Mary O'Hara

Posterior Chamber Intraocular Lens Use in Children

PURPOSE The authors report on the efficacy of intraocular lens implantation during pediatric cataract surgery and the results of a consecutive series of intraocular lens implantation in children. METHODS Twenty-one children underwent implantation of intraocular lenses in 23 eyes. Twenty-one surgeries were primary implantation immediately following anterior lensectomy. Two surgeries were secondary implantations. Primary posterior capsulectomy was performed in 18 of 21 primary implantations. All but two eyes underwent a primary anterior vitrectomy. Topical prednisolone acetate was administered in all cases. Oral prednisone was administered in 17 of 23 cases. Pre- and postoperative visual acuity, cycloplegic refraction, and postoperative complications related to inflammation such as intraocular lens (IOL) capture, IOL decentration, and posterior capsule opacification were examined. RESULTS Eighteen of 23 eyes have achieved a visual acuity of 20/40 or better. None of the cases in which oral prednisone was used developed complications related to postoperative inflammation. One of the six cases (17%) in which oral prednisone was not used developed such complications. CONCLUSION Intracular lens implantation accompanied by primary posterior capsulectomy, anterior vitrectomy, and management of postoperative inflammation appears to provide appropriate and safe optical rehabilitation in children.

Primary Ocular Posttransplant Lymphoproliferative Disease in Pediatric Liver Transplant Patients

Posttransplantation lymphoproliferative disease (PTLD) is an opportunistic neoplasm demonstrated to be related to Epstein–Barr virus (EBV) infection and immunosuppressive regimens required for graft survival. A strong association exists between PTLD and primary EBV infection in an immune-compromised host (1–3). Incidence estimates for PTLD range from 2% to 28% and are clearly higher in pediatric than in adult patients (1). The increased risk may result from the EBV naive status of pediatric patients. The incidence is highest early after transplantation or after episodes of acute graft rejection, when immunosuppression is maximal. Although varied, the clinical presentation of PTLD has been described as an acute mononucleosis-like illness, a mass or generalized lymphadenopathy, or disseminated disease. We describe a rare case of isolated primary ocular PTLD occurring years after transplantation and compare our patient’s course with patients’ in the three previously published cases.

A Comparison of Prophylactic Ondansetron Hydrochloride and Droperidol for Strabismus Repair in Adults

BACKGROUND Prophylactic administration of an antiemetic is a common procedure for patients undergoing strabismus surgery. Droperidol and ondansetron hydrochloride are commonly used antiemetics. This study compared the rates of postoperative nausea and vomiting (PONV) in adult patients undergoing strabismus surgery with prophylactically administered Droperidol or ondansetron hydrochloride. METHODS A double-masked, randomized, prospective study was conducted comparing droperidol with ondansetron hydrochloride when administered prophylactically to adults undergoing strabismus surgery. RESULTS Forty-five patients entered the study with a mean age of 30 years. Twenty percent of patients had nausea immediately postoperatively and 37% had nausea before discharge with no significant differences between groups. Overall rate of emesis, time in the recovery room, and time to discharge was not significantly different between the droperidol and ondansetron hydrochloride group. CONCLUSION No real differences in the ability to prevent PONV between the two medications were found in this study.

Migraine in a pediatric ophthalmology practice.

PURPOSE A prospective study of children between the ages of 2 and 15 years was conducted to investigate the prevalence and characteristics of migraine in children seeking ophthalmic care. METHODS A questionnaire, based on established criteria for the diagnosis of migraine, was administered to 1479 consecutive children presenting to a single pediatric ophthalmologist (H.P.K.). Over 25% of all respondents reported headaches that met the criteria for migraine. In general, these individuals were older than non-migraine sufferers (mean age of 8.3 years vs. 6.6 years). There were no significant sex differences. RESULTS Headache was the chief complaint for 8.9% of all patients seeking ophthalmic care in this study population. Eighty percent of this subpopulation described headaches that met the diagnostic criteria for migraine. This study found childhood migraine symptoms to be present in a significant proportion of the patient population of a pediatric ophthalmologist. CONCLUSION Ophthalmologists must be aware of the high prevalence of migraine in children seeking ophthalmic care with a chief complaint of headache. Such knowledge will aid the ophthalmologist in the timely diagnosis, treatment, and appropriate referral of patients with symptoms of migraine.