Objective: To present 3 cases of Möbius sequence exposed in utero to misoprostol and discuss their clinical presentations, etiopathogenesis, and management. Methods: Medical records of 3 patients with Möbius sequence and prenatal exposure to misoprostol were reviewed. Clinical findings were compared with those reported in the literature. Results: Lack of facial-muscle movement, lagophthalmos with secondary exposure keratitis, decreased ability to crease forehead, and shallow nasolabial fold imply facial-nerve dysfunction. Small- and large-angle esotropia and apparent orthotropia with abduction limitation showed varying degrees of abducens nerve involvement. Two patients had early prenatal exposure to misoprostol during the first 3 months of gestation. Conclusion A history of misoprostol exposure should be routinely elicited from parents of children with Möbius sequence. Associated deficiencies in Möbius sequence and its variants require a multidisciplinary approach.
Abducens Nerve Vestibulocochlear Nerve Paralysis

OBJECTIVES: 

1. To describe the performance of medical students in comprehensive examinations given after each learning unit or year level. 

2. To correlate the scores of the students in the comprehensive examinations to the general weighted average grade (GWAG) for the same learning unit.

3. To correlate the scores in the subject-based part of the comprehensive examinations to the scores in the Physicians Licensure Examination (PLE)

 

METHODS: The scores of graduates of the University of the Philippines Manila College of Medicine (UPCM) for the years 2009-2011 in the comprehensive examinations, their general weighted average grade per learning unit, and scores in the PLE were retrieved and analyzed. Correlation coefficients of comprehensive examination score and GWAG, and comprehensive examination score and PLE score were computed.

RESULTS: A total of 434 out of 463 graduates from UPCM were included in this study. There was no trend observed in the performance of students in the comprehensive examinations as they progressed from one learning unit to the next. Performance in both portions of the comprehensive examinations was observed to have significant correlation to students' LU GWAG for most of the learning units, with the exception of LU 6 and LU 7 for Class B. Performance in the subject-based portion of the comprehensive examinations was observed to have significant correlation to students' PLE scores.

CONCLUSIONS: The students' scores in the comprehensive examinations had moderate to strong correlation with the GWAG for the corresponding learning unit. Similarly, scores in the subject-based portion of the comprehensive examination had moderate to strong correlation with PLE scores.

Human ; Male ; Female ; Students, Medical ; Philippines ; Learning ; Licensure ; Physicians ; Physical Examination

OBJECTIVES: This study was conducted to examine the validity of the National Medical Admissions Test (NMAT) score, Pre-Medicine general weighted average grade (Pre-Med GWAG) in predicting the academic performance in medical school, as measured by the medical school general weighted average grade (Med GWAG) and Physician Licensure Examination (PLE). It also aimed to study which among the NMAT, pre-medicine GWAG and MedGWAG best correlates with PLE.

METHODS: Records of graduates of th UPCM from 2004 to 2009 were retrieved and data regardin the following entry characteristics were collected: National Medical Admissions Test (NMAT) scores, pre-Medicine general weighted average grade (MedGWAG). Average and individual subject scores in the PLE were retrieved for this study. Statistical analysis using the Pearson correlation analysis was performed using STATA.

RESULTS: The NMAT, MedGWAG and PLE scores of the direct and lateral entrants were not significantly different from each other. There was weak correlation between NMAT and Pre-Med GWAG and weak to moderate correlation between NMAT and Med GWAG. Except for the 2009 graduates where no correlation between NMAT and PLE scores was noted for 2004-2008 graduates. There was moderate to strong correlation between Pre-Med GWAG and Med GWAG and weak correlation between Pre-Med GWAG and PLE scores. There was strong correlation between Med GWAG and PLE scores.

CONCLUSIONS: Pre-Med GWAG had higher correlations to Med GWAG than NMAT scores. In Terms of PLE scores, the Medicine GWAG showed the highest correlation followed by Pre-Med GWAG, then NMAT scores.

Schools, Medical ; Licensure ; Medicine ; Physicians ; Academic Performance

A prospective study on the refractive changes after horizontal extraocular muscle surgery was conducted involving 51 eyes of 41 subjects. Three variables were measured: axis, cylinder power, and sphere power up to 30 days postoperatively. The behavior and progression of these variables were also evaluated in the postop period Mean changes in axis and cylinder power were found to be significant between the preop and 1 day postop. Mean changes in sphere power were only significant between the 1 day postop and 15 days postop. Mean changes of the three variables between preop and 30 days postop were not significant. The results showed that the effects of horizontal extraocular muscle surgery on the refractive state were only transient and it decreased over time. (Author)
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; REFREACTION ; REFRACTIVE ERRORS/ETIOLOGY ; OPHTHALMOLOGIC SURGICAL PROCEDURES/ADVERSE EFFECTS ; STRABISMUS/SURGERY ; CORNEAL TOPOGRAPHY ; OCULOMOTOR MUSCLES/SURGERY ; HUMAN ; FEMALE ; MALE ; PROSPECTIVE STUDIES

Objective: This study determined the correlation between the performance in the Philippine Board of Ophthalmology (PBO) written qualifying examinations and the Ophthalmology In-Training Proficiency Examinations (OPEX). Methods: PBO written certifying examinations and the OPEX scores of residency graduates covering the years 2005 to 2010 and 2004 to 2009 respectively were retrieved for this study. ANOVA statistical test compared OPEX scores through residency (Y1, Y2, Y3, and Y4) and determined if the number of times the OPEX was taken reflected significant differences in the PBO scores of the different groups. Pearson’s test determined the correlation between OPEX and PBO written examination scores. Results: Of the 165 subjects included in the study, 5 took the OPEX four times during their residency, 87 thrice, 39 twice, and 34 once. Mean OPEX scores for the different levels of residency training was observed to be statistically different from each other (p < 0.001). Mean PBO scores improved with increase in the number of times that OPEX was taken during residency (p < 0.001). Significant positive correlation was observed between the PBO scores and OPEX scores for all year levels of residency, average OPEX scores and terminal OPEX scores (r = 0.57 to 0.73, p < 0.0001) with the highest correlation noted between terminal OPEX and PBO scores. Based on the number of OPEX taken, significant correlation was strongest for the group with three OPEX taken (r = 0.73, p < 0.001). Conclusions There is a positive correlation between residents’ performance in the OPEX to their future performance in the written certifying examinations of the PBO.
Ophthalmology ; Education

Objective: This study described the demographics of pediatric patients who sustained open globe injuries, determined the visual outcome of open globe injuries in pediatric patients and the factors associated with final visual acuity. Methodology: The medical charts of 195 patients aged 0-18 years seen for open globe injury in a Philippine tertiary hospital for three years were reviewed. Results: The average age of patients was 7.9 years with 41% belonging to the 5-9 years old group. Seventy-five percent (75%) of the patients were males. Ninety-five percent (95%) of the open globe injuries were accidental, mostly from play (67%). The most common agents of injury were metallic objects (42%) followed by wooden objects (24%). The cornea was injured in 80% of the cases, cornea and sclera in 10%, sclera in 7%, and globe rupture in 3%. Eighty-six percent (86%) of the patients underwent surgery. Initial visual acuity was associated with the presence of complication and the site of injury. Final visual acuity was associated with the initial visual acuity, the interval from injury to consultation, the site of injury, and the presence of complications. Conclusions The majority of the injuries were accidental and thus avoidable. The education of parents and caregivers on proper storage of potentially harmful objects at home and proper supervision of children at play are important in addition to early consultation after the injury as well as a timely intervention.
Child

Background: Optical coherence tomography (OCT) can accurately assess the optic nerve and retinal fiber layer (RNFL) to closely look at the anatomical ocular pathology of amblyopia. Objectives: This study aimed to determine and compare optic nerve parameters and RNFL in amblyopic and normal Filipino children using OCT. Methodology: Forty-two eyes of 21 normal participants and 40 eyes of 20 amblyopic participants underwent complete eye examinations and OCT scanning of optic nerve and RNFL. The following data were collected: age, refraction, intraocular pressure, optic nerve parameters (including rim area-vertical cross-section, average nerve width, disc diameter, cup diameter, rim length, vertical integrated rim area, horizontal integrated rim width, disc area, rim area, cup area, cup to disk area ratio, cup-to-disk horizontal ratio, cup to disc vertical ratio), and peripapillary RNFL. Results: There was a statistically significant difference between normal and amblyopic groups with regard to the following parameters: cup area, rim area, cup-disc area ratio, cup-disc horizontal ratio, cup-disc vertical ratio, superior RNFL, and inferior RNFL. The rim area was significantly smaller in amblyopic eyes compared to normal whereas the cup-disc area ratio, cup area, cup-disc vertical and horizontal ratios were significantly larger in amblyopic eyes. The RNFL inferiorly and superiorly were also thinner in amblyopic eyes. Conclusion As measured by OCT, some optic nerve parameters and RNFL thickness in Filipino children were significantly different in amblyopic eyes compared to normal.
Optic Nerve ; Amblyopia

Objective: To describe the clinical profile of patients with amblyopia seen at a Philippine tertiary hospital. Methodology: This was a cross-sectional study utilizing a chart review of children ages 6 months to 18 years old diagnosed with amblyopia at a Philippine tertiary hospital. Records with complete entry of history and ocular examinations were included. Verbal children with best-corrected visual acuity in both eyes of less than 6/15 or a 2 line difference between eyes were considered amblyopic. Response to alternate occlusion or refixation patterns was used as a basis for diagnosing amblyopia in pre-verbal children. Patients with visual deprivation amblyopia such as from cataract who had undergone lens extraction and optical correction were included. Results: There were 334 patients included in the study. The mean age was 5±3 years with 52% being male. Deprivation type of amblyopia was present in 192 (58%) patients, strabismic type in 81 (24%), and refractive type in 61 (18%). No sex predilection was observed. Majority of the patients were 3-6 years old on initial consult. Cataract was the most common cause of deprivation amblyopia affecting 127 (66%) patients. Strabismic amblyopia was present in 58 patients with 74% being esotropic. Anisometropic refractive amblyopia was more common at 37 (58%) than isometropic refractive amblyopia. Conclusion Visual deprivation amblyopia was the most common cause of amblyopia in a Philippine tertiary hospital.
Amblyopia ; Cataract ; Anisometropia ; Strabismus

Objective: To determine refractive changes in children post-cataract extraction and intraocular lens (IOL) implantation at a Philippine tertiary hospital. Methods: This is a retrospective cohort study involving patients aged 1 to 10 years in the Department of Ophthalmology of a Philippine tertiary hospital who underwent cataract extraction and IOL implantation between 2004 to 2013. Results: We included 55 eyes of 34 patients in the analysis. Thirty-eight eyes (69%) eyes underwent primary IOL implantation. The mean duration of follow-up was 3.5 ± 2.1 years. The median refractive changes were -2.00 (-2.50, -0.50) diopters (D) for the 1- to 3-year-old group, -1.25 (-1.50, -0.25) D for the 4- to 7-year-old group, and -1.00 (-1.63, -0.25) D for the 8- to 10-year-old group. Only the 1- to 3-year-old group had significant difference between the initial post-operative refraction and the latest follow-up refraction (p<0.001). For the primary implantation group, patients in the 1- to 3-year-old group had the highest median refractive change at -2.00 (-3.125, -1.00) D while patients in the 8- to 10-year-old group had the highest median refractive change at -2.12 (-2.56, -1.69) D in the secondary implantation group. Refractions of eyes with IOL-implanted and normal eyes showed a median difference of -1.00 (-0.25, -3.5) D. Conclusion The determination of the power of IOL implants in pediatric patients who underwent cataract extraction remains challenging despite availability of recommendations.
Lens Implantation, Intraocular ; Child ; Cataract

Background: Vision impairment impacts children’s physical well-being, psychological state, and productivity. The Impact of Vision Impairment for Children (IVI_C) is a vision-specific pediatric instrument designed to assess the effects of visual impairment on the quality of life (QoL) in children aged 8 to 18 years who have no additional disabilities. It measures quality of life to assess the needs of children with low vision and outcomes of interventions by deriving answers from both children and their caregivers. Objectives: The primary objective of the study was to determine the effect of visual impairment on the quality of life of children aged 8 to 18 years. Methods: This was an observational, analytical, cross-sectional study conducted at the Outpatient Department of the University of the Philippines-Philippine General Hospital, Sentro Oftalmologico Jose Rizal (SOJR), General and Pediatric Ophthalmology Clinics. We included children 8 to 18 years of age with best corrected visual acuity of less than or equal to 20/40 in the better-seeing eye for the visually impaired (VI) group. The control group included children aged 8 to 18 years with best corrected visual acuity of 20/20 to 20/30 in both eyes. Participants underwent a complete ophthalmologic examination, including the determination of visual acuity using the Early Treatment Diabetic Retinopathy Study( ETDRS ) chart prior to administration of the Filipino version of IVI_C questionnaire. After the ophthalmologic examination and prior to end of the medical consultation, the investigator administered the questionnaire to the children and their parents. Results: A total of 133 participants were included in the study, 67 in the visually impaired group and 66 in the control group. Participants had a median age of 10 years (range, 8 to 18), and 54% were female. Overall QoL scores and sub-scores across domains were significantly lower in the visually impaired group compared to the control group. The mean total and domain IVI_C scores progressively declined with increasing severity of visual impairment. The mean (±SD) total score ranged from 56 ± 6 in the mildly impaired to 42 ± 8 in the severe bilateral impairment group. On multivariate analysis, the significant predictors of quality of life were visual impairment and age. Quality of life of children with visual impairment is lower by 33.59 points (95% CI -35.82 to -31.36) than those in the control group. The QoL score increased by 0.579 per one unit increase in age. This model explained 87.05% of the variance in the IVI_C scores (p < 0.01). Conclusion Children with visual impairment have significantly decreased IVI_C and quality of life scores, overall and across domains. Lower scores are associated with increased severity of visual impairment.
Vision Disorders ; Quality of Life ; Child