Michael J. Wan

Complications of Strabismus Surgery: Incidence and Risk Factors

Abstract Purpose: To perform a systematic review of the complications of strabismus surgery, focusing on incidence and risk factors. Material and Methods: A systematic literature search was performed using the Medline and Cochrane databases. Results: Local complications, such as conjunctival injection and mild scarring, are almost universal but only rarely have long-term clinical significance. There are several important complications that are uncommon but associated with significant long-term sequelae, including slipped muscles, lost muscles, stretched scars, incarcerated muscles, pulled-in-two syndrome, periocular infections, orbital cellulitis, scleral perforations, retinal detachments, endophthalmitis, anterior segment ischemia, and surgical errors. Discussion: Strabismus surgery is associated with a number of common and serious complications, and it is important for both surgeons and patients to be aware of the risks.

Visual Outcomes in Pediatric Optic Neuritis

PURPOSE To describe the visual outcomes of a large cohort of pediatric patients presenting to a tertiary care pediatric hospital with first-episode optic neuritis. DESIGN Retrospective, observational cohort study. METHODS In a tertiary care pediatric hospital, patients with first-episode optic neuritis and at least 3 months of follow-up over a 10-year period were assessed and followed-up in the ophthalmology department. The main outcome measures were visual acuity at 3 months and 1 year of follow-up, with analysis of risk factors for poor visual outcomes and the time course of visual recovery. RESULTS Of the 59 pediatric patients with first-episode optic neuritis, 46 had at least 3 months of follow-up and 36 had at least 1 year of follow-up. The mean age was 12.6 years old; 72% were female, 41% had bilateral involvement, 52% had or developed an underlying diagnosis (39% multiple sclerosis, 7% acute disseminated encephalomyelitis, 7% neuromyelitis optica), and 91% received treatment (85% steroids, 7% multimodal). At 1 year, 81% were at least 20/20 and 89% were at least 20/40. A poor visual outcome at 1 year (<20/40) was associated with vision of <20/20 at 3 months (P = 0.041). Other clinical characteristics, including visual acuity at presentation, sex, bilateral involvement, optic nerve edema, and underlying diagnoses were not significantly associated with poor visual outcomes. CONCLUSIONS In this cohort of pediatric patients with optic neuritis, the majority of patients regained normal visual acuity at 1 year, regardless of baseline clinical characteristics.

Removal of a barbed fish hook from the cornea of an 8-year-old boy

This video article shows the surgical removal of a three-pronged barbed fish hook from the cornea and anterior chamber of an 8-year-old boy. The advance-and-cut method is shown: the embedded barbed point of the fish hook was advanced through the cornea, its point was cut off, and the shank of the hook was withdrawn. This method was chosen due to the three-pronged configuration of the fish hook to minimize additional trauma to the eye. Other methods of fish hook removal are briefly reviewed.