Photorefractive Keratectomy for Myopic Anisometropia: A Retrospective Study on 18 Children

Purpose

To evaluate the safety and efficacy of photorefractive keratectomy (PRK) performed under topical anesthesia in children with myopic anisometropia.

Methods

Medium to high unilateral myopia was corrected in 18 patients by PRK. At the time of surgery patients were between 7 and 17 years of age (mean 10 years). All the surgical procedures were performed under topical anesthesia. Pre- and postoperative data regarding visual acuity, eye alignment, and binocular vision were analyzed.

Results

The mean correction (SE) obtained with excimer laser was −8.21 D (range: −2.25 to −14.50, SD 3.90). The mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/70, and the postoperative mean BSCVA was 20/50. A significant difference was observed between the arithmetic mean of the preoperative and postoperative BSCVA (p=0.001). Two of 18 patients improved stereopsis; furthermore, surgery variation strabismus was registered in 33.3% of the patients, following PRK. Patients were followed up for a mean of 39 months.

Conclusions

The treatment of medium to high unilateral myopia with PRK under local anesthesia was found effective and safe in pediatric and adolescent patients. This procedure may improve ocular alignment and stereopsis. Further studies are needed to increase the patient experience and extend follow-up time in order to assess the long-term stability of the results.

Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke

Background and Purpose—

Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.

Methods—

Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.

Results—

Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P <0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF ( r =0.76; P =0.0002).

Conclusions—

This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.

Treatment of blepharospasm with botulinum neurotoxin type A: long-term results

PURPOSE

To describe the long-term efficacy and side effects of treatment of blepharospasm with botulinum neurotoxin type A (Botox).

METHODS

A total of 178 patients with blepharospasm were treated by injections of botulinum toxin in the Eye Clinic of the University of Naples from 1980 to 2001. The severity of spasm for each patient was graded on a four-point scale. Duration of improvement was assessed and reported in months.

RESULTS

Of 178 cases, 10 were lost to follow-up; of the remaining patients, 93% reported improvement after treatments. The mean duration of improvement was 3.6 months. Twelve patients (76%) who underwent more than 14 treatments maintained stable relief. Three patients (1.7%) had a total remission of spasms. Side-effects were local; none of the 168 patients experienced any systemic or toxic reaction.

CONCLUSIONS

Botulinum toxin therapy for blepharospasm can provide long-lasting relief and reduction of spasms in the majority of patients. This therapy has the advantages of being safe, simple, and repeatable.

Spontaneous resolution of congenital bilateral Brown's syndrome

We report a case of bilateral Brown's syndrome in a 4-year-old girl. Forced duction testing confirmed the clinical diagnosis. After 7 months we observed a spontaneous resolution in the right eye. The problem in her left eye did not show any significant change over 36 months of follow-up. Various spontaneous resolutions in bilateral cases are reviewed.

The outer capsid glycoprotein VP7 of simian rotavirus SA11 contains two distinct neutralization epitopes

Seven neutralizing monoclonal antibodies (MAbs) to the rotavirus simian agent 11 were produced. Although displaying variable degrees of haemagglutination-inhibiting activity, they were shown by radioimmunoprecipitation and Western blot analyses to react with the major outer capsid glycoprotein (VP7). In competition binding assays, MAbs defined two distinct VP7 epitopes, which appeared to be close to each other or partially overlapping. In addition, MAbs of the two epitope groups enhanced binding of a broadly reactive, non-neutralizing, MAb specific for rotavirus group antigen.

Biosynthesis and metabolism of androgenic hormones in cancer of the prostate

The conversion of dehydroepiandrosterone sulfate into testosterone, delta4-androstenedione, and dihydrotestosterone has been measured in minced prostatic adenocarcinoma tissue from three untreated patients, two patients treated with diethylstilbestrol, and one treated with cyproterone acetate. The results obtained show that in both treated and untreated patients the dehydroepiandrosterone sulfate is actively transformed into dehydroepiandrosterone. The subsequent conversion into testosterone and dihydrotestosterone is less evident and inconstant in untreated patients and is inhibited in patients treated with diethylstilbestrol or cyproterone acetate. No formation of delta4-androstenedione was demonstrated in either treated or untreated patients.