Gregory J. Griepentrog

Absolute Pitch in Infant Auditory Learning: Evidence for Developmental Reorganization.

To what extent do infants represent the absolute pitches of complex auditory stimuli? Two experiments with 8-month-old infants examined the use of absolute and relative pitch cues in a tone-sequence statistical learning task. The results suggest that, given unsegmented stimuli that do not conform to the rules of musical composition, infants are more likely to track patterns of absolute pitches than of relative pitches. A 3rd experiment tested adults with or without musical training on the same statistical learning tasks used in the infant experiments. Unlike the infants, adult listeners relied primarily on relative pitch cues. These results suggest a shift from an initial focus on absolute pitch to the eventual dominance of relative pitch, which, it is argued, is more useful for both music and speech processing.

Prevalence and clinical characteristics of congenital dacryocystocele.

OBJECTIVE To report the prevalence, clinical findings, and outcomes in children diagnosed with congenital dacryocystocele in a well-defined population during a 20-year period. METHODS The medical records of all Olmsted County, Minnesota, patients diagnosed with congenital dacryocystocele from January 1, 1988, through December 31, 2007, were retrospectively reviewed. RESULTS A total of 9 children were diagnosed with dacryocystocele during the 20-year period, yielding a birth prevalence of 1 in 3,884 live births. The median age at diagnosis was 12 days (range, birth to 40 days); 7 (78%) were female. Eight patients (89%) had unilateral disease. Clinical findings included a cystic mass in all 9, dacryocystitis in 3 (33%), intranasal cysts in 3 (33%), and 1 (11%) each with facial cellulitis and dacryocystocele-induced astigmatism. Conservative treatment resolved the obstruction in 3 (33%), whereas the remaining 6 (67%) each underwent one surgery. Complete resolution was observed in all 9 patients. CONCLUSIONS Congenital dacryocystocele is an uncommon unilateral condition of predominantly neonatal females. Clinical findings support a relatively high incidence of complications such as dacryocystitis and intranasal cysts as well as a less common finding of astigmatism that resolved without evidence of amblyopia. One-third of the cases were successfully managed with conservative treatment alone; most patients required surgical intervention.

Incidence and Demographics of Childhood Ptosis

PURPOSE To report the incidence and demographics of childhood ptosis diagnosed over a 40-year period in a well-defined population. DESIGN Retrospective, population-based cohort study. PARTICIPANTS Patients (<19 years) diagnosed with childhood ptosis and residents of Olmsted County, Minnesota, from January 1, 1965, through December 31, 2004. METHODS The medical records of all potential patients identified by the Rochester Epidemiology Project were reviewed. MAIN OUTCOME MEASURES Calculated annual age- and gender-specific incidence rates and demographic information. RESULTS A total of 107 children were diagnosed with ptosis during the 40-year period, yielding an incidence of 7.9 per 100000 younger than 19 years (95% confidence interval [CI], 6.4-9.5). Ninety-six (89.7%) of the 107 had congenital-onset disease. Eighty-one (75%) of the 107 had simple congenital ptosis, yielding a birth prevalence of 1 in 842 births. A family history of childhood ptosis was present in 12% of queried patients with simple congenital ptosis. Three (4%) of the simple congenital ptosis cases were bilateral and 55 (68%) of the unilateral cases involved the left upper eyelid (95% CI, 57%-78%; P<0.001). CONCLUSIONS Childhood ptosis was diagnosed in 7.9 per 100000 patients younger than 19 years (95% CI, 6.4-9.5). Simple congenital ptosis was the most prevalent form, occurring in 1 in 842 births, and was significantly more likely to involve the left side. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Amblyopia in Childhood Eyelid Ptosis

PURPOSE To report the prevalence and causes of amblyopia among children with ptosis diagnosed in a well-defined population over a 40-year period. DESIGN Retrospective, population-based cohort study. METHODS We retrospectively reviewed the charts of 107 patients younger than 19 years for the prevalence and causes of amblyopia who were diagnosed with childhood ptosis and were residents of Olmsted County, Minnesota, from January 1, 1965, through December 31, 2004. RESULTS Amblyopia was diagnosed in 16 (14.9%) of the 107 patients with childhood ptosis. Fourteen (14.6%) of 96 patients diagnosed with a congenital form of ptosis demonstrated amblyopia. Twelve (14.8%) of the 81 patients diagnosed with simple congenital ptosis had amblyopia, 7 (8.6%) cases of which solely were the result of eyelid occlusion of the visual axis. The causes of amblyopia in the remaining 5 patients were significant refractive error in 3 patients and strabismus in 2 patients. CONCLUSIONS Amblyopia occurred in 1 in 7 children diagnosed with ptosis in this population-based cohort. In approximately half of those with amblyopia, or less than 10% of all patients, the disease solely was the result of eyelid occlusion of the visual axis.

Periorbital Edema Following Hyaluronic Acid Gel Injection: A Retrospective Review

Introduction: The purpose of this study is to investigate the incidence, clinical features, and treatment of prolonged periorbital edema following the injection of hyaluronic acid gel to the infraorbital hollows. Materials and Methods: Retrospective descriptive study. The medical records of patients from 4 physician practices with prolonged (≥1 month) periorbital edema following the placement of hyaluronic acid gel to the infraorbital hollows, diagnosed between January 1, 2008 and December 31, 2011, were reviewed. Results: A total of 51 charts were reviewed, of which 12 (24%) patients were diagnosed with prolonged periorbital edema with a mean follow-up time of 7.1 ± 4.2 months (range, 1.5–15.3 months). The mean patient age was 50.4 years (range, 36.4–64.9 years), and the edema lasted an average of 5.4 months (range, 2.7–5.3 months). A minority of patients had a preprocedural history of fluid retention (17%), seasonal allergies (25%), previous lower eyelid or midface surgery (25%), or festoons on examinat...

Pseudomonas keratitis associated with daily wear of silicone hydrogel contact lenses.

Purpose. To report two cases of pseudomonas keratitis associated with daily wear of silicone hydrogel contact lenses. Methods. Medical records of two patients who developed pseudomonas keratitis while wearing silicone hydrogel lenses on a daily-wear schedule are reviewed and discussed. Results. A 13-year-old girl who wore ACUVUE Advance lenses (Johnson & Johnson Vision Care, Jacksonville, FL) 12 to 14 hours daily developed a paracentral corneal ulcer in her left eye 4 months after beginning contact lens use. Cultures were positive for Pseudomonas aeruginosa. The ulcer responded to fortified antibiotics and resolved in 10 days. Best-corrected visual acuity after resolution of the ulcer was 20/25−1. A 58-year-old woman with a 30-year history of rigid gas-permeable contact lens wear was refitted with O2 Optix lenses (CIBA Vision, Duluth, GA). Six months later, she had a 4.9 × 4.0 mm epithelial defect with an underlying stromal infiltrate in the right eye. Cultures were positive for P. aeruginosa. The ulcer responded to fortified antibiotics and resolved in 30 days. Best-corrected visual acuity after resolution of the ulcer was 20/30−1. Conclusions. Increased oxygen permeability associated with silicone hydrogel contact lenses may reduce, but does not eliminate, the risk of pseudomonas keratitis. Studies have yet to quantify the risk of keratitis associated with daily wear of these lens materials. Further study is necessary to identify the risks of complications with daily wear of silicone hydrogel lenses and to determine which factors may contribute to those risks.

A Clinicopathologic Case Study of Two Patients with Pediatric Orbital IgG4-related Disease

Abstract The purpose of this report is to describe the clinical, radiographica, and histopathologic findings in two pediatric patients with orbital IgG4-related disease.

Anatomical position of hyaluronic Acid gel following injection to the infraorbital hollows.

Purpose: To examine with histology the anatomical location of hyaluronic acid gel injected to the infraorbital hollows of cadaver specimens. Methods: The authors dissected 5 fresh hemifacial cadaver specimens following preperiosteal injection of hyaluronic acid gel to the infraorbital hollows. Following tissue fixation, full-thickness soft tissue sections were obtained along the medial, central, and lateral lower eyelid/midface of each specimen. Histologic examination of the anatomical location of hyaluronic acid gel was performed using hematoxylin and eosin and Hale colloidal iron stains. Results: Histologic examination of the central and lateral lower eyelid/midface sections revealed a significant portion of hyaluronic acid gel in either a postorbicularis or a subcutaneous plane in 8 of 10 sections. Only 2 sections displayed hyaluronic acid gel solely within a preperiosteal plane. The medial sections revealed hyaluronic acid gel resting in either a preperiosteal or an intraorbicularis plane. Soft tissue structures such as deep fat compartment septa and the orbicularis oculi muscle appeared to play a significant role in influencing the resting position of hyaluronic acid gel. Conclusions: In most specimens, the location of a significant portion of hyaluronic acid gel following injection to the infraorbital hollows differed from the intended injection plane. Soft tissue structures including fat compartment septa and the orbicularis oculi muscle appear to influence the resting position of hyaluronic acid gel. Careful attention should be used to avoid overfilling the thin soft tissue layers of the medial infraorbital hollows or tear trough.

Update on the medical treatment of Graves’ ophthalmopathy

Purpose: To review recent advances in the understanding of Graves’ ophthalmopathy (GO) pathogenesis as well as discuss current and future medical management strategies. Design: Interpretive essay. Methods: Literature review and interpretation. Results: Medical treatment of GO has slowly evolved during the past few decades and has been hampered by a poor understanding of the disease at a cellular and molecular level. Current treatment recommendations and guidelines therefore focus on nonspecific immuno-suppression. Newer classes of treatment agents hold promise to more selectively target underlying cellular and molecular alterations in GO. Conclusion: Cooperation between individual patients, physicians and between differing medical centers, together with a refined understanding of the pathogenesis of GO, will lead to newer more-effective treatments for the disease and improve patient quality of life.

Rate of amblyopia in periocular infantile hemangiomas.

the 5-year event-free survival was 96%. Conservative management is acceptable when surgical resection appears to be curative. In the only fully documented prior case of conjunctival PFL to our knowledge, a 6-year-old boy with a small placoid epibulbar lesion underwent local excision without ancillary chemotherapy or radiotherapy. Three years later, he was disease free as verified by a repeated systemic workup. Despite lymphocytic tissue identified at the base of the excision, which may have been benign, and in the absence of any clinical evidence of residual or recurrent disease, we have elected to defer adjunctive local therapy and will be following up with the patient closely.