scholarly journals A multicenter Spanish study of atropine 0.01% in childhood myopia progression

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Inés Pérez-Flores ◽  
Beatríz Macías-Murelaga ◽  
Jesús Barrio-Barrio ◽  
Inés Pérez Flores ◽  
Marta Valcárcel Vizcaíno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Effects ◽  
Pupil Diameter ◽  
Pediatric Population ◽  
Anterior Chamber Depth ◽  
Eye Drops ◽  
Myopia Progression ◽  
Telephone Consultation ◽  
Progression Risk

AbstractTo evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective, multicenter study was designed. Children aged between 6 and 14 years, with myopia between − 2.00 D to − 6.00 D, astigmatism < 1.50 D and documented previous annual progression greater than − 0.5 D (cycloplegic spherical equivalent, SE) were included. Once nightly atropine 0.01% eye drops in each eye were prescribed to all participants for 12 months. Age, gender, ethnicity and iris color were registered. All patients underwent the same follow-up protocol in every center: baseline visit, telephone consultation 2 weeks later and office controls at 4, 8 and 12 months. At each visit, best-corrected visual acuity, and cycloplegic autorefraction were assessed. Axial length (AL), anterior chamber depth and pupil diameter were measured on an IOL Master (Carl Zeiss Meditec, Inc, Dublin, CA). Adverse effects were registered in a specific questionnaire. Mean changes in cycloplegic SE and AL in the 12 months follow-up were analyzed. SE progression during treatment was compared with the SE progression in the year before enrollment for each patient. Correlation between SE and AL, and annual progression distribution were evaluated. Progression risk factors were analyzed by multivariate logistic regression analyses. Of the 105 recruited children, 92 completed the treatment. Mean SE and AL changes were − 0.44 ± 0.41 D and 0.27 ± 0.20 mm respectively. Mean SE progression was lower than the year before treatment (− 0.44 ± 0.41 D versus − 1.01 ± 0.38 D; p < 0.0001). An inverse correlation between SE progression and AL progression (r: − 0.42; p < 0.0001) was found. Fifty-seven patients (62%) had a SE progression less than − 0.50 D. No risk factors associated with progression could be identified in multivariate analyses. Mean pupil diameter increment at 12-months visit was 0.74 ± 1.76 mm. The adverse effects were mild and infrequent, and decreased over the time. Atropine 0.01% is effective and safe for myopia progression control in a multicentric Spanish children cohort. We believe this efficacy might be extensible to the myopic pediatric population from Western countries with similar social and demographic features. More studies about myopia progression risk factors among atropine treated patients are needed.

scholarly journals Atropine 0.01% for the Control of Myopia in Chinese Children: Effect on Accommodation Functions and Pupil Size

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yuliang Wang ◽  
Jing Yao ◽  
Xiaomei Qu
Keyword(s):  
Pupil Size ◽  
Pupil Diameter ◽  
Chinese Children ◽  
Secondary Outcome ◽  
Control Group ◽  
Eye Drops ◽  
Myopia Progression ◽  
Single Vision ◽  
To Receive

Background. To explore the effect of atropine 0.01% on accommodation functions and pupil size for safely and effectively controlling myopia in Chinese children. Methods. This was a single-center randomized clinical trial. 63 participants with myopia of at least −0.50 D and astigmatism of ≤−2.50 D were enrolled and randomized to receive atropine 0.01% once nightly with regular single-vision lenses or to wear regular single-vision lenses, in an allocation ratio of 3 : 2. Primary outcomes included changes of accommodation functions, pupil diameter, distant and near best-corrected visual acuity (BCVA), near stereoacuity, and intraocular pressure (IOP). Secondary outcome was myopic progression at 6 months. Results. 61 participants completed the follow-up. Compared with the control group, the atropine-treated children showed a statistically significant increase in pupil diameter after 6 months (0.7 ± 0.7 vs. 0.1 ± 0.5 mm, P=0.01). Despite the enlarged pupil, routine vision-related activities were not affected. The mean changes in accommodative functions, BCVA, near stereoacuity, and IOP, did not differ significantly between the groups. At 6 months, participants in the control group showed greater myopia progression than those in the atropine group (spherical equivalent: −0.60 ± 0.43 vs.−0.30 ± 0.42 D, P<0.001; axial length: 0.35 ± 0.20 vs. 0.24 ± 0.16 mm, P=0.001). Conclusions. Atropine 0.01% eye drops significantly increased pupil diameter less than one mm, but it did not affect accommodative functions, BCVA, near stereoacuity, and IOP. Combined with its reducing myopia progression, atropine 0.01% can be used as a safe and effective treatment for myopia in Chinese children.

scholarly journals Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu Liu ◽  
Chunjie Liu ◽  
Dongmei Guo ◽  
Ning Wang ◽  
Ying Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Closed Reduction ◽  
Pediatric Population ◽  
Normal Weight ◽  
Medical Community ◽  
Overweight Children ◽  
Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

scholarly journals Effect of low-dose atropine on myopia progression, pupil diameter and accommodative amplitude: low-dose atropine and myopia progression

2020 ◽  
pp. bjophthalmol-2019-315440 ◽  
Author(s):  
Aicun Fu ◽  
Fiona Stapleton ◽  
Li Wei ◽  
Weiqun Wang ◽  
Bingxin Zhao ◽  
...  
Keyword(s):  
Low Dose ◽  
Pupil Diameter ◽  
Repeated Measurements ◽  
Control Group ◽  
Eye Drops ◽  
Control Groups ◽  
Myopia Progression ◽  
Registration Number ◽  
And Control ◽  
Accommodative Amplitude

PurposeTo evaluate the effects of 0.01% and 0.02% atropine eye drops on myopia progression, pupil diameter and accommodative amplitude in myopic children.MethodsA cohort study assessed 400 myopic children divided into three groups: 138 and 142 children were randomised to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine eye drop applied to both eyes once nightly. Control children (n=120) only wore SV spectacles. Repeated measurements of spherical equivalent refractive errors (SERs), axial length (AL), pupil diameter and accommodative amplitude were performed at baseline, and 4, 8 and 12 months after treatment.ResultsAfter 12 months, the SER change was −0.38±0.35D, −0.47±0.45D, −0.70±0.60D and AL change was 0.30±0.21 mm, 0.37±0.22 mm, 0.46±0.35 mm in the 0.02%, 0.01% atropine and control groups, respectively. There were significant differences in the change in AL and SER between three groups (all p<0.001). Between baseline and the 12-month visit, the overall change in accommodative amplitude was 1.50±0.25D, 1.61±0.31D and change in pupil diameter was 0.78±0.42 mm, 0.69±0.39 mm, with 0.02% and 0.01% atropine, respectively. Accommodative amplitude significantly decreased and pupil diameter significantly increased in two atropine groups (all p<0.001). Moreover, there was no statistical difference in the change difference in accommodative amplitude and pupil diameter between two atropine groups (p=0.24, p=0.38), whereas the accommodative amplitude (p=0.45) and pupil diameter (p=0.39) in the control group remained stable.Conclusions0.02% atropine eye drops had a better effect on myopia progression than 0.01% atropine, but 0.02% and 0.01% atropine showed similar effects on pupil diameter and accommodative amplitude after 12 months of treatment.Trial registration numberChiCTR-IPD-16008844.

scholarly journals LESSONS FROM A LARGE NATIONWIDE STUDY OF 350 CHILDREN WITH OVARIAN MATURE TERATOMA: A PLEA FOR OVARIAN-SPARING SURGERY

2021 ◽  
Author(s):  
Fanny Delehaye ◽  
Sabine SARNACKI ◽  
Daniel Orbach ◽  
Alaa Cheikhelard ◽  
Jérémie Rouger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Population ◽  
Mature Teratoma ◽  
Laboratory Studies ◽  
Tumor Rupture ◽  
Palpable Mass ◽  
First Choice ◽  
Choice Of Treatment ◽  
Type Of Surgery

Objective Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10% to 20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed. This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. Design A retrospective review of all girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, follow-up second events and their management were retrieved. Results Overall, 350 children were identified. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: 8 cases including one malignant tumor, contralateral: 18 cases, both ovaries: 3 cases). A large palpable mass, bilateral forms at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas type of surgery or approach did not. Conclusion This study is a plea in favor of OSS as the first choice of treatment of OMT when possible. Close follow-up during the first five years is mandatory considering the risk of 8.3% of second events especially in cases with risk factors.

scholarly journals P577 Withdrawal of thiopurines in patients with Ulcerative Colitis in remission

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S534-S534
Author(s):  
C Amor Costa ◽  
C Suárez Ferrer ◽  
J Poza Cordón ◽  
J L Rueda García ◽  
M Sánchez Azofra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Standard Deviation ◽  
Adverse Effects ◽  
Medical Decision ◽  
Concomitant Treatment ◽  
Duration Of Treatment ◽  
The Mean ◽  
Time To Relapse

Abstract Background Thiopurines (TP) are widely used in monotherapy in patients with ulcerative colitis (UC), mainly for the maintenance of remission in case of corticodependence or corticoresistance after cyclosporine use. However, these are drugs with significant side effects, especially in the long term. The optimal duration of treatment with TP remains unknown, so it is important to determine the risk factors for relapse in order to identify the group of patients in which treatment can be withdrawn. Methods A retrospective study was performed. Patients with UC in remission, in maintenance treatment with TP, who had discontinued the drug due to either maintained remission or the onset of adverse effects were included. Results 26 patients were included, 1 with proctitis, 9 with left colitis and 16 with pancolitis. 24 (92.31%) were treated with azathioprine and 2 (7.69%) with mercaptopurine. The mean treatment time with TP was 68.09 months (standard deviation 56.65). 11 patients (42.31%) discontinued TP due to adverse effects and the remaining patients (57.69%) discontinued it by medical decision because they were in prolonged remission. After withdrawal of TP, 92.34% of patients continued treatment with mesalazine and the remaining 7.69% without concomitant treatment. During follow-up, 10 patients (38.4%) relapsed and 16 patients (61.53%) had no relapse until the end of follow-up. The mean time from TP withdrawal to the onset of relapse was 69.15 months (standard deviation 52.53). Of the 10 patients who presented a flare, 5 (50%) were controlled by optimizing the dose of mesalazine, 4 (40%) required the addition of oral corticosteroids and 1 (10%) required biologics. No significant differences were found when comparing the time to relapse if the reason for discontinuation of TP was having had an adverse effect (65.05 months) or maintained remission (79.79 months) (p=0.42). No statistically significant differences were found in time to relapse when comparing time on TP treatment, presence of concomitant treatment with mesalazine or active smoking. Conclusion One third of patients relapsed after TP withdrawal. Discontinuation of TP in patients with UC in remission should be individualized according to the patient’s risk factors, the indication and the duration of treatment.

scholarly journals 1402. NTM Infections; A Rising Global Health Problem/Clinical Characteristics and Outcomes of Patients with Non-Tuberculous Mycobacterial Infections at Two Tertiary Academic Medical Centers

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S785-S786
Author(s):  
Abdelhameed Nawwar ◽  
Julieta Madrid-Morales ◽  
Carolina Velez-Mejia ◽  
Rigoberto De Jesus Pizarro ◽  
Victor Cepeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Effects ◽  
Disease Process ◽  
University Hospital ◽  
Categorical Variables ◽  
Similar Distribution ◽  
Hospital System ◽  
Duration Of Therapy ◽  
Extra Pulmonary

Abstract Background Non-Tuberculous Mycobacteria (NTM) cause infections in immunocompetent as well as immunocompromised individuals affecting pulmonary and extra pulmonary sites. These pathogens are widely distributed globally and recent reports have shown their rise in many developed countries. Our study aimed to assess the disease magnitude, describe patient characteristics and risk factors, assess diagnostic and therapeutic measures and review outcomes furthering our understanding of the overall disease process. Methods We conducted a retrospective, multicenter review of patients with positive NTM cultures treated at University Hospital System and South Texas Veterans Health Care System (STVHCS) from 2011 to 2018. Infections were classified as pulmonary or extrapulmonary, and we recorded demographics, microbiological data, treatment regimens, duration, complications, follow-up and mortality. All categorical variables were described using percentages and compared between groups using the chi-square test. Results A total of 176 patients were included for analysis, of which 111 (63.1%) met criteria for NTM disease (2020 ATS/IDSA). The most common cultured mycobacterium was M. Avium Complex (MAC). M. abscessus-chelonae was more commonly associated with clinical disease and isolated from an extra pulmonary site whereas M. simiae complex had similar distribution between the infected and un-infected groups. Over 50% of patients received treatment (80% in the infected group). Cure was seen in 47.2%, all-cause mortality was 27% at last follow-up. Median duration of therapy was 10 months. 47% of patients experienced adverse effects which led to treatment discontinuation in one third of patients. Patients who were able to achieve a cure received a longer duration of therapy (12 vs 7 months; not statistically significant) and treatment was halted more commonly in the group that did not achieve eventual cure (42.6% vs. 16.7%, p=0.007). Conclusion NTM infections represent a therapeutic challenge with low cure rates and high mortality. An understanding of the risk factors, treatment options and outcomes is essential to guide appropriate management. Our study highlights high rates of adverse effects and discontinuation which precludes prolonged courses of therapy required to achieve cure. Disclosures All Authors: No reported disclosures

scholarly journals Ten-year incidence of primary angle closure in elderly Chinese: the Liwan Eye Study

2018 ◽  
Vol 103 (3) ◽  
pp. 355-360 ◽  
Author(s):  
Lanhua Wang ◽  
Wenyong Huang ◽  
Shengsong Huang ◽  
Jian Zhang ◽  
Xinxing Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incident Angle ◽  
Significant Risk ◽  
Anterior Chamber Depth ◽  
Angle Closure ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Study Participants ◽  
Angle Width

PurposeTo determine the 10-year incidence of all forms of primary angle closure (PAC) in phakic eyes and its risk factors in an urban Chinese population aged 50 years and older.MethodsSurvivors of 1405 baseline participants were invited to attend the 10-year follow-up visit in the Liwan Eye Study. Participants with established baseline angle closure, including primary angle closure suspects (PACS), PAC and primary angle closure glaucoma (PACG), or those who underwent bilateral cataract surgery during the 10-year period, as well as those who did not tolerate gonioscopic examinations, were excluded from this analysis. Incident PAC was present when those with open angles at baseline developed angle closure in any form in either eye during the 10-year period.ResultsAmong 791 participants who returned during the 10-year follow-up visit, 620 (78.4%) provided data on PAC incidence. The 10-year cumulative incidence of any forms of PAC was 20.5% (127/620, 95% CI 17.4% to 24.9%), including 16.9%, 2.4% and 1.1% with incident PACS, PAC and PACG in either eye, respectively. In multiple logistic regression, significant risk factors for incident angle closure were greater baseline lens thickness (OR=1.82 per mm, p=0.003), shallower anterior chamber depth (OR=3.18 per mm decreased, p=0.010) and narrower angle width (OR=1.63 per decreased angle width, p<0.0001).ConclusionsApproximately one in five people aged 50 years and older developed some form of angle closure over a 10-year period. Small ocular dimensions and hyperopia at baseline were associated with the development of angle closure.

scholarly journals Inflammatory Response in the Anterior Chamber after Implantation of an Angle-Supported Lens in Phakic Myopic Eyes

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Suphi Taneri ◽  
Saskia Oehler ◽  
Carsten Heinz
Keyword(s):  
Inflammatory Response ◽  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Postoperative Treatment ◽  
Eye Drops ◽  
Quick Recovery ◽  
Safe Level ◽  
Laser Flare

Purpose. To evaluate the inflammatory reaction after implantation of an angle-supported foldable acrylic anterior chamber IOL for myopia correction over time.Methods. Adult individuals seeking vision correction with stable myopia >7.0 D were included. Exclusion criteria are anterior chamber depth <2.8 mm, insufficient endothelial cell density, other preexisting ocular conditions, and prior eye surgery. Laser flare photometry and slitlamp examination were performed before and up to 1 year after implantation of an AcrySof Cachet IOL (Alcon Laboratories, Forth Worth, TX, USA). Postoperative treatment comprised antibiotic eye-drops for 5 days and nonsteroidal anti-inflammatory eye-drops (NSAIDs) for 4 weeks.Results. Average laser flare values of 15 consecutive eyes of 15 patients were8.3±9.7preoperatively and19.0±24.2(1 day),24.0±27.5(1 week),17.6±13.4(1 month),14.9±15.4(3 months), and10.0±7.0(1 year) photon counts/ms after implantation, respectively. Slitlamp examination yielded 0 or 1+ cells (SUN classification) in every one eye throughout the follow-up period.Conclusion. Results indicate a low maximum inflammatory response and a quick recovery to a long-term safe level. The use of NSAIDs seems sufficient in routine cases, thus avoiding potential drawbacks of using corticoids.

scholarly journals Evolution of treatment for children with esthesioneuroblastoma (1969–2019)

2021 ◽  
Vol 11 (3) ◽  
pp. 56-71
Author(s):  
A. D. Rodina ◽  
A. S. Krylov ◽  
T. V. Gorbunova ◽  
V. A. Korolyov ◽  
O. A. Merkulov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Tumor ◽  
Pediatric Population ◽  
Disease Onset ◽  
Specific Treatment ◽  
Special Treatment ◽  
Cervical Lymph Nodes ◽  
Tumor Dissemination ◽  
Long Term Treatment

Introduction. Esthesioneuroblastoma is a rare neuroectodermal malignant tumor. The incidence of this tumor in children under 15 years of age is 0.1 per 100,000 pediatric population. The information on incidence, disease course, and treatment of esthesioneuroblastoma in children vary significantly and depend on the follow-up period and statistical methods.Objective – to assess risk factors for esthesioneuroblastoma and evaluate treatment strategies used in children and their prospects.Materials and methods. This study included 29 patients aged 2 to 17 years diagnosed with esthesioneuroblastoma and treated at the Research Institute of Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russia between 1969 and 2019. The median age upon diagnosis was 10 years. Six patients (20 %) developed the disease early in their life (being under 3 years of age). Esthesioneuroblastoma was equally common in boys and girls. More than half of the patients (n = 15; 51 %) had stage IV disease. The primary tumor invaded the maxillary sinus (n = 25; 86 %), orbit (n = 10; 34 %), ethmoid sinus (n = 18; 62 %), and cranial cavity (n = 12; 41 %). The majority of children (n = 28; 96 %) received pharmacotherapy and radiotherapy (n = 27; 93 %); the total focal dose was 50 Gy in case of primary tumor. The affected cervical lymph nodes were irradiated in 10 (35 %) patients (total focal dose 40 Gy). Ten (35 %) patients have undergone surgery.Results. The follow-up period varied between 3 months and 50 years. Nine (34 %) patients are still alive. Fourteen patients (48 %) died due to tumor progression; 1 (3 %) patient died due to complications from special treatment. Five (17 %) patients were lost to follow-up at different stages.Conclusion. The following risk factors were associated with poor prognosis in children with esthesioneuroblastoma: disease onset in early childhood, no adequate diagnosis of distant metastases prior to specific treatment initiation, disseminated disease, and high Ki-67 index. In patients with advanced cancer, surgeries were effective only in combination with chemoradiotherapy. Long-term treatment outcomes in children with esthesioneuroblastoma are poor due to high risk of recurrence and tumor dissemination.  

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