Ahmed Awadein

Evaluation of intralesional propranolol for periocular capillary hemangioma

Background: The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangioma. Methods: A prospective study was performed in 22 consecutive patients with periocular hemangioma. Twelve patients underwent intralesional propranolol injection and ten patients underwent intralesional triamcinolone injection. The size of the lesion was measured serially every week during the first month, every 2 weeks for the second month, and then monthly for another 2 months. The refractive error and degree of ptosis if present were measured before injection and at the end of the study. Results: There was reduction in the size of hemangioma, astigmatic error, and degree of ptosis in both groups. The difference in outcome between both groups was not statistically significant. Rebound growth occurred in 25% of the propranolol group and 30% of the steroid group but responded to reinjection. No adverse effects were reported during or after intralesional propranolol injection. Conclusion: Intralesional propranolol injection is an alternative and effective method for treatment of infantile periocular hemangioma.

Clinical findings, orbital imaging, and intraoperative findings in patients with isolated inferior rectus muscle paresis or underaction

PURPOSE To present the clinical findings, orbital imaging, and intraoperative findings of patients with inferior rectus muscle underaction and to determine whether specific findings can help discern the underlying cause. METHODS A retrospective observational study was performed on patients presenting with isolated inferior rectus muscle underaction between January 2007 and October 2011. Patient history, ocular motility, fundus torsion, Lancaster red-green plots, and radiographic findings were analyzed. For patients who had surgery, intraoperative findings also were considered. RESULTS A total of 28 patients with inferior rectus muscle underaction were identified. Of these, 13 (46%) presented with inferior rectus muscle underaction after orbital trauma; 25 (89%) showed no increase in hypertropia >4(Δ) on head tilt to either side. Fundus intorsion was present in all patients. Of 15 patients evaluated by Lancaster red-green testing, 12 (80%) showed subjective intorsion. Twenty patients underwent orbital imaging via computed tomography or magnetic resonance imaging, and the results in 8 (40%) revealed obvious changes in the inferior rectus muscle. Nineteen patients underwent surgery; intraoperatively, the muscle appeared grossly normal in 8 patients (42%) and showed posterior muscle slippage in 4 (26%). Less common findings included stretched scar formation, flap tear, missing tissue, extensive muscle adhesions, or inability to identify the muscle. CONCLUSIONS Clinical findings in patients with inferior rectus muscle underaction are not sufficiently different to identify the cause, and orbital imaging identified a specific abnormality in only 40% of cases.

A computerized version of the Lancaster red-green test.

PURPOSE To compare results from a computerized version of the Lancaster red-green test with those of the conventional test. METHODS Consecutive adult patients with noncomitant strabismus were tested with the conventional Lancaster red-green test and with a computerized version of the same. The computerized test was administered by means of a 40-inch monitor at a working distance of 50 cm or a projector and screen at a working distance of 1 meter. Agreement between the measured horizontal, vertical, and torsional deviations in the conventional test and both computerized versions was evaluated with the mountain plot, Bland-Altman plot, and Deming regression analysis models. RESULTS A total of 82 patients were tested. Agreement of measured horizontal deviation in the conventional test was better with the projector version of the test (limits of agreement: right eye, -4.6(Δ) to 3.4(Δ); left eye, -4.9(Δ) to 3.5(Δ)) than the monitor version (limits of agreement: right eye, -10(Δ) to 4.2(Δ); left eye, -8.9(Δ) to 4.1(Δ)). The measured vertical and torsional deviation in the conventional test showed good agreement with both versions of the computerized test (limits of agreement <5(Δ) for vertical measurements and <3° for torsional measurements). Agreement was similar for right and left eyes. CONCLUSIONS The vertical and torsional deviations measured with both computerized versions of the test were in good agreement with those obtained with the conventional test. For measured horizontal deviations, the projector version had better agreement than the monitor version.

Comparison of superior oblique suture spacers and superior oblique silicone band expanders

PURPOSE To compare suture spacers with silicone band expanders in superior oblique-weakening surgery. METHODS We retrospectively reviewed the charts of consecutive patients who had superior oblique weakening with either suture spacers or silicone expanders and had been followed for a minimum follow-up of 6 months. The ductions, versions, and the degree of fundus torsion were analyzed in all patients before and after surgery. In addition, surgery time and postoperative complications were analyzed. RESULTS The record review identified 25 patients, of whom 13 had been treated with superior oblique muscle suture spacers and 12 with superior oblique muscle silicone expanders. Both groups showed improved ductions and versions. In patients with Brown syndrome, complete normalization of superior oblique muscle overaction occurred in 67% of patients who had suture spacers and 67% of patients who had silicone expanders. In patients with A-pattern strabismus, normal function of the superior oblique muscle occurred in 75% of patients with suture spacers and 67% of patients with silicone expanders. Surgery time was significantly less in patients who had suture spacers. Severe orbital inflammation occurred in 1 patient around the silicone band and was managed by removal of the implant. CONCLUSIONS Both suture spacers and silicone expanders improved the comitance of versions and normalized superior oblique muscle function. Longer surgery time and more severe inflammatory reaction are possible drawbacks of silicone expanders.

Polypropylene vs silicone Ahmed valve with adjunctive mitomycin C in paediatric age group: a prospective controlled study

PurposeTo compare the results of silicone and polypropylene Ahmed glaucoma valves (AGV) implanted during the first 10 years of life.MethodsA prospective study was performed on 50 eyes of 33 patients with paediatric glaucoma. Eyes were matched to either polypropylene or silicone AGV. In eyes with bilateral glaucoma, one eye was implanted with polypropylene and the other eye was implanted with silicone AGV.ResultsFifty eyes of 33 children were reviewed. Twenty five eyes received a polypropylene valve, and 25 eyes received a silicone valve. Eyes implanted with silicone valves achieved a significantly lower intraocular pressure (IOP) compared with the polypropylene group at 6 months, 1 year, and 2 years postoperatively. The average survival time was significantly longer (P=0.001 by the log-rank test) for the silicone group than for the polypropylene group and the cumulative probability of survival by the log-rank test at the end of the second year was 80% (SE: 8.0, 95% confidence interval (CI): 64–96%) in the silicone group and 56% (SE: 9.8, 95% CI: 40–90%) in the polypropylene group. The difference in the number of postoperative interventions and complications between both groups was statistically insignificant.ConclusionSilicone AGVs can achieve better IOP control, and longer survival with less antiglaucoma drops compared with polypropylene valves in children younger than 10 years.

Inferior oblique myectomy for upshoots mimicking inferior oblique overaction in Duane retraction syndrome

PURPOSE To evaluate the results of inferior oblique myectomy in selected patients with Duane retraction syndrome with upshoot on adduction. METHODS This was a prospective, interventional study of consecutive patients with types 1, 2, or 3 Duane syndrome with isolated upshoot in adduction operated on from January 2007 to December 2011. Patients underwent inferior oblique myectomy on the side of the upshooting eye. Only patients with gradual elevation of the eye in adduction in a pattern similar to inferior oblique overaction or patients with hypertropia in the primary position were included. All patients were followed for at least 6 months. Ductions, versions, degree of upshoot, degree of fundus torsion, and pattern of strabismus were analyzed in all patients before and after surgery. RESULTS A total of 11 patients were included in the study. Mean patient age at time of surgery was 6.4 ± 5.2 years (range, 3-22 years). Two patients had bilateral inferior oblique myectomy and 4 had simultaneous bilateral medial rectus muscle recession to correct horizontal misalignment. Mean duration of follow-up was 8.6 months (range, 6-36 months). Of the 11 patients, 10 (91%) had complete disappearance of the upshoot at last follow-up. None of the patients developed inferior oblique underaction postoperatively. There was a statistically significant improvement of V pattern after surgery (P < 0.01). Mean vertical misalignment in primary position was 5(Δ) before surgery and 1(Δ) after (P = 0.02). Most patients had no significant fundus torsion before or after surgery. CONCLUSIONS Inferior oblique muscle weakening can improve upshoot in selected patients with Duane retraction syndrome without inducing inferior oblique muscle underaction.

ICL Versus Veriflex Phakic IOL for Treatment of Moderately High Myopia: Randomized Paired-Eye Comparison

PURPOSE To compare the objective and subjective outcome of implantable collamer lenses (ICLs; Staar Surgical, Monrovia, CA) versus Veriflex lenses (AMO, Santa Ana, CA) for the correction of moderately high myopia. METHODS A prospective randomized comparative eye study was performed on 24 patients with bilateral myopia that ranged from -6 to -14.5 diopters (D). One eye was implanted with an ICL and the other eye was implanted with a Veriflex phakic intraocular lens (PIOL). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), contrast sensitivity, patient satisfaction, central endothelial cell count, and PIOL centration were determined 6 months after surgery RESULTS The logMAR UDVA and CDVA improved significantly in both groups (P < .001). There was no statistically significant difference in postoperative logMAR UDVA (P = .41) or logMAR CDVA (P = .36) between the two groups. Postoperative deviation from target refraction was -0.06 ± 0.41 D in the ICL group and -0.07 ± 0.49 D in the Veriflex group (P = .15). The difference in both induced and absolute postoperative HOAs between groups was not statistically significant. The area under the log contrast sensitivity function increased significantly in both groups postoperatively. The difference in patient satisfaction between both PIOLs was not statistically significant. A higher but statistically insignificant central endothelial cell count loss occurred in the Veriflex group (P = .11). CONCLUSION Both ICL and Veriflex PIOLs have equally satisfactory objective and subjective visual outcomes after surgery.

Changes in binocular function in anisometropic nonstrabismic children with optical correction and occlusion therapy

PURPOSE To identify factors that influence binocular function in anisometropic, nonstrabismic children before and after optical correction and amblyopia therapy. METHODS This was a prospective observational study of consecutive patients with nonstrabismic anisometropia. Visual acuity and responses to the 4(Δ) base-out prism test, the Worth 4-dot test, and the TNO test were recorded after spectacle correction and every 3 months for 1 year. Factors affecting visual acuity and binocular function were analyzed using univariate and multiple stepwise regression analysis. RESULTS A total of 118 subjects were enrolled. At the end of the first year, the mean improvement in visual acuity was 2.6 ± 2.3 lines. The percentage of patients showing a positive response to the 4(Δ) base-out prism test increased from 47% to 79%; fusion in the Worth 4-dot test, from 37% to 66%; and measurable stereopsis on TNO testing, from 59% to 80%. Better initial visual acuity and better final visual acuity were associated with better binocular function. Interocular refractive error difference was a predictor of poor binocular function in multiple regression analysis if the difference in spherical error exceeded 4 D. Patients with amblyopia showed significantly worse binocular function compared to those with no amblyopia. CONCLUSIONS Binocular function of anisometropic children can be improved with refractive correction and amblyopia therapy.

Retrospective cohort study shows that the risks for retinopathy of prematurity included birth age and weight, medical conditions and treatment

This study described the characteristics and risk factors of neonates who developed retinopathy of prematurity (ROP) and severe treatable ROP in two Egyptian neonatal intensive care units (NICUs).

Lateral rectus recession with/without transposition in V-pattern exotropia without inferior oblique overaction

OBJECTIVE To compare bilateral lateral rectus (BLR) recession with BLR recession combined with half-tendon upward transposition in the management of patients with V-pattern exotropia (XT; 15-20 prism diopters [PD] greater XT in upgaze than downgaze) with no or minimal inferior oblique overaction. DESIGN Retrospective, observational, cohort study. PARTICIPANTS Twenty-nine patients had BLR recession (Group A). Twenty-one patients had BLR recession combined with half-tendon upward transposition (Group B). METHODS A retrospective study was performed on patients with V-pattern XT with no or minimal inferior oblique overaction. Ductions, versions, pattern strabismus, stereoacuity, and degree of fundus torsion were analyzed in all patients before and after surgery. Patients were included in the study only if they achieved a minimum follow-up of 6 months. RESULTS Normalization of V pattern (<5Δ) was achieved in 14% in Group A and 64% in Group B (p < 0.001). Mean reduction in V pattern after surgery was 7Δ ± 6Δ in Group A and 13Δ ± 4Δ in Group B (p < 0.001). No change in fundus intorsion occurred in Group A, whereas fundus extorsion occurred in 8 patients (44%) in Group B. Orthophoria within 8Δ in the primary position was achieved in 79% in Group A and 82% in Group B (p = 1.00). There was no statistically significant difference in the postoperative stereoacuity in both groups (p = 0.67). CONCLUSIONS BLR with half-tendon upward transposition is much more effective than BLR recession alone in correcting V pattern.