Purpose The purpose of the study was to evaluate the feasibility and acceptability of utilizing elbow splints as a method of increasing amblyopic patching compliance in pediatric ophthalmology patients who fail to comply with prescribed patching regimens. Patients and methods Patients o6 years of age who were not adhering to pre-specified patching guidelines were prescribed elbow splints in order to increase patching compliance at the discretion of a pediatric ophthalmologist. If the child was noncompliant (patching o50% of specified time or consistently removing patch), parents were asked to try using the elbow splints until patching compliance was achieved. Nonparametric Wilcoxon signed-rank tests were used to compare patching time pre-and postsplints. Results 41/48 children who were prescribed elbow splints to increase patching compliance for amblyopia were included for analysis. Seven children were excluded due to patching and splints being prescribed at the outset (n = 4), and for not using the splinting intervention (n = 3). Median age at being prescribed elbow splints was 37 (12-68) months. Mean daily patching prior to splints was 1.5 ± 1.7 h, whereas mean prescribed daily patching was 4.95 ± 1.5 h. Following splinting, 34/41 (83%) became compliant with patch alone, and visual acuity increased in 39/41 (95%) patients, with no patients developing amblyopia in the fellow eye. Median amount of time splints was required to improve compliance was 7 (1-240) days. Conclusion Elbow splinting seems to be a viable alternative method to increase pediatric amblyopic patching compliance when patching alone fails to achieve satisfactory compliance.
Exotropia in a patient with CPEO was managed with bilateral medial rectus resections. Molecular genetic analysis of DNA from a skeletal muscle biopsy confirmed a deletion of the mitochondrial DNA. The resected muscle tendon was subjected to transmission electron microscopy, revealing muscle fibre variability and ragged red fibres with mitochondrial abnormalities.
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