Introducing a new hobby for other people may inspire them to join with you. Reading, as one of mutual hobby, is considered as the very easy hobby to do. But, many people are not interested in this hobby. Why? Boring is the reason of why. However, this feel actually can deal with the book and time of you reading. Yeah, one that we will refer to break the boredom in reading is choosing pediatric ophthalmology and strabismus as the reading material.

Pediatric ophthalmology and strabismus

In starting this review, I should say that I know and greatly admire both authors; therefore, it should be no surprise that I have found virtually nothing in this book to which I can take serious exception. It is truly a complete textbook; although not encyclopedic, every aspect of the subject is fully discussed and documented. It is divided into four sections: (1) physiology of the sensorimotor cooperation of the eyes; (2) introduction to the neuromuscular anomalies of the eyes; (3) clinical characteristics of the neuromuscular anomalies of the eye; and (4) principles of therapy. The first two sections were written by the senior author, Burian, and the last two by von Noorden, although both accept full responsibility for the entire work. It is hard to imagine a happier or more successful way to handle this large, complicated subject—a single author could hardly hope to cover it adequately. Even though

Binocular Vision and Ocular Motility: Theory and Management of Strabismus

Background
Sevoflurane is an inhaled volatile anaesthetic that is widely used in paediatric anaesthetic practice. Since its introduction, postoperative behavioural disturbance known as emergence agitation (EA) or emergence delirium (ED) has been recognized as a problem that may occur during recovery from sevoflurane anaesthesia. For the purpose of this systematic review, EA has been used to describe this clinical entity. A child with EA may be restless, may cause self-injury or may disrupt the dressing, surgical site or indwelling devices, leading to the potential for parents to be dissatisfied with their child's anaesthetic. To prevent such outcomes, the child may require pharmacological or physical restraint. Sevoflurane may be a major contributing factor in the development of EA. Therefore, an evidence-based understanding of the risk/benefit profile regarding sevoflurane compared with other general anaesthetic agents and adjuncts would facilitate its rational and optimal use.

Objectives
To compare sevoflurane with other general anaesthetic (GA) agents, with or without pharmacological or non-pharmacological adjuncts, with regard to risk of EA in children during emergence from anaesthesia. The primary outcome was risk of EA; secondary outcome was agitation score.

Search methods
We searched the following databases from the date of inception to 19 January 2013: CENTRAL, Ovid MEDLINE, Ovid EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost), Evidence-Based Medicine Reviews (EBMR) and the Web of Science, as well as the reference lists of other relevant articles and online trial registers.

Selection criteria
We included all randomized (or quasi-randomized) controlled trials investigating children < 18 years of age presenting for general anaesthesia with or without surgical intervention. We included any study in which a sevoflurane anaesthetic was compared with any other GA, and any study in which researchers investigated adjuncts (pharmacological or non-pharmacological) to sevoflurane anaesthesia compared with no adjunct or placebo.

Data collection and analysis
Two review authors independently searched the databases, decided on inclusion eligibility of publications, ascertained study quality and extracted data. They then resolved differences between their results by discussion. Data were entered into RevMan 5.2 for analyses and presentation. Comparisons of the risk of EA were presented as risk ratios (RRs) with 95% confidence intervals (CIs). Sevoflurane is treated as the control anaesthesia in this review. Sensitivity analyses were performed as appropriate, to exclude studies with a high risk of bias and to investigate heterogeneity.

Main results
We included 158 studies involving 14,045 children. Interventions to prevent EA fell into two broad groups. First, alternative GA compared with sevoflurane anaesthesia (69 studies), and second, use of an adjunct with sevoflurane anaesthesia versus sevoflurane without an adjunct (100 studies). The overall risk of bias in included studies was low. The overall Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) assessment of the quality of the evidence was moderate to high. A wide range of EA scales were used, as were different levels of cutoff, to determine the presence or absence of EA. Some studies involved children receiving potentially inadequate or no analgesia intraoperatively during painful procedures.

Halothane (RR 0.51, 95% CI 0.41 to 0.63, 3534 participants, high quality of evidence) and propofol anaesthesia were associated with a lower risk of EA than sevoflurane anaesthesia. Propofol was effective when used throughout anaesthesia (RR 0.35, 95% CI 0.25 to 0.51, 1098 participants, high quality of evidence) and when used only during the maintenance phase of anaesthesia after sevoflurane induction (RR 0.59, 95% CI 0.46 to 0.76, 738 participants, high quality of evidence). No clear evidence was found of an effect on risk of EA of desflurane (RR 1.46, 95% CI 0.92 to 2.31, 408 participants, moderate quality of evidence) or isoflurane (RR 0.76, 95% CI 0.46 to 1.23, 379 participants, moderate quality of evidence) versus sevoflurane.

Compared with no adjunct, effective adjuncts for reducing the risk of EA during sevoflurane anaesthesia included dexmedetomidine (RR 0.37, 95% CI 0.29 to 0.47, 851 participants, high quality of evidence), clonidine (RR 0.45, 95% CI 0.31 to 0.66, 739 participants, high quality of evidence), opioids, in particular fentanyl (RR 0.37, 95% CI 0.27 to 0.50, 1247 participants, high quality of evidence) and a bolus of propofol (RR 0.58, 95% CI 0.38 to 0.89, 394 participants, moderate quality of evidence), ketamine (RR 0.30, 95% CI 0.13 to 0.69, 231 participants, moderate quality of evidence) or midazolam (RR 0.57, 95% CI 0.41 to 0.81, 116 participants, moderate quality of evidence) at the end of anaesthesia. Midazolam oral premedication (RR 0.81, 95% CI 0.59 to 1.12, 370 participants, moderate quality of evidence) and parental presence at emergence (RR 0.91, 95% CI 0.51 to 1.60, 180 participants, moderate quality of evidence) did not reduce the risk of EA.

One or more factors designated as high risk of bias were noted in less than 10% of the included studies. Sensitivity analyses of these studies showed no clinically relevant changes in the risk of EA. Heterogeneity was significant with respect to these comparisons: halothane; clonidine; fentanyl; midazolam premedication; propofol 1 mg/kg bolus at end; and ketamine 0.25 mg/kg bolus at end of anaesthesia. With investigation of heterogeneity, the only clinically relevant changes to findings were seen in the context of potential pain, namely, the setting of adenoidectomy/adenotonsillectomy (propofol bolus; midazolam premedication) and the absence of a regional block (clonidine).

Authors' conclusions
Propofol, halothane, alpha-2 agonists (dexmedetomidine, clonidine), opioids (e.g. fentanyl) and ketamine reduce the risk of EA compared with sevoflurane anaesthesia, whereas no clear evidence shows an effect for desflurane, isoflurane, midazolam premedication and parental presence at emergence. Therefore anaesthetists can consider several effective strategies to reduce the risk of EA in their clinical practice. Future studies should ensure adequate analgesia in the control group, for which pain may be a contributing or confounding factor in the diagnosis of EA. Regardless of the EA scale used, it would be helpful for study authors to report the risk of EA, so that this might be included in future meta-analyses. Researchers should also consider combining effective interventions as a multi-modal approach to further reduce the risk of EA.

Effects of sevoflurane versus other general anaesthesia on emergence agitation in children

Nasal chondromesenchymal hamartoma (NCMH) is a very rare, benign tumour of the sinonasal tract usually presenting in infants. We present a systematic review of NCMH cases alongside a case report of an adult with asymptomatic NCMH. A systematic review was conducted in accordance with PRISMA guidelines. A PubMed, EMBASE and manual search through references of relevant publications was used to identify all published case-reports of NCMH. Data was collected from each case-report on: patient demographics, laterality, size and location of NCMH, presentation, co-morbidities, investigations, treatment and follow-up. The systematic review identified 48 patients (including ours): 33 male, 15 female. Mean age was 9.6 years (range: 1 day–69 years) with the majority aged 1 year or younger at presentation (n = 18). Presentations included: nasal congestion (n = 17), nasal mass (n = 15) and eye signs (n = 12). NCMH also involved the paranasal sinuses (n = 26), orbit (n = 16) and skull-base (n = 14). All patients underwent operative resection of NCMH. A small 2014 case-series found DICER1 mutations in 6 NCMH patients, establishing a link to the DICER1 tumour spectrum. NCMH is a rare cause of nasal masses in young children and adults. In light of the newly established link between NCMH and DICER1 mutations surgeons should be vigilant for associated DICER1 tumours, as NCMH may be the ‘herald tumour’ of this disease spectrum.

/pdf/nasal-chondromesenchymal-hamartoma-ncmh-a-systematic-review-1ad70ia3yy.pdf

Nasal Chondromesenchymal Hamartoma (NCMH): a systematic review of the literature with a new case report.

PURPOSE Stereopsis in normal subjects aged between 7 and 76 years was compared to examine changes in stereopsis with age. METHODS Eighty subjects with no ocular disease were divided into 8 groups by age. Near stereopsis was evaluated with the TNO, Titmus, and Randot tests; distance stereopsis with the Mentor B-VAT II video acuity tester. RESULTS The results of all 4 tests showed decreased stereopsis with increasing age (p<0.05). Compared to the stereoacuity of 7 to 10-year-old group, both the TNO and distance stereopsis test results were significantly decreased for the 6th, 7th, and 8th decade groups, while both the Titmus and Randot test results were significantly decreased for the 8th decade group (p<0.05). CONCLUSIONS Overall, both near and distance stereopsis decreased with increasing age. Thus, decreased stereopsis should be taken into account when performing the stereopsis test.

/pdf/change-of-stereoacuity-with-aging-in-normal-eyes-1bsy66jnc8.pdf

Change of Stereoacuity with Aging in Normal Eyes

Correction to: Eye (2012) 26, 846–852; doi:10.1038/eye.2012.55; published online 23 March 2012

/pdf/prognostic-factors-for-recurrence-after-bilateral-rectus-2uso8qa25j.pdf

Prognostic factors for recurrence after bilateral rectus recession procedure in patients with intermittent exotropia

The clinical course of recurrent intermittent exotropia following one or two surgeries over 24 months postoperatively

/pdf/the-clinical-course-of-recurrent-intermittent-exotropia-3ba2supbcp.pdf

Purpose To investigate the variability of preoperative measurements in patients with intermittent exotropia and to compare surgical outcomes according to the variability. Methods Patients who underwent unilateral lateral rectus recession and medial rectus resection and had 24 months' postoperative follow-up were enrolled. Patients were divided into three groups according to variability, which was defined as the largest angle minus the smallest angle ever measured during the preoperative visits; group C comprised patients with consistent exodeviation; group VL, patients with less variability ( Results A total of 344 patients were included: 128 in group C, 155 in group VL, and 61 in group VM. The largest variability was 20Δ and 62.8% (216/344, group VL + group VM) of the patients showed variable angles of deviation during the preoperative measurements. The postoperative exodeviation increased in all groups over the 24-month follow-up; however, the postoperative exodeviation of group VM was lower than that of both groups C and VL (repeated-measure ANOVA, P = 0.032). There was a trend toward decreased rates of reoperation from group VM compared with groups VL and C (linear by linear association, P = 0.004). Conclusions More than half of patients with intermittent exotropia showed variable angles of deviation during the preoperative measurements. The surgical outcomes were better in those with variable preoperative measurements than in those with consistent preoperative measurements.

Variability of preoperative measurements in intermittent exotropia and its effect on surgical outcome.

Purpose: To study the efficacy of unilateral rectus resection in the surgical treatment of undercorrected or recurrent strabismus. Methods: A retrospective chart review of patients who had undergone a unilateral rectus resection with at least 6 months (mean 35.6 months) of postoperative follow-up was performed. Results: A resection of a single rectus muscle was undergone by 92 patients: 70 underwent a unilateral resection of the medial rectus and 22 underwent a unilateral resection of the lateral rectus. The mean preoperative deviations of patients were 23.65.9 prism diopters (PD). The amount of unilateral medial rectus resection ranged from 3 to 7 mm and unilateral lateral rectus resection ranged from 5 to 10 mm. The satisfactory surgical result was considered to be any deviation within 8 PD. The success rates were 81.4% in the unilateral medial rectus resection group and 72.7% in the unilateral lateral rectus resection group. The satisfactory surgical result of the group of preoperative deviation less than or equal to 20 PD was 93.2%, the group of greater than 20 PD and less than or equal to 25 PD was 65.6% and the group of greater than 25 PD was 68.8%. This difference in results between three groups was statistically significant (p=0.006). Conclusions: The unilateral rectus resection is an effective procedure for the treatment of undercorrected or recurrent strabismus with small to moderate preoperative deviations.

The Efficacy of Unilateral Rectus Resection in the Reoperation of Strabismus

Purpose : It is the purpose of this paper to study the long-term results of surgically treated intermittent exotropia of 25 prism diopters (PD) of preoperative deviation. Methods: We analyzed and compared 364 patients (376 cases) with at least 6 months of postoperative follow-up. Two surgical methods were done: 6 mm bilateral recession of lateral rectus muscle in 190 patients (190 cases) and unilatera14 mm recession of lateral rectus muscle combined with 3 mm resection of medial rectus muscle in 174 patients (186 cases). Results: The average age of operation was 6.2 years, ranging from 3 to 16 years, and the follow-up period after surgery ranged 6 to 128 months (mean 27.3 months). The satisfactory surgical result defined as orthophoria and deviation between 5 PD esodeviation and 10 PD exodeviation. The final success rates were 75.3% in bilateral recession group and 64.5% in unilateral recession-resection group. This difference in success rates between the two groups was statistically significant (P=0.023), and the age at operation did not influence the surgical results. Those cases who were over-corrected 6 to 10 PD had a higher success rate and there was a statistically significant relationship between alignment immediately after surgery and on the final postoperative day in the two surgical groups (P=0.0001). Conclusions : The outcome of the bilateral recession is better than that of the unilateral recession-resection for correction of 25 PD intermittent exotropia in any age group.

Comparison of Surgical Results between Bilateral Recession and Unilateral Recession-Resection in 25 PD Intermittent Exotropia

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