Robbin B. Sinatra

Ocular involvement in children with candidemia.

PURPOSE To evaluate ocular findings in hospitalized children with systemic Candida species infection. DESIGN Retrospective review of inpatient hospital consultations. METHOD Inpatient hospital consultations performed by a pediatric ophthalmology service over a 30-month period were reviewed. RESULTS Of 600 consultations performed by the service, 30 were to rule out ocular findings in patients with suspected or known candida infection. No patients had ocular findings consistent with endophthalmitis or chorioretinitis. One patient had nonspecific findings of multisystem organ failure, and one had vascular findings secondary to elevated pulmonary venous pressures. CONCLUSIONS In contrast to the results of studies performed 10 to 15 years ago, ocular involvement is highly unusual in children with candidemia, but such consultations account for a substantial workload. Further attention to risk factors associated with ocular infection is warranted.

Distribution of refractive error in healthy infants

PURPOSE Few data exist regarding the upper limits of refractive error distributions in healthy infants; the data that do exist are biased because they were selected from the records of pediatric ophthalmology practices. We sought to obtain these data to validate examination failure criteria for vision screening. METHODS We reviewed records from all children age birth to 5 years seen at the Tennessee Lions Eye Center at Vanderbilt Childrens Hospital with a billing diagnosis of nasolacrimal duct obstruction and no comorbid ocular diagnoses except for refractive error. This was to avoid referral bias for any condition that could have influenced refractive error. All patients received a complete eye examination and cycloplegic refraction. Cumulative probability distribution (CPD) plots and means for spherical and cylindrical refractive error and anisometropia were prepared. RESULTS One hundred thirty patients were studied; mean age was 15.5 +/- 9.9 months (range, 2 days to 66 months). The mean refractive error (spherical equivalent) was +1.4 D +/- 1.1 D. CPD plot analysis showed 95% of hyperopia to be < +3.25 D. Two children had myopia </=-1.00 D. The mean astigmatism was +0.2 D +/- 0.4 D, and 74% of patients had no astigmatism. Seven children had astigmatism > +1.00 D in one eye. CPD plot analysis showed 95% of astigmatism to be < +1.50 D and 95% of meridional anisometropia to be < 1.50 D. Six children had anisometropia >/=1.50 D, and 3 children had anisometropia > 3.00 D. CONCLUSIONS At least 95% of children have hyperopia < +3.25 D, astigmatism < +1.50 D, and anisometropia < 1.50 D. This information will prove useful in identifying the natural history and prevalence of amblyogenic factors identified during preschool vision screening.

The Use of Intraocular Lenses in Children

Managing children with cataracts is time consuming and often frustrating. None of the options for the correction of aphakia in childhood are ideal, and amblyopia remains the biggest obstacle to good vision. Spectacles, contact lenses, and epikeratophakia all have significant disadvantages, and intraocular lenses are beginning to emerge as a widely accepted alternative. Although amblyopia will continue to be the toughest management issue, advances in surgical technique and lens design may make management of childhood cataracts simpler. This article will review current trends of intraocular lens use in children, with an emphasis on surgical techniques and recommendations. Results and precautions will also be discussed, as well as controversial areas such as bilateral intraocular lens and the use of intraocular lens in very young children.

Surgery on the Normal Eye in Duane Retraction Syndrome/Surgery on the Normal Eye in Duane Retraction Syndrome: Discussion

Duane retraction syndrome is a well-described congenital eye movement disorder whose management is still controversial. Various surgical strategies have been advocated, usually limited to the involved (restricted) eye to eliminate a face turn or a manifest deviation in the primary position. However, surgery on the normal eye has the potential to expand the field of single binocular vision as well as restore primary position alignment. In patients with mild-to-moderate duction deficiencies in the restricted eye, we have used very large recessions or posterior fixation sutures on the normal eye to create matching duction limitations, which in some cases produce a wider range of fusion postoperatively.