Barry N. Wasserman

Sequential Bilateral Dacryocele

tion of a pigmented neuroendocrine tumor. Arch Ophthalmol. 2000;118(6):841-845. 6. Mashayekhi A, Shields CL, Eagle RC Jr, Shields JA. Cavitary changes in retinoblastoma: relationship to chemoresistance. Ophthalmology. 2005;112(6):1145-1150. 7. Lois N, Shields CL, Shields JA, Eagle RC Jr, De Potter P. Cavitary melanoma of the ciliary body: a study of eight cases. Ophthalmology. 1998; 105(6):1091-1098. 8. Zakka KA, Foos RY, Spencer WH, Kerman BM, Newman NM, Pettit TH. Cavitation in intraocular malignant melanoma. Arch Ophthalmol. 1982;100(1):112-114. 9. Croxatto JO, Malbran ES, Lombardi AA. Cavitary melanocytoma of the ciliary body. Ophthalmologica. 1984;189(3):130-134. 10. CapeánsC,PiñeiroA,BlancoMJ,etal.Ultrasound biomicroscopic findings in a cavitary melanocytomaof theciliarybody.CanJOphthalmol. 2003; 38(6):501-503. 11. Becerra EM, Saornil MA, Blanco G, Méndez MC, Muiños Y, Esteban MR. Cavitary choroidal melanoma. Can J Ophthalmol. 2005;40(5): 619-622. 12. Faraj H, Levy-Gabriel C, Lumbroso-Le Rouic L, et al. Cavitary choroidal melanoma in a child [in French]. J Fr Ophtalmol. 2006;29(5):559-563.

The relationship between nystagmus and surgical outcome in congenital esotropia.

PURPOSE Congenital esotropia is often associated with congenital nystagmus. This study examines the relationship between the presence of nystagmus and surgical outcome in the treatment of patients with congenital esotropia. METHODS In this institutional retrospective study, we reviewed the charts of 200 consecutive patients who underwent surgical correction for congenital esotropia between 1991 and 1995. Preoperative clinical characteristics and subsequent need for additional strabismus surgery for a residual or consecutive deviation were noted. Minimum follow-up was 6 months after the original operation. RESULTS Of the 84 patients who met the inclusion criteria, 15 patients (18%) had latent or manifest latent nystagmus, and 69 patients (82%) had no nystagmus. Eight of the 15 patients with nystagmus had or required reoperation according to our criteria (53%). Nineteen of the 69 patients (28%) without nystagmus had or required reoperation (P =.155). CONCLUSIONS Nystagmus, when associated with congenital esotropia, may increase the risk of requiring additional strabismus surgery for residual or consecutive deviations. Appropriate and complete preoperative counseling of patients with congenital esotropia who also have nystagmus should include this increased risk.

Occult intraorbital conjunctival inclusion cyst discovered almost 70 years after strabismus surgery.

Orbital conjunctival epithelial inclusion cysts are a rare complication of strabismus surgery. A subconjunctival cystic mass with translucent fluid is the most common presentation. The authors describe a case of an epithelial inclusion cyst presenting as an occult orbital mass during reoperation strabismus surgery almost 70 years after strabismus surgery.Orbital conjunctival epithelial inclusion cysts are a rare complication of strabismus surgery. A subconjunctival cystic mass with translucent fluid is the most common presentation. The authors describe a case of an epithelial inclusion cyst presenting as an occult orbital mass during reoperation strabismus surgery almost 70 years after strabismus surgery.Orbital conjunctival epithelial inclusion cysts are a rare complication of strabismus surgery. A subconjunctival cystic mass with translucent fluid is the most common presentation. The authors describe a case of an epithelial inclusion cyst presenting as an occult orbital mass during reoperation strabismus surgery almost 70 years after strabismus surgery.

Diplopia after laser in situ keratomileusis (LASIK) in a patient with a history of strabismus

In patients with a history of strabismus, refractive surgery can result in decompensation of ocular alignment, with subsequent diplopia. Refractive surgery in the management of strabismus has been described, although it remains controversial. We present a young adult with past history of strabismus surgery and new-onset diplopia after refractive surgery. Binocular diplopia was treated surgically with laser in situ keratomileusis.

Ocular manifestations of PACS1 mutation

Heterozygous mutation in the PACS1 (phosphofurin acidic cluster sorting proteins 1) gene is a known cause of developmental delay, multiple congenital anomalies, dysmorphism, and ocular abnormalities. We present the case of an affected 10-year-old girl, conceived by assisted reproductive technology, who has ocular coloboma and findings characteristic of PACS1 mutation.

Clinical Evaluation of Four-Muscle Tenotomy Surgery for Nystagmus

PURPOSE To document prospectively the effect of four-muscle tenotomy surgery on visual acuity (VA) and nystagmus intensity and assess, by the use of a questionnaire, the experience of adult patients and the parents of children who have had the four-muscle tenotomy procedure for nystagmus in the absence of strabismus or an anomalous head position. The qualitative perceived benefits or lack thereof from the procedure were compared to the subjective effects on nystagmus intensity and VA. METHODS Fifteen patients diagnosed as having congenital/infantile or acquired nystagmus, including albinism or other visual sensory disorders without anomalous head positions or coexisting strabismus, were included in this study. The changes in preoperative and postoperative VA and nystagmus were evaluated based on clinical and perceptual measurements and video recordings. RESULTS All 15 patients had preoperative and postoperative ophthalmological examinations. One patient had a postoperative conjunctival cyst, which was successfully removed. Fourteen patients (93%) showed clinical VA improvement in at least one eye. Fourteen patients were video recorded preoperatively and postoperatively to analyze their nystagmus intensity; case 9 was not included. Postoperatively, 10 patients (71%) showed a decrease in nystagmus intensity. Thirteen patients (87%) perceived vision improvement and 11 patients (73%) perceived a decrease in nystagmus intensity. All patients experienced either clinically improved VA or a decrease in nystagmus intensity. Fourteen patients (93%) perceived either improved VA or a decrease in nystagmus intensity. The preoperative and postoperative changes in VA (P = .002) and nystagmus intensity (P = .043) were both statistically significant. CONCLUSIONS The authors have shown that four-muscle tenotomy surgery for nystagmus can improve VA and decrease nystagmus intensity. The study yielded subjective patient satisfaction, modest objective improvement in VA, and no significant complications.

Bedside repair of congenital upper eyelid entropion: A variation of the Quickert suture technique

Purpose The current literature is void of any lasting bedside treatments for congenital upper eyelid entropion repair. Observations A six-day old male was born with bilateral upper eyelid entropion associated with a duplication of the long arm of chromosome 3q11.1-q24. Conservative management with ocular lubrication and observation did not yield spontaneous resolution, and surgical intervention was performed at the bedside with a Quickert suture technique. Conclusions and importance We discuss the novel use of this technique and review the relevant literature. Our technique is something not previously described in the literature for congenital upper eyelid entropion. It obtained satisfactory and sustained resolution.

What does convergence insufficiency look like to the strabismologist

Purpose: The purpose of this retrospective chart review is to delineate what convergence insufficiency looks like to a strabismologist. By classifying the entity, determining the most prevalent symptoms and findings of the disease, a standard will be set for further research into the disease patterns and treatment parameters. Conclusion: Our study suggests that CI can present in ways that are not expected. Symptoms: A large number of our patients were asymptomatic at presentation. The presence or absence of strabismus may not play a role in the diagnosis of CI Up to 8% of patients who have been diagnosed with CI were described by some strabismologists as esotropic or esophoric. 20% of patients had a NPC of 1 cm Fusional amplitudes may play a role in diagnosis of CI, data has been collected, results pending.

Vertically oval corneas in a child with holoprosencephaly.

Vertically oval-shaped corneas are an uncommon ophthalmic finding. The normal human cornea has an oval shape, but is wider in the horizontal dimension. The etiology of vertically oval corneas is unclear. This report presents a case of bilateral vertical oval corneas in a male infant with semilobar holoprosencephaly.