Children with Disabilities/Special Health Needs and Ocular Refractive Disorders

Children with special needs face many eye problems that should be promptly addressed. Many eye diseases can be treatable if discovered in infancy. There is data showing these children have a higher prevalence of refractive errors than their non-disabled peers. If diagnosed and treated promptly, refractive errors can provide a good quality of life for special needs children.

Tulburările de refracţie la copii

Conform estimărilor curente, la nivel global există aproximativ 150 milioane de persoane cu o tulburare de refracţie necorectată, însumând 27% din populaţia mondială. Dintre aceştia, aproximativ 1,4 milioane sunt copii şi prezintă o formă mai uşoară sau mai gravă de disfuncţie vizuală secundară viciilor de refracţie. Începând cu 1990, afecţiunile oculare considerate a fi o problemă de sănătate publică în rândul copiilor şi care produc disfuncţie vizuală sunt erorile refractive, având o prevalenţă de până la 43%. Maturarea vederii se produce în copilăria precoce, când toate simţurile şi abilităţile motorii conlucrează pentru achiziţia limbajului, a primelor impresii despre mediul înconjurător şi a tuturor elementelor care definesc persoana în sine. Vederea este un sistem percepţional contributiv în dezvoltarea cognitivă, socială, senzorio-motorie şi în acumularea de informaţii despre mediul înconjurător. În primii ani de viaţă, copilul descoperă activităţi tot mai complexe, fiind necesare abilităţile de schimbare a fixaţiei în spaţiu de la un punct la altul şi o motilitate binoculară normală.

Refractive disorders in children

According to current estimations, globally, there are around 150 million people with an uncorrected refractive disorder, which means 27% of the world’s population. Approximately 1.4 million of these are children and have a milder or more severe form of visual dysfunction secondary to refractive errors. Since 1990, refractive errors are considered to be a public health problem among children and cause visual dysfunction, with a prevalence of up to 43%. Vision maturation occurs in early childhood, when all the senses and motor skills work together to acquire language, first ideas about the environment and all the elements that define the person himself. Sight is a contributory perceptual system for the cognitive, social, sensory-motor development and for the assemblage of information about the environment. In the first years of life, the child increasingly discovers complex activities, requiring the ability to change the eyes fixation in space from one point to another and a normal binocular motility.

Fulminant evolution in one case of choroidal melanoma - predictive factors for general metastasis

Comparing with other malignant tumors, uveal melanomas determine tardive general spreading. Even in the absence of local treatment, general metastasis is less than 20%, in the first five years, many factors being involved. This paper present a particular case of choroid melanoma with very unusual and unpredictable evolution of the disease; the high growth of tumor size (in only half year the tumor almost doubled up dimensions), was associated with hepatic metastasis developed in only several months. In our opinion, this case, presenting a very atypical evolution may contribute to increase our knowledge of the mechanisms underlying metastasis and the identification of reliable progression parameters as prognostic markers in primary uveal melanoma. Several histological characteristics and demographic factors have been associated with disease evolution: presence of retinal neovessels and neovascular glaucoma, rapid increasing tumor thickness, scleral invasion, epithelioid cell types with large nucleoli, lymphocytic infiltration, and vascular pattern with networks of loops. Sclera invasion is uncommon in choroid tumors, but it is associated with an unfavorable bad prognosis, giving a great propensity to metastasize and to affect the liver. The median survival following diagnosis of hepatic metastasis is only several months.

Endometrial stromal sarcoma developed on outer endometriosis foci

INTRODUCTION

Endometrial stromal tumor is a rare mesenchymal uterine tumor. Endometriosis, an affection of the women during her fertile period, is reported in the pertinent literature to have an incidence varying from 1% to 53%, which shows a wide difference from one study to another. The pathology that grafts onto the endometriosis foci is rare, and the malignant tumoral pathology is extremely rare. The most frequent malignant tumors quoted in the pertinent literature are of the adenocarcinoma type, on the endometriosis, and the alterations of the sarcomatous type can appear extremely rarely. Most sarcomas appear on the foci of the rectosigmoid endometriosis. These rare tumors should not be taken for the mesenchymal gastrointestinal tumors. The recurrence of the malignant alterations of the endometriosis foci is estimated at about 0.7-1% in the pertinent literature.

MATERIALS AND METHODS

We are presenting a case of endometrial stromal sarcoma, developed on foci of outer endometriosis (sigmoid and appendicular endometriosis), diagnosed in our laboratory on two operatory pieces taken from the same woman, at a 2-month interval. The macroscopic and microscopic study was done on operatory pieces, with the routine procedure, macroscopic examination, fixing in 10% formalin, embedding in paraffin and staining with Hematoxylin-Eosin and than we used immunohistochemical markers, for endometrial stroma.

RESULTS

The endometrial stromal sarcoma developed on foci of endometriosis is very rare, has an incidence of 6% within the endometrial malignant tumors, with various degrees of malignancy, low malignancy, or high malignancy.

CONCLUSIONS

We do not exclude the appearance of the endometrial sarcoma on the outer endometriosis foci. Moreover, the endometriosis foci can be considered as pre-malignant conditions.

Ocular migraine and antiphospholipid antibodies--where we stand?

There is no doubt that ocular migraine also known as retinal migraine or ophthalmic migraine should not to be confused with ophthalmoplegic migraine. The hallmark of ocular migraine is the unilateral visual loss or "monocular transient loss of vision" associated or followed by the headache. Better safe than sorry, therefore an ophthalmologic examination during the migraine attack is the most diagnostic method. age with typical history for ocular migraine. Importantly supportive data sustain that different neuro-ophthalmologic manifestations as amaurosis fugax, retinal vascular thrombosis and optic neuropathy, may be considered as the ocular hallmarks of the Hughes's syndrome. Clues for the evaluating of antiphospholipid antibodies include recurrent thrombosis especially in young people, recurrent fetal loss, and thrombocytopenia. There are no studies that focus exclusively on the prophylaxis of ocular migraine. Ocular features due to antiphospholipid antibodies - induced thrombosis or Hughes's syndrome should be treated with anticoagulant therapy.

Ocular manifestations of antiphospholipid (Hughes)' syndrome--minor features?

The ocular manifestations are described in autoimmune disease, being most common associated with systemic lupus erythematosus, scleroderma, rheumatoid arthritis, insulin-dependent diabetes mellitus, and dermatomyositis. Nonetheless, the antiphospholipid syndrome is a relatively newly recognized autoimmune disorder. Ocular conditions in which to consider antiphospholipid syndrome include amaurosis fugax, transient ischemic attack, retinal haemorrhages and cotton wool spots, central retinal vein and artery occlusion, anterior ischemic optic neuropathy, ophthalmic and cilioretinal artery occlusions. Ocular features due to antiphospholipid antibodies - induced thrombosis should be treated with anticoagulant drugs. In opposition, for the treatment of ocular features due to immunological mechanisms such as vasculitis, immunosuppressants seem to be more suitable. The aim of this article is to underline the mainly ocular features of Hughes' syndrome and for the most part attention should be paid to the patients with central retinal vascular occlusion with no cause but most likely caused by lupus anticoagulant.

[Malignant non-Hodgkin conjunctival-orbital lymphoma in the years 1990-2005 at the Ophthalmology Clinic of Oradea]

Non-Hodgkin conjunctival-orbital Malignant Lymphoma, there are rare tumors, difficult to be diagnosed. We've made a clinical and paraclinical retrospective study, along 15 years (1990-2005) period of time, analyzing from the point of view, clinical features and anatomo-pathological results, each of the 11 cases that we found.

Choroidal melanocytes and associated pathology

The embryologic origins of choroidal and cutanoeus melanocytes, also of the genes involved in cutaneous and choroidal melanoma, are identical, even the two kinds of tumors are different entities. This is a general scientific report, which stretches the molecular mechanisms, as basement of choroidal melanocytes proliferation.

Non-Hodgkin Malignant Lymphoma Study--admitted cases during 1990-2005 in Ophthalmologic Clinical Department, Oradea

Non-Hodgkin Malignant Lymphomas are rare tumors, difficult to be diagnosed. We've made a clinical and paraclinical retrospective study, along 15 years (1990-2005), estimating the moment of onset, clinical and anatomo-pathological features, in each of the 11 cases.

[Epidemiologic study of amblyopia in children between 7 and 11 years of age in Bihor county, Romania]

This descriptive epidemiologic study is effectuated on a representative children's group in Bihor County, aged to 7-11 years old. We studied the incidence and prevalence of amblyopia in children and the importance of early trace to the adequate treatment.

[Complications of refraction disorders]

Refraction disorders, myopia, hypermetropy, astigmatism and anisometropy represent an important segment in ocular pathology as well as an economic and social problem for. Refractions disorders are also responsible for a series of complications generated by different levels of damages of the visual function. The purpose of this paper is to methodically present the possible complications at different types of refraction disorders at different ages.

[Epidemiology of refraction disorders]

THE PURPOSE OF THIS STUDY

Is to appreciate the prevalence and incidence of the refraction disturb among the children aged 7-11 years old.

MATERIAL AND METHOD

Using the descriptive study method, we examined 3562 children aged between 7 to 11 years old, a representative group for Bihor Country.

RESULTS

Among the studied children batch, hypermetropy represents 89.8%, myopia 1.4%, astigmatism 4.9% and anisotropy 4%. The amblyopy was diagnosed in 474 cases (13.3%). The medium amblyopy is predominant.

CONCLUSIONS

The refraction disturb incidence is 9.5@1000 and their prevalence is 82.4@1000. In the studied group, the hypermetropy is predominant. In the group of children with 10 years old, we encountered the greatest number of myopia and emetropy. Amblyopic represents 13.3% from all cases. It is required an ophthalmological health program that will include the refraction disturb with children, as well.

[Secondary cataract treatment with laser YAG-ND]

The purpose of the study is to present the favorable results of YAG: Nd laser capsulotomy for the treatment of secondary opacification of the posterior capsule, in our department. A 3 years retrospective study was performed. For 1440 cataract operations, most of them extracapsular extractions with PMMA IOL placed in the posterior chamber (ciliary sulcus or capsular bag), 285 laser capsulotomies were done. The results are presented statistically, including sex and age distribution, type of cataract surgery and implant, treatment protocol (number of sessions, number of impulses per session, energy per impulse) and complications. The frequency of secondary capsular opacification in our study is 19.78%. It is most important in the age group 60-70 years, where the surgery for cataract is performed more often. Capsulotomy was done after extracapsular extraction with IOL placed in the posterior chamber, but especially after extracapsular extraction without implant placement or with complications that have permitted only the use of an anterior chamber implant. Capsulotomy is performed in only one session in 88% of the cases. The energy per impulse is usually 3-5 mJ and the mean number of impulses per session is 10-30. There are few complications: transient elevation of intraocular pressure in 14.73%, discrete laser marks on the implant in 8.77% and moderate iritis in 1% of the cases. YAG: Nd laser capsulotomy appears to be a safe and efficient method of treating secondary cataract; it improved visual acuity in all cases, if different ocular pathology had not influenced it.