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Basic Research
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PEDIATRIC
OPHTHALMOLOGY & STRABISMUS |
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The Institute of Ophthalmology
and Visual Science houses The Fight For Sight Childrens
Eye Center, 1 of only 5 such centers in the United States.
The Institute also houses the States only
Ocular Genetics Unit,
which specializes in the evaluation and treatment of pediatric
patients referred to the Unit. |
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Biostaining-Assisted
Anterior Virectomy for Pediatric and Complicated
Adult Cataract Surgery |
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Suqin Guo, MD;
Rudolph S. Wagner,
MD |
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The goal of this project is to improve visualization of the vitreous
during surgery by using various biostains during anterior vitrectomy
for congenital and/or complicated adult cataract surgery. Congenital
cataract can cause severe visual impairment in young children if not
treated properly or promptly. Primary treatment of this condition
is a cataract extraction with intraocular lens implantation. However,
a major drawback to this procedure is the very high incidence of secondary
cataract formation (posterior capsular opacity) postoperatively, reported
to be as high as 98.5% and occurring as quickly as a few weeks after
surgery. Secondary cataract can cause severe amblyopia and blindness
in a very short period of time. A primary anterior vitrectomy is an
important surgical step for avoiding secondary cataract in pediatric
patients. The transparent vitreous is extremely difficult to visualize
in the anterior chamber during cataract surgery, and it is important
to ensure that the anterior chamber and surgical wounds are free from
vitreous strands. Reducing postoperative complications is challenging
but crucial. Common complications due to vitreous traction include
chronic uveitis, endophthalmitis (intraocular infection), and retinal
detachment. The latter two may lead to blindness.
Biostaining of the vitreous will not only enhance visualization of
the vitreous to ensure a clean anterior vitrectomy, but also act to
preclude potential postoperative complications. The biostains chosen
for this animal model study are being tested for 1) lowest concentration
required to stain and best visualize the vitreous and 2) toxicity
of biostains to ocular tissues, including cornea, uvea, and retina
at different concentrations. During a complicated cataract and intraocular
lens implantation surgery in adult patients, the posterior lens capsule
may be ruptured accidentally, thus requiring anterior vitrectomy as
a next necessary step of the surgery. Incarceration of transparent
vitreous to the surgical wound is a common complication of anterior
vitrectomy due to the poor visualization of the vitreous in the anterior
chamber. Vitreous traction may cause sight-threatening complications.
Improving visualization of the transparent vitreous with different
biostains in the anterior chamber surgery will be helpful for efficient
cleaning of vitreous from the surgical wounds and for reducing potential
sight-threatening postoperative complications. The ultimate goal of
this study is to find the lowest and least toxic concentration of
biodyes for enhanced visualization of the vitreous and, thus, to allow
the best results of anterior vitrectomy.
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Pediatric Intraocular
Implants |
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Suqin Guo, MD |
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Dr. Guo is studying various surgical approaches
for intraocular implants in children, since pediatric eyes differ from
those of adults (eg, growth rate). Dr. Guo is also comparing the effects
of clear corneal incisions and scleral incisions on postoperative astigmatism
in pediatric implants. Additionally, she is randomly using different
intraocular implants and comparing postoperative ocular reactions. Early
optic correction with intraocular implants is an important means of
preventing amblyopia. |
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Natural History of
Retinitis Associated With Children Born Infected With HIV |
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Rudolph
S. Wagner, MD |
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Many children who are HIV-positive at birth develop a chorioretinitis
due, presumably, to cytomegalovirus (CMV) and/or Toxoplasma gondii.
A prospective study is being undertaken to determine the incidence
and course of retinal disease in this pediatric population. Our group
has access to the largest such population in the United States and
is undertaking this project in conjunction with Dr. James Oleske of
the Department of Pediatrics at UMDNJ, who has considerable NIH finding
for his studies on children infected with HIV. One of the goals of
this investigation is to determine new routes for the delivery of
medications to treat retinitis. This is important, since traditional
intravenous delivery is associated with numerous systemic complications.
In addition, the prophylactic effect of triple pharmacologic
therapy will be evaluated.
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Intraocular Lens
Implantation in Children |
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Rudolph
S. Wagner, MD; Suqin Guo, MD |
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Because of the small size of childrens
eyes, implantation of intraocular lenses poses special problems. Drs.
Wagner and Guo are investigating ideal lens size, surgical technique,
and factors to decrease postoperative inflammation. During the past
year, Drs. Wagner and Guo have successfully implanted IOLs in children.
The use of indocyanine green dye has allowed visualization of the anterior
capsule, thus facilitating capsulorrhexis. |
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Unexpected Strabismus
Following Refractive Surgery |
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Rudolph
S. Wagner, MD |
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Dr. Wagner has been evaluating the factors
that predispose to the development of strabismus following LASIK surgery.
Patients with histories of strabismus or anisometropia are at particular
risk for postsurgical redevelopment of these conditions. Thus far, 7
patients in the series have been identified. Dr. Wagner is currently
developing a presurgical predictive protocol for the refractive surgeon
to determine which patients are at risk. If these patients can be identified,
preventive measures, eg, avoidance of overcorrection from myopia to
hyperopia, can be implemented. |
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Preschool Vision
Screening |
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Rudolph
S. Wagner, MD; Kathryn
S. Pokorny, PhD |
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It is estimated that
fewer than 60% of children undergo eye screening/eye examination before
entering kindergarten. Of the most common visual disorders of childhood
(for example, amblyopia and strabismus), many cannot be treated successfully
at a more advanced age. It is imperative to diagnose and treat these
disorders in children before the age of ~6 years. The negative consequences
associated with lack of treatment are far-reaching and include both
an educational and societal (monetary) component. Early vision screening
can successfully detect not only common visual disorders, but also more
serious ocular pathologic conditions, for example, cataract and retinal
tumors, which ultimately reduce visual acuity. Because many children
do not have access to a pediatrician, ophthalmologist, or to a screening
program, Drs. Wagner and Pokorny have devised a simple, inexpensive
method to detect common visual disorders, which can be easily implemented
by nonmedical personnel. The usefulness of this method was tested with
preschool children in daycare centers. Drs. Wagner and Pokorny concluded
that more accurate results were obtained when each eye was alternately
occluded with paper tape than by using an occluder. Future plans include
expansion of this type of program, to include the screening by nonprofessional
personnel of adults in residences, such as senior citizens homes.
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Prescribing
Eyeglasses in Young Children |
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Patrick A.
DeRespinis, MD; Rudolph
S. Wagner, MD; Anthony R. Caputo, MD |
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Results from this
long-term, ongoing study have once again been presented at the American
Academy of Ophthalmology. Prescribing eyeglasses in very young children
(birth to age 3) can be problematic, not only because there are no specific
guidelines, but also because of other significant variables, eg, age
of practitioner, training program, and regional prescribing trends.
In this nationwide survey, pediatric ophthalmologists are requested
to complete a 22-item questionnaire. The study address the different
levels of myopia, hypermetropia, and astigmatism (symmetric and asymmetric);
influence of the different varieties of strabismus on prescribing patterns;
use of bifocals to treat a variety of conditions; therapeutic use of
minus lenses for conditions such as convergence insufficiency; and use
of polycarbonate and other types of lenses. Data from this survey will
aid in supporting decisions regarding appropriate prescription of eyeglasses
for young children. |
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