those obtained with spectacles as well as the theoretically calculated angle were analyzed. Results The mean age was 15.6±10.9 years. Average spherical equivalent was −9.1±4.2 D. Measurements obtained with contact lenses were significantly lower than those with spectacles (P<0.001) with coefficient of variation of 27.7%, indicating poor agreement of both measurements. Limits of agreement in Bland–Altman plots were more than 9 PD ([INLINE:1] ± 2 s, −8.8 to 6 PD). The agreement was lower with larger angles. Measurements obtained with contact lenses were significantly lower than theoretical angles (P=0.002) but coefficient of variation between both measurements was 8.8%, indicating good agreement of measurements. There was little systematic or proportionate bias between the contact lens measurements and the theoretical angle. Conclusions Contact lens measurements were significantly lower than spectacle measurements in myopic patients. The contact lens measurements were in good agreement with the theoretically calculated angle. This overestimation of the angle with spectacles might be responsible for overcorrection of myopic patients with exotropia after surgery