293. Pediatric Ophthalmology And Orthoptics

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293. Pediatric Ophthalmology And Orthoptics

293. Pediatric Ophthalmology And Orthoptics

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 293

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Syllabus

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 Sjöstrand
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

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
Worthwhile? . . . . . . . . . . . . . . . . . . . . 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

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
7.1 Classification . . . . . . . . . . . . . . . . . . . 95
7.2 Diagnostic 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 Medical 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 Surgical 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 Glaucoma 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 Surgical Complications . . . . . . . . . . . 106
7.5.1 Intraoperative Complications . . . . . 106
7.5.2 Postoperative Complications . . . . . . 107
7.6 Prognosis . . . . . . . . . . . . . . . . . . . . . . 108
7.7 Concluding 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

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. Moore
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

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

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