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`Marjorie A. Bowman, MD,-MPA .. ,o.:,·: :':,.James.Jeffrey Malatack, MD
`Glenn D . Braunstein, MD ·
`Brian F. Mandell, MD, PhD
`,. ·' :::-·~ ·'·.·,
`-~ ·::··· deraid L: Mandell, MD
`Sidney Cohen; MD
`Judit~·s;Palfrey, MD
`Linda Emanuel, PhD
`· ·. i · 0
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`' · · · : ·· ' ... · •· . ·, ·. Albert) \. R.undio, Jr., PhD
`David A. Spain, MD
`Eugene P. Frenkel, MD
`Paul H. Tanser, MD
`Susan L. Hendri~; DO .. ·
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`· > =
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`Page 1 of 7
`
`SENJU EXHIBIT 2067
`INNOPHARMA v. SENJU
`IPR2015-00903
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`Library of Congress Catalog Card Number 1-31760
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`

`
`Contents
`
`•TAB.
`
`'-:
`
`. ; --~·
`
`• NO. ;: .· : SEGION ·.
`.
`. ' : .. : ·•· '
`Guide for Readers ....
`· ··
`Abbreviations
`Editors and Editorial Board .:. ·
`'· ·Consultants ·•
`Contributors
`
`••
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`·· ' VIII
`· ix
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`· · ~. · ' ' .', · 2015
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`·. 2243
`
`• _ _ :
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`Nutritional Disorders
`·· · · casttoi~testinai Disorders -· · ··
`.
`H~patic and Biliary Disorders
`3
`I®Ji~~. ·:.·: .. 4 · ,; _ :.MU.sC'u_l?.~k.~letal ahd.connect!veTissu~'Diso.rders '
`Ear, Nose, Throat, and Dental Disorders
`4#~jt
`5
`tii!ll .
`.. 6
`. Eye Disorders
`41~n•·, ...... 1
`Dermatologic p.isorder~ ;.-.:
`Endocrine and Metabolic ·oiso.rde~~- .
`8
`Hematology and OncOlogy._· :.•'· . .. :;" .·· · · : ... >'::., ••
`9 . ·
`· 10 ··
`· ··. · lmm(u1ology;'AIIergi_c.pisorders : i, -~ :
`I@I~JI
`Infectious Diseases
`41~11
`11
`11Ji11·;: ,.it ii'
`.. PsychiatriC Di$6rders... -·· ' · · ·
`N·e~rologic Dis~~der~ ·. · ·
`1~1§1)
`13
`_pulmonary _Disorders .. .
`14
`. .
`. ;
`· Cardiovascular Disorders· - , ·.;.·. :
`15.
`.. ' . :
`1s · · ·· · Critical care M~dicine ,. •
`Genitourinary Disorders ·
`17
`·· · Gyne<:ology a~iobstetric5
`' 18 '
`. . . . . . \ : .... ,.
`Pediatrics: ·::. '<
`. .. · ., ·
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`Ready Reference Guides.,_.:::'·_::;.; '
`,. ·· .· Nolmat_Laborato[yValues·· . -~
`' ... -.';',_ ·._:_• ·.·· ·.·.:··. :·.' ;. : ·., .' .• ·, ::
`· : 34~1
`. Trade Names of Some Commonly Used Drugs ·
`3505
`·' Index
`3521
`
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`Page 3 of 7
`
`

`
`3562
`
`Index·
`
`Casal's necklace 31 ···· ·
`·-~ · .. ; .·· ·
`.. _,
`- ~....
`Cascara 87
`· :._·
`..
`. ! ,-::· ~\=: .1 :·;
`:. · .. :· --~ -~- . . ;
`· ·
`inelderly3101
`Caspofungin 1320, 1323> · ·:· _ .. . : · . ·· .:·
`Cast 3203 <. • ~ - • • • ~
`. ~ '-·.
`: · ; ·:
`: : .. -. .-. ·'
`Castleman disease 1394
`.... · ..
`. · :
`Castor bean poisoning 3337 . ·._. ·
`': · . ·_. ! ·)
`Castor oil 87
`· · ·
`· ·-'
`:··; . '
`. , .. :
`Casts, urinary 2309,2311, 2375 '. !;_ ·<.;.
`Cataplexy 1704, 1712 ... :; -> ·: ·.: ,-:.:; -· ,:- :. 1
`Cataracts 606-607
`· ,:._:_ '-. · . ': ; · .· ·: '~- ·. ·
`congenital2920 .· ... · :-- ·· ·· ·;; · ·: ·i:.-•.: . :-;,:
`Catatonia 1541, 1560 :. ' · ... _:' ., ·, ;,. _.;
`·. :
`Catecholamines 791 (see also Epinephrine; ···
`<: · · · .. t · . · ·, · · ";
`Norepinephrine)
`in MEN 2A syndrome 912 ·· . ·:
`,- :_.
`·'' :• :• · ·
`pheochromocytoma secretion of 801 """803,·
`:.'·; ''"·;·,. ·:
`.•.;;: .~::
`• 912
`;':
`: . . uDnary 802, ·3500 ··
`.::·:···.]. ·:>.
`·
`~ · t •
`Catechol 0-methyltransferase inhibitors · .. ·
`.. ... --;-:..
`.,
`.
`1768, 1769
`Catheterization .. ··:.: , .. --: .. ··, •' -· • ·-.·- ·
`·. ::- ;·
`arterial2249-2250 : :,.•,: ' · ... : .
`bladder 2316-2317 ·.:. : -~. ;_: ·, 1 ..;" • •· . -~ -·. ;
`in children 2845
`-- . · · :· {:r:;::::. ·:.
`· .\
`for incontinence 2359,~ 2362,-2364 ·. , .. )
`·.
`' · ·
`. · . · :.; ;_· .· :'' ,·:
`in-dwelling 2362
`... : >;·_; ., ·:.·
`infection and 2378' ·
`oliguria with-2252...:.2253, 2252 ... . '·
`in trauma 3192 .. ~· :
`·,,.;
`·· · .. H
`cardiac 2048-2052, 2050, 2051 · :·:•.·-·i· ·'
`complications of2051..;.2052 ;· ..-;·· ·.:>
`left-heart 2048
`:.~:·.~ : .. : ~ l · :• ·· ~··. · !
`right-heart-2048, 2 105,.2205 .: .. • . ·,. · ..
`central venous 2247.:..2249-, 2249 :~- •'--' · ..
`ih cardiopulmonary. resus~itation 2259
`for dialysis 2449 ,.: .. :;,·~ ·K; .::t:. •.•·' :',::::·:::.:
`··:-.- infection and 1166 ,.:· .. ··.::·- .:·. <.- : .. i! ,. ·:;
`· .. :·, pleural effusion:and 1998 · -... ··.· · .·-: .-·.!
`intra-abdominal abscess drainage ~ith :
`'.1
`119
`·
`'>: r '· ·;: :',.-;;:
`·.-·:•· ._'';
`<-l· ~-•· ~:·.
`intracranial 2246
`peripheral vein 2247
`\ ~·::·. v · , . ::/ .; _,:
`·_-. :··· -~:;·,::.:_-=--; ·:,>! ...
`peritoneal2451
`pleural2001,2003 .
`._- · .. -.:· ,!·:, )
`pulmonary artery 1986;2244-2246; 2245,
`2246
`,;, : : ·,: .• :,,
`:_:[!~-
`in shock 2299,:.2301-:':(: c' ·:;: :·.: ~ -~: . :.,')
`urinary (see Catheterization,.l:)ladder) ,.., .. :·)
`CAT scan (see Computed tomography)-·r:.::~
`Cat-scratch disease 469, 1158, 1244-L 1245,
`1244 t)<"·_;:;. ·;.::;;,;,.· :!; ·' . .. :; ,;, (.'3C:J.~ :. ,--: . ·
`Cauda equina 1804 · .. _-.:,()'_'; u~;>::;_:-; ;:~·;;: ,,i
`
`:
`
`:
`
`- : ·. ·
`
`:. · · ,;: ·
`
`Cauda equina syndrome 1806, 3228, 3228, · ;
`3229 :
`. . . .
`. :~· .;_~ : ;.: .··
`., .!
`Cauliflower ear 323 1 · . . -
`· - · ·
`· ,.
`Causalgia (complex regional pain syndrome)
`1633-1634
`.
`. ...
`Caustic ingestion 3335-:3336 ·· :_ :: -: ' ' ,
`gastritis with 133 · ·. ·; · ·
`. . .
`.
`Cavernous hemangioma 976 ·.· · ,_ :· ·. ·
`·: :. ;
`Cavernous lymphangioma 748 ... :.:
`Cavernous sinus thrombosis 554, 560, : · · ·
`. . =·. -. ·. ; -: '· : ' ;•.
`624-625 . .
`CEA (see Carcinoembryonic antigen)
`; . · . · ·
`Cecum
`· ·. ·. ·. ....
`' :.-
`·.= :.;;:.: _. ·~-
`.~
`: .- <:
`ameboma of 1368 : · . _:.: .
`.
`·volvulus of 117 · ·' ,; ·· ·:·:
`.. · : . .- ; ·.· · ..
`. < :.-·:·.'·.·
`Cefaclor 1187
`inotitismedia449 < ._ , :· ·-·~ ~
`· :·
`··
`Cefadroxill186 ' · .. ..
`·= ~
`in endocarditis prophylaxis 2200 ·
`·
`· · ·.;:. ·
`:; .. _,
`-
`Cefazolin 1186
`in endocarditis prophylaxis 2200 ·
`in infective endocarditis 2198 ·
`. · .: ·
`neonatal dosage of 2812 · · -
`-. . :
`as preoperative prophylaxis 3349~~350
`Cefepime 1188, 1202 > : · .. · · ,_ ·' · ~
`in infective endocarditis 2198 · ·: =. ·· -~;
`. : . .
`in meningitis 1139,.1740,-17_41 : .. .
`neonatal dosage of 2813 ~ : · <. : .. · . · ·,
`Cefoperazone 1187 . -= · .. · .:-~ : .. · : ·; •. ••.
`Cefotaxime 1187, 1203
`·--:~: -
`in meningitis 1739, 1740,:1741'·; ·
`neonataldosageof2813 :::;;::-:::•,
`·., ·•·
`,;: · ·: ... ;; .':: . . ;: -;: __ . :::-:
`Cefotetan 1187
`Cefoxitiid187 ·; =·:_ .. ; .. ' _. ·: ·.·· .·. ; ·i ·.·•.<
`.-:, :· :·:·
`Ce'fpodoxime 1188;·1203 .: ·=· :
`Cefprozi11187
`·. · ~-'\ .· .:.'. ~--.
`Ceftazidime 1188, 1203 . . -' -· ·:.· ,·. ·
`: .. : iri infective·endocarditis 2198 · :c. -·: ··
`,;'• .. :: :.- -(cid:173)
`in meningitis 1740, 1741 ::
`neonatal dosage of2813 :
`~-··:· =: •. · ': .
`Ceftibutcn 1188·-'.: :· ·_._: ·. · -···:: .. ;..: ·. · -··
`: = ·· ·- ·
`Ceftizoxime 1188
`Ceftobiprole 1202 - ·. _;., _; · ·· · .· '· : ---~ ::
`Ceftriaxone 1'184, 1188, 120T ,· -~·-..
`in children 2761 · .· . · :· -· _.;.-..
`·. · · :-- ·
`, · in infective endocarditis 2197-2198 · ·.
`in Lyme disease 1271, 1271 -=· .. ::-'
`in meningitis 1739, 1740,-1741 . ·:~.-- . .__.-
`~ neonataldo·sage of 2813 ,. · · ·=~ ·, <: '( :· :·.; ·
`• · ::: i_,:; · ,.,
`::~ 1 ·•··• :·· ·-
`in otitis media 449
`Cefuroxime 1187
`;:· ; i_:··.-. ·,:,, ,._ '
`~in Lyme disease 1271 · .:· .;: ,! .. ·; :::;·,t · "~
`iri otitis media 449 i'.-_. : :· ·=·;.::~ -: ~,_;., :., ;,;
`
`·. · :
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`...
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`Page 4 of 7
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`

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`606
`
`SEGION 6 :· Eye.Disorders
`
`block. It is done as soon as the cornea is clear
`and inflammation bas· subsided. In some cases
`the cornea clears within hours oflowering the
`lOP~ in other cases, it can take .I to 2 days. Be(cid:173)
`cause the chance .of.having an acute attack in
`the other eye is 80%, LPI is done on both eyes.
`The risk of complications with'-LPI is ex.:.
`tremely low compared.with its _benefits. G~are,
`which can be bothersome, may occur if.thejri(cid:173)
`dotom~ i$ n.~t placed sup_eriorly en.~ugh for .the
`upper lid to ~over it. · ; . . . . . . ,
`.- . .. . .
`.
`.
`. . . . :
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`. . . . : . .
`. . . . . .
`
`. Chronic angle-closure glaucoma; Patients
`with chronic, subacute, 'or intermittent angle(cid:173)
`closure glaucoma should also have LPI. Ad(cid:173)
`ditionally, patients with a narrow angle. even in
`the absence of symptoms, should undergo
`promptLPI to prevent angle-closure glaucoma.
`.. The drug and surgical treatments- are the
`same as with open-angle glaucoma. Laser tra(cid:173)
`beculoplasty is relatively contraindicated if the
`angle is so narrow that additional PAS may
`form after the laser procedure . .... : .. ·;,:: ·
`' :: !~ :;
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`a:tdl ;· c~~a ra ct .. :~:~·. ':. : .. ·_,_~_<:;~;
`' disti~~uishi·~~-dai~ b;·~~ ~r~~-~i~ck.·_~ainle~s
`blurring eventually occurs: The degree of blur(cid:173)
`·(F~·r development~' o~ c~nge~itai c~t~lcrs:
`ring depends on the location and extent of the
`see ·. 2920.)
`·
`:·"·. · ·
`·
`· · ·• ~ · :
`opaCity: Double vision occurS rarely.:_ ··--.~ -:;
`p ..... '!t
`·~ .
`. . · ....
`. ·• .. ·
`. .
`.. ; • ·''·
`·. With· a nuclear cataract (see Plate 4), ·dis(cid:173)
`A cataract is a congenital ~r d~e~~rati~e-~pa·~­
`'ta'nce visiori'worsens. Near vision may' im(cid:173)
`ity of the lens. The main symptom is gradual,
`prove _in the earJy ~tages because of changes
`painless vision blurring. Diagnosis is by oph(cid:173)
`~I?: ~e ~e.frastive in~ex_ofthe lens; pre~byopic
`thalmoscopy and slit-lamp examination. Treat(cid:173)
`patient~ may be temporarily able to read with~
`ment is surgical removal and placement of an
`out glasses (second sight).
`· · · ·-'' .... · :-:;
`intraocular lens.
`, ; ~ , ·:-:· · ·:. ·
`! ·· A posterior subcapsular cataract dispropor(cid:173)
`·. Lens opacity ·c~ de~~lo~ 'in ~;~~~ locah6n~:
`tionately affectS vision because the_ opacity is
`!_~cated ~.t.the_ crossiQg point of incOming light
`· • Central lens' nucleus (nuclear <::ataract). ·
`rays. Such cataractS reduce visual ·acuity inore
`~ ~eneath the posterior lens capsule·(poste(cid:173)
`wh:~ the p~pil con~tricts (eg,' in ~ght 'light,
`.;• nor subcap·sular cataract)>·:· :·.·· ... _,, :. • ... ; ·
`~unng readmg). They __ are a,lso the type most
`; ~: ,,;:·:~;
`~kely to cause loss of contrast' as well as· glare;
`... , . ::: · ·. ·, ~·:: .... " ., ...
`·· ·· :
`Etiology : :
`~sp~c~ally from bfight lights or from car head(cid:173)
`~ghts_whi!cd)ivi'ngatnig_ht: : _· :.'· ... :_ ... .-_ ·· >.
`. . Catara~ts. occtir wit~ aging. btlier rlsk fac(cid:173)
`tors may 1nclude the followincr: : ; ...... ,) '· ··
`.. R,ar~ly; ~~ ca~a~tswe~s;_o~cluding the tra(cid:173)
`. .
`.
`.
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`_·.·~. r~~uhi~ (;J~~ti~~ caus~g ~J~~t~ ),~ars ·.
`becular dramage meshwork ·and causing 'Sec(cid:173)
`later) · .... ,·-··: ··· ·· · ... ......
`. ... ,
`ondary closed-angle glaucoma and pain.
`,,
`:.":.~~~~~g~~:~,':;,.:.·_ :·.: .;:.:.; -.. ~:·:·.;;_.:·~!;~;,::,<'· .'/'·:·;
`'.·;. ::: ~ ..: ·~ ·~ : .. :·, ·: ... .. ~;;·~ . . · .. · .:.:
`Diagnosis .. ·:.-.· .. ··),.: .... ::_ .. :--. -. ~· ~., .: ,1 ... ·: .~.
`;:~· Exposure t9 x-~ay~1 ~.·. _'_·. -~-~:;: ~<··:.:-~:-~, :··.:::_:-: :~.
`. ~- ·_9p~tl1~~~Copy follow~ by slit-lamp_:ex-
`_,". Heat fr?~ ~~rared exposur~. ~ .... ·. ··. :: · ::
`anunauon . ·
`·.
`-· · ·· ···, · · -, · · , .... "·,.)
`;.:~:-: ,r:
`• Syst~~c di~e!lse (eg, dia~tes) · ·: ·;. =: · .~-: :··
`Diagnosis is best. made wiili. the pupil di(cid:173)
`· ·.q :.-!:!.~ !: , . ·::·:·; :; :
`• Uvettis .
`·
`· · : _
`. · · · · ... ·!
`· • Syste~~ ~g$_:c~i. ~~rti~~st~i-did~) ·:·.: '~·
`lated. ~~ll-developed cataracts appear a~
`. • Undernutntton . .
`. : · · · · _ . .
`· · · ·.
`gray, whit~, or_ yellow-brown opacities in the
`• · .• ; .=·.··-.·
`.... , i· ~-
`:.~ T;:>ark'eyes· 1
`l~ns. ·Exanu~all?n of.the red reflex through the
`. :
`;.·_
`..
`dilated pupJl.Wlth:the ophthalmoscope held
`. • .Po~~~bly -~~of1l_c ~l~~yi?j~(~~po~~r~''i··;.;;~
`; ·Many people have rio risk factors other than
`abou_t,30 em away usually discloses subtle
`opacities. Small cataracts stand out as dark de(cid:173)
`a~e .. Some cataracts are congenital, associated
`fec~· in the red reflex. :A large cataract may
`w~th nu~erous syndromes and diseases . . ···.:;
`~bliterat~ the red reflex .. Slit-lamp examina(cid:173)
`· .. ·.
`·.: \ · · ·\.. : ·r :: i ~-; : •. \;;.
`. .. :; .
`. .......•.
`~....
`tion I?rov1des more details about the:.character,
`~ymptoms a~d Signs : ... ·:·-:, , :_ :·,. :·:,:.: .. ·. );;
`locattorr, and extent ,of the opacity: '::;.n·:·:·~ ~.::
`. ·. ,Cataracts_generaliy' develop slo~ly over
`~ears. E~ly sy~pt~ins.maybeloss of contrast,
`_glat~ (h~l~~ a~1d star~ursts around lights),
`needmg more light to see well;'and problems
`
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`: i. S'titgk~l rem6~al of.the t~tarad' <· .. ,. :,,:.~:
`• Placement of an ihtraocular lens ._.,-·:.:·:\":.:!
`
`Page 5 of 7
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`

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`T
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`.. ~·.·:
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`':. ·';.~~·.-:~·.~~ .. ··:··· : ......... . .
`
`: · = . CHAPTER 66 . Cataract
`
`607
`
`.
`
`•
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`plarie le·ns): Iris pia·ne lenses· are rarely used in
`the US because many designs led to a high
`frequency of postoperative complicatipns·.
`Multifocal intraocular· lenses 'arc newer and
`have. different focusing zones that may re(cid:173)
`duce dependence on gl~sses after surgery. Pa(cid:173)
`·tients.occasionally experience glare or halos
`with these lenses, especially unde~ low-light
`. ·. .
`· ·.
`·
`.
`.con<Jitipns.
`~·: In most cases, a ta~ring schedule of topical
`~ntiqio~ics (eg, moxifloxacin 0.5% 1 drop'qid)
`and topiCal corticosteroids ( eg, prednisolo.ne
`acetate 1% 1 drop. qid) is ~sed .for t,~p to4 ~k
`postsurgery. Patients often .wear an eye shield
`while sleeping ·an.d shohld avo.id lhe Valsalva
`maneuver, heavy' lifting, exce$sive forw~rd
`bending, and eye _rubbing for several weeks: ..
`. · Majof complications of cataract surgery are
`rare. Complications include the following: · .
`~ Intraoperative: Bleeding·· beneath the· ret-
`ina, causing the intraocular contents to
`·:: .. extrude· through · the incision (choroidal
`· ·':hemorrhage), vitreous prolapsing out· ~f
`.~· ·the incision (vitreous loss), fragments of
`·· the ·cataract dislocating ihto the vitreou~.
`incisional burn, and detachment of corneal
`.·· endothelium and its basement membrane
`·.· .
`.
`· · (Descemet's membrane) . .
`.• Within· the · ftrs~ wee~: · Endopht~alfi?.itis
`·~ · (infection withln the eye) and glaucoma ·
`• Within the .first month: Cystoid macular
`·. .
`. . : ·. . .. . ..
`. .' edema : ·' ': . . . . ~
`• Months hiter: Bullous keratopathy ·~ie;s~ell­
`. · 'ing of the cornea due to·damage to the cor:-
`neal pump ·cells during'cataract surgery),
`. retinal detachn:tent, and poster.i~r. capsular
`·opacification (common, but treatable with
`·:. laser) · ·. _ .. ;,
`· · : · · · · ., ... . · ..
`'·· · · ·
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`· Frequent refraction's arid corrective lens ··
`prescription changes may help maintain useful
`vision during cataract development. Occa(cid:173)
`sionalfy, long-term pupillary dilation (with
`phenylephrine 2.5% q 4 to 8 h) is helpful for
`small centrally located cataracts. Indirect light(cid:173)
`ing while 'rea~ing minimizes pupillary con(cid:173)
`striction and may optimize vision for close
`tasks. Polariz~ Ie.nses'reduce glare. ·· · · ·
`Usual indications· for surgery .include the
`following: ;,',. .. . ':
`·· :. · .. ~· ·.
`: .. · '·_':
`, • Bes't v.ision. obtai ~ed with g·j~;se~ .is ·.~ors·~
`.than.-20/40 (< .6112), or visio.n is signiti(cid:173)
`. cantly . decreased under glar~ conditions
`(eg, oblique lighting while .trying to reaq a
`chart) in a patient with bothersome halos or
`.: · .... · · · ·. ·:.· ... -::
`. starbursts . .... ;·.-: .:·•
`• Patients sense that vision is limiting·(eg,
`by preventing activities of daily living
`such as driving, reading, bobbie~, :,tnd
`occupational activities). · · ·
`· ·
`· .. ·
`• Vision could potentially: be meaningfully
`. improved if the cataract is removed (ie, a
`significant portion of the vision loss must be
`· · · · · · ·
`· caused by the cataract}. ~· ·' ·
`· Far .. Iess. ~ommon indication~· include 'cata(cid:173)
`rncts that cause glaucoma or that obscure the
`~nd~s· in. patients who need periodic fu.ndus
`ex~ma~ops for management of diseases such
`~dla~tiC retinopathy anq glaucoma. The~e is
`~oadvantage to,rerripving a cat<:tC<ict early. · _:
`<;atara7t extraction i.s usually' done: using a
`top1cal or local ane&thetic and 'IV sedation.
`There. are,3 extra¢tiori techniques:)~ in.tra~
`capsular cataract extraction the cataract
`and l~ns c~psule areremq~ed in 6ne piece; this
`tcchmque 1s rarely usee!.' Iri extracapsular cata·
`~act extraction; the hard ·central nucleus is
`~~moved in one piece and then the soft 'cortex
`~ remov:d i~ t;tu1tipte. small pi.eces .. . In pha:(cid:173)
`. oe!Uulstficabon, the hard central' nucleus
`}S diSS~Jved by !J)trasoun·d ~d then.:the· SOft
`~rtex 1s re.~ove.d in multiple small piec~s:.
`. ~coemulstficatton requires the smallest 'in(cid:173)
`CISIOn, thus.enabling the fastest healing and i~
`~ually the preferred p,rdcedure. In extr;dlpsli-
`1ar extracti?~ ~nd phacoemulsification, the
`~scapsule IS not removed . . ·
`· · ··
`·•
`... ,
`· A plastic or. silicone lens is almoseal~:~y· ~
`tmpla t d ·
`·
`·
`·
`'~'
`1 ti.n e. mtraocularly to replace the opli-
`~a . oc~stng power lost by removal of the
`ryl stallme lens. '}he lens implan't '!•s usually
`Pacedonorw'th' h' 1 ·
`chambe I
`1 m. t e e.ns capsuh~ (po~terior
`frontof r en.s~. Th~ le~S'Ca!l also be placed in
`taclied tthe 10~ ~~~tenor cham9er·lens) or at(cid:173)
`... , ,,~}Jl~Jr.t.~; ~nd .. w.ithi~ the pupil (iris
`. "~ ;, ~ : :. :'.·;· . : . ·. ·,. ·',: '· ::, ·····'·· . . . . '
`. ; . ~; .. · ·_,~ _, ....
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`Mter surgery, vision returns to 20/40 (6/12)
`or better in 95% of eyes if there are no preex(cid:173)
`isting disorders such.as amblyopia, retinopa(cid:173)
`.tl)y, macular .degeneration, and glaucoma. If
`an intraocular lens is not implanted, pontac~
`lenses or thick glasses are needed to correct the
`resulting hyperopia. .
`· : ·
`'
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`Prevent.ion
`Many ()phthatrriologists.recommend ultra;(cid:173)
`~i<;>Jet-coated eyeglasses or sunglasses as a
`preventive measure. Reducing risk factors ·such
`as' alcohol,' tobacco, and corticosteroid.s and
`·controllif!g blood glucose in diabete~ 'delay
`onset. A diet high in vitamin C; vitamin A, and
`carotenoids (contained .'in vegetable~ s.u'ch as
`'spinach and kale) inay protect against cataracts.
`•l.·: · .· ' ..
`~: .. .. : .
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`Page 6 of 7
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`

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`"RfftW)%
`
`29 20
`
`SEGION 19- .Pediatrics . ·::·· ·· ; ·. ..
`
`. _ .. : ...
`
`.... Tteatrii.ent should be directed byJm·oph- .·. life:·Eyes·with partiai ·cataracts have a better
`thalmologist. Any underlying causes must be
`visual outcome.
`.·-. ', ·ir.·>: ···-i_ ..... :
`;-·-'~:.'.::;::(;~~~;
`-~.J'··· :.:;
`treated (eg, eyeglasses or co~tac.t lenses to
`correct refractive error: removal 'of a ca~act)'.
`PRIMARY INFANTILE·;,_:.,,.,,_._,.
`... GLA. ·u· ·c .OMA.: .. r"/ ~ ; ~
`Use of the amblyopic eye is then encouraged
`by patchin!fthe better eye or by administ_ering
`·
`·
`· -.. ~·· : .. _ · • ~-·
`'., . c' ; . ·... . . . ;
`atropirle._drops into th~ better eye to provide' a
`visual advantage to the amblyopiC eye. Ad-
`(Infantile Glaucoma;·. ongenital : ! ~
`Glaucoma; Buphthal111:os) .
`herence to treatment is better with drop thei-
`apy .. Maintenance treatme~t fqr prevention of Primary infantile . glaucoma . is a rare deve-lop-
`recurrences rria'y be recommende<;l after in1- mental. defect in the iridocomeal filtration angle .
`provement ha·s stabi.lized;--until- a child is
`of the anterior:chambei' thatprevents aqueous
`· · :- ''. : ' : · .. · · ~ · .. ~ -~; . : ·' -~ ,. • · .:
`about 8 to 10: ·
`fluid from' property ·draining from the· eye. 111is
`obstruction ·can cause.:increases in· the intra-
`-:· .. , .. :' ·
`:<: ··
`' . .-.:: . ·• :·: ... _ . ..
`· · · · .. \"':>···;
`ocular pressure; which if untreated can damage
`the optic nerve. ·
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`(Infantile Cat~~ct) . n :.
`Congenital cataract is a lens opacity that is present
`at birth or shortly after birth> .-: :,' : ,i._'<'.,;:.i. ·'
`· ::· .• ;·· •. ·· ·~ ;::. :
`: ! ~ ;: t ·~ ! .. t, •
`• •• ~ •rt' ;
`',,:t < ;:·
`· Congenital catanicts may be sporadi~,.or they
`may be caused by _chromosomal anomalies,
`metabolic' disease ( eg; galactosemia)i or'in-:
`trimterine· infection ( eg;'rubella) -or 'othy'r ina..:
`ternal'disease during·pregilaney: Cataract$
`may b~ located iri_the centertifthe lens'(iiu~
`clear}, ot they- ·may involve the leris_material
`underneath the· anterior' Or posterior lens ·cap,;
`sule (subcapsular or cortkal). T hey· may· be
`unilateral-or l;>ilateraLThey may·not. be no.-'
`ticed unless th~ red·reflex is· checked or unl_ess
`ophthalmoscopy is done at birth: :As ~ith other
`cataracts;the lens opacity obscures vision::, Cat..:
`aracts m,ay· obscur:e the view qf the ,optic'disk
`and vessels atid.ShOl,lld. always b~ ·evaluated
`by ari'ophthalmql<?g(st.'J ~ =~: ·:,; :·•.-k·i~, .' - - :: ,:~~ ::; ~
`"'-Removal of ii. cataiacFwitliin '17 \vk after
`birth petmits' the 'developnie·nt'ofvisiqn ~rid
`co~calvisi.lal pathways. Catarac~ ~ i:emovect
`by -aspirating them throug~ a ~mall incision:
`Iri m:any· childieri; _an' intraocul~ Iens:may-:p~
`impiante·d:~·Postop~rative vi'su·al ;coi~e'Ctio~
`with eyegla8ses, coritact'lenses/ ofboth is usu:.
`ally required to as~iy~~ the best 9UtCO!ll~t.''''~
`After a unilateral cataract is removed; .the
`quality of the image in the treated ~y-e is 'i,nf~­
`rior to that of the other eye· (assuming the other
`eye is normal) .. _Because the better ey~ is pre~
`ferred1 the brairi suppresses the pooret-quality
`iinage, and am.blyopia (seep. ;2919}.develops.
`Thus·, effective amblyopi~.therapy isneces,;
`sary'forthe treated eye to· develop normal sight
`Some.childreir are unable to attain good visual
`acuity because-of accompanying structural de~
`fects:'In contrast, children with: bilateral cata(cid:173)
`ract removal in~ which image· quality is similar
`iJ!·b6.1h: eyes.mo~e: frequently deve~?P.~~- vg
`ston m both·eyes; w.·'i -· cr.Jn ;c: ·.:;~:; ); , ) -u :~;:_:;~
`Some cataracts are partial .(pusterior lenti:.
`conus) and opacify during the 1st decade of
`
`The disorder :occurs in infants imd young
`children and maybe lliiilaterai ( 40%) or bilateral
`(60%). Intraocular pressure increases above the
`normal range (10 to-22-mm .. Hg) .. Giaucoma
`can also: occur. in .infants aftet:trauma or in(cid:173)
`traocular surgery~(eg; .. Cataract extraction).
`Dlatrcoma· associated: with aniridia or Lowe
`syndrome or Sturge-Weber: syndrome is called
`secondary glaucoma,~L'!~' ·.·' _; ... >,:: :· ., .-·, .~:.-:s-
`The eye becomes enlarged because the col(cid:173)
`lagen of the sdera and cornea can stretch from
`the. increased intraocular pre~ sure·. The.large(cid:173)
`qiameter (>· 12 mm} cornea is thinned and
`sometimes cloudy. The infant may have tearing
`and photophobia: If untreated, corneal clouding
`progresses, the optic nerve is damaged (as ev(cid:173)
`idenced clinically by ·optic nerve cuppmg), and
`blindne·ss·may· occur. Early surgical interv.en(cid:173)
`tion-(eg;:'goniotomy; 'trabeculotomy; trabec,
`ulectomy) is the mainstay .of treatment:··, .. :··
`·., .. <;-::··;):· ; ~.) ::·-t.·. :·~~: r~: .~r;:! ~:: · :.:-:·~.~ .~:t;: ;
`--: : •::::··: ... :;_!<·.
`~;:,' ::(/~::r ,'-STRABISMUS·:' .. ·:::·+,.::·
`; . : . : i :-: .. ·. -~ ~;: 1 ! .. . ·.
`.. .. ~
`.
`.
`.
`.
`Strabismus is misalignment of the eyes, whic~
`causes deviation from the parallelism of normal
`gare D~osis i.S' dinical." induding ObServation of
`the Corneal lighh·efle)r and.' use of a 'rover test
`Treatment -~ inclUde mrrectiori ·of ~~ impair;
`rnent With .patching and ror'redive ~ align~~
`by cOfi.emve tenses. and surgical repair ... ':: ':; . .: .. ~-
`· ~.·~·· , ' : 0,o •~!!l.·1 :· : :l ; L~ .. - · . ... .. :.,.
`: .. .. : : :-~ ; ~ : :-• .. •.;
`·~ :\:
`.~.: • • •
`.::Strabismus occurs· in about 3%bf children.
`Although most strabismus is caused bY: re(cid:173)
`fractive errors -or muscle ·imbalance, rare .causes
`include; retinoblastoma or :ether. serious -ocular
`defects ·.and.neurologic disease-: Left untrea~;
`about.50% of children with ·strabismus have
`some visual loss due to ainblyopia(see p. 2919).
`tr.::Several varieties-ofstrabismus have bee~
`described based on direction of deviation;
`specific·c~ndidons under. which :deviati9n ·
`occurs. and whether :deviation is constant or
`in term'ittent. Description of these. varieties
`requires the definition of several terms.
`*
`..
`
`•
`
`Page 7 of 7