Robert Gordon, MD
1. Quinn GE, Dobson V, Kivlin J, Kaufman,L.M., Repka,M.X., Reynolds,J.D., Gordon,R.A., et al. Prevalence of myopia between 3 months and 5 1/2 years in preterm infants with and without retinopathy of prematurity. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology. 1998;105:1292-300.
PURPOSE: The purpose of the study was to examine spherical equivalent refractive errors, especially myopia, at six ages between 3 months and 5 1/2 years post-term in preterm children with birth weights of less than 1251 g. DESIGN: A cohort study. PARTICIPANTS: There were a total of 827 participants in the multicenter study of cryotherapy for retinopathy of prematurity (ROP). Approximately one third of the eyes did not develop ROP, whereas two thirds developed mild-to-severe ROP. None of the eyes underwent cryotherapy. INTERVENTION: Refractive error was measured at 3 months, 1 year, and 5 1/2 years term due date at the five long-term follow-up centers. In most eyes, refractive error also was measured at 2, 3 1/2, and 4 1/2 years. MAIN OUTCOME MEASURE: Myopia was defined as 0.25 diopter (D) or greater with high myopia as 5 D or greater. RESULTS: The proportion of eyes with myopia in this preterm population was increased compared to published data on full-term children and was related to severity of both acute-phase and cicatricial-phase ROP. The percentage of eyes with myopia varied little across ages, ranging from 21.2% at 1 year to 15.7% at 4 1/2 years. The percentage of eyes with high myopia doubled from 1.8% to 3.9% between 3 months and 1 year and remained stable thereafter. The distribution of refractive errors in eyes with mild acute-phase ROP was similar to that of eyes with no ROP. In contrast, eyes with moderate or severe acute-phase ROP showed an increased prevalence of high myopia. The distribution of refractive errors changed between 3 months and 1 year with little change after 1 year. This pattern of refractive development differs from that of full-term infants. Birth weight, severity of ROP, and degree of myopia at 3 months predicted the presence of myopia and high myopia at 5 1/2 years of age. CONCLUSIONS: The distribution of refractive errors in preterm infants from age 3 months to 5 1/2 years varies with severity of acute-phase ROP and cicatricial disease. Changes in refractive error distribution occur primarily between 3 months and 1 year and involve a decrease in the proportion of eyes with hyperopia and an increase in the proportion with high degrees of myopia.
2. Kivlin JD, Biglan AW, Gordon RA, et al. Early retinal vessel development and iris vessel dilatation as factors in retinopathy of prematurity. Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Cooperative Group [see comments]. Archives of Ophthalmology. 1996;114:150-4.
OBJECTIVE: To determine whether the extent of retinal vessel development present on early screening examinations for retinopathy of prematurity has prognostic value? DESIGN: The prospectively collected data from the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity were used to compare the development of acute retinopathy of prematurity and long-term structural and visual outcomes for eyes with differing extents of retinal vessel development. PATIENT: Study patients had eyes with the following vessel development. In zone I eyes, vessels extended from the disc less than twice the distance from the disc to the macula. In zone II eyes, vessels extended beyond zone I but not to the nasal ora serrata. Transitional eyes had vessels partly in zone I and partly in zone II. RESULTS: The chance of developing threshold retinopathy of prematurity was inversely related to the early degree of vessel development: 54% for zone I eyes, 25% for transitional eyes, and 8% for zone II eyes. The presence of prominent iris vessels at 34 to 35 weeks of postmenstrual age was associated with increased risk for all three groups; zone I eyes almost always needed treatment (94%). The chance of having an unfavorable anatomic alteration of the posterior fundus, or poor vision at the ages of 1 year and 3 1/2 years, was also inversely related to the degree of early vessel development. Vessel development was an independently important factor even when birth weight, gestational age, and race were considered. CONCLUSIONS: The degree of early retinal vessel development is a significant predictor of outcome from retinopathy of prematurity. Iris vessel dilatation is an important indication for greater vigilance in following these infants.
3. Haik BG, Karcioglu ZA, Gordon RA, Pechous BP. Capillary hemangioma (infantile periocular hemangioma). [Review] [237 refs]. Survey of Ophthalmology. 1994;38:399-426.
Capillary hemangiomas are the most common orbital tumors in children. They typically arise early in life, grow rapidly during a proliferative phase and then slowly regress in an involutional phase. The tumors may present as small isolated lesions of minimal clinical significance or as large disfiguring masses that can cause visual impairment and systemic symptomatology. Capillary hemangiomas are managed effectively by establishing a secure diagnosis, outlining the extent of the tumor, and understanding the natural history of the lesion, as well as its response to therapy. The ophthalmic and systemic manifestations of capillary hemangiomas are discussed in detail, as are the histopathology, radiologic findings, differential diagnosis, and therapeutic alternatives. [References: 237]
4. Gordon RA, Lolley VR. Monitoring retinopathy of prematurity: a new form for the nursery [letter]. American Journal of Diseases of Children. 1993;147:927-9.
5. Saunders RA, Stratas BA, Gordon RA, Holgate RC. Acute-onset Brown's syndrome associated with pansinusitis. Archives of Ophthalmology. 1990;108:58-60.
We treated a 5-year-old girl and a 6-year-old boy with acquired Brown's syndrome associated with pansinusitis. In both patients, the diagnosis was established roentgenographically, and the patients were treated with oral antibiotics. Systemic corticosteroids were used in one case, although their clinical value was uncertain. Patients presenting with acute-onset Brown's syndrome of undetermined cause should undergo computed imaging of the orbits and paranasal sinuses.
6. Karcioglu ZA, Haik BG, Gordon RA. Frozen section of the optic nerve in retinoblastoma surgery. Ophthalmology. 1988;95:674-6.
The usefulness of the frozen section examination to determine the extension of retinoblastoma into the optic nerve is discussed. Frozen sections performed at the time of surgery in seven retinoblastoma patients revealed the presence of tumor at the resection margin of the optic nerve in two cases.
7. Gordon RA, Donzis PB. Myopia associated with retinopathy of prematurity. Ophthalmology. 1986;93:1593-8.
A complete analysis of the components of refractive error was performed on ten eyes of five patients with myopia and retinopathy of prematurity (ROP). In comparison to an age-matched control group, these eyes exhibited both lenticular and axial myopia. Only the high crystalline lens powers, which ranged from 22.20 to 44.13 diopters (D) (mean value, 31.27 D), were found to be statistically significant. In two patients, only one eye had high myopia. The lens power in these eyes was approximately 11 D more powerful than the lens of the fellow eye. Further investigation into the ocular changes induced by prematurity and abnormal oxygen metabolism is needed to determine the reason for the high degree of lenticular myopia.
8. Donzis PB, Kastl PR, Gordon RA. An intraocular lens formula for short, normal and long eyes. CLAO Journal. 1985;11:95-8.
9. Donzis PB, Insler MS, Gordon RA. Corneal curvatures in premature infants [letter]. American Journal of Ophthalmology. 1985;99:213-5.
10. Gordon RA, Donzis PB. Refractive development of the human eye. Archives of Ophthalmology. 1985;103:785-9.
A complete refractive investigation was performed on 148 normal eyes of 79 patients ranging from premature newborns to 36-year-old adults. Cycloplegic refraction, keratometry, and axial length measurements were performed. From these data, we then calculated the refractive power of the lens. The change with respect to age in these measurements was subjected to cross-sectional analysis. The full-term newborn eye had a mean axial length of 16.8 mm, a mean keratometric power of 51.2 diopters (spherical equivalent), and a mean lens power of 34.4 D. The adult values for these measurements were 23.6 mm, 43.5 D, and 18.8 D, respectively. This information concerning the expected change with age in the refractive components should aid in the refractive management of pediatric patients requiring cataract extraction.
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