Lorraine Cassidy

Outcome of lens aspiration and intraocular lens implantation in children aged 5 years and under

AIMS To determine the visual outcome and complications of lens aspiration with intraocular lens implantation in children aged 5 years and under. METHODS The hospital notes of all children aged 5 years and under, who had undergone lens aspiration with intraocular lens implantation between January 1994 and September 1998, and for whom follow up data of at least 1 year were available, were reviewed. RESULTS Of 50 children who underwent surgery, 45 were eligible based on the follow up criteria. 34 children had bilateral cataracts and, of these, 30 had surgery on both eyes. Cataract was unilateral in 11 cases; thus, 75 eyes of 45 children had surgery. Cataracts were congenital in 28 cases, juvenile in 16, and traumatic in one case. The median age at surgery was 39 months (range 11–70 months). Follow up ranged from 12–64 months (median 36 months). Of 34 children with bilateral disease, 25 (73.5%) had a final best corrected visual acuity of 6/12 or better, while seven (20.5%) achieved 6/18 or less; in one child the vision improved from UCUSUM to CSM but another, who had only one eye operated on, was unable to fix or follow with this eye preoperatively or 2 years postoperatively. Of 11 children with unilateral cataract, five (45.5%) had a final best corrected visual of 6/12 or better, and six (54.5%) 6/18 or less. A mild fibrinous uveitis occurred in 20 (28.2%) eyes in the immediate postoperative period, but resolved with topical steroids. One child had a vitreous wick postoperatively requiring surgical division. Glaucoma, endophthalmitis, or retinal detachment have not been observed so far in any patient postoperatively. CONCLUSION From this series the authors suggest that, in children aged 5 years and under, lens aspiration with intraocular lens implantation is a safe procedure, with a good visual outcome in the short term. Further studies are needed to investigate these outcomes in the long term.

Should we aggressively treat unilateral congenital cataracts

Early surgery for unilateral congenital cataracts—why? Some might protest that visual results are notoriously poor after surgery for a unilateral congenital cataract. Why drag the family and child through all the turmoil required for the treatment of infantile cataracts for, at best, a “spare eye”? The answer is simple: two eyes are better than one. Two eyes give us a larger field of view, a reserve if one eye is lost, and that wonderful trait of binocular vision with stereopsis. Sure, you can get along with one eye but if there is any reasonable possibility for obtaining two functioning eyes, then we should go for it! I have both a personal and a professional interest in unilateral cataract as my sister had technically successful unilateral congenital cataract surgery at 21⁄2 years, followed by three strabismus surgeries. She had a childhood of being teased, an adult life of concern for her one good eye and corrected vision of counting fingers in the aphakic eye.

Congenital cataract and multisystem disorders

A knowledge of those syndromes associated with congenital cataract is essential for the paediatric ophthalmologist, as congenital cataracts are manifest in a large number of syndromes. It is important to have the correct diagnosis in such cases, not only for genetic and prognostic information, but also in order to help the parents to understand their childs condition. This paper describes the more common syndromes seen in association with congenital cataract, and emphasises the importance of looking at the whole child and family. We aim to provide a practical clinical guide to the diagnosis of hereditary and non-hereditary syndromes associated with congenital cataract.

Choroidal folds and papilloedema

AIMS To assess the clinical and fluorescein angiographic features of choroidal folds seen in association with papilloedema. METHODS In a retrospective study, the clinical data from a database on patients with choroidal folds (1963–97), including fundus photography and fluorescein angiography, from 32 patients (64 eyes) with choroidal folds in association with papilloedema were reviewed. The clinical and fluorescein angiographic features and the clinical course of choroidal folds in these patients are described. RESULTS 32 patients had choroidal folds associated with papilloedema. Folds of two distinct categories were observed, either coarse folds or wrinkles. The folds persisted in all cases, even after resolution of papilloedema. Follow up ranged from 1 month to 20 years. Only one patient suffered permanent visual impairment as a result of a choroidal fold. CONCLUSIONS Choroidal folds exist in two forms, coarse folds and wrinkles. They persist even after papilloedema has resolved. Final visual acuity did not appear to be affected by the presence of choroidal folds in the majority of patients.

Prognostic Indicators and Outcome Measures for Surgical Removal of Symptomatic Nonadvanced Cataract

OBJECTIVES To report changes in perceived visual functioning after surgery for symptomatic cataract with preoperative corrected distance visual acuity [CDVA] of 0.4 logMAR or better (Snellen equivalent, 20/50) and to investigate the relationship between any observed changes and preoperative physical characteristics and psychophysical consequences of the lens opacity and any changes in psychophysical findings after the procedure. METHODS Eighty-five patients with cataract completed a validated questionnaire concerning functional vision satisfaction and a series of visual performance assessments before and 2 months after cataract surgery. The lens optical density and Lens Opacities Classification System III score of the cataract were recorded. Correlations between changes in the Rasch-analyzed questionnaire score and changes in visual performance after cataract surgery, as well as preoperative psychophysical measures, lens optical density, and Lens Opacities Classification System III score, were determined. RESULTS The mean (SD) questionnaire score improved from 2.15 (0.36) to 1.54 (0.41) (P < .001). The preoperative questionnaire score (r = -0.44), preoperative mesopic glare disability [GD] (at 1.5 cycles per degree [cpd] [r = 0.34] and 3.0 cpd [r = 0.27]), and preoperative photopic GD (at 1.5 cpd [r = 0.24] and 3.0 cpd [r = 0.30]) showed statistically significant correlations with perceived improvements in visual functioning after surgery (P < .05). Changes in perceived visual functioning correlated significantly with changes in mesopic GD (at 1.5 cpd [r = -0.43] and 3.0 cpd [r = -0.28]; P < .05) and photopic GD (at 1.5 cpd [r = -0.24] and 3.0 cpd [r = -0.39]; P < .05). Neither preoperative CDVA nor change in CDVA after surgery correlated significantly with perceived improvement in visual functioning after the procedure (P > .05 for both). CONCLUSION Psychophysical tests alternative to CDVA better represent improvements in self-reported visual functioning following removal of symptomatic nonadvanced cataract.

Effect on refractive outcomes after cataract surgery of intraocular lens constant personalization using the Haigis formula

PURPOSE: To quantify the effect on refractive outcomes after cataract surgery of personalization of Haigis intraocular lens (IOL) constants for a given surgeon–IOL combination. SETTING: Institute of Eye Surgery and Institute of Vision Research, Whitfield Clinic, Butlerstown North, Waterford, Ireland. METHODS: Personalization of Haigis IOL constants was performed using a series of 248 suitable eyes after biometry by partial coherence interferometry (IOLMaster) and IOL prediction based on optimized IOL constants derived from pooled data from the User Group for Laser Interference Biometry web site. A mean error of prediction and a mean absolute error were then calculated using the personalized IOL constants and compared with those derived using optimized IOL constants, allowing evaluation and quantification of the maximum realizable refractive benefits (if any) of personalization. RESULTS: There was no statistically significant difference between personalized and optimized Haigis IOL constants in absolute error or the proportion of eyes within ±1.00 diopters (D), ±0.50 D, or ±0.25 D of the target postoperative refraction in all eyes, short eyes (axial length [AL] <22 mm; n = 19), average eyes (AL ≥22 mm and <24.5 mm; n = 149), or long eyes (AL >24.5 mm; n = 46) (all P>.05, McNemar test). Ten eyes with a short AL had a smaller absolute error (by ≥0.30 D) in association with personalized IOL constants. CONCLUSION: Personalized Haigis IOL constants showed marginal, but statistically nonsignificant, refractive advantages over optimized Haigis IOL constants, but only in eyes with a short AL. Financial Disclaimer: No author has a financial or proprietary interest in any material or method mentioned.

Posterior optic nerve infarction after lower lid blepharoplasty

We describe a case of acute and total loss of vision after lower lid blepharoplasty. This major complication followed minor cosmetic surgery. Magnetic resonance imaging (MRI) showed posterior segmental infarction of the optic nerve, a finding not previously demonstrated.

Psychophysical impact and optical and morphological characteristics of symptomatic non-advanced cataract

PurposeTo investigate whether psychophysical, morphological, and/or optical characteristics of symptomatic non-advanced cataract are complementary to, or more appropriate than, visual acuity (VA) for the purposes of recording visual data that reflect subjective visual difficulty in patients with cataract that exhibit relative sparing of high contrast acuity (0.4 logarithm of minimal angle of resolution (logMAR) scale or better).MethodsEighty-two patients with symptomatic non-advanced cataract and no other ocular pathology were asked to complete a validated questionnaire, and to perform a series of visual function assessments including: corrected distance VA (CDVA); photopic and mesopic contrast sensitivity; photopic and mesopic glare disability (GD); reading acuity and reading speed; stereoacuity; and retinal sensitivity. Optical and morphological characteristics of the cataract were evaluated by lens optical density and by the Lens Opacities Classification System III, respectively. Correlations between questionnaire score and each of these measures were calculated.ResultsStatistically significant negative correlations were observed between the Rasch-scaled questionnaire score and mesopic GD (at 3 and 6 cycles per degree (cpd); r=−0.396 (P<0.01) and −0.451 (P<0.05), respectively) and between the Rasch-scaled questionnaire score and photopic GD (at 3 and 6 cpd; r=−0.328 (P<0.01) and −0.440 (P<0.01), respectively).ConclusionSymptomatic non-advanced cataract, in the presence of good CDVA, is associated with measurable subjective visual difficulty, best reflected in a decrease in mesopic and photopic GD (at medium spatial frequencies). CDVA does not reflect the patients visual dissatisfaction in such cases.

Intraocular pressure, pulse amplitude and pulsatile ocular blood flow measurement in premature infants screened for retinopathy of prematurity

Intraocular pressure, pulse amplitude and pulsatile ocular blood flow measurement in premature infants screened for retinopathy of prematurity

The relationship between HLA-DRB1 alleles and optic neuritis in Irish patients and the risk of developing multiple sclerosis

Aims: To investigate the role of the major histocompatibility complex in Irish patients with optic neuritis (ON) and determine whether HLA-DRB1 genotypes are a risk factor for the development of multiple sclerosis (MS) in such patients. Method: All patients were Caucasian, had Irish ancestry and had MRI of brain and optic nerves within 2–3 weeks of presentation. Patients were referred to a neurologist if MRI findings were consistent with a diagnosis of MS. HLA-DRB1 allele and phenotype frequencies for 78 patients with a clinical diagnosis of acute ON were compared with those for 250 healthy bone marrow donors. Results: An ON/MS positive patient was 3.4 times more likely than an ON/MS negative patient to be DRB1*15 positive. No difference in age profile was detected between ON/MS positive and ON/MS negative patients or between the ON male and female subgroups. No gender or HLA-DRB1 association was identified for ON/MS negative patients. Female gender was significantly increased among ON/MS positive patients with a p value of 0.0053. Conclusions: DRB1*15 is a significant predisposing factor for ON. This ON patient cohort has also provided an opportunity to evaluate the relationship of HLA genotype with the risk of MS development. The findings of this study indicate that Irish individuals presenting with ON and who are HLA DRB1*15 positive have a higher risk than HLA DRB1*15 negative patients of presenting with MRI findings indicative of MS. This study has also demonstrated that female gender is a risk factor for developing MS in the Irish population.