Priyanka Arora

Results of late surgical intervention in children with early-onset bilateral cataracts.

Background Cataracts are a major cause of childhood blindness globally. Although surgically treatable, it is unclear whether children would benefit from such interventions beyond the first few years of life, which are believed to constitute ‘critical’ periods for visual development. Aims To study visual acuity outcomes after late treatment of early-onset cataracts and also to determine whether there are longitudinal changes in postoperative acuity. Methods We identified 53 children with dense cataracts with an onset within the first half-year after birth through a survey of over 20u2005000 rural children in India. All had accompanying nystagmus and were older than 8u2005years of age at the time of treatment. They underwent bilateral cataract surgery and intraocular lens implantation. We then assessed their best-corrected visual acuity 6u2005weeks and 6u2005months after surgery. Results 48 children from the pool of 53 showed improvement in their visual acuity after surgery. Our longitudinal assessments demonstrated further improvements in visual acuity for the majority of these children proceeding from the 6-week to 6-month assessment. Interestingly, older children in our subject pool did not differ significantly from the younger ones in the extent of improvement they exhibit. Conclusions and relevance Our results demonstrate that not only can significant vision be acquired until late in childhood, but that neural processes underlying even basic aspects of vision like resolution acuity remain malleable until at least adolescence. These data argue for the provision of cataract treatment to all children, irrespective of their age.

Impact of low vision rehabilitation on functional vision performance of children with visual impairment

Purpose: To evaluate the impact of low vision rehabilitation on functional vision of children with visual impairment. Materials and Methods: The LV Prasad–Functional Vision Questionnaire, designed specifically to measure functional performance of visually impaired children of developing countries, was used to assess the level of difficulty in performing various tasks pre and post visual rehabilitation in children with documented visual impairment. Chi-square test was used to assess the impact of rehabilitation intervention on functional vision performance; a P < 0.05 was considered significant. Results: LogMAR visual acuity prior to the introduction of low vision devices (LVDs) was 0.90 ± 0.05 for distance and for near it was 0.61 ± 0.05. After the intervention, the acuities improved significantly for distance (0.2 ± 0.27; P < 0.0001) and near (0.42 ± 0.17; P = 0.001). The most common reported difficulties were related to their academic activities like copying from the blackboard (80%), reading textbook at arms length (77.2%), and writing along a straight line (77.2%). Absolute raw score of disability pre-LVD was 15.05 which improved to 7.58 post-LVD. An improvement in functional vision post visual rehabilitation was especially found in those activities related to their studying lifestyle like copying from the blackboard (P < 0.0001), reading textbook at arms length (P < 0.0001), and writing along a straight line (P = 0.003). Conclusions: In our study group, there was a significant improvement in functional vision post visual rehabilitation, especially with those activities which are related to their academic output. It is important for these children to have an early visual rehabilitation to decrease the impairment associated with these decreased visual output and to enhance their learning abilities.

Visual and Refractive Outcomes of Children After Early Secondary Cataract Extraction Following Wound Repair for Penetrating Ocular Trauma

PURPOSEnTo evaluate the visual and refractive outcomes in children 8 years of age or younger with corneal laceration and cataract following penetrating ocular injuries who underwent primary corneal tear repair followed within 1 to 8 weeks by early secondary cataract extraction.nnnMETHODSnThis retrospective, non-comparative case series reviewed the admission and operative charts of children 8 years of age or younger (range: 3 to 8 years) who underwent corneal wound repair as the primary surgical procedure followed within 1 to 8 weeks by cataract extraction with intraocular lens implantation, with a minimum follow-up period of 6 months. The main outcome measures were best corrected visual acuity (BCVA) and refractive error as the spherical equivalent at the final follow-up visit.nnnRESULTSnA total of 47 children (33 boys, 14 girls) were included. The mean age at the time of injury was 5.9 ± 2.2 years (range: 3 to 8 years). Follow-up periods ranged from 6 months to 3 years (median: 18 months). The mean time gap between the wound repair and cataract extraction was 5 weeks (range: 1 to 8 weeks). Approximately 36 (77%) eyes obtained BCVA better than 6/18. All but one eye achieved BCVA better than 6/60. The deviation from emmetropia was less than 1.00 diopter (D) in 23 (54%) eyes, 1.00 to 3.00 D in 15 (35%) eyes, and more than 3.00 D in 5 (12%) eyes.nnnCONCLUSIONSnEarly removal of cataract with intraocular lens implantation 1 to 8 weeks after the primary wound repair in young children with penetrating corneal injuries can result in excellent visual and refractive outcomes with early intervention and aggressive amblyopia treatment. [J Pediatr Ophthalmol Strabismus. 2018;55(2):122-127.].

Duane's retraction syndrome with severe upshoot and ipsilateral superior rectus contracture: A rare presentation

Type III Duanes retraction syndrome (DRS) is a rare condition and represents only 1% of all cases of Duanes syndrome. It consists of limited/absent abduction as well as adduction of the affected eye. A characteristic upshoot/downshoot/both, in adduction, and globe retraction may occur in DRS patients. Secondary muscle changes like medial rectus contracture or superior rectus contracture (SRC) may rarely be associated with DRS. SRC has been reported in patients with unilateral superior oblique palsy and dissociated vertical deviation. However, no case report of association of SRC with DRS has been reported. We report a rare case of type III DRS with severe upshoot, globe retraction and ipsilateral SRC. It is hypothesized that a long standing severe upshoot could be the reason for development of secondary SRC. The condition was treated with Y-split of lateral rectus and superior rectus recession.

Simultaneous surgical correction of dissociated vertical deviation, superior oblique overaction and A-pattern with associated horizontal strabismus: A case series.

LASIK is suitable in well controlled autoimmune disorders such as SLE. Smith and Maloney performed LASIK in 49 eyes of 26 patients with autoimmune diseases, 7 of whom had SLE and reported no complications. We recommend judicious use of topical steroids in cases of episcleritis due to the attendant risks Simultaneous surgical correction of dissociated vertical deviation, superior oblique overaction and A‐pattern with associated horizontal strabismus: A case series