Miles J Burke

An Alternative Approach to the Surgical Management of Exotropia-The Unilateral Lateral Rectus Recession

Fifty-five patients with moderate angle exotropia of 15 to 20 prism diopters were surgically treated with a unilateral lateral rectus recession of 7.0, 7.5, or 8.0 mm. The mean age at surgery was 14.5 years. The mean preoperative deviation was 18.0 delta. The mean lateral rectus recession was 7.6 mm. At the initial postoperative follow up, all patients were either a small-angle exotropia or esotropia, or orthophoric. Twenty-eight of the 55 patients (51%) were orthophoric at their most recent follow up. Twenty-four patients (44%) were undercorrected, with 22 of these having residual exodeviations less than 8 delta. Three patients (5%) were overcorrected.

Glaucoma and Findings Simulating Glaucoma in the Rubinstein-Taybi Syndrome

Information is reviewed on the ophthalmologic findings in 614 individuals with Rubinstein-Taybi syndrome (RTS). The data were collected from the world literature, from communication with colleagues and with families of individuals with RTS, and from personal observations. Particular emphasis is given in this article to the association of RTS with glaucoma and five other findings that may be confused with glaucoma (corneal lesions, megalocornea, colobomatous or cystic optic nerve, excavation of papilla, and large cup-to-disc ratio). A case report is presented including autopsy results on a 5-year-old black female with RTS, corneal lesions, colobomas of the optic nerves, and normal intraocular pressure.

Eye involvement in Kawasaki disease.

Kawasaki disease or mucocutaneous lymph node syndrome is an acute febrile illness primarily affecting children. The principal signs and symptoms recognizable during the acute phase of the illness are described. Kawasaki disease is fatal in up to 3% of cases due to cardiac complications secondary to a systemic vasculitis. In a prospective series, ophthalmologic examinations on 10 children with Kawasaki disease showed that eight had anterior uveitis during the acute phase of the illness. All cases resolved within two to eight weeks. Because of these findings, 15 patients who had had Kawasaki disease with documented bilateral conjunctival injection, but who had never undergone slit-lamp examinations, were recalled for ophthalmologic evaluation. Results of these follow-up examinations were normal in all 15 children.

Anterior Uveitis in Kawasaki's Disease

Kawasakis disease (mucocutaneous lymph node syndrome) is an acute febrile illness primarily affecting children. Slit-lamp examinations of six children with kawasakis disease, ranging in age from 22 months to 16 years, showed that five had anterior uveitis during the acute phase of the illness. Two of the children were treated with corticosteroids and cycloplegic drugs and three received no treatment. In all five, the anterior uveitis resolved completely within a few weeks.

Follow-Up Ophthalmologic Examinations in Children with Kawasaki's Disease

We recalled 15 patients who had had Kawasakis disease with documented bilateral conjunctival injection but who had not undergone slit-lamp examinations during the acute phase of the illness. Although anterior uveitis has been found in the acute phase of Kawasakis disease, results of the follow-up studies (including slit-lamp examination, visual acuity testing, and assessment of pupillary reaction, muscle balance, and intraocular pressure) were normal in all 14 children.

Alveolar Soft-Part Sarcoma of the Orbit

A 10-year-old girl with gradual-onset proptosis in her left eye was diagnosed with orbital alveolar soft-part sarcoma. The tumor and the contiguous medial rectus muscle in the left eye were excised and compensatory strabismus procedures were performed. Five years postoperatively, she has central binocular vision with no evidence of tumor recurrence.

Safety evaluation of BSS plus in pediatric intraocular surgery.

An open-label study was conducted to determine the safety of a new intraocular irrigating solution, BSS Plus, when used during pediatric ophthalmic surgery. BBS Plus is a modified glutathione-bicarbonate-Ringers solution which contains the necessary ions, buffers, and substrates for maintenance of normal cellular metabolism, function, and structural integrity when used as a perfusate during ophthalmic surgical procedures. At three centers, 30 patients undergoing lens aspiration or anterior segment reconstruction using vitrectomy instrumentation were enrolled in this study. Transient postoperative increases in intracellular pressure and internal or external ocular inflammatory signs were seen which were consistent with the trauma produced by the surgical procedure. The solution was judged to be safe when used in these surgical indications.