Nathalie F. Azar

Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination

OBJECTIVE To evaluate the effect of the introduction of the Haemophilus influenzae B (Hib) vaccine (introduced first in 1985, then extended in 1990 to children at least 2 months of age) on the epidemiologic features of periorbital and orbital cellulitis. DESIGN Retrospective, comparative case series. PARTICIPANTS Three hundred fifteen pediatric inpatients. METHODS Children at Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary with discharge diagnosis of periorbital or orbital cellulitis from 1980 through 1998 were reviewed. MAIN OUTCOME MEASURES Case rate, culture-positive isolates, and associated conditions. RESULTS A total of 297 cases of periorbital cellulitis and 18 cases of orbital cellulitis were reviewed. Before 1990, there were 27 cases of Hib-related cellulitis (11.7% of total in that period), whereas after 1990, there were only three (3.5% of total; P = 0.028). The number of cases per year was significantly lower after 1990 (21.2 +/- 10.4 vs. 8.7 +/- 3.9; P = 0.008), as were the number of positive culture isolates (for any organism) after 1990 (76 [33. 0%] vs. 9 [10.6%]; P < 0.001). The medical conditions most commonly associated with periorbital cellulitis were sinusitis (44 [14.5%]) and upper respiratory infections (73 [26.6%]). All cases of orbital cellulitis were associated with sinusitis. CONCLUSIONS The introduction of the Hib vaccine coincided with a sharp decline not only in the number of periorbital and orbital cellulitis cases related to H. influenzae, but also in the annual case rate. These data are consistent with a facilitative role for H. influenzae in the development of cellulitis secondary to other pathogens. They also may support restriction of the spectrum of antibiotics used to manage these conditions.

Orbital Dermoids in Children

Orbital dermoid cysts are benign congenital choristomas. They are common in pediatric population, developing adjacent to suture lines, most commonly located in antero-lateral fronto-zygomatic suture, and are slowly progressive. Complete surgical excision without rupture of cyst is the standard of care. Deep orbital cysts cause proptosis, require imaging, and may present a surgical challenge with a difficult approach. Rupture of the cyst leads to severe inflammatory reaction in surrounding tissues. Overall prognosis remains good with isolated reports of malignancy masquerading as dermoid cysts. keywords

Corneal transplantation in children.

Ever since the first series of successful corneal transplantations in children nearly 30 years ago, the success rate of this procedure has slowly but steadily improved. Young children are particularly vulnerable to corneal opacities because the development of their visual system is in progress. Depriving their retinas of a clear image will lead to amblyopia. Penetrating keratoplasty may be the only solution that allows these patients to enjoy clear vision both during their early years and as adults.

Proteomic analysis of the hyaloid vascular system regression during ocular development.

We describe a proteomic approach to investigate the differential protein expression patterns and identify the physiologically relevant angiogenic and antiangiogenic factors involved in the hyaloid vascular system regression. Differentially expressed proteins were identified using two-dimensional gel electrophoresis followed by nanoflow chromatography coupled with tandem mass spectrometry. These proteins are expected to provide insight as to their function in the early maintenance and eventual regression of the hyaloid vascular system.

Mechanisms of disease: cataracts

Studying the mechanisms that are responsible for the transparency of the lens we see that multiple factors are involved in the maintenance of lens clarity as well as in cataractogenesis. Is there a unifying mechanism? Since the function of the lens is the transmission of electromagnetic radiation in the visible spectrum, fundamental physical laws should apply. Attenuation of a light beam that passes through a medium happens by two major processes: absorption and scattering. In absorption, light energy is dissipated into heat as the result of energy-absorbing electronic transitions. In scattering, radiation is redirected away from the incident pathway, thereby reducing the transmitting power. Depending on the angular dependence of the scattered light, the wave front of the transmitted light is distorted. In the case of cataract, the primary factor is turbidity secondary to scattering. A perfectly uniform medium exhibits no light scattering; thus a continuous medium can scatter light only when it contains spatial fluctuations around the mean density governed by specific equations. These equations simply state that the amplitude of scattering is proportional to the Fourier amplitude of the density fluctuations in the medium [12]. Electron micrograph analysis using Fourier transformation has shows an increase in the fluctuation of spatial density of the opaque fiber [12,26,37,93]. Thus, all transparency mechanisms and all cataractogenic factors can be thought of as opposing effectors of spatial density fluctuation affecting scatter and antithetical producers of light absorbing moieties.

Pediatric refractive surgery

13.00) Phakic Lesueur 5 11.8 9.4 –12.8 NR 20/600 0 IOL (3–16) (–8.00 to

Surgical timing for infantile esotropia.

Infantile esotropia (IE) is defined as a large-angle esotropia that has an onset within the first 6 months of life. It has also been referred to as ‘‘congenital esotropia’’; however, only 40% of the infants with this entity have esotropia from birth. IE has an incidence of 0.3% to 0.5% among healthy infants. The differential diagnosis of esotropia in infancy includes early-onset accommodative esotropia, nonaccommodative esotropia, paralytic esotropia, and esotropia associated with central nervous system abnormalities. Infantile esotropia is clinically characterized by a deviation

Conjunctival marginal zone b-cell lymphoma in a 13-year-old child

30 prism diopters (PD), crossfixation, mildly limited abduction, and abnormal motor phenomena that becomemanifest after 1 year of age. These phenomena include optokinetic nystagmus (OKN) asymmetry, dissociated vertical deviation (DVD), inferior oblique overaction (IOOA), and latent nystagmus. Infantile esotropia has been generally regarded as a single clinical entity with homogenous characteristics. Recently, the Congenital Esotropia Observational Study (CEOS) evaluated the characteristics of infantile esotropia in 175 infants who developed esotropia in the first 20 weeks of life and whose deviations measured at least 20 PD in the primary position. This study revealed that the size and character of the esotropia was highly variable, such that only approximately 50% of the patients had a medium to large angle esotropia that was>40 PD, andmany patients had intermittent esotropia. Infantile esotropia is generally associated with a poor binocular vision outcome. The successful end result formost infants with infantile esotropia is a small angle esotropia with subnormal stereopsis, central suppression, and peripheral fusion. Several clinical studies have been undertaken to

The Characteristics and Surgical Outcomes of Medial Rectus Recessions in Graves’ Ophthalmopathy

Ocular adnexal lymphoma is a hematopoietic tumor that arises in the conjunctiva, orbit, eyelid, lacrimal gland, or lacrimal sac. The treatment options in children have not been addressed in the literature. The authors describe a 13-year-old child with ocular adnexal lymphoma and discuss the treatment options.