Notes

Differences throughout Aids Scientific Phases Continuing development of Individuals in Out-patient Hospitals inside Democratic Republic involving Congo.
020). The measurable stereopsis rate was higher in the early group (37% vs 3.8% and 3.8%, respectively) (P = .001). The amblyopia rate was similar between groups.

The results show that performing surgery later in life in patients with infantile esotropia increases the motor success rate of surgery. In addition, orthophoria is achieved with fewer surgical operations. However, earlier surgery may improve stereopsis. [J Pediatr Ophthalmol Strabismus. 2020;57(5)319-325.].
The results show that performing surgery later in life in patients with infantile esotropia increases the motor success rate of surgery. In addition, orthophoria is achieved with fewer surgical operations. However, earlier surgery may improve stereopsis. [J Pediatr Ophthalmol Strabismus. 2020;57(5)319-325.].
To compare the results of augmented superior rectus transposition (with or without medial rectus recession) with simple medial rectus recession in the treatment of patients with esotropic Duane retraction syndrome.

This was a prospective, randomized, and interventional comparative study of 20 patients with esotropic type 1 Duane retraction syndrome. Patients were randomly divided into two groups. In the first group (superior rectus transposition group), superior rectus transposition with or without medial rectus recession was performed. In the second group (non-superior rectus transposition group), unilateral medial rectus recession was performed.

Each group included 10 patients. Esotropia improved from 20.4 prism diopters (PD) preoperatively to 0.6 PD postoperatively in the superior rectus transposition group and from 22.5 PD preoperatively to 0.9 PD postoperatively in the non-superior rectus transposition group. Face turn improved from 11.5° preoperatively to 0.5° postoperatively in the superior rectubut it can be complicated by vertical deviation. [J Pediatr Ophthalmol Strabismus. 2020;57(5)309-318.].
To study interobserver variability for measurement of grating acuity in preverbal and nonverbal children with developmental delay using Lea Grating Paddles (Lea Hyvärinen).

In this prospective study, preverbal patients younger than 3 years and older nonverbal patients (with developmental delay) were included. Those with poor neck holding were excluded. Binocular and monocular visual acuity assessment was done simultaneously using Lea Grating Paddles by two examiners who were blinded from each other's results.

Thirty-one children were tested (19 [61.29%] males and 12 [38.71%] females). The mean age was 28.5 months (range 4 to 44 months). A total of 92% of the observations showed interobserver agreement of 0.5 octave or better in binocular testing. Results for monocular testing showed interobserver agreement (0.5 octaves or better) in 95.65% and 95.23% of right and left eyes, respectively. Combined results showed agreement better than 0.5 octaves in 94.20%. The mean binocular visual acuity was 2.07 and 2.14 cycles per degree (cpd) for the first and second observer, respectively (P = .59). Similarly, the mean monocular visual acuity for the right and left eyes was 0.98 and 0.97 cpd for observer 1 and 0.89 and 0.79 cpd for observer 2, respectively (P = .91 and .14, for the right and left eyes, respectively).

Interobserver variability for grating acuity measurement using Lea Grating Paddles is minimal, signifying it to be a reliable and reproducible alternative to conventional preferential looking testing procedures. [J Pediatr Ophthalmol Strabismus. 2020;57(5)305-308.].
Interobserver variability for grating acuity measurement using Lea Grating Paddles is minimal, signifying it to be a reliable and reproducible alternative to conventional preferential looking testing procedures. [J Pediatr Ophthalmol Strabismus. 2020;57(5)305-308.].
To evaluate the efficacy and tolerability of cyclopentolate 1% administered as a spray in pediatric patients between 3 and 6 years old.

In this prospective, randomized, parallel group study, healthy volunteers were randomly assigned to receive cyclopentolate 1% as a single drop or a single puff into closed eyes.

There were 61 patients included in the study; 31 received cyclopentolate 1% as drops and 30 received cyclopentolate 1% as spray. The mean age at presentation was 4.5 ± 1.07 years (range 3 to 6 years) and 4.2 ± 1.06 years (range 3 to 6 years) in the drops and spray groups, respectively. The distress level was significantly lower at the time of receiving cyclopentolate as a spray (P < .0001), with the exception of patients aged 6 years. There were no significant differences in pupil diameter between the two groups (P = .51), whereas 5 of 30 patients (16.6%) with dark irises who received cyclopentolate spray did not have adequate cycloplegia to allow for accurate refraction.

Cycloplegia achieved with cyclopentolate 1% administered as a spray may be an option in uncooperative children because it is less distressing compared to cyclopentolate 1% drops. However, physicians should be aware that cycloplegia obtained is only partially effective in children with dark irises. [J Pediatr Ophthalmol Strabismus. 2020;57(5)301-304.].
Cycloplegia achieved with cyclopentolate 1% administered as a spray may be an option in uncooperative children because it is less distressing compared to cyclopentolate 1% drops. However, physicians should be aware that cycloplegia obtained is only partially effective in children with dark irises. [J Pediatr Ophthalmol Strabismus. 2020;57(5)301-304.].
To analyze clinical characteristics, treatment, and long-term outcomes of pediatric patients with glaucoma after congenital cataract surgery at a single tertiary care hospital.

Medical records of pediatric patients diagnosed as having glaucoma secondary to congenital cataract surgery between 1996 and 2016 were reviewed retrospectively.

A total of 58 eyes of 42 patients were included with a median follow-up time of 55 months (interquartile range [IQR] 27 to 128) after glaucoma diagnosis. Mean time of glaucoma onset after cataract surgery was 35 months (IQR 5 to 96). At diagnosis, 81% of the eyes were aphakic and the majority presented with an open angle (86%). Multivariate analysis demonstrated that glaucoma diagnosis was made earlier in eyes with persistent fetal vasculature (β = -0.334, P = .006) and aphakic eyes (β = 0.404, P = .001). Two-thirds of eyes required surgical treatment for glaucoma. Seventy percent had an Ahmed glaucoma valve (New World Medical, Inc) implantation as their primary procedurered as both first- and second-line treatment. SN 52 Functional outcome was more favorable in those eyes with medically controlled glaucoma. [J Pediatr Ophthalmol Strabismus. 2020;57(5)292-300.].
To determine the prognostic factors for poor visual outcomes in childhood glaucoma.

The medical records of patients with childhood glaucoma diagnosed at age 4 years or younger who were treated surgically from 2002 to 2019 at Songklanagarind Hospital, Hatyai, Thailand, were retrospectively reviewed. Glaucoma subtypes, clinical characteristics, final visual acuity, and etiology of visual impairment were recorded. The generalized estimating equation for logistic regression analysis was used to determine prognostic factors for final visual acuity of worse than 20/200.

Forty-five eyes of 31 patients were included (33.3% had primary glaucoma and 66.7% had secondary glaucoma). At the final visit (mean 6.8 years), 20.5% had good visual acuity (20/50 or better), 15.9% had fair visual acuity (worse than 20/50 to 20/200), and 63.6% had poor visual acuity (worse than 20/200). The major cause of visual impairment (worse than 20/50) was deprivation amblyopia. Prognostic factors for poor final visual acuity (worse thaPediatr Ophthalmol Strabismus. 2020;57(5)283-291.].Due to electronic residency applications, US Medical Licensing Examination Step 1 scores are frequently used by orthopedic surgery program directors to screen applicants. Prospective applicants therefore often use Step 1 scores as a proxy for specialty competitiveness. The goal of this investigation was two-fold (1) to determine whether trends in Step 1 scores are indicative of trends in competitiveness of orthopedic surgery and (2) to report the characteristics that optimize a US medical student's match success. A retrospective review of published National Resident Matching Program data from 2009 to 2018 was performed for orthopedic surgery residency applicants. Additional data from the Charting Outcomes reports were used for specific analyses of applicant characteristics. From 2009 to 2018, the number of orthopedic surgery residency positions grew at an annual rate of 1.51% (95% confidence interval [CI], 1.37% to 1.64%; P less then .001), accommodating the 1.26% (95% CI, 0.63% to 1.90%; P=.006) annual increase in the number of applicants who ranked orthopedic surgery as their preferred specialty choice (only choice or first choice). There were no significant changes in the applicant-to-position ratio (95% CI, -0.85% to 0.37%; P=.483) or the match rate for US seniors who ranked orthopedic surgery as their preferred choice (95% CI, -0.23% to 0.87%; P=.313). Increases in mean Step 1 scores of matched orthopedic surgery applicants parallel national Step 1 growth trends (0.49% vs 0.44%, respectively). Although orthopedic surgery is currently a competitive specialty to match into, this has been the case since 2009. Increasing Step 1 scores of matched applicants is not unique to orthopedic surgery and should not be misinterpreted as a proxy for increasing competitiveness of the specialty. [Orthopedics. 2020;43(6)e616-e622.].A variety of surgical approaches are used for total hip arthroplasty (THA). Controversy still exists regarding whether the direct anterior approach truly minimizes muscle damage. The purpose of this study was to determine the effect of surgical approach for THA on muscle atrophy quantified through magnetic resonance imaging (MRI). The study included 25 hips in patients with a mean age of 64.72±8.35 years who underwent a primary unilateral THA for severe osteoarthritis. Patients were grouped according to surgical approach direct anterior (n=9), direct lateral (n=9), and posterior (n=7). Magnetic resonance images were collected at the 24-week postoperative time point to assess atrophy/fatty infiltration of the hip musculature. All MRIs were assessed by a fellowship-trained radiologist who was blinded to all clinical information. There were no significant differences preoperatively and 1 year postoperatively between the surgical approach groups in terms of patient-reported outcome measures (P>.05). Significant differences in fatty infiltration differences between surgical approaches were observed in the gluteus medius, gluteus minimus, iliacus, obturator externus, obturator internus, pectineus, psoas, quadratus femoris, sartorius, and vastus intermedius (P less then .05). The direct anterior approach to THA resulted in less atrophy of the hip musculature compared with a direct lateral or posterior approach; however, there were no differences in patient-reported clinical outcome scores at 1 year between the surgical approaches. [Orthopedics. 2020;43(6)361-366.].The authors retrospectively reviewed the first 30 patients who underwent bilateral simultaneous carpal and cubital releases (quadruple tunnel release). Patients were asked to complete a questionnaire over the phone regarding their satisfaction with the procedures and willingness to make the same choice of bilateral carpal and cubital releases simultaneously, as well as the time to return to unrestricted use. Of 24 patients who responded to the questionnaire, 23 (95.8%) were satisfied or highly satisfied with their care, and 23 (95.8%) would again choose to have release of the 4 tunnels simultaneously. Time to unrestricted use in this patient cohort averaged 27 days. Quadruple tunnel release is technically feasible and well tolerated. This procedure has the potential to save considerable amounts of recuperation time and is less expensive than performing 4 individual procedures for patients who have bilateral carpal and bilateral cubital tunnel syndrome. [Orthopedics. 2020;43(6)e592-e594.].
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