Iris S. Kassem

Dry Eye, Blinking, and Blepharospasm

this prediction by comparing the SO-evoked blinks of individuals with dry eye with those of age-matched controls. Given the frequent occurrence of dry eye at the onset of benign essential blepharospasm (BEB), 7 blink modifications associated with dry eye may play a role in the origin of BEB. We present a hypothesis that links the adaptive processes initiated by dry eye with the origin of BEB.

Exotropia in children with high hyperopia

PURPOSE To describe the clinical characteristics, treatment, and subsequent clinical course of children with exotropia and high hyperopia. METHODS The medical records of 26 patients seen between 1990 and 2009 who had an exotropia and ≥4.00 D of hyperopia were retrospectively reviewed. We analyzed the clinical characteristics, treatments, and subsequent alignment outcomes. RESULTS A total of 26 patients between the ages of 2.5 months and 9 years were included. Of these, 15 had associated medical conditions or developmental delay. Of 22 patients with measured visual acuities, 19 had amblyopia (10 unilateral, 9 bilateral). None of the patients demonstrated fine stereoacuity. Twenty-three exotropic children were treated with spectacles: 15 were fully corrected, 10 of whose exotropia improved; 8 received partial correction of their hyperopia, 3 of whose exotropia improved. Six patients who presented with large, poorly controlled exotropia and did not improve with spectacle correction required strabismus surgery. CONCLUSIONS Children with high hyperopia and exotropia are likely to have developmental delay or other systemic diseases, amblyopia, and poor stereopsis. Treatment of high hyperopia in exotropic children with their full cycloplegic refraction can result in excellent alignment.

Marcus Gunn jaw winking with trigemino-oculomotor synkinesis of the inferior division of the oculomotor nerve

Synkinetic aberrant innervation syndromes can involve abnormal movements of multiple extraocular and eyelid muscles. The authors describe a case of eyelid elevation associated with simultaneous adduction and depression of the eye upon chewing, sucking on a bottle, or wide opening of the mouth since birth. This represents a unique case of congenital Marcus Gunn jaw winking with trigemino-oculomotor synkinesis involving the inferior branch of the oculomotor nerve. The most likely explanation for these abnormal movements is prenatal aberrant innervation of eyelid and extraocular muscles.

Anterior capsular rupture following blunt ocular injury.

A 10-year-old boy suffered a large, oblique anterior capsular tear following blunt injury to his right eye. The boy was followed daily for hyphema resolution and progressive traumatic cataract formation. After the hyphema had resolved, the lens was removed using an anterior approach and an intraocular lens was placed with excellent visual outcome.

A Case Report of Ablepharon-Macrostomia Syndrome with Amniotic Membrane Grafting

We describe a rare case of an infant who was born with multiple congenital anomalies, including the absence of eyelids. This patient had many dysmorphic features consistent with a severe phenotype of ablepharon-macrostomia syndrome (AMS) including a fish-like appearance of the mouth, rudimentary ears, absence of body hair, thin skin, absent nipples, abdominal distension, and genital abnormalities. Upon presentation, there was severe exposure keratopathy causing large bilateral sterile ulcers culminating in corneal melting of both eyes. An amniotic membrane graft was used to attempt to maintain the corneal surface integrity. However, because of the late presentation, the corneas could not be salvaged. Extensive surgical reconstruction of both eyelids and bilateral penetrating keratoplasty was ultimately performed successfully to protect the ocular surfaces while trying to maximize the visual potential. Early amniotic membrane grafting may be done at the bedside and may help preserve the ocular in patients with severe eyelid deformities until more definitive treatment is performed.

Traumatic eye injuries from collapsible wire laundry hampers.

Two patients presented to the University of Illinois at Chicago Eye and Ear Infirmary within 1 year with penetrating eye injuries caused by similar collapsible cloth and wire laundry hampers. Penetrating eye injuries in children are relatively rare but can result in poor visual outcomes and multiple vision-threatening complications. Both injuries at the University of Illinois resulted in an eye laceration as well as retinal complications similar to those reported with a high velocity injury. This now represents a significant pattern of eye injury and suggests that there exists a nontrivial risk for all children in households with this type of collapsible laundry hamper. Parents should receive a warning of the risks of these hampers.

Findings in Persistent Retinopathy of Prematurity

BACKGROUND AND OBJECTIVE: To determine whether retinopathy of prematurity (ROP) that persists beyond a postmenstrual age (PMA) of 45 weeks has abnormalities that can be documented by fundus photography or fluorescein angiography (FA). PATIENTS AND METHODS: Fundus photographs and FAs were reviewed for all premature infants who underwent FA for persistent ROP after 45 weeks PMA. RESULTS: Of the 487 infants who were screened for ROP, 16 (3.3%) demonstrated ROP beyond 45 weeks. Seven (43.8%) infants received prior treatment with intravitreal bevacizumab (IVB) for Type 1 ROP. FAs were obtained in eight cases; four subjects were previously treated with IVB. Leakage at the vascular-avascular border was demonstrated in seven subjects (87.5%). Shunt vessels, posterior retinal nonperfusion, and absence of the foveal avascular zone was limited to the IVB group. CONCLUSIONS: There are persistent vascular abnormalities among infants with ROP beyond 45 weeks. Findings that may be missed by RetCam fundus photographs were highlighted with FA.

Engineering a light-attenuating artificial iris

Purpose Discomfort from light exposure leads to photophobia, glare, and poor vision in patients with congenital or trauma-induced iris damage. Commercial artificial iris lenses are static in nature to provide aesthetics without restoring the natural iriss dynamic response to light. A new photo-responsive artificial iris was therefore developed using a photochromic material with self-adaptive light transmission properties and encased in a transparent biocompatible polymer matrix. Methods The implantable artificial iris was designed and engineered using Photopia, a class of photo-responsive materials (termed naphthopyrans) embedded in polyethylene. Photopia was reshaped into annular disks that were spin-coated with polydimethylsiloxane (PDMS) to form our artificial iris lens of controlled thickness. Results Activated by UV and blue light in approximately 5 seconds with complete reversal in less than 1 minute, the artificial iris demonstrates graded attenuation of up to 40% of visible and 60% of UV light. There optical characteristics are suitable to reversibly regulate the incident light intensity. In vitro cell culture experiments showed up to 60% cell death within 10 days of exposure to Photopia, but no significant cell death observed when cultured with the artificial iris with protective encapsulation. Nuclear magnetic resonance spectroscopy confirmed these results as there was no apparent leakage of potentially toxic photochromic material from the ophthalmic device. Conclusions Our artificial iris lens mimics the functionality of the natural iris by attenuating light intensity entering the eye with its rapid reversible change in opacity and thus potentially providing an improved treatment option for patients with iris damage.

One Year of Pediatric Ophthalmology and Strabismus Research in Review.

PurposeTo highlight recent advances in amblyopia and strabismus. DesignLiterature review. MethodsA literature search of articles published in the English language was performed in PubMed or MEDLINE between May 2012 and April 2013 using the terms amblyopia or strabismus. Articles deemed relevant were selected. ResultsThe review highlights articles that increase our understanding of strabismus and amblyopia as well as newer treatment strategies. ConclusionsThe review highlights some new information and possible future advances in amblyopia and strabismus.