Pediatric ophthalmology, neuro-ophthalmology, genetics: 25 tables
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Berlin [u.a.]
Springer
2006
|
| Schriftenreihe: | Essentials in ophthalmology
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI, 240 S. Ill., graph. Darst. |
| ISBN: | 3540225943 9783540225942 |
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| 300 | |a XVI, 240 S. |b Ill., graph. Darst. | ||
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Datensatz im Suchindex
| _version_ | 1804135155793657856 |
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| adam_text | CHAPTER 1
DEVELOPMENT OF OCULAR REFRACTION:
LESSONS FROM ANIMAL EXPERIMENTS
FRANK SCHAEFFEL, HOWARD C. HOWLAND
1.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 1
1.2 OVERVIEW ON THE EXPERIMENTAL
RESULTS IN ANIMAL MODELS . . . . . . . . 2
1.2.1 WHAT IS THE EVIDENCE FOR VISUAL
CONTROL OF REFRACTIVE DEVELOPMENT
AND AXIAL EYE GROWTH? . . . . . . . . . . . 2
1.2.2 WHICH KIND OF VISUAL STIMULATION
INDUCES REFRACTIVE ERRORS
IN ANIMAL MODELS? . . . . . . . . . . . . . . 2
1.2.3 WHAT IS KNOWN ABOUT THE RETINAL
IMAGE PROCESSING THAT LEADS
TO REFRACTIVE ERRORS? . . . . . . . . . . . . . 4
1.2.4 HOW LONG MUST DEFOCUS PERSIST
TO INDUCE CHANGES IN EYE GROWTH? 5
1.2.5 WHAT IS KNOWN ABOUT THE TISSUE
RESPONSES AND THE SIGNALING CASCADE
FROM THE RETINA TO THE SCLERA? . . . . . 5
1.3 CAN ANIMAL MODELS HELP
TO IMPROVE THE MANAGEMENT
OF MYOPIA IN CHILDREN? . . . . . . . . . . . 7
1.3.1 UNDERCORRECTION, OVERCORRECTION,
AND FULL CORRECTION OF MYOPIA . . . . 7
1.3.2 READING GLASSES . . . . . . . . . . . . . . . . . 8
1.3.3 CONTACT LENSES VERSUS
SPECTACLE LENSES. . . . . . . . . . . . . . . . . 8
1.3.4 ILLUMINATION, READING DISTANCE,
COMPUTER WORK VERSUS
READING TEXT IN A BOOK . . . . . . . . . . . 9
1.3.5 HOW LONG MUST THE NEAR WORK
BE PERFORMED TO INDUCE MYOPIA? . . 10
1.3.6 NIGHT LIGHT, BLUE LIGHT . . . . . . . . . . . 10
1.3.7 HOW COULD VISUAL ACUITY
IMPROVE WITHOUT GLASSES? . . . . . . . . 12
1.3.8 AGE WINDOW FOR INTERVENTION . . . . . 13
1.3.9 PHARMACOLOGICAL INTERVENTION
FOR MYOPIA . . . . . . . . . . . . . . . . . . . . . 13
1.3.10 EMMETROPIZATION IN HYPEROPIA
WITH
AND WITHOUT OPTICAL
CORRECTION. . . . . . . . . . . . . . . . . . . . . . 13
1.4 SUMMARY OF EFFECTS OF DIFFERENT
INTERVENTION REGIMENS ON MYOPIA 15
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CHAPTER 2
PRESCHOOL VISION SCREENING:
IS IT WORTHWHILE?
JOSEFIN OHLSSON, JOHAN SJOESTRAND
2.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 19
2.1.1 DEFINITION OF SCREENING. . . . . . . . . . . 19
2.1.2 AIMS OF VISION SCREENING . . . . . . . . . 20
2.2 PRESCHOOL VISION SCREENING . . . . . . . 20
2.2.1 DEFINITION OF PRESCHOOL
VISION SCREENING . . . . . . . . . . . . . . . . 20
2.2.2 TARGET CONDITIONS
FOR PRESCHOOL VISION SCREENING . . . . 21
2.2.3 NATURAL HISTORY
OF UNTREATED AMBLYOPIA . . . . . . . . . . 22
2.2.4 WHOM TO SCREEN? . . . . . . . . . . . . . . . 22
2.3 VISION SCREENING METHODOLOGY . . . . 23
2.3.1 WHAT TEST TO USE FOR SCREENING? . . . 23
2.3.2 VISUAL ACUITY . . . . . . . . . . . . . . . . . . . 23
2.3.3 STEREO TESTS . . . . . . . . . . . . . . . . . . . . . 23
2.3.4 ORTHOPTIC ASSESSMENT . . . . . . . . . . . 24
2.3.5 PHOTOREFRACTIVE SCREENING . . . . . . . . 24
2.3.6 COST-EFFECTIVENESS
OF DIFFERENT TESTS . . . . . . . . . . . . . . . . 24
2.3.7 WHO SHOULD PERFORM
THE SCREENING? . . . . . . . . . . . . . . . . . . 24
2.3.8 AT WHAT LEVEL SHOULD PASS/
FAIL CRITERIA BE SET? . . . . . . . . . . . . . . 24
2.4 WHEN TO SCREEN? . . . . . . . . . . . . . . . . 25
2.4.1 TREATMENT OUTCOME AND AGE . . . . . . 25
CONTENTS
2.4.2 TESTABILITY AND AGE . . . . . . . . . . . . . . 26
2.4.3 AGE AT VISION SCREENING AND RISK
OF NEW CASES OR REBOUNDING
AMBLYOPIA . . . . . . . . . . . . . . . . . . . . . 26
2.4.4 AGE AND PSYCHOSOCIAL IMPACT
OF TREATMENT . . . . . . . . . . . . . . . . . . . 26
2.4.5 CURRENT RECOMMENDATIONS
ON SUITABLE
AGE FOR VISION SCREENING 27
2.5 THE EFFECT
OF PRESCHOOL VISION SCREENING . . . . . 27
2.5.1 THE NECESSITY
OF HIGH PARTICIPATION RATES . . . . . . . 27
2.5.2 EVALUATING THE EFFECT
OF PRESCHOOL VISION SCREENING . . . . . 29
2.6 WHAT IS THE *BEST BUY*
FOR VISION SCREENING? . . . . . . . . . . . . 30
2.6.1 EARLY VERSUS LATE VISION SCREENING 30
2.6.2 WHAT TEST SHOULD BE USED? . . . . . . . 31
2.6.3 WHAT AGE IS THE *BEST BUY*
FOR PRESCHOOL VISION SCREENING? . . . 31
2.7 IS PRESCHOOL VISION SCREENING
WO R T HW H I L E ? . . . . . . . . . . . . . . . . . . . . 32
2.7.1 THE RISK OF LOSING
THE NONAMBLYOPIC EYE . . . . . . . . . . . 32
2.7.2 IS IT DISABLING TO BE AMBLYOPIC? . . . 32
2.7.3 COST-EFFECTIVENESS OF SCREENING
AND TREATMENT FOR AMBLYOPIA . . . . . 33
2.8 FUTURE EVIDENCE NEEDED . . . . . . . . . 34
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
CHAPTER 3
MODERN TREATMENT OF AMBLYOPIA
MICHAEL CLARKE
3.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . 37
3.2 WHAT IS AMBLYOPIA? . . . . . . . . . . . . . 37
3.3 SHOULD AMBLYOPIA BE TREATED? . . . . 38
3.4 WHAT DIFFERENCE DOES IT MAKE
WHEN THE PATIENT IS A CHILD? . . . . . . 39
3.5 WHY TREAT AMBLYOPIA? . . . . . . . . . . . 39
3.6 WHAT ARE PATIENT PERCEPTIONS
OF THE DISABILITY DUE TO AMBLYOPIA? 41
3.7 IDENTIFICATION OF AMBLYOPIA . . . . . . 41
3.8 TREATMENT OF AMBLYOPIA . . . . . . . . . 42
3.8.1 EVIDENCE FOR EFFECTIVENESS
OF AMBLYOPIA TREATMENT . . . . . . . . . 43
3.8.2 CORRECTION OF REFRACTIVE ERROR . . . . 43
3.8.3 PATCHING . . . . . . . . . . . . . . . . . . . . . . . 43
3.8.4 ATROPINE . . . . . . . . . . . . . . . . . . . . . . . 45
3.8.5 WHY DOES AMBLYOPIA TREATMENT
NOT ALWAYS WORK? . . . . . . . . . . . . . . . 46
3.9 NEW DEVELOPMENTS . . . . . . . . . . . . . . 46
3.9.1 L-DOPA . . . . . . . . . . . . . . . . . . . . . . . . 46
3.9.2 VISUAL STIMULATION . . . . . . . . . . . . . . 48
3.10 TRANSLATION INTO PRACTICE . . . . . . . . . 48
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
CHAPTER 4
RETINOPATHY OF PREMATURITY:
MOLECULAR MECHANISM OF DISEASE
LOIS E.H. SMITH
4.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 51
4.2 PATHOGENESIS: TWO PHASES OF ROP . . 51
4.2.1 PHASE I OF ROP . . . . . . . . . . . . . . . . . . 52
4.2.2 PHASE II OF ROP . . . . . . . . . . . . . . . . . 52
4.3 MOUSE MODEL OF ROP . . . . . . . . . . . . 52
4.4 VASCULAR ENDOTHELIAL GROWTH
FACTOR AND OXYGEN IN ROP . . . . . . . . 52
4.4.1 VEGF AND PHASE II OF ROP . . . . . . . . 53
4.4.2 VEGF AND PHASE I OF ROP . . . . . . . . 53
4.5 OTHER GROWTH FACTORS
ARE INVOLVED IN ROP . . . . . . . . . . . . . 54
4.5.1 IGF-1 DEFICIENCY
IN THE PRETERM INFANT . . . . . . . . . . . . 54
4.5.2 GH AND IGF-1 IN PHASE II OF ROP . . 55
4.5.3 IGF-1 AND VEGF INTERACTION . . . . . . 55
4.5.4 LOW LEVELS OF IGF-I AND PHASE I
OF ROP . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.5.5 CLINICAL STUDIES: LOW IGF-1 IS
ASSOCIATED WITH DEGREE OF ROP . . . 56
4.5.6 LOW IGF-1 IS ASSOCIATED
WITH DECREASED VASCULAR DENSITY . . 56
4.5.7 IGF-1 AND BRAIN DEVELOPMENT . . . . . 57
4.6 CONCLUSION: A RATIONALE
FOR THE EVOLUTION OF ROP. . . . . . . . . . 57
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
CHAPTER 5
SCREENING FOR RETINOPATHY OF PREMATURITY
BIRGIT LORENZ
5.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 63
5.2 THE DISEASE . . . . . . . . . . . . . . . . . . . . 64
5.2.1 CLASSIFICATION . . . . . . . . . . . . . . . . . . . 65
5.2.2 TREATMENT REQUIRING ROP . . . . . . . . 65
5.2.3 TREATMENT OF ACUTE ROP . . . . . . . . . . 69
5.3 EPIDEMIOLOGY OF ROP . . . . . . . . . . . . 69
5.3.1 RISK FACTORS . . . . . . . . . . . . . . . . . . . . 70
5.3.2 INCIDENCE OF ROP . . . . . . . . . . . . . . . . 70
5.4 SCREENING GUIDELINES . . . . . . . . . . . . 72
5.5 SCREENING METHODS . . . . . . . . . . . . . . 73
X
CONTENTS
5.5.1 CONVENTIONAL SCREENING . . . . . . . . . . 73
5.5.2 DIGITAL PHOTOGRAPHY . . . . . . . . . . . . . 75
5.5.3 TELEMEDICINE . . . . . . . . . . . . . . . . . . . 76
5.6 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . 77
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
CHAPTER 6
CONTROVERSIES IN THE MANAGEMENT
OF INFANTILE CATARACT
SCOTT R. LAMBERT
6.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 81
6.1.1 EPIDEMIOLOGY . . . . . . . . . . . . . . . . . . . 81
6.2 OPTIMAL AGE FOR INFANTILE
CATARACT SURGERY . . . . . . . . . . . . . . . . 82
6.2.1 APHAKIC GLAUCOMA . . . . . . . . . . . . . . 83
6.2.2 PUPILLARY MEMBRANES . . . . . . . . . . . . 83
6.2.3 LENS REPROLIFERATION . . . . . . . . . . . . . 84
6.2.4 GENERAL ANESTHESIA DURING
THE NEONATAL PERIOD . . . . . . . . . . . . . 84
6.3 VISUAL REHABILITATION
IN CHILDREN WITH A UNILATERAL
CONGENITAL CATARACT . . . . . . . . . . . . . 84
6.3.1 VISUAL REHABILITATION
IN CHILDREN WITH BILATERAL
CONGENITAL CATARACTS . . . . . . . . . . . . 85
6.3.2 CONTACT LENSES . . . . . . . . . . . . . . . . . . 85
6.3.3 INTRAOCULAR LENSES . . . . . . . . . . . . . . . 85
6.3.4 SURVEYS OF NORTH AMERICAN
PEDIATRIC OPHTHALMOLOGISTS . . . . . . . 87
6.4 INFANT APHAKIA TREATMENT STUDY . . . 89
6.4.1 ELIGIBILITY CRITERIA . . . . . . . . . . . . . . . 89
6.4.2 SURGICAL PROCEDURE FOR INFANTS
RANDOMIZED TO CONTACT LENSES . . . . 89
6.4.3 SURGICAL PROCEDURE FOR INFANTS
RANDOMIZED TO IOL . . . . . . . . . . . . . . 89
6.4.4 TYPE OF IOL . . . . . . . . . . . . . . . . . . . . . 90
6.4.5 IOL POWER . . . . . . . . . . . . . . . . . . . . . . 90
6.5 BILATERAL SIMULTANEOUS SURGERY . . . . 91
6.5.1 ENDOPHTHALMITIS . . . . . . . . . . . . . . . . 91
6.5.2 VISUAL REHABILITATION . . . . . . . . . . . . 92
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
CHAPTER 7
MANAGEMENT OF INFANTILE GLAUCOMA
THOMAS S. DIETLEIN,
GUENTER K. KRIEGLSTEIN
7.1CLASSIFICATION
. . . . . . . . . . . . . . . . . . . 95
7.2 D IAGNOSTIC ASPECTS . . . . . . . . . . . . . . 96
7.2.1 CLINICAL BACKGROUND . . . . . . . . . . . . . 96
7.2.2 TONOMETRY . . . . . . . . . . . . . . . . . . . . . 97
7.2.3 OPTIC DISC EVALUATION . . . . . . . . . . . . 97
7.2.4 SONOGRAPHY. . . . . . . . . . . . . . . . . . . . . 98
7.2.5 CORNEAL MORPHOLOGY . . . . . . . . . . . . . 98
7.2.6 VISUAL FIELD TESTING . . . . . . . . . . . . . . 99
7.2.7 OBJECTIVE REFRACTION . . . . . . . . . . . . . 99
7.3 ME DI CAL TREATMENT . . . . . . . . . . . . . . 100
7.3.1 MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . 100
7.3.2 BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . 101
7.3.3 CARBONIC ANHYDRASE INHIBITORS . . . . 101
7.3.4 PROSTAGLANDINS . . . . . . . . . . . . . . . . . . 101
7.3.5 ALPHA-2 AGONISTS . . . . . . . . . . . . . . . . 101
7.4 SU RG ICAL THERAPY . . . . . . . . . . . . . . . . 101
7.4.1 GONIOTOMY . . . . . . . . . . . . . . . . . . . . . 102
7.4.2 TRABECULOTOMY . . . . . . . . . . . . . . . . . . 102
7.4.3 TRABECULOTOMY COMBINED
WITH TRABECULECTOMY. . . . . . . . . . . . . 103
7.4.4 TRABECULECTOMY . . . . . . . . . . . . . . . . . 103
7.4.5 USE OF ANTIFIBROTIC AGENTS . . . . . . . . 104
7.4.6 G L AUCOMA IMPLANTS . . . . . . . . . . . . . . 104
7.4.7 NONPERFORATING GLAUCOMA SURGERY 105
7.4.8 CYCLODIALYSIS . . . . . . . . . . . . . . . . . . . 105
7.4.9 CYCLODESTRUCTIVE PROCEDURES . . . . . . 105
7.4. 10 SURGICAL IRIDECTOMY
(LASER IRIDOTOMY) . . . . . . . . . . . . . . . 106
7.4.11 SPECIAL ASPECTS . . . . . . . . . . . . . . . . . 106
7.5 SU RG ICAL COMPLICATIONS . . . . . . . . . . . 106
7.5.1 INTRAOPERATIVE COMPLICATIONS . . . . . 106
7.5.2 POSTOPERATIVE COMPLICATIONS . . . . . . 107
7.6 PRO G N OS IS . . . . . . . . . . . . . . . . . . . . . . 108
7.7 C ONCLUDING REMARKS . . . . . . . . . . . . 108
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
CHAPTER 8
PEDIATRIC OCULAR ONCOLOGY
CAROL L. SHIELDS, JERRY A. SHIELDS
8.1 GENERAL CONSIDERATIONS . . . . . . . . . . 111
8.1.1 CLINICAL SIGNS OF CHILDHOOD
OCULAR TUMORS . . . . . . . . . . . . . . . . . . 112
8.1.2 DIAGNOSTIC APPROACHES . . . . . . . . . . . 112
8.1.3 THERAPEUTIC APPROACHES . . . . . . . . . 113
8.2 EYELID TUMORS . . . . . . . . . . . . . . . . . . 114
8.2.1 CAPILLARY HEMANGIOMA . . . . . . . . . . 114
8.2.2 FACIAL NEVUS FLAMMEUS . . . . . . . . . . 115
8.2.3 KAPOSI*S SARCOMA . . . . . . . . . . . . . . . 115
8.2.4 BASAL CELL CARCINOMA . . . . . . . . . . . . 115
8.2.5 MELANOCYTIC NEVUS . . . . . . . . . . . . . . 116
8.2.6 NEUROFIBROMA . . . . . . . . . . . . . . . . . . . 116
8.2.7 NEURILEMOMA (SCHWANNOMA) . . . . . 116
CONTENTS
XI
8.3 CONJUNCTIVAL TUMORS . . . . . . . . . . . . 117
8.3.1 DERMOID . . . . . . . . . . . . . . . . . . . . . . . 117
8.3.2 EPIBULBAR OSSEOUS CHORISTOMA . . . . 117
8.3.3 COMPLEX CHORISTOMA . . . . . . . . . . . . 117
8.3.4 PAPILLOMA . . . . . . . . . . . . . . . . . . . . . . 117
8.3.5 NEVUS . . . . . . . . . . . . . . . . . . . . . . . . . 118
8.3.6 CONGENITAL OCULAR MELANOCYTOSIS . . 118
8.3.7 PYOGENIC GRANULOMA . . . . . . . . . . . . 119
8.3.8 KAPOSI*S SARCOMA . . . . . . . . . . . . . . . . 119
8.4 INTRAOCULAR TUMORS . . . . . . . . . . . . . . 119
8.4.1 RETINOBLASTOMA . . . . . . . . . . . . . . . . . 119
8.4.2 RETINAL CAPILLARY HEMANGIOMA . . . 121
8.4.3 RETINAL CAVERNOUS HEMANGIOMA . . 121
8.4.4 RETINAL RACEMOSE HEMANGIOMA . . . 122
8.4.5 ASTROCYTIC HAMARTOMA OF RETINA . . 122
8.4.6 MELANOCYTOMA OF THE OPTIC NERVE 122
8.4.7 INTRAOCULAR MEDULLOEPITHELIOMA . . . 123
8.4.8 CHOROIDAL HEMANGIOMA . . . . . . . . . . 123
8.4.9 CHOROIDAL OSTEOMA . . . . . . . . . . . . . . 123
8.4.10 UVEAL NEVUS . . . . . . . . . . . . . . . . . . . . 124
8.4.11 UVEAL MELANOMA . . . . . . . . . . . . . . . . 124
8.4.12 CONGENITAL HYPERTROPHY
OF RETINAL PIGMENT EPITHELIUM . . . . 125
8.4.13 LEUKEMIA . . . . . . . . . . . . . . . . . . . . . . 126
8.5 ORBITAL TUMORS . . . . . . . . . . . . . . . . . 126
8.5.1 DERMOID CYST . . . . . . . . . . . . . . . . . . . 126
8.5.2 TERATOMA . . . . . . . . . . . . . . . . . . . . . . . 127
8.5.3 CAPILLARY HEMANGIOMA . . . . . . . . . . 127
8.5.4 LYMPHANGIOMA . . . . . . . . . . . . . . . . . 127
8.5.5 JUVENILE PILOCYTIC ASTROCYTOMA . . . . 127
8.5.6 RHABDOMYOSARCOMA . . . . . . . . . . . . . 128
8.5.7 GRANULOCYTIC SARCOMA (CHLOROMA) 128
8.5.8 LYMPHOMA . . . . . . . . . . . . . . . . . . . . . 129
8.5.9 LANGERHANS CELL HISTIOCYTOSIS . . . . . 129
8.5.10 METASTATIC NEUROBLASTOMA . . . . . . . . 129
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
CHAPTER 9
PAEDIATRIC ELECTROPHYSIOLOGY:
A PRACTICAL APPROACH
GRAHAM E. HOLDER, ANTHONY G. ROBSON
9.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 133
9.2 ELECTROPHYSIOLOGICAL TECHNIQUES . . . 133
9.2.1 ELECTRORETINOGRAPHY . . . . . . . . . . . . . 133
9.2.2 PATTERN ELECTRORETINOGRAPHY . . . . . . 135
9.2.3 CORTICAL VISUAL EVOKED POTENTIALS . . 136
9.2.4 ELECTRO-OCULOGRAPHY . . . . . . . . . . . . . 136
9.3 INVESTIGATION OF NIGHT BLINDNESS . . . 137
9.3.1 RETINITIS PIGMENTOSA
(ROD*CONE DYSTROPHY) . . . . . . . . . . 137
9.3.2 CONGENITAL STATIONARY
NIGHT BLINDNESS . . . . . . . . . . . . . . . . . 140
9.3.3 ENHANCED S-CONE SYNDROME . . . . . . 142
9.4 EARLY ONSET NYSTAGMUS . . . . . . . . . . 143
9.4.1 CONE AND CONE*ROD DYSTROPHY . . . 143
9.4.2 LEBER CONGENITAL AMAUROSIS . . . . . . 145
9.4.3 CONE DYSFUNCTION SYNDROMES . . . . . 145
9.4.4 ALBINISM . . . . . . . . . . . . . . . . . . . . . . . 145
9.4.5 OPTIC NERVE HYPOPLASIA . . . . . . . . . . 146
9.5 VISUAL IMPAIRMENT
IN MULTISYSTEM DISORDERS . . . . . . . . . 147
9.6 INVESTIGATION OF CHILDREN
WHO PRESENT WITH UNEXPLAINED
VISUAL ACUITY LOSS . . . . . . . . . . . . . . . 147
9.6.1 MACULAR DYSTROPHIES . . . . . . . . . . . . . 147
9.6.2 OPTIC NERVE DYSFUNCTION . . . . . . . . . 149
9.7 UNEXPLAINED VISUAL LOSS
IN THE NORMAL CHILD . . . . . . . . . . . . . 151
9.7.1 AMBLYOPIA . . . . . . . . . . . . . . . . . . . . . 151
9.7.2 NONORGANIC VISUAL LOSS . . . . . . . . . . 151
9.8 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . 152
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
CHAPTER 10
CLINICAL AND MOLECULAR GENETIC ASPECTS
OF LEBER*S CONGENITAL AMAUROSIS
ROBERT HENDERSON, BIRGIT LORENZ,
ANTHONY
T. MO ORE
10.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 157
10.1.1 CLINICAL FINDINGS . . . . . . . . . . . . . . . . 157
10.1.2 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . 157
10.2 MOLECULAR GENETICS . . . . . . . . . . . . . . 158
10.2.1 GUCY-2D (LCA1 LOCUS) . . . . . . . . . . 160
10.2.2 RPE65 (LCA2). . . . . . . . . . . . . . . . . . . 160
10.2.3 CRX . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
10.2.4 AIPL1 (LCA4) . . . . . . . . . . . . . . . . . . . 164
10.2.5 RPGRIP1 (LCA6) . . . . . . . . . . . . . . . . 165
10.2.6 TULP1 . . . . . . . . . . . . . . . . . . . . . . . . . 166
10.2.7 CRB1 . . . . . . . . . . . . . . . . . . . . . . . . . . 167
10.2.8 RDH12 . . . . . . . . . . . . . . . . . . . . . . . . . 169
10.2.9 OTHER LOCI . . . . . . . . . . . . . . . . . . . . . 169
10.3 HETEROZYGOUS CARRIERS . . . . . . . . . . . 170
10.4 FUTURE THERAPEUTIC AVENUES . . . . . . 170
10.4.1 GENE THERAPY . . . . . . . . . . . . . . . . . . . 170
10.4.2 RETINAL TRANSPLANTATION
AND STEM CELL THERAPY . . . . . . . . . . . 171
10.4.3 PHARMACOLOGICAL THERAPIES . . . . . . . 171
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
XII
CONTENTS
CHAPTER 11
CHILDHOOD STATIONARY
RETINAL DYSFUNCTION SYNDROMES
MICHEL MICHAELIDES, ANTHONY T. MOORE
11.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 179
11.2 STATIONARY RETINAL DYSFUNCTION
SYNDROMES . . . . . . . . . . . . . . . . . . . . . 182
11.2.1 ROD DYSFUNCTION SYNDROMES
(STATIONARY NIGHT BLINDNESS) . . . . . . 182
11.2.2 CONE DYSFUNCTION SYNDROMES . . . . 184
11.3 MANAGEMENT OF STATIONARY RETINAL
DYSFUNCTION SYNDROMES . . . . . . . . . 188
11.4 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . 188
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
CHAPTER 12
CHILDHOOD RETINAL DETACHMENT
ARABELLA V. POULSON, MARTIN P. SNEAD
12.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 191
12.2 TRAUMA . . . . . . . . . . . . . . . . . . . . . . . . 192
12.2.1 BLUNT OCULAR TRAUMA . . . . . . . . . . . . 192
12.2.2 PENETRATING OCULAR TRAUMA . . . . . . . 193
12.3 NONTRAUMATIC RETINAL DIALYSIS. . . . . 193
12.4 FAMILIAL RETINAL DETACHMENT . . . . . . 194
12.4.1 THE STICKLER SYNDROMES . . . . . . . . . . 194
12.4.2 KNIEST SYNDROME . . . . . . . . . . . . . . . . 197
12.4.3 SPONDYLOEPIPHYSEAL DYSPLASIA
CONGENITA . . . . . . . . . . . . . . . . . . . . . . 197
12.4.4 SPONDYLOEPIMETAPHYSEAL DYSPLASIA
(STRUDWICK TYPE) . . . . . . . . . . . . . . . . 198
12.4.5 VITREORETINOPATHY ASSOCIATED
WITH PHALANGEAL EPIPHYSEAL
DYSPLASIA . . . . . . . . . . . . . . . . . . . . . . 198
12.4.6 DOMINANT RHEGMATOGENOUS
RETINAL DETACHMENT . . . . . . . . . . . . . 198
12.4.7 MARFAN SYNDROME . . . . . . . . . . . . . . . 198
12.4.8 EHLERS*DANLOS SYNDROME . . . . . . . . 198
12.4.9 WAGNER VITREORETINOPATHY . . . . . . . . 199
12.4.10 X-LINKED RETINOSCHISIS . . . . . . . . . . . 199
12.4.11 FAMILIAL EXUDATIVE
VITREORETINOPATHY . . . . . . . . . . . . . . . 199
12.4.12 NORRIE DISEASE . . . . . . . . . . . . . . . . . . 200
12.4.13 INCONTINENTIA PIGMENTI . . . . . . . . . . 200
12.5 RETINAL DETACHMENT COMPLICATING
DEVELOPMENTAL ABNORMALITIES . . . . . 201
12.5.1 CONGENITAL CATARACT . . . . . . . . . . . . . 201
12.5.2 OCULAR COLOBOMA . . . . . . . . . . . . . . . 201
12.5.3 OPTIC DISC PITS
AND SEROUS MACULAR DETACHMENT . . 201
12.5.4 RETINOPATHY OF PREMATURITY . . . . . . . 202
12.6 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . 202
12.6.1 INFLAMMATORY OR INFECTIOUS . . . . . . . 202
12.6.2 EXUDATIVE RETINAL DETACHMENT . . . . 202
12.7 PROPHYLAXIS IN RHEGMATOGENOUS
RETINAL DETACHMENT . . . . . . . . . . . . . 203
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
CHAPTER 13
EYE MANIFESTATIONS OF INTRAUTERINE INFECTIONS
MARILYN BAIRD METS,
ASHIMA VERMA KUMAR
13.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . 205
13.2 TOXOPLASMA GONDII . . . . . . . . . . . . . . 205
13.2.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 205
13.2.2 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 205
13.2.3 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 206
13.2.4 EYE MANIFESTATIONS . . . . . . . . . . . . . . 206
13.2.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 207
13.2.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . 207
13.3 RUBELLA VIRUS . . . . . . . . . . . . . . . . . . . 207
13.3.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 207
13.3.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 207
13.3.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 208
13.3.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 208
13.3.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 208
13.3.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 209
13.3.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 209
13.4 CYTOMEGALOVIRUS . . . . . . . . . . . . . . . . 209
13.4.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 209
13.4.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 209
13.4.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 209
13.4.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 209
13.4.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 209
13.4.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 210
13.4.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 210
13.5 HERPES SIMPLEX VIRUS . . . . . . . . . . . . 210
13.5.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 210
13.5.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 210
13.5.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 211
13.5.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 211
13.5.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 211
13.5.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 211
13.5.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 212
CONTENTS
XIII
13.6 LYMPHOCYTIC CHORIOMENINGITIS
VIRUS . . . . . . . . . . . . . . . . . . . . . . . . . . 212
13.6.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 212
13.6.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 212
13.6.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 212
13.6.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 212
13.6.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 213
13.6.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 213
13.6.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 213
13.7 OTHERS . . . . . . . . . . . . . . . . . . . . . . . . . 213
13.7.1 TREPONEMA PALLIDUM . . . . . . . . . . . . 213
13.7.2 VARICELLA*ZOSTER VIRUS . . . . . . . . . . . 213
13.7.3 HUMAN IMMUNODEFICIENCY VIRUS . . 214
13.7.4 EPSTEIN*BARR VIRUS . . . . . . . . . . . . . . 214
13.8 WEST NILE VIRUS . . . . . . . . . . . . . . . . . 214
13.8.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 214
13.8.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 214
13.8.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 214
13.8.4 SYSTEMIC AND EYE MANIFESTATIONS . . 215
13.8.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 215
13.8.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . 215
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
CHAPTER 14
NONACCIDENTAL INJURY.
THE PEDIATRIC OPHTHALMOLOGIST*S ROLE
ALEX V. LEVIN
14.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 219
14.1.1 BASICS . . . . . . . . . . . . . . . . . . . . . . . . . 219
14.1.2 REPORTING . . . . . . . . . . . . . . . . . . . . . . 219
14.1.3 TESTIFYING . . . . . . . . . . . . . . . . . . . . . . 220
14.2 PHYSICAL ABUSE . . . . . . . . . . . . . . . . . . 221
14.2.1 BLUNT TRAUMA . . . . . . . . . . . . . . . . . . . 221
14.2.2 SHAKEN BABY SYNDROME . . . . . . . . . . 222
14.2.3 MUNCHAUSEN SYNDROME BY PROXY
(FACTITIOUS ILLNESS BY PROXY) . . . . . . 225
14.3 SEXUAL ABUSE . . . . . . . . . . . . . . . . . . . 226
14.4 NEGLECT AND NONCOMPLIANCE . . . . . . 227
14.5 EMOTIONAL ABUSE . . . . . . . . . . . . . . . . 227
14.6 CONCLUSION . . . . . . . . . . . . . . . . . . . . . 227
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
SUBJECT INDEX
. . . . . . . . . . . . . . . . . . . . . . . . . 231
XIV
CONTENTS
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| adam_txt |
CHAPTER 1
DEVELOPMENT OF OCULAR REFRACTION:
LESSONS FROM ANIMAL EXPERIMENTS
FRANK SCHAEFFEL, HOWARD C. HOWLAND
1.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 1
1.2 OVERVIEW ON THE EXPERIMENTAL
RESULTS IN ANIMAL MODELS . . . . . . . . 2
1.2.1 WHAT IS THE EVIDENCE FOR VISUAL
CONTROL OF REFRACTIVE DEVELOPMENT
AND AXIAL EYE GROWTH? . . . . . . . . . . . 2
1.2.2 WHICH KIND OF VISUAL STIMULATION
INDUCES REFRACTIVE ERRORS
IN ANIMAL MODELS? . . . . . . . . . . . . . . 2
1.2.3 WHAT IS KNOWN ABOUT THE RETINAL
IMAGE PROCESSING THAT LEADS
TO REFRACTIVE ERRORS? . . . . . . . . . . . . . 4
1.2.4 HOW LONG MUST DEFOCUS PERSIST
TO INDUCE CHANGES IN EYE GROWTH? 5
1.2.5 WHAT IS KNOWN ABOUT THE TISSUE
RESPONSES AND THE SIGNALING CASCADE
FROM THE RETINA TO THE SCLERA? . . . . . 5
1.3 CAN ANIMAL MODELS HELP
TO IMPROVE THE MANAGEMENT
OF MYOPIA IN CHILDREN? . . . . . . . . . . . 7
1.3.1 UNDERCORRECTION, OVERCORRECTION,
AND FULL CORRECTION OF MYOPIA . . . . 7
1.3.2 READING GLASSES . . . . . . . . . . . . . . . . . 8
1.3.3 CONTACT LENSES VERSUS
SPECTACLE LENSES. . . . . . . . . . . . . . . . . 8
1.3.4 ILLUMINATION, READING DISTANCE,
COMPUTER WORK VERSUS
READING TEXT IN A BOOK . . . . . . . . . . . 9
1.3.5 HOW LONG MUST THE NEAR WORK
BE PERFORMED TO INDUCE MYOPIA? . . 10
1.3.6 NIGHT LIGHT, BLUE LIGHT . . . . . . . . . . . 10
1.3.7 HOW COULD VISUAL ACUITY
IMPROVE WITHOUT GLASSES? . . . . . . . . 12
1.3.8 AGE WINDOW FOR INTERVENTION . . . . . 13
1.3.9 PHARMACOLOGICAL INTERVENTION
FOR MYOPIA . . . . . . . . . . . . . . . . . . . . . 13
1.3.10 EMMETROPIZATION IN HYPEROPIA
WITH
AND WITHOUT OPTICAL
CORRECTION. . . . . . . . . . . . . . . . . . . . . . 13
1.4 SUMMARY OF EFFECTS OF DIFFERENT
INTERVENTION REGIMENS ON MYOPIA 15
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CHAPTER 2
PRESCHOOL VISION SCREENING:
IS IT WORTHWHILE?
JOSEFIN OHLSSON, JOHAN SJOESTRAND
2.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 19
2.1.1 DEFINITION OF SCREENING. . . . . . . . . . . 19
2.1.2 AIMS OF VISION SCREENING . . . . . . . . . 20
2.2 PRESCHOOL VISION SCREENING . . . . . . . 20
2.2.1 DEFINITION OF PRESCHOOL
VISION SCREENING . . . . . . . . . . . . . . . . 20
2.2.2 TARGET CONDITIONS
FOR PRESCHOOL VISION SCREENING . . . . 21
2.2.3 NATURAL HISTORY
OF UNTREATED AMBLYOPIA . . . . . . . . . . 22
2.2.4 WHOM TO SCREEN? . . . . . . . . . . . . . . . 22
2.3 VISION SCREENING METHODOLOGY . . . . 23
2.3.1 WHAT TEST TO USE FOR SCREENING? . . . 23
2.3.2 VISUAL ACUITY . . . . . . . . . . . . . . . . . . . 23
2.3.3 STEREO TESTS . . . . . . . . . . . . . . . . . . . . . 23
2.3.4 ORTHOPTIC ASSESSMENT . . . . . . . . . . . 24
2.3.5 PHOTOREFRACTIVE SCREENING . . . . . . . . 24
2.3.6 COST-EFFECTIVENESS
OF DIFFERENT TESTS . . . . . . . . . . . . . . . . 24
2.3.7 WHO SHOULD PERFORM
THE SCREENING? . . . . . . . . . . . . . . . . . . 24
2.3.8 AT WHAT LEVEL SHOULD PASS/
FAIL CRITERIA BE SET? . . . . . . . . . . . . . . 24
2.4 WHEN TO SCREEN? . . . . . . . . . . . . . . . . 25
2.4.1 TREATMENT OUTCOME AND AGE . . . . . . 25
CONTENTS
2.4.2 TESTABILITY AND AGE . . . . . . . . . . . . . . 26
2.4.3 AGE AT VISION SCREENING AND RISK
OF NEW CASES OR REBOUNDING
AMBLYOPIA . . . . . . . . . . . . . . . . . . . . . 26
2.4.4 AGE AND PSYCHOSOCIAL IMPACT
OF TREATMENT . . . . . . . . . . . . . . . . . . . 26
2.4.5 CURRENT RECOMMENDATIONS
ON SUITABLE
AGE FOR VISION SCREENING 27
2.5 THE EFFECT
OF PRESCHOOL VISION SCREENING . . . . . 27
2.5.1 THE NECESSITY
OF HIGH PARTICIPATION RATES . . . . . . . 27
2.5.2 EVALUATING THE EFFECT
OF PRESCHOOL VISION SCREENING . . . . . 29
2.6 WHAT IS THE *BEST BUY*
FOR VISION SCREENING? . . . . . . . . . . . . 30
2.6.1 EARLY VERSUS LATE VISION SCREENING 30
2.6.2 WHAT TEST SHOULD BE USED? . . . . . . . 31
2.6.3 WHAT AGE IS THE *BEST BUY*
FOR PRESCHOOL VISION SCREENING? . . . 31
2.7 IS PRESCHOOL VISION SCREENING
WO R T HW H I L E ? . . . . . . . . . . . . . . . . . . . . 32
2.7.1 THE RISK OF LOSING
THE NONAMBLYOPIC EYE . . . . . . . . . . . 32
2.7.2 IS IT DISABLING TO BE AMBLYOPIC? . . . 32
2.7.3 COST-EFFECTIVENESS OF SCREENING
AND TREATMENT FOR AMBLYOPIA . . . . . 33
2.8 FUTURE EVIDENCE NEEDED . . . . . . . . . 34
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
CHAPTER 3
MODERN TREATMENT OF AMBLYOPIA
MICHAEL CLARKE
3.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . 37
3.2 WHAT IS AMBLYOPIA? . . . . . . . . . . . . . 37
3.3 SHOULD AMBLYOPIA BE TREATED? . . . . 38
3.4 WHAT DIFFERENCE DOES IT MAKE
WHEN THE PATIENT IS A CHILD? . . . . . . 39
3.5 WHY TREAT AMBLYOPIA? . . . . . . . . . . . 39
3.6 WHAT ARE PATIENT PERCEPTIONS
OF THE DISABILITY DUE TO AMBLYOPIA? 41
3.7 IDENTIFICATION OF AMBLYOPIA . . . . . . 41
3.8 TREATMENT OF AMBLYOPIA . . . . . . . . . 42
3.8.1 EVIDENCE FOR EFFECTIVENESS
OF AMBLYOPIA TREATMENT . . . . . . . . . 43
3.8.2 CORRECTION OF REFRACTIVE ERROR . . . . 43
3.8.3 PATCHING . . . . . . . . . . . . . . . . . . . . . . . 43
3.8.4 ATROPINE . . . . . . . . . . . . . . . . . . . . . . . 45
3.8.5 WHY DOES AMBLYOPIA TREATMENT
NOT ALWAYS WORK? . . . . . . . . . . . . . . . 46
3.9 NEW DEVELOPMENTS . . . . . . . . . . . . . . 46
3.9.1 L-DOPA . . . . . . . . . . . . . . . . . . . . . . . . 46
3.9.2 VISUAL STIMULATION . . . . . . . . . . . . . . 48
3.10 TRANSLATION INTO PRACTICE . . . . . . . . . 48
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
CHAPTER 4
RETINOPATHY OF PREMATURITY:
MOLECULAR MECHANISM OF DISEASE
LOIS E.H. SMITH
4.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 51
4.2 PATHOGENESIS: TWO PHASES OF ROP . . 51
4.2.1 PHASE I OF ROP . . . . . . . . . . . . . . . . . . 52
4.2.2 PHASE II OF ROP . . . . . . . . . . . . . . . . . 52
4.3 MOUSE MODEL OF ROP . . . . . . . . . . . . 52
4.4 VASCULAR ENDOTHELIAL GROWTH
FACTOR AND OXYGEN IN ROP . . . . . . . . 52
4.4.1 VEGF AND PHASE II OF ROP . . . . . . . . 53
4.4.2 VEGF AND PHASE I OF ROP . . . . . . . . 53
4.5 OTHER GROWTH FACTORS
ARE INVOLVED IN ROP . . . . . . . . . . . . . 54
4.5.1 IGF-1 DEFICIENCY
IN THE PRETERM INFANT . . . . . . . . . . . . 54
4.5.2 GH AND IGF-1 IN PHASE II OF ROP . . 55
4.5.3 IGF-1 AND VEGF INTERACTION . . . . . . 55
4.5.4 LOW LEVELS OF IGF-I AND PHASE I
OF ROP . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.5.5 CLINICAL STUDIES: LOW IGF-1 IS
ASSOCIATED WITH DEGREE OF ROP . . . 56
4.5.6 LOW IGF-1 IS ASSOCIATED
WITH DECREASED VASCULAR DENSITY . . 56
4.5.7 IGF-1 AND BRAIN DEVELOPMENT . . . . . 57
4.6 CONCLUSION: A RATIONALE
FOR THE EVOLUTION OF ROP. . . . . . . . . . 57
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
CHAPTER 5
SCREENING FOR RETINOPATHY OF PREMATURITY
BIRGIT LORENZ
5.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 63
5.2 THE DISEASE . . . . . . . . . . . . . . . . . . . . 64
5.2.1 CLASSIFICATION . . . . . . . . . . . . . . . . . . . 65
5.2.2 TREATMENT REQUIRING ROP . . . . . . . . 65
5.2.3 TREATMENT OF ACUTE ROP . . . . . . . . . . 69
5.3 EPIDEMIOLOGY OF ROP . . . . . . . . . . . . 69
5.3.1 RISK FACTORS . . . . . . . . . . . . . . . . . . . . 70
5.3.2 INCIDENCE OF ROP . . . . . . . . . . . . . . . . 70
5.4 SCREENING GUIDELINES . . . . . . . . . . . . 72
5.5 SCREENING METHODS . . . . . . . . . . . . . . 73
X
CONTENTS
5.5.1 CONVENTIONAL SCREENING . . . . . . . . . . 73
5.5.2 DIGITAL PHOTOGRAPHY . . . . . . . . . . . . . 75
5.5.3 TELEMEDICINE . . . . . . . . . . . . . . . . . . . 76
5.6 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . 77
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
CHAPTER 6
CONTROVERSIES IN THE MANAGEMENT
OF INFANTILE CATARACT
SCOTT R. LAMBERT
6.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 81
6.1.1 EPIDEMIOLOGY . . . . . . . . . . . . . . . . . . . 81
6.2 OPTIMAL AGE FOR INFANTILE
CATARACT SURGERY . . . . . . . . . . . . . . . . 82
6.2.1 APHAKIC GLAUCOMA . . . . . . . . . . . . . . 83
6.2.2 PUPILLARY MEMBRANES . . . . . . . . . . . . 83
6.2.3 LENS REPROLIFERATION . . . . . . . . . . . . . 84
6.2.4 GENERAL ANESTHESIA DURING
THE NEONATAL PERIOD . . . . . . . . . . . . . 84
6.3 VISUAL REHABILITATION
IN CHILDREN WITH A UNILATERAL
CONGENITAL CATARACT . . . . . . . . . . . . . 84
6.3.1 VISUAL REHABILITATION
IN CHILDREN WITH BILATERAL
CONGENITAL CATARACTS . . . . . . . . . . . . 85
6.3.2 CONTACT LENSES . . . . . . . . . . . . . . . . . . 85
6.3.3 INTRAOCULAR LENSES . . . . . . . . . . . . . . . 85
6.3.4 SURVEYS OF NORTH AMERICAN
PEDIATRIC OPHTHALMOLOGISTS . . . . . . . 87
6.4 INFANT APHAKIA TREATMENT STUDY . . . 89
6.4.1 ELIGIBILITY CRITERIA . . . . . . . . . . . . . . . 89
6.4.2 SURGICAL PROCEDURE FOR INFANTS
RANDOMIZED TO CONTACT LENSES . . . . 89
6.4.3 SURGICAL PROCEDURE FOR INFANTS
RANDOMIZED TO IOL . . . . . . . . . . . . . . 89
6.4.4 TYPE OF IOL . . . . . . . . . . . . . . . . . . . . . 90
6.4.5 IOL POWER . . . . . . . . . . . . . . . . . . . . . . 90
6.5 BILATERAL SIMULTANEOUS SURGERY . . . . 91
6.5.1 ENDOPHTHALMITIS . . . . . . . . . . . . . . . . 91
6.5.2 VISUAL REHABILITATION . . . . . . . . . . . . 92
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
CHAPTER 7
MANAGEMENT OF INFANTILE GLAUCOMA
THOMAS S. DIETLEIN,
GUENTER K. KRIEGLSTEIN
7.1CLASSIFICATION
. . . . . . . . . . . . . . . . . . . 95
7.2 D IAGNOSTIC ASPECTS . . . . . . . . . . . . . . 96
7.2.1 CLINICAL BACKGROUND . . . . . . . . . . . . . 96
7.2.2 TONOMETRY . . . . . . . . . . . . . . . . . . . . . 97
7.2.3 OPTIC DISC EVALUATION . . . . . . . . . . . . 97
7.2.4 SONOGRAPHY. . . . . . . . . . . . . . . . . . . . . 98
7.2.5 CORNEAL MORPHOLOGY . . . . . . . . . . . . . 98
7.2.6 VISUAL FIELD TESTING . . . . . . . . . . . . . . 99
7.2.7 OBJECTIVE REFRACTION . . . . . . . . . . . . . 99
7.3 ME DI CAL TREATMENT . . . . . . . . . . . . . . 100
7.3.1 MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . 100
7.3.2 BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . 101
7.3.3 CARBONIC ANHYDRASE INHIBITORS . . . . 101
7.3.4 PROSTAGLANDINS . . . . . . . . . . . . . . . . . . 101
7.3.5 ALPHA-2 AGONISTS . . . . . . . . . . . . . . . . 101
7.4 SU RG ICAL THERAPY . . . . . . . . . . . . . . . . 101
7.4.1 GONIOTOMY . . . . . . . . . . . . . . . . . . . . . 102
7.4.2 TRABECULOTOMY . . . . . . . . . . . . . . . . . . 102
7.4.3 TRABECULOTOMY COMBINED
WITH TRABECULECTOMY. . . . . . . . . . . . . 103
7.4.4 TRABECULECTOMY . . . . . . . . . . . . . . . . . 103
7.4.5 USE OF ANTIFIBROTIC AGENTS . . . . . . . . 104
7.4.6 G L AUCOMA IMPLANTS . . . . . . . . . . . . . . 104
7.4.7 NONPERFORATING GLAUCOMA SURGERY 105
7.4.8 CYCLODIALYSIS . . . . . . . . . . . . . . . . . . . 105
7.4.9 CYCLODESTRUCTIVE PROCEDURES . . . . . . 105
7.4. 10 SURGICAL IRIDECTOMY
(LASER IRIDOTOMY) . . . . . . . . . . . . . . . 106
7.4.11 SPECIAL ASPECTS . . . . . . . . . . . . . . . . . 106
7.5 SU RG ICAL COMPLICATIONS . . . . . . . . . . . 106
7.5.1 INTRAOPERATIVE COMPLICATIONS . . . . . 106
7.5.2 POSTOPERATIVE COMPLICATIONS . . . . . . 107
7.6 PRO G N OS IS . . . . . . . . . . . . . . . . . . . . . . 108
7.7 C ONCLUDING REMARKS . . . . . . . . . . . . 108
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
CHAPTER 8
PEDIATRIC OCULAR ONCOLOGY
CAROL L. SHIELDS, JERRY A. SHIELDS
8.1 GENERAL CONSIDERATIONS . . . . . . . . . . 111
8.1.1 CLINICAL SIGNS OF CHILDHOOD
OCULAR TUMORS . . . . . . . . . . . . . . . . . . 112
8.1.2 DIAGNOSTIC APPROACHES . . . . . . . . . . . 112
8.1.3 THERAPEUTIC APPROACHES . . . . . . . . . 113
8.2 EYELID TUMORS . . . . . . . . . . . . . . . . . . 114
8.2.1 CAPILLARY HEMANGIOMA . . . . . . . . . . 114
8.2.2 FACIAL NEVUS FLAMMEUS . . . . . . . . . . 115
8.2.3 KAPOSI*S SARCOMA . . . . . . . . . . . . . . . 115
8.2.4 BASAL CELL CARCINOMA . . . . . . . . . . . . 115
8.2.5 MELANOCYTIC NEVUS . . . . . . . . . . . . . . 116
8.2.6 NEUROFIBROMA . . . . . . . . . . . . . . . . . . . 116
8.2.7 NEURILEMOMA (SCHWANNOMA) . . . . . 116
CONTENTS
XI
8.3 CONJUNCTIVAL TUMORS . . . . . . . . . . . . 117
8.3.1 DERMOID . . . . . . . . . . . . . . . . . . . . . . . 117
8.3.2 EPIBULBAR OSSEOUS CHORISTOMA . . . . 117
8.3.3 COMPLEX CHORISTOMA . . . . . . . . . . . . 117
8.3.4 PAPILLOMA . . . . . . . . . . . . . . . . . . . . . . 117
8.3.5 NEVUS . . . . . . . . . . . . . . . . . . . . . . . . . 118
8.3.6 CONGENITAL OCULAR MELANOCYTOSIS . . 118
8.3.7 PYOGENIC GRANULOMA . . . . . . . . . . . . 119
8.3.8 KAPOSI*S SARCOMA . . . . . . . . . . . . . . . . 119
8.4 INTRAOCULAR TUMORS . . . . . . . . . . . . . . 119
8.4.1 RETINOBLASTOMA . . . . . . . . . . . . . . . . . 119
8.4.2 RETINAL CAPILLARY HEMANGIOMA . . . 121
8.4.3 RETINAL CAVERNOUS HEMANGIOMA . . 121
8.4.4 RETINAL RACEMOSE HEMANGIOMA . . . 122
8.4.5 ASTROCYTIC HAMARTOMA OF RETINA . . 122
8.4.6 MELANOCYTOMA OF THE OPTIC NERVE 122
8.4.7 INTRAOCULAR MEDULLOEPITHELIOMA . . . 123
8.4.8 CHOROIDAL HEMANGIOMA . . . . . . . . . . 123
8.4.9 CHOROIDAL OSTEOMA . . . . . . . . . . . . . . 123
8.4.10 UVEAL NEVUS . . . . . . . . . . . . . . . . . . . . 124
8.4.11 UVEAL MELANOMA . . . . . . . . . . . . . . . . 124
8.4.12 CONGENITAL HYPERTROPHY
OF RETINAL PIGMENT EPITHELIUM . . . . 125
8.4.13 LEUKEMIA . . . . . . . . . . . . . . . . . . . . . . 126
8.5 ORBITAL TUMORS . . . . . . . . . . . . . . . . . 126
8.5.1 DERMOID CYST . . . . . . . . . . . . . . . . . . . 126
8.5.2 TERATOMA . . . . . . . . . . . . . . . . . . . . . . . 127
8.5.3 CAPILLARY HEMANGIOMA . . . . . . . . . . 127
8.5.4 LYMPHANGIOMA . . . . . . . . . . . . . . . . . 127
8.5.5 JUVENILE PILOCYTIC ASTROCYTOMA . . . . 127
8.5.6 RHABDOMYOSARCOMA . . . . . . . . . . . . . 128
8.5.7 GRANULOCYTIC SARCOMA (CHLOROMA) 128
8.5.8 LYMPHOMA . . . . . . . . . . . . . . . . . . . . . 129
8.5.9 LANGERHANS CELL HISTIOCYTOSIS . . . . . 129
8.5.10 METASTATIC NEUROBLASTOMA . . . . . . . . 129
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
CHAPTER 9
PAEDIATRIC ELECTROPHYSIOLOGY:
A PRACTICAL APPROACH
GRAHAM E. HOLDER, ANTHONY G. ROBSON
9.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 133
9.2 ELECTROPHYSIOLOGICAL TECHNIQUES . . . 133
9.2.1 ELECTRORETINOGRAPHY . . . . . . . . . . . . . 133
9.2.2 PATTERN ELECTRORETINOGRAPHY . . . . . . 135
9.2.3 CORTICAL VISUAL EVOKED POTENTIALS . . 136
9.2.4 ELECTRO-OCULOGRAPHY . . . . . . . . . . . . . 136
9.3 INVESTIGATION OF NIGHT BLINDNESS . . . 137
9.3.1 RETINITIS PIGMENTOSA
(ROD*CONE DYSTROPHY) . . . . . . . . . . 137
9.3.2 CONGENITAL STATIONARY
NIGHT BLINDNESS . . . . . . . . . . . . . . . . . 140
9.3.3 ENHANCED S-CONE SYNDROME . . . . . . 142
9.4 EARLY ONSET NYSTAGMUS . . . . . . . . . . 143
9.4.1 CONE AND CONE*ROD DYSTROPHY . . . 143
9.4.2 LEBER CONGENITAL AMAUROSIS . . . . . . 145
9.4.3 CONE DYSFUNCTION SYNDROMES . . . . . 145
9.4.4 ALBINISM . . . . . . . . . . . . . . . . . . . . . . . 145
9.4.5 OPTIC NERVE HYPOPLASIA . . . . . . . . . . 146
9.5 VISUAL IMPAIRMENT
IN MULTISYSTEM DISORDERS . . . . . . . . . 147
9.6 INVESTIGATION OF CHILDREN
WHO PRESENT WITH UNEXPLAINED
VISUAL ACUITY LOSS . . . . . . . . . . . . . . . 147
9.6.1 MACULAR DYSTROPHIES . . . . . . . . . . . . . 147
9.6.2 OPTIC NERVE DYSFUNCTION . . . . . . . . . 149
9.7 UNEXPLAINED VISUAL LOSS
IN THE NORMAL CHILD . . . . . . . . . . . . . 151
9.7.1 AMBLYOPIA . . . . . . . . . . . . . . . . . . . . . 151
9.7.2 NONORGANIC VISUAL LOSS . . . . . . . . . . 151
9.8 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . 152
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
CHAPTER 10
CLINICAL AND MOLECULAR GENETIC ASPECTS
OF LEBER*S CONGENITAL AMAUROSIS
ROBERT HENDERSON, BIRGIT LORENZ,
ANTHONY
T. MO ORE
10.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 157
10.1.1 CLINICAL FINDINGS . . . . . . . . . . . . . . . . 157
10.1.2 DIFFERENTIAL DIAGNOSIS . . . . . . . . . . . . 157
10.2 MOLECULAR GENETICS . . . . . . . . . . . . . . 158
10.2.1 GUCY-2D (LCA1 LOCUS) . . . . . . . . . . 160
10.2.2 RPE65 (LCA2). . . . . . . . . . . . . . . . . . . 160
10.2.3 CRX . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
10.2.4 AIPL1 (LCA4) . . . . . . . . . . . . . . . . . . . 164
10.2.5 RPGRIP1 (LCA6) . . . . . . . . . . . . . . . . 165
10.2.6 TULP1 . . . . . . . . . . . . . . . . . . . . . . . . . 166
10.2.7 CRB1 . . . . . . . . . . . . . . . . . . . . . . . . . . 167
10.2.8 RDH12 . . . . . . . . . . . . . . . . . . . . . . . . . 169
10.2.9 OTHER LOCI . . . . . . . . . . . . . . . . . . . . . 169
10.3 HETEROZYGOUS CARRIERS . . . . . . . . . . . 170
10.4 FUTURE THERAPEUTIC AVENUES . . . . . . 170
10.4.1 GENE THERAPY . . . . . . . . . . . . . . . . . . . 170
10.4.2 RETINAL TRANSPLANTATION
AND STEM CELL THERAPY . . . . . . . . . . . 171
10.4.3 PHARMACOLOGICAL THERAPIES . . . . . . . 171
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
XII
CONTENTS
CHAPTER 11
CHILDHOOD STATIONARY
RETINAL DYSFUNCTION SYNDROMES
MICHEL MICHAELIDES, ANTHONY T. MOORE
11.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 179
11.2 STATIONARY RETINAL DYSFUNCTION
SYNDROMES . . . . . . . . . . . . . . . . . . . . . 182
11.2.1 ROD DYSFUNCTION SYNDROMES
(STATIONARY NIGHT BLINDNESS) . . . . . . 182
11.2.2 CONE DYSFUNCTION SYNDROMES . . . . 184
11.3 MANAGEMENT OF STATIONARY RETINAL
DYSFUNCTION SYNDROMES . . . . . . . . . 188
11.4 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . 188
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
CHAPTER 12
CHILDHOOD RETINAL DETACHMENT
ARABELLA V. POULSON, MARTIN P. SNEAD
12.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 191
12.2 TRAUMA . . . . . . . . . . . . . . . . . . . . . . . . 192
12.2.1 BLUNT OCULAR TRAUMA . . . . . . . . . . . . 192
12.2.2 PENETRATING OCULAR TRAUMA . . . . . . . 193
12.3 NONTRAUMATIC RETINAL DIALYSIS. . . . . 193
12.4 FAMILIAL RETINAL DETACHMENT . . . . . . 194
12.4.1 THE STICKLER SYNDROMES . . . . . . . . . . 194
12.4.2 KNIEST SYNDROME . . . . . . . . . . . . . . . . 197
12.4.3 SPONDYLOEPIPHYSEAL DYSPLASIA
CONGENITA . . . . . . . . . . . . . . . . . . . . . . 197
12.4.4 SPONDYLOEPIMETAPHYSEAL DYSPLASIA
(STRUDWICK TYPE) . . . . . . . . . . . . . . . . 198
12.4.5 VITREORETINOPATHY ASSOCIATED
WITH PHALANGEAL EPIPHYSEAL
DYSPLASIA . . . . . . . . . . . . . . . . . . . . . . 198
12.4.6 DOMINANT RHEGMATOGENOUS
RETINAL DETACHMENT . . . . . . . . . . . . . 198
12.4.7 MARFAN SYNDROME . . . . . . . . . . . . . . . 198
12.4.8 EHLERS*DANLOS SYNDROME . . . . . . . . 198
12.4.9 WAGNER VITREORETINOPATHY . . . . . . . . 199
12.4.10 X-LINKED RETINOSCHISIS . . . . . . . . . . . 199
12.4.11 FAMILIAL EXUDATIVE
VITREORETINOPATHY . . . . . . . . . . . . . . . 199
12.4.12 NORRIE DISEASE . . . . . . . . . . . . . . . . . . 200
12.4.13 INCONTINENTIA PIGMENTI . . . . . . . . . . 200
12.5 RETINAL DETACHMENT COMPLICATING
DEVELOPMENTAL ABNORMALITIES . . . . . 201
12.5.1 CONGENITAL CATARACT . . . . . . . . . . . . . 201
12.5.2 OCULAR COLOBOMA . . . . . . . . . . . . . . . 201
12.5.3 OPTIC DISC PITS
AND SEROUS MACULAR DETACHMENT . . 201
12.5.4 RETINOPATHY OF PREMATURITY . . . . . . . 202
12.6 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . 202
12.6.1 INFLAMMATORY OR INFECTIOUS . . . . . . . 202
12.6.2 EXUDATIVE RETINAL DETACHMENT . . . . 202
12.7 PROPHYLAXIS IN RHEGMATOGENOUS
RETINAL DETACHMENT . . . . . . . . . . . . . 203
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
CHAPTER 13
EYE MANIFESTATIONS OF INTRAUTERINE INFECTIONS
MARILYN BAIRD METS,
ASHIMA VERMA KUMAR
13.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . 205
13.2 TOXOPLASMA GONDII . . . . . . . . . . . . . . 205
13.2.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 205
13.2.2 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 205
13.2.3 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 206
13.2.4 EYE MANIFESTATIONS . . . . . . . . . . . . . . 206
13.2.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 207
13.2.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . 207
13.3 RUBELLA VIRUS . . . . . . . . . . . . . . . . . . . 207
13.3.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 207
13.3.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 207
13.3.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 208
13.3.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 208
13.3.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 208
13.3.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 209
13.3.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 209
13.4 CYTOMEGALOVIRUS . . . . . . . . . . . . . . . . 209
13.4.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 209
13.4.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 209
13.4.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 209
13.4.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 209
13.4.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 209
13.4.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 210
13.4.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 210
13.5 HERPES SIMPLEX VIRUS . . . . . . . . . . . . 210
13.5.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 210
13.5.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 210
13.5.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 211
13.5.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 211
13.5.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 211
13.5.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 211
13.5.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 212
CONTENTS
XIII
13.6 LYMPHOCYTIC CHORIOMENINGITIS
VIRUS . . . . . . . . . . . . . . . . . . . . . . . . . . 212
13.6.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 212
13.6.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 212
13.6.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 212
13.6.4 SYSTEMIC MANIFESTATIONS . . . . . . . . . . 212
13.6.5 EYE MANIFESTATIONS . . . . . . . . . . . . . . 213
13.6.6 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 213
13.6.7 PREVENTION . . . . . . . . . . . . . . . . . . . . . 213
13.7 OTHERS . . . . . . . . . . . . . . . . . . . . . . . . . 213
13.7.1 TREPONEMA PALLIDUM . . . . . . . . . . . . 213
13.7.2 VARICELLA*ZOSTER VIRUS . . . . . . . . . . . 213
13.7.3 HUMAN IMMUNODEFICIENCY VIRUS . . 214
13.7.4 EPSTEIN*BARR VIRUS . . . . . . . . . . . . . . 214
13.8 WEST NILE VIRUS . . . . . . . . . . . . . . . . . 214
13.8.1 AGENT AND EPIDEMIOLOGY . . . . . . . . . 214
13.8.2 TRANSMISSION . . . . . . . . . . . . . . . . . . . 214
13.8.3 DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . 214
13.8.4 SYSTEMIC AND EYE MANIFESTATIONS . . 215
13.8.5 TREATMENT . . . . . . . . . . . . . . . . . . . . . . 215
13.8.6 PREVENTION . . . . . . . . . . . . . . . . . . . . . 215
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
CHAPTER 14
NONACCIDENTAL INJURY.
THE PEDIATRIC OPHTHALMOLOGIST*S ROLE
ALEX V. LEVIN
14.1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . 219
14.1.1 BASICS . . . . . . . . . . . . . . . . . . . . . . . . . 219
14.1.2 REPORTING . . . . . . . . . . . . . . . . . . . . . . 219
14.1.3 TESTIFYING . . . . . . . . . . . . . . . . . . . . . . 220
14.2 PHYSICAL ABUSE . . . . . . . . . . . . . . . . . . 221
14.2.1 BLUNT TRAUMA . . . . . . . . . . . . . . . . . . . 221
14.2.2 SHAKEN BABY SYNDROME . . . . . . . . . . 222
14.2.3 MUNCHAUSEN SYNDROME BY PROXY
(FACTITIOUS ILLNESS BY PROXY) . . . . . . 225
14.3 SEXUAL ABUSE . . . . . . . . . . . . . . . . . . . 226
14.4 NEGLECT AND NONCOMPLIANCE . . . . . . 227
14.5 EMOTIONAL ABUSE . . . . . . . . . . . . . . . . 227
14.6 CONCLUSION . . . . . . . . . . . . . . . . . . . . . 227
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
SUBJECT INDEX
. . . . . . . . . . . . . . . . . . . . . . . . . 231
XIV
CONTENTS |
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| discipline | Medizin |
| discipline_str_mv | Medizin |
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| index_date | 2024-07-02T14:03:30Z |
| indexdate | 2024-07-09T20:36:01Z |
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| title | Pediatric ophthalmology, neuro-ophthalmology, genetics 25 tables |
| title_auth | Pediatric ophthalmology, neuro-ophthalmology, genetics 25 tables |
| title_exact_search | Pediatric ophthalmology, neuro-ophthalmology, genetics 25 tables |
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| title_full | Pediatric ophthalmology, neuro-ophthalmology, genetics 25 tables eds. B. Lorenz ... |
| title_fullStr | Pediatric ophthalmology, neuro-ophthalmology, genetics 25 tables eds. B. Lorenz ... |
| title_full_unstemmed | Pediatric ophthalmology, neuro-ophthalmology, genetics 25 tables eds. B. Lorenz ... |
| title_short | Pediatric ophthalmology, neuro-ophthalmology, genetics |
| title_sort | pediatric ophthalmology neuro ophthalmology genetics 25 tables |
| title_sub | 25 tables |
| topic | Augenkrankheit (DE-588)4112627-0 gnd Kind (DE-588)4030550-8 gnd Neuroophthalmologie (DE-588)4171592-5 gnd |
| topic_facet | Augenkrankheit Kind Neuroophthalmologie Aufsatzsammlung |
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