Naval Sondhi

Refractive change in pediatric pseudophakia: 6-year follow-up☆

Purpose: To evaluate the long‐term evolution of refractive error changes in eyes of children who have primary intraocular lens (IOL) implantation to allow more accurate prediction of what IOL power should be implanted at a given age. Setting: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA. Methods: This study comprised all children between 2 and 15 years of age who had posterior chamber IOL implantation and who were followed for a minimum of 4 years postoperatively. Thirty‐eight eyes of 27 patients with a mean follow‐up of 6.1 years were evaluated. All refractions were performed manually by an experienced pediatric ophthalmologist. Results: Children operated on at age 2 or 3 years had a mean myopic shift of 4.60 diopters (D) (range 0.50 to 10.75 D) over a mean of 5.8 years postoperatively. Children operated on at age 6 or 7 years had a mean myopic shift of 2.68 D (range 0.50 to 6.60 D) over a mean of 5.3 years. Children operated on at age 8 or 9 years had a mean myopic shift of 1.25 D (range −0.75 to 2.60 D) over a mean of 6.8 years. Patients operated on between ages 10 and 15 years had a mean shift of 0.61 D (range 0 to 1.90 D) over a mean of 5.7 years. Conclusions: The mean rate of myopic shift decreased throughout childhood, and the range of shift among individuals narrowed as patient age increased. However, the ability to predict future myopic shift for a given individual remains difficult, especially in younger patients.

Capsular management and refractive error in pediatric intraocular lenses.

BACKGROUND Guidelines for intraocular lens (IOL) implantation in children regarding patient selection, age limitations, operative techniques, including management of the posterior capsule, and refractive goals are not universally agreed on. METHODS The authors placed posterior chamber IOLs in the capsular bag of 79 eyes in 57 children. Patient age ranged from 10 months to 17 years. Follow-up averaged 2 years. Patients were selected on the basis of age, cataract morphology, laterality, and lack of potential complicating factors. In general, postoperative refractions were intended to be mildly hyperopic with the magnitude dependent on patient age. RESULTS Seventy-nine percent of patients able to report a postoperative visual acuity showed 20/40 or better visual acuity. Vision was limited by amblyopia in the remaining patients. There were no significant complications. The posterior capsule opacified on average 2 years after surgery regardless of patient age. CONCLUSIONS Implantation of posterior chamber IOLs in carefully selected children appears to be effective and safe. Consideration should be given to primary posterior capsulectomy-anterior vitrectomy at the time of lens implant in children who are not expected to be candidates for yttrium aluminum garnet (YAG) capsulotomy within 18 months of surgery.

Linear Subcutaneous Fat Atrophy After Corticosteroid Injection of Periocular Hemangiomas

Two children developed evidence of subcutaneous fat atrophy after corticosteroid injection of periocular hemangiomas. The atrophy appeared at the site of injection and followed the expected course of lymphatic channels to the vicinity of regional lymph nodes.

Development of normal ocular alignment.

Ocular alignment was examined in a large population of normal infants to determine the prevalence of various motility findings at ages ranging from birth to 10 months. Exodeviations were frequently seen up to the age of 6 months. Esodeviations were occasionally seen in infants who did not go on to develop congenital esotropia, but not after 2 months of age. It is unclear whether precursors of pathologic strabismus, such as congenital esotropia, can be distinguished from these transient ocular deviations seen in normal infants. However, any strabismus persisting after the ages listed above should be considered abnormal and receive ophthalmologic evaluation.

Evaluation of an Absorbable Muscle Sleeve to Limit Postoperative Adhesions in Strabismus Surgery

A muscle sleeve fashioned from polyglactin 910 Vicryl mesh was used in a rabbit animal model to evaluate its efficacy in decreasing postoperative adhesions encountered in extraocular muscle surgery. Clinical observations, as well as gross and histological comparison of the experimental and control groups, revealed a significant reduction in postoperative adhesions under conditions of normal surgical trauma. Where there was extensive trauma, however, no significant reduction was observed. No evidence of toxicity of the material to ocular tissues was found.

Comparison of the MTI Photoscreener and the Welch-Allyn SureSight autorefractor in a tertiary care center.

INTRODUCTION The MTI photoscreener (MTI) and the Welch-Allyn SureSight autorefractor are commonly used for preschool vision screening. We compared both of these methods on 100 consecutive patients in a prospective, randomized, masked, clinical trial conducted at a tertiary care center. METHODS One hundred patients between 1 and 6 years of age were included in the study. All participants underwent a comprehensive eye examination with cycloplegic refraction. Examination failure analysis was done on the SureSight data using the manufacturers referral criteria, the Vision in Preschoolers study (VIP) 90% specificity criteria, the VIP 94% specificity criteria, and the referral criteria proposed by Rowatt and colleagues. RESULTS Data were successfully obtained on 76% of children using the SureSight and 96% with the MTI. The sensitivity and specificity of the SureSight to detect clinically significant amblyogenic factors using the manufacturers criteria was 96.6 and 38.1%, using the VIP 90% criteria was 79.3 and 64.3%, using the VIP 94% criteria was 67.2 and 69.0%, and using criteria proposed by Rowatt and colleagues was 62.1 and 73.8%. The sensitivity and specificity of the MTI photoscreener was 94.8 and 88.1%, respectively. CONCLUSIONS Using the manufacturers referral criteria, the SureSight had a sensitivity equal to the MTI photoscreener; however, the specificity was low and over-referrals were anticipated. As specificity levels were increased, a substantial number of children with amblyogenic risk factors were not appropriately identified within our study population..

Presumed Isolated Inflammation of the Superior Oblique Muscle in Idiopathic Orbital Myositis

OBJECTIVE To describe isolated involvement of the superior oblique muscle in association with idiopathic orbital myositis. DESIGN A case report with review of the literature. PARTICIPANT A 57-year-old man with acquired strabismus participated. INTERVENTION Oral steroid therapy was administered. MAIN OUTCOME MEASURES Clinical and radiographic features before and after treatment were measured. RESULTS Computed tomographic scanning showed isolated enlargement of the superior oblique muscle consistent with orbital myositis. Clinical and radiographic abnormalities quickly improved after oral steroid therapy. CONCLUSIONS Orbital pseudotumor may present as a myositis isolated to the superior oblique muscle. This extremely rare condition has been reported in only three patients, each of whom lacked early diagnosis or treatment. Early recognition may improve chances for a successful clinical outcome.

Astigmatism after small-incision clear corneal cataract extraction and intraocular lens implantation in children

Purpose: To investigate the magnitude of postoperative astigmatism in children having cataract extraction with intraocular lens (IOL) implantation through a 3.0 mm superior clear corneal incision. Setting: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA. Methods: This retrospective chart review comprised all pediatric patients having cataract surgery with IOL implantation through a 3.0 mm clear corneal incision from 1997 to 2002. One hundred two eyes of 75 patients were included. All refractions were performed manually by an experienced pediatric ophthalmologist. Results: The mean postoperative retinoscopic cylinder in all patients was 0.63 diopter (D) (range 0.0 to 4.50 D) at 1 month, 0.40 D (range 0.0 to 1.75 D) at 6 months, and 0.51 D (range 0.0 to 2.50 D) at 1 year. Patients aged 0 to 36 months at the time of surgery had a mean postoperative cylinder of 0.22 D at 1 month, 0.03 D at 6 months, and 0.21 D at 1 year. Patients between 36 months and 6 years of age at surgery had a mean refractive cylinder of 0.50 D, 0.38 D, and 0.75 D, respectively. Patients older than 6 years at surgery had a mean refractive cylinder of 0.94 D, 0.75 D, and 0.76 D, respectively. Conclusions: Small‐incision clear corneal cataract extraction with IOL implantation in children led to minimal postoperative astigmatism that remained stable over time. Less astigmatism was observed in children having surgery before they were 36 months old.

Pseudomonas-induced bilateral endophthalmitis with corneal perforation in a neonate

Neonatal endophthalmitis is a rare entity that may be exogenous or endogenous. Pseudomonas aeruginosa is a ubiquitous gram-negative rod that may appear as a nosocomial source of infection in the neonatal intensive care unit. A case of bilateral Pseudomonas-induced endophthalmitis is presented, and a discussion of the case and of the relevant literature follows.