Daisy Godts

Binocular vision impairment after refractive surgery

Purpose: To illustrate the need for an accurate preoperative orthoptic examination to prevent postoperative changes in binocular vision. Setting: Department of Ophthalmology, University Hospital Antwerp, Edegem, Belgium. Methods: Five patients presenting major subjective complaints after refractive surgery were analyzed. Results: In 1 patient, a latent N IV palsy decompensated after laser in situ keratomileusis (LASIK) in the more myopic eye to achieve monovision. A second patient, operated on for N IV palsy 10 years earlier, presented a recurrence of the palsy after bilateral LASIK for myopia. The third patient complained of discomfort in binocular vision caused by aggravation of a preexisting intermittent esotropia that worsened after LASIK for hyperopia. The fourth patient complained of diplopia after LASIK in the highly anisometropic and exotropic eye. The fifth patient experienced a decrease in fusion and stereopsis at the time he became anisometropic after bilateral LASIK. Conclusions: Special care should be taken of patients who have a preoperative history of strabismus surgery, an overcorrection or undercorrection in 1 or both eyes, or anisometropia and of those who are unhappy with contact lenses. An orthoptic examination should be done with and without spectacle correction to detect underlying vertical phorias. Intended monovision should be examined initially using contact lenses.

Bag-in-the-lens intraocular lens implantation in the pediatric eye

PURPOSE: To study the efficacy, safety, and feasibility of implantation of a bag‐in‐the‐lens intraocular lens (IOL) in children and babies. SETTING: Departments of Ophthalmology, University Hospital, Antwerp, Belgium, and the University Hospital, Ljubljana, Slovenia, and a private ophthalmology practice, Oudenaarde, Belgium. METHODS: Thirty‐four eyes of 22 children had implantation of a bag‐in‐the‐lens IOL. The ages ranged from 2 months to 14 years. Congenital cataract was present in 26 eyes, and persistent fetal vasculature (PFV) was concomitantly present in 4 eyes. Fifteen patients had bilateral cataract, and 6 had unilateral cataract. RESULTS: In 3 eyes, the IOL could not be properly implanted. In these cases, secondary intervention was necessary because of early posterior capsule opacification. The mean postoperative follow‐up was 17.45 months ± 17.12 (SD) (range 4 to 68 months). None of the children except those presenting with PFV had anterior vitrectomy during surgery. The optical axis remained clear during the follow‐up in all patients who had successful IOL implantation. CONCLUSIONS: The bag‐in‐the‐lens implantation technique in children and babies was safe and kept the visual axis clear after cataract surgery. In the near future, 4.0 or 4.5 mm IOLs will be available that may improve the success rate of IOL implantation in the small eyes of babies.

Distance esotropia in the elderly

Aim To describe the clinical features of an under-recognised small esodeviation and horizontal diplopia on distance fixation seen in elderly patients not associated with lateral rectus underaction or coexisting neurological abnormalities. Methods 87 elderly patients (age range 62–91 years) with constant or intermittent horizontal diplopia at distance were prospectively recruited and assessed from February 2008 until February 2012. Ocular alignment, fusion amplitudes, and horizontal eye movements were measured for distance and near. Results Distance esodeviation varied from 2–18 prism dioptres (PD) esotropia (ET). At near fixation, deviation ranged from 10 PD exophoria to 12 PD esophoria. Divergence fusional amplitude at distance ranged from 0–10 PD while the divergence fusional amplitude at near ranged from 2–18 PD. Horizontal ductions and versions were full in all patients. Six patients presented with an increase of distance esodeviation combined with a decrease of divergent fusional amplitude over a period of 6–12 years. All patients were successfully treated with prisms, ranging from 2–16 PD base-out. Conclusions Our findings indicate that patients with age-related distance ET may experience a slight increase in distance esodeviation over time, with a slow decrease of fusional divergence amplitudes with normal ocular motility. The aetiology is still unclear. However, patients may be assured that this is a benign condition with slow progression, and can be successfully treated with prism correction. Surgery may be reserved for the minority of cases with severe esodeviation.

Pediatric bag-in-the-lens intraocular lens implantation: Long-term follow-up

Purpose To evaluate long‐term follow‐up results of pediatric cataract surgery using the bag‐in‐the‐lens (BIL) intraocular lens (IOL) implantation technique. Setting Antwerp University Hospital, Edegem, Antwerp, Belgium. Design Prospective case series. Methods All pediatric cataract surgeries with BIL IOL implantation performed at the Antwerp University Hospital were evaluated. Only cases that completed a follow‐up of 5 years at the hospital’s Department of Ophthalmology were included in this study. Results Forty‐six eyes of 31 children had a complete follow‐up of 5 years or more after BIL IOL implantation. Sixteen cases were unilateral and 15 were bilateral. Patient age at time of surgery ranged from 2 months to 14 years. The mean refraction at the end of follow‐up was −1.99 diopters (D) ± 3.70 (SD). In bilateral cases, a corrected distance visual acuity (CDVA) of better than 0.5 was attained in 86.7% and a CDVA of 1.0 was achieved in 56.7%. In unilateral cases, 31.2% achieved a CDVA of better than 0.5 but none obtained a CDVA of 1.0. A clear visual axis was maintained in 91.3% of cases during follow‐up. Visual axis reopacification was detected in 4 eyes of 3 cases, all due to inadequate BIL IOL positioning. None of these eyes needed more than 1 intervention to maintain visual axis clarity. Other than 1 case of glaucoma, no severe complications were detected. Conclusion Long‐term follow‐up results show that BIL IOL implantation is a safe, well‐tolerated approach for treating pediatric cataract with a very low rate of visual axis reopacification and a low rate of secondary interventions for other postoperative complications. Financial Disclosure Dr. Tassignon has intellectual property rights to the bag‐in‐the‐lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794.PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany. No other author has a financial or proprietary interest in any material or method mentioned.

Binocular Vision in Chronic Fatigue Syndrome

Introduction and Purpose To compare binocular vision measurements between Chronic Fatigue Syndrome (CFS) patients and healthy controls. Methods Forty-one CFS patients referred by the Reference Centre for Chronic Fatigue Syndrome of the Antwerp University Hospital and forty-one healthy volunteers, matched for age and gender, underwent a complete orthoptic examination. Data of visual acuity, eye position, fusion amplitude, stereopsis, ocular motility, convergence, and accommodation were compared between both groups. Results Patients with CFS showed highly significant smaller fusion amplitudes (P < 0.001), reduced convergence capacity (P < 0.001), and a smaller accommodation range (P < 0.001) compared to the control group. Conclusion In patients with CFS binocular vision, convergence and accommodation should be routinely examined. CFS patients will benefit from reading glasses either with or without prism correction in an earlier stage compared to their healthy peers. Convergence exercises may be beneficial for CFS patients, despite the fact that they might be very tiring. Further research will be necessary to draw conclusions about the efficacy of treatment, especially regarding convergence exercises. To our knowledge, this is the first prospective study evaluating binocular vision in CFS patients.

177 Implant « bag-in-the-lens » en pédiatrie

But La premiere complication post-operatoire de la chirurgie de la cataracte chez l’enfant est l’opacification capsulaire posterieure. Cette opacification capsulaire posterieure retarde la maturation du systeme visuel et pose le probleme du traitement au laser Nd-YAG chez le tres jeune enfant. Elle arrivait classiquement dans 80 % des cas la premiere annee. Il a ete montre qu’un rhexis capsulaire posterieur retardait l’apparition d’opacification capsulaire posterieure. Ce geste chirurgical est maintenant la pratique courante en pediatrie. La lentille « bag-in-the-lens » permet, apres un double capsulorhexis, d’inserer les capsules anterieures et posterieures dans le sillon de l’implant pour contenir les cellules epitheliales du cristallin restantes afin d’eradiquer l’opacification capsulaire posterieure. Nous proposons l’analyse des performances de cette lentille intra-oculaire en pediatrie. Materiels et Methodes Quarante-huit yeux chez 33 enfants, souffrant de diverses pathologies (cataracte congenitale, traumatique ou toxique, spherophaquie, syndrome de Marfan,…) ont recu l’implant « bag-in-the-lens » entre 2000 et 2007. L’âge des enfants a la date de la chirurgie etait de 6.5 ± 5 ans (de 0 a 14 ans). Nous avons evalue les performances de cet implant en chirurgie pediatrique en termes de taux d’opacification capsulaire posterieure, de recuperation de l’acuite visuelle et de performances refractives. Resultats Le suivi actuel est de 22 ± 17 mois (0.5 a 70 mois). L’implant a pu etre correctement insere dans 47 yeux. Dans un œil (3 e cas), le rhexis capsulaire trop grand a justifie l’explantation. A partir du moment ou la capsule a ete correctement inseree dans le sillon, l’axe visuel est reste clair dans les 45 yeux (0 % d’opacification capsulaire posterieure). Discussion L’acuite visuelle moyenne quand elle a pu etre mesuree en decimale (dans 34 yeux, les 11 restants etant des patients trop jeunes ou presentant un retard mental) est 0.9 ± 0.8 (0.006 a 1). Les plus mauvaises valeurs sont celles dont l’indication etait une persistance hyperplasique du vitre primitif. Pour cette derniere population de 34 yeux, la refraction post-operatoire est en moyenne –0.7 ± 2.3 D (de 3.5 D a -7 D). Conclusion L’implant « bag-in-the-lens » permet d’eradiquer l’opacification capsulaire posterieure. Son implantation est particulierement indiquee chez l’enfant ou un rhexis posterieur est necessaire. Les performances visuelles sont bonnes. Les resultats refractifs sont inegaux du fait de la difficulte d’une mesure precise chez les enfants de moins de 3 ans.