Kara M. Cavuoto

Surgical Management in Primary Congenital Glaucoma: Four Debates

Primary congenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment. As the abundance of surgical treatment options continues to expand, the authors will compare and contrast the available options and attempt to provide a consensus on surgical management.

Infectious Pseudomonas scleritis after strabismus surgery.

Scleral inflammation and necrosis are rare but serious complications of ocular surgery. We present a case of Pseudomonas infectious scleritis following strabismus surgery with an exuberant, presumably sterile endophthalmitis in an immunocompromised 62-year-old man that was responsive to topical and oral antibiotics.

Zone 3 ruptured globe from a dog bite.

Periocular injuries from dog bites are relatively common in school-age children, but intraocular trauma is exceedingly rare. We present a 7-year-old boy who sustained a zone 3 ruptured globe injury after attack by a Perro de Presa Canario. At presentation, visual acuity in the injured eye was counting fingers. Surgical exploration revealed an inferotemporal corneoscleral laceration extending 15 mm posterior to the limbus, with protrusion of uveal tissue, which was repaired. Visual acuity improved to 20/40 by the first postoperative month.

The Spectrum of Pediatric Orbital BB Gun Injuries: A Case Series.

Three cases of pediatric BB orbital injury are reported demonstrating varying outcomes. Pediatric orbital BB injuries have a wide spectrum of clinical outcomes depending on the ocular structures involved. Improved safety education of patients and parents is necessary to reduce the burden of these vision-threatening injuries.

Patient demographic and microbiology trends in bacterial conjunctivitis in children

The management of bacterial conjunctivitis has a significant economic impact, despite the relatively benign nature of the disease. We reviewed the medical records for children diagnosed with conjunctivitis at inpatient and outpatient facilities of a tertiary university center over a 5-year period to examine the microbial trends and physician practice patterns and found that most cases of conjunctivitis were treated empirically. When cultures were performed and an organism was recovered, there were significant differences in the organism based on age. Although bacterial conjunctivitis accounted for only 10% of cases, antibiotics were dispensed in more than half of the cases. Pediatricians prescribed antibiotics for conjunctivitis more than twice as often as ophthalmologists. Less than 5% of patients who did not receive antibiotics returned to clinic within 1xa0month for persistent symptoms.

Evolving Perspectives on Congenital Glaucoma

Congenital glaucoma differs from adult glaucoma in that it represents a panocular disorder defined by structural, functional, and physiologic parameters. In order to achieve excellent visual outcomes, the management of congenital glaucoma involves concurrently controlling intraocular pressure and treating amblyopia, while minimizing any influence of a compromised visual axis. Thus far, difficulty in assessing visual function in pre-verbal children has resulted in a paucity of long-term visual outcome data. However, based on commonly recognized obstacles to structural/physiologic stability and functional rehabilitation status, we propose a congenital glaucoma severity scale in order to provide a cross-sectional stratification of disease severity. As the severity of pathology evolves over time, the severity score should be adjusted accordingly. The initial score and rate of changes in severity (“severity slope”) will help in prognosticating outcome. Future studies will be required to validate, calibrate, and discriminate this severity scale before clinical and research applications.

Tip of iceberg: when unusual vision complaints with a normal examination prompt a closer look

Nonorganic vision loss (NOVL) is a relatively common condition in pediatric patients. Prompt diagnosis can prevent costly, time‐consuming, and frustrating workups. It is valuable for general practitioners and specialists alike to include NOVL in their differential when evaluating patients with visual complaints that are inconsistent with normal examination findings.

The Effect of Patient Characteristics and Sleep Quality on Visual Field Performance Reliability

Purpose To investigate the association of automated visual field (VF) reliability indices (false positive [FP], false negative [FN], and fixation loss [FL]) and sleep quality, VF experience, and age. Methods Prospective, cross-sectional study. Adult patients (ageu2009≥u200918 years) completing automated VF testing were invited to participate. Baseline participant characteristics were obtained, and all participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Nonparametric Spearman correlations and logistical regression models were performed. Results 63 patients were enrolled. Lower PSQI score was correlated with higher percentage (%) FL in the right eye (p = 0.03). Fewer prior VF was significantly correlated with higher %FP in the right eye (p = 0.008). Older age was significantly correlated with higher %FN in the left eye (p = 0.01). Greater mean deviation (MD) and pattern standard deviation (PSD) were strongly correlated with higher %FN in the right (p = 0.02 and 0.002, resp.) and left eyes (p = 0.01 and 0.02, resp.). Conclusion In this prospective, cross-sectional study, worse MD and PSD are strongly correlated with increased FN in both eyes. Increased FN in the left eye associated with older age might be attributable to test fatigue. Worse sleep quality is associated with decreased FL in the right eye.

Clinical management outcomes of childhood glaucoma suspects

Purpose To investigate the outcomes of childhood glaucoma suspects. Design Retrospective case series. Methods Records of childhood glaucoma suspects were identified using financial claims data; medical history, baseline biometric and exam findings were recorded. Conversion from suspect to glaucoma was determined based on the Childhood Glaucoma Research Network criteria. The study adheres to the tenets of the Declarations of Helsinki. Results 214 subjects were enrolled, with median age at initial presentation of 6.37 years (interquartertile range: Q1 = 2.46, Q3 = 8.90). 22 (10.2%) subjects developed glaucoma, 64 (29.9%) had ocular hypertension but no glaucoma, 9 (4.2%) had high-risk condition or syndrome without either ocular hypertension or glaucoma after a mean follow up of 39 +/- 34 months. Neither a family history of glaucoma nor patient gender was significantly different between the groups. 40.2% of subjects (86 of 214) had two or more episodes of intraocular pressure (IOP) > 21 mmHg, among which 25.6% (22 of 86) developed glaucoma after a mean duration of 32.8 +/- 33.5 months. Conclusions Up to 25% of children with 2 or more episodes of elevated IOP may develop glaucoma. In 50% of suspects who converted to glaucoma, elevated IOP was not present at the initial evaluation. There is no significant difference in gender, family history, or baseline central corneal thickness between suspects who developed glaucoma compared to the rest. While suspects who converted to glaucoma had higher average, maximum and minimum IOP measurements, there is no clear cutoff between the groups.

Ophthalmic findings in Frank-ter Haar syndrome: report of a sibling pair

Frank-ter Haar syndrome (FTHS) is an autosomal recessive disorder characterized by abnormalities that affect the development of bone, heart, and eyes. We report a sibling pair with FTHS caused by a homozygous, novel mutation pLys133Glnfs*13 in the SH3PXD2B gene: one sibling had bilateral ocular hypertension and unilateral colobomas of iris, choroid and retina; the other, unilateral myelinated nerve fiber layer of the optic disk and papilledema due to idiopathic intracranial hypertension. Both children had refractive amblyopiaxa0and megalocornea.