Lasten kaihin seulonta ja leikkaukset

Lähtökohdat Lapsen kaihi tulee leikata varhaisessa vaiheessa näönkehityksen turvaamiseksi. ­Selvitimme TYKS:ssa vuosina 2003–2016 tehtyjen lasten kaihileikkausten tuloksia.Menetelmät Tutkimukseen valittiin alle 5-vuotiaat lapset, joille tehtiin kaihileikkaus ja asetettiin ­primaaristi keinolinssi.Tulokset Leikatuista 24 lapsesta kummankin silmän kaihi oli 11:llä ja toisen silmän kaihi 13:lla. 83 % lapsista lähetettiin neuvolasta tai lastenlääkäriltä. Leikkausiän mediaani oli 8,6 kk (0,8–50,4 kk). ­Kuusi potilasta (10 silmää) leikattiin alle 2 kk:n iässä (25 % potilaista). Glaukooma kehittyi kolmelle, joista kaikki oli leikattu 1 kk:n iässä. Saavutetun kaukonäöntarkkuuden Snellenin mediaani oli 0,40: bilateraalisilla 0,63 ja unilateraalisilla 0,25. Ryhmien välillä ei todettu tilastollisesti merkitsevää eroa (p = 0,186). ­Leikatuissa silmissä taitteisuus muuttui likitaittoiseen suuntaan: 1–18 kk leikkauksen jälkeen keskimäärin –2,85 D ja 1,5–5 v ­leikkauksen jälkeen –2,80 D.Päätelmät Suomessa lapset ohjautuvat tutkimuksiin hyvin seulontojen ansiosta. Kaihileikkauksen jälkeen nähdään leikattujen silmien muuttuminen likitaittoisiksi ja se on nopeinta ensimmäisinä vuosina leikkauksen jälkeen.</p

Peripapillary retinal nerve fibre layer thickness and macular ganglion cell layer volume in association with motor and cognitive outcomes in 11-year-old children born very preterm

Purpose: The purpose of the study was to study the association between retinal parameters and motor and cognitive outcomes in children born very preterm.Methods: This study is part of a prospective cohort study of very preterm infants (birth weight ≤ 1500 grams/gestational age Results: A total of 141 children were included. The mean (SD) average PRNFL was 95 μm (10.2 μm). The mean (SD) macular GCL volume was 0.34 mm3 (0.03 mm3 ). Higher PRNFL thickness associated with higher percentiles for total scores in the motor assessment (b = 0.5, 95% CI 0.1-0.8, p = 0.01) and higher macular GCL volume with higher scores in the cognitive assessment (b = 1.4, 95% CI 0.5-2.3, p = 0.002), also when adjusted for gender, birth weight z-score (birth weight in relation to gestational age) and major brain pathology at term.Conclusion: The associations between higher average PRNFL thickness and better motor performance as well as higher macular GCL volume and better cognitive performance refer to more generalized changes in the brain of 11-year-old children born very preterm. Retinal OCT examinations might provide a deeper insight than mere eyesight in long-term neurodevelopmental follow-up of children born very preterm.</p

Ring melanoma of the anterior chamber angle as a mimicker of pigmentary glaucoma

A 19-year-old man noticed blurred vision in his right eye. He had an intraocular pressure of 60 versus 12 mmHg in the fellow eye. He was initially diagnosed with an atypical, advanced pigmentary glaucoma. The intraocular pressure did not respond to maximal medication, deep sclerectomy, goniopuncture, and 2 cyclophotocoagulations. Sixteen months after presentation, malignancy was first suspected, and the eye was enucleated. A ring melanoma of the anterior chamber angle was confirmed by the histopathologic examination. Normal nuclear staining for breast cancer 1 gene (BRCA1)-associated protein 1 suggested that the tumor was likely of disomy 3 type with a favorable prognosis. No local or systemic recurrence has developed within 4 years. A literature review of this rare type of minimal volume diffuse uveal melanoma identified 18 additional patients. The initial diagnosis in 18 of the 19 patients with a ring melanoma of the anterior chamber angle was unilateral glaucoma with a median intraocular pressure of 40 mmHg and an age range of 16-76 years. Liver metastasis developed in 5 of 12 patients older than 45 years. This rare subtype is estimated to account for 0.05%-0.16% of all uveal melanomas. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

ORIGINAL STUDY Lifetime Visual Disability in Open-angle Glaucoma

Purpose: To study how many of the patients with treated glaucoma or ocular hypertension go blind during their lifetime and which factors are associated with blindness. Patients: The data on 106 consecutive patients who had died between 1991 and 2002 was retrospectively evaluated. At diagnosis 39 patients had primary open-angle glaucoma, 27 had exfoliation glaucoma, and 40 had ocular hypertension. Methods: Clinical records and causes of death were reviewed. Visual disability at the last visit before death was evaluated. Outcome measures were visual handicap and blindness based on visual acuity and/or visual fields. Results: At the last visit, 17 patients [16%, 95 % confidence interval (CI) 9-23] were visually handicapped. Thirteen patients (14%) were bilaterally blind. Glaucoma was the cause of blindness in one or both eyes in 16 patients (15%, 95 % CI 8-22) and in both eyes in 6 patients (6%, 95 % CI 1-10). In the analysis of only 1 eye of each patient, the cumulative incidence of glaucoma-cause

Case report: bilateral Mooren ulcer in association with hepatitis C

Abstract Background Mooren ulcer has been considered as an idiopathic autoimmune keratitis. However, it has been in some cases suggested to be associated with hepatitis C, although the evidence is very vague. Case presentation We present a case of a man who was diagnosed with a primary Mooren ulcer in his right eye. The eye became blind despite of intensive treatment with local medications and extensive surgical procedures. After 10 years, the patient was diagnosed with the same disease, now in his left, previously healthy eye. There was no history that would suggest a secondary Mooren ulcer, but a chronic hepatitis C infection was detected. Treatment was targeted against hepatitis C (ribavirin and interferon) in addition to immunosuppressive medical and surgical treatment which resulted in a full and more than 6 years lasting remission of the disease. Conclusions Whether the immunomodulatory and immunosuppressive medication against hepatitis C was the key reason for the good results in the treatment of the second eye, remains elusive. The causality of hepatitis C with respect to the pathogenesis of Mooren ulcer on this patient remains open, but should be considered as one of the possible etiological factors of the disease