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Risk factors for developing multiple sclerosis after childhood optic neuritis
Edited by Jeffrey N. Bloom, MD
Risk factors for developing multiple sclerosis after childhood optic neuritis. Lucchinetti CF, Kiers L, O'Duffy A, *et al. Neurology 1997; 49:1413-8. The aims of this study were to determine important factors preceding the onset of optic neuritis (ON) in children younger than 16 years old, define the clinical symptoms and prognosis for visual recovery, and recognize indicators that may predict the risk of developing multiple sclerosis (MS). A review of records from 1950 to 1988 identified 94 patients with idiopathic ON, younger than 16 years, of whom 79 had detailed follow-up information (median length of follow-up 19.4 years, range 2.7 to 43.2 years, mean 22 years). The median age of onset of ON was 11 years (range 2to 16 years). The ratio of females to males was 1.6:1.0. Visual loss was the most frequent presenting symptom, occurring in 98% of children; ocular pain and headache each were reported in 37%. Neurologic signs or symptoms during or within the first month of ON were reported in 46% of patients. These findings included myelitis, seizures, encephalopathy, and meningismus. Unilateral attacks of ON occurred in 39% of children, while 57% had bilateral attacks (simultaneous or sequential). Recurrent ON was reported in 3% of patients. Fundoscopic examination of the affected eye or eyes atthe initial exam revealed: normal (40%), temporal pallor (60%), optic atrophy (17%) and papillitis (47%). Visual acuity atthe last follow-up was: normal (35%): improved, but not normal (48%); minimal recovery (17%). Life-table analysis showed that 19% of the 79 patients with long-term follow-up progressed to clinically or laboratory-supported definite MS by 20 years after the onset of ON. Of the patients who converted to MS, 47% did so within the first year after the ON. 6ender, age, fundoscopic findings, visual acuity, or family history of either ON or MS did not predict the development of MS. The risk of acquiring MS was greater in those patients with bilateral sequential or recurrent ON than for children with a single episode of ON in either one eye or both eyes simultaneously. The presence of infection within 2 weeks before the onset of ON decreased the risk of progression to MS. The authors concluded that childhood ON is associated with a lower risk of MS than is ON in adults.--JN Bloom
Abstracts
IOL between 1990 and 1995 was studied. Cataract types included congenital (18), traumatic (1), and postinflammatory (1). The mean age of patients atthe time of surgery was 6.1 years (range 1.5 to 12 years). The follow-up period extended from 1 to 4.5 years (mean 2 years). The posterior capsule and anterior vitreous were managed in a variety of ways: the posterior capsule was left intact in 5 eyes, whereas 15 eyes underwent posterior continuous curvilinear capsu° Iorhexis (PCCC):6 cases with anterior vitrectomy and 9 cases without vitrectomy. In 8 eyes posterior optic capture was performed, 3 with and 5 without vitrectomy. Visually significant secondary cataract developed in all 5 eyes with intact posterior capsules and in the four eyes that underwent PCCC without vitrectomy and without posterior optic capture. In contrast, the optical axis remained clear in the eyes that underwent PC IOL implantation with vitrectomy, with and without posterior optic capture. Although all optic capture cases without vitrectomy also were initially clear, after 6 months 4 of the 5 developed opacification. The authors concluded that posterior capsulorhexis with anterior vitrectomy was the only effective method to prevent or delay secondary cataract formation in infants and children.--JN Bloom
*Dr. M. Rodriguez, Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, tCullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas. (Reprints not available.)
Limbus versus pupil center for ocular alignment measurement with corneal reflexes. ~Barry J-C, Backes A. Invest 0phthalmol Vis Sci 1997;38:2597-607. Purpose: To investigate the accuracy of ocular misalignment measurement, using corneal reflections. Methods: Corneal reflex positions were measured relative to two landmarks, the limbus center and the entrance pupil center, using high-resolution digital images for cyclopean gaze angles from 0° to 18.8° (34.04 prism diopters; PO) to the right and to the left in 10 subjects. Distance hfrom the center of the corneal curvature to each landmark was determined from linear regressions and showed significant differences between both conditions: mean hlimbuswas 5.243 mm, and mean hpupiI was 4.884 mm. From these, limbus- and entrance-pupil-center-related Hirschberg ratios were determined as 11°/ram (19.43 PD/mm) and 11.82°/mm (20.92 Pg/mm), respectively; and ocular alignment was calculated for both conditions. Simulated angles of strabismus were calculated as the binoculardifference between ocular alignment of the right and left eyes (condition 1), and as the monocular difference between the ocular alignment of right eyes and left eyes separately (condition 2). Results: Condition 1: Errors in simulated angles of strabismus were approximately twice as large for entrance pupil center compared with those in limbus-center-based evaluation; in the primary position, the 95% pupil-related confidence interval of the binocular difference was +5.217° (9.1 PD), compared with _+3.174° (5.5 PD) for the limbus-related option. Condition 2: Errors were approximately equal. Conclusions: The entrance pupil center is a less reliable landmark than is the limbus center for measuring ocular alignment by using corneal reflections, because of unreliable positions of the entrance pupil center; different mean Hirschberg ratios should be used in both conditions.--Authors" abstract
J AAPOS 1998;2:191-2. Copyright © 1998 by the Amelqcan Assodationfor Pediatric Ophthalmology and Strabimms. 1091-8Y31/98 $5.00 + 0 75/3/91256
*Department of Ophthalmology, Medical Faculty of Eberhardt Karls University, Schleichstr. 12-16, D-72076T(.ibingen, Germany.
A retrospective comparison of techniques to prevent secondary cataract formation following posterior chamber intraocular lens implantation in infants and children, tKoch 13D,Kohnen T. Trans Am Ophthalmol Soc 1997;95:351-65. The authors investigated the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsular opacification in children implanted with posterior chamber intraocular lenses (PC iOL). A retrospective series of 20 eyes of 15 children who underwent primary cataract surgery with PC
7ournal of AAPOS
~une 1998 1 9 1
Risk factors for developing multiple sclerosis after childhood optic neuritis. Lucchinetti CF, Kiers L, O'Duffy A, *et al. Neurology 1997; 49:1413-8. The aims of this study were to determine important factors preceding the onset of optic neuritis (ON) in children younger than 16 years old, define the clinical symptoms and prognosis for visual recovery, and recognize indicators that may predict the risk of developing multiple sclerosis (MS). A review of records from 1950 to 1988 identified 94 patients with idiopathic ON, younger than 16 years, of whom 79 had detailed follow-up information (median length of follow-up 19.4 years, range 2.7 to 43.2 years, mean 22 years). The median age of onset of ON was 11 years (range 2to 16 years). The ratio of females to males was 1.6:1.0. Visual loss was the most frequent presenting symptom, occurring in 98% of children; ocular pain and headache each were reported in 37%. Neurologic signs or symptoms during or within the first month of ON were reported in 46% of patients. These findings included myelitis, seizures, encephalopathy, and meningismus. Unilateral attacks of ON occurred in 39% of children, while 57% had bilateral attacks (simultaneous or sequential). Recurrent ON was reported in 3% of patients. Fundoscopic examination of the affected eye or eyes atthe initial exam revealed: normal (40%), temporal pallor (60%), optic atrophy (17%) and papillitis (47%). Visual acuity atthe last follow-up was: normal (35%): improved, but not normal (48%); minimal recovery (17%). Life-table analysis showed that 19% of the 79 patients with long-term follow-up progressed to clinically or laboratory-supported definite MS by 20 years after the onset of ON. Of the patients who converted to MS, 47% did so within the first year after the ON. 6ender, age, fundoscopic findings, visual acuity, or family history of either ON or MS did not predict the development of MS. The risk of acquiring MS was greater in those patients with bilateral sequential or recurrent ON than for children with a single episode of ON in either one eye or both eyes simultaneously. The presence of infection within 2 weeks before the onset of ON decreased the risk of progression to MS. The authors concluded that childhood ON is associated with a lower risk of MS than is ON in adults.--JN Bloom
Abstracts
IOL between 1990 and 1995 was studied. Cataract types included congenital (18), traumatic (1), and postinflammatory (1). The mean age of patients atthe time of surgery was 6.1 years (range 1.5 to 12 years). The follow-up period extended from 1 to 4.5 years (mean 2 years). The posterior capsule and anterior vitreous were managed in a variety of ways: the posterior capsule was left intact in 5 eyes, whereas 15 eyes underwent posterior continuous curvilinear capsu° Iorhexis (PCCC):6 cases with anterior vitrectomy and 9 cases without vitrectomy. In 8 eyes posterior optic capture was performed, 3 with and 5 without vitrectomy. Visually significant secondary cataract developed in all 5 eyes with intact posterior capsules and in the four eyes that underwent PCCC without vitrectomy and without posterior optic capture. In contrast, the optical axis remained clear in the eyes that underwent PC IOL implantation with vitrectomy, with and without posterior optic capture. Although all optic capture cases without vitrectomy also were initially clear, after 6 months 4 of the 5 developed opacification. The authors concluded that posterior capsulorhexis with anterior vitrectomy was the only effective method to prevent or delay secondary cataract formation in infants and children.--JN Bloom
*Dr. M. Rodriguez, Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, tCullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas. (Reprints not available.)
Limbus versus pupil center for ocular alignment measurement with corneal reflexes. ~Barry J-C, Backes A. Invest 0phthalmol Vis Sci 1997;38:2597-607. Purpose: To investigate the accuracy of ocular misalignment measurement, using corneal reflections. Methods: Corneal reflex positions were measured relative to two landmarks, the limbus center and the entrance pupil center, using high-resolution digital images for cyclopean gaze angles from 0° to 18.8° (34.04 prism diopters; PO) to the right and to the left in 10 subjects. Distance hfrom the center of the corneal curvature to each landmark was determined from linear regressions and showed significant differences between both conditions: mean hlimbuswas 5.243 mm, and mean hpupiI was 4.884 mm. From these, limbus- and entrance-pupil-center-related Hirschberg ratios were determined as 11°/ram (19.43 PD/mm) and 11.82°/mm (20.92 Pg/mm), respectively; and ocular alignment was calculated for both conditions. Simulated angles of strabismus were calculated as the binoculardifference between ocular alignment of the right and left eyes (condition 1), and as the monocular difference between the ocular alignment of right eyes and left eyes separately (condition 2). Results: Condition 1: Errors in simulated angles of strabismus were approximately twice as large for entrance pupil center compared with those in limbus-center-based evaluation; in the primary position, the 95% pupil-related confidence interval of the binocular difference was +5.217° (9.1 PD), compared with _+3.174° (5.5 PD) for the limbus-related option. Condition 2: Errors were approximately equal. Conclusions: The entrance pupil center is a less reliable landmark than is the limbus center for measuring ocular alignment by using corneal reflections, because of unreliable positions of the entrance pupil center; different mean Hirschberg ratios should be used in both conditions.--Authors" abstract
J AAPOS 1998;2:191-2. Copyright © 1998 by the Amelqcan Assodationfor Pediatric Ophthalmology and Strabimms. 1091-8Y31/98 $5.00 + 0 75/3/91256
*Department of Ophthalmology, Medical Faculty of Eberhardt Karls University, Schleichstr. 12-16, D-72076T(.ibingen, Germany.
A retrospective comparison of techniques to prevent secondary cataract formation following posterior chamber intraocular lens implantation in infants and children, tKoch 13D,Kohnen T. Trans Am Ophthalmol Soc 1997;95:351-65. The authors investigated the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsular opacification in children implanted with posterior chamber intraocular lenses (PC iOL). A retrospective series of 20 eyes of 15 children who underwent primary cataract surgery with PC
7ournal of AAPOS
~une 1998 1 9 1