Roberta Carelli

Incidence of ocular pathologies in Italian children with Down syndrome

Purpose This study identifies the incidence of primary ocular pathologies in a population of Italian children with Down syndrome. Methods A total of 157 Italian children with Down syndrome, age between 1 month and 18 years, were screened between February 2005 and October 2006. The ophthalmologic evaluation included a global inspection of orbit and bulbus oculi, evaluation of ocular motility and visual acuity, slit lamp biomicroscopy, cycloplegic skiascopy, tonometry, and indirect ophthalmoscopy. Results The overall incidence of ocular abnormalities was epicanthal fold (132 patients, 84%), hyperopia (93 patients, 59%), astigmatism (44 patients, 28%), myopia (14 patients, 9%), strabismus (56 patients, 36%, 45 cases of esotropia and 11 cases of exotropia), congenital nasolacrimal duct obstruction (35 patients, 22%), cataract (18 patients, 11%), nystagmus (9 patients, 6%), blepharitis and conjunctivitis (6 patients, 4%), and retinal anomalies (10 patients, 6%). Unlike previous reports in patients with Down syndrome, no congenital glaucoma, keratoconus, or Brushfield spots were observed. Conclusions Compared to other studies in patients with Down syndrome, we observed a higher incidence of hyperopia and a lower incidence of myopia. The incidence of nystagmus, blepharitis, and conjunctivitis was less than that reported in other studies, while strabismus, especially exotropia (20%), had a high incidence in our cohort. We also frequently observed obstruction of the nasolacrimal duct (22%), but no keratoconus or glaucoma.

Congenital cataract extraction with primary aphakia and secondary intraocular lens implantation in the posterior chamber

Purpose To evaluate visual outcomes, eye movement abnormalities, and postoperative complications after secondary posterior chamber intraocular lens (IOL) implantation in aphakic children who had initial LAC correction. Methods A retrospective study was carried out on 53 patients (94 eyes). Following aphakic surgery and LAC correction the patients received secondary IOL implantation in the posterior chamber. Special attention was paid to factors that may have influenced their visual outcomes, such as eye movement abnormalities, cataract unilaterality, and cataract density. Results No association was found between age at surgery and the onset of strabismus (p=0.611) or with visual acuity (p=0.086). However, unilaterality and total cataract density were found to have a negative association with poor vision (p<0.001). Strabismus and nystagmus were found to have a statistically significant negative association with visual acuity (p=0.002). Posterior capsule opacification occurred in six eyes of five patients following cataract extraction; IOL dislocation occurred in four eyes after IOL intraocular implantation, and secondary glaucoma occurred in one eye. Conclusions IOL implantation before 12 months of age may be useful in unilateral cataract; in bilateral cataract, simultaneous surgical aphakia, LAC correction, and then IOL implantation at 2.5–3 years of age, together with anti-amblyopic therapy when strabismus or asymmetric cataract density occur, are efficient methods to obtain visual recovery. Extraocular muscle surgery may be required to correct strabismus.

Long-Term Outcomes of Primary Intraocular Lens Implantation for Unilateral Congenital Cataract

Abstract Purpose: In congenital cataracts, the need for early intervention is well established to prevent visual deprivation and amblyopia. We evaluated patients with unilateral amblyogenic congenital who had undergone simultaneous cataract removal and intraocular lens implantation. Methods: We retrospectively reviewed all patients operated on between 1990 and 2010 at the Pediatric Eye Department of the University Federico II of Naples (Italy). Minimum follow-up for inclusion was 48 months. Results: 52 patients (28 females, 24 males, mean age at surgery 9.0 ± 4.5 months, range 2–21 months) were included in this retrospective review. Mean follow-up was 100.7 ± 57.0 months (range, 48–270 months). At last visit, mean BCVA in the operated eyes was 0.65 ± 0.4 (range, 0.04–1.3) LogMAR and 40 patients (76.9%) had strabismus. In patients undergoing surgery at an age >12 months, BCVA was significantly lower (0.92 ± 0.4 LogMAR versus 0.60 ± 0.4 LogMAR, p = 0.01), although development of myopic shift was less frequent (61.5% versus 43.5%, p = 0.03). BCVA at last visit was higher in patients with a first stable pseudophakic SE between +1D and +3D (p = 0.02). Conclusions: Worse final BCVA, despite less frequent development of myopic shift, was observed when surgery was performed after 12 months of age. A hyperopic correction in first stable pseudophakic SE seems advisable.

Refractive surgery for accommodative esotropia: 5-year follow-up.

PURPOSE To assess the long-term effectiveness and safety of refractive surgery with LASIK or photorefractive keratectomy (PRK) for treating accommodative esotropia in adults. METHODS All patients with accommodative esotropia treated with LASIK or PRK until December 2007 and with a minimum follow-up of 5 years were retrospectively included. RESULTS LASIK was performed on 44 eyes of 22 patients (12 women, 10 men; mean age: 22.7 ± 2.9 years). Mean postoperative follow-up was 62.1 ± 3.2 months. PRK was performed on 16 eyes of 8 patients (4 women, 4 men; mean age: 23.7 ± 1.7 years). Mean postoperative follow-up was 61.3 ± 2.8 months. At the 5-year follow-up, the mean cycloplegic refraction was more hyperopic in the PRK group (0.3 ± 0.8 vs 0.06 ± 0.3 diopters, P = .01). Correction of esotropia to esophoria or orthotropia was present in 21 patients (95.4%) treated with LASIK and in all patients treated with PRK. CONCLUSIONS Both LASIK and PRK were effective in the long-term reduction of accommodative esotropia.

Ocular complications of eyebrow piercing.

Piercing, a type of body art, is increasing in popularity among young people. Two patients presented with complications a few days after having an eyebrow piercing. The first had posterior cellulitis and the second had anterior cellulitis. In both cases, symptoms decreased after 1 week of therapy with antibiotics and cortisone.

Infantile esotropia: risk factors associated with reoperation

The aim of this study was to identify clinical and demographic factors associated with misalignment after first surgery performed on children affected by infantile esotropia to evaluate the reoperation rate. A retrospective study was carried out, analyzing data from 525 children who underwent bilateral medial recti recession, bilateral lateral recti resection, and inferior oblique recession and anteroposition by the same surgeon (AM). Postoperative evaluation included assessment of motor alignment at approximately 3 months, 6 months, 1 year, and 5 years. Statistical analysis was performed with a logistical regression model in which the dependent variable was the presence/absence of reoperation. We found that late surgery (after 3 years of age) and a family history of strabismus are associated with a higher risk of reoperation, while some clinical factors, including some classically associated with worst motor outcome as preoperative angle, dissociated vertical deviation, and amblyopia, did not influence the incidence of reoperation in infantile esotropia. Male patients and patients with hyperopia in preoperative examinations have a significantly decreased reoperation rate.

Long-Term Follow-Up after Surgery for Congenital and Developmental Cataracts

Abstract Purpose: To evaluate long-term functional outcomes after surgery for congenital and developmental cataracts. Methods: In this retrospective interventional study, patients with congenital and developmental cataracts observed from 1996 to 2013 were included. Traumatic cataracts and cataracts secondary to other pathologies were excluded from the study. Minimum follow-up for inclusion was five years. Results: We included 117 patients operated on for congenital cataracts (58 females and 59 males, mean age 0.59 ± 0.2 years, 160 eyes) and 73 patients operated on for developmental cataracts (32 females and 41 males, mean age 6.63 ± 0.7 years, 121 eyes). Mean postsurgical follow-up was 9.26 ± 1.3 years (range, 5–14 years). After surgery for developmental cataracts, both distance and near BCVA were greater (p = 0.001), as was the presence of binocular vision (p = 0.001), while incidence of strabismus and myopic shift was lower (p = 0.001 and p = 0.02, respectively). Conclusion: Postsurgical data showed better functional outcomes in developmental cataracts when compared to congenital cataracts.

Congenital and Developmental Cataracts: Focus on Strabismus Outcomes at Long-Term Follow-Up.

ABSTRACT Purpose: To evaluate the incidence of strabismus in congenital and developmental cataract surgery in patients with a follow-up longer than five years. Methods: All patients with congenital and developmental cataracts observed from 1996 to 2013 with a follow-up longer than five years were retrospectively included. Results: We included 117 patients (58 females and 59 males, mean age 0.62±0.3 years, 160 eyes) with congenital cataracts and 73 patients (32 females and 41 males, mean age 6.63±0.7 years, 121 eyes) with developmental cataracts. Before cataract surgery, strabismus was present in 88 patients with congenital cataracts (75.2%) and in 30 patients with developmental cataracts (41.1%) (p=0.01). After a follow-up of 9.26±1.3 years (range, 5–14 years), a significantly greater incidence of strabismus was observed after surgery only in patients with unilateral congenital cataracts who underwent cataract removal and primary IOL implantation (p=0.02). Distance BCVA and near BCVA were better after surgery for developmental cataracts (p<0.05). Presence of binocular vision was more frequent after surgery for developmental cataracts (p=0.001). Conclusion: Incidence of strabismus and postsurgical onset of strabismus at long-term follow-up was greater in patients with congenital cataracts.

Essential Infantile Esotropia: Postoperative Sensory Outcomes of Strabismus Surgery

ABSTRACT Background: The optimum age for Essential Infantile Esotropia surgery is a controversial subject. Sensory status was evaluated in patients who underwent surgery at different ages in a retrospective study. The setting of the study is the ophthalmology department of a teaching hospital. Methods: Different clinical characters were analyzed pre- and postoperatively; nine different surgeries were performed. A total of 188 patients presented valid postoperative sensorial data, divided in two groups: surgery at ≤2 years (n=69) or >2 years (n=119). Sensory status was dichotomized in binocular single vision (BSV) and exclusion. Univariate differences were assessed with the chi-square test (or Fisher exact test). To identify the independent role of factors associated with the sensory status, all variables showing in univariate analyses a significant association (p<0.05) with the outcome variable were entered into a multivariate logistic regression model. All statistical tests were two-sided. Results: Multivariate analysis confirmed that children operated >2 years were 0.4 times less likely to obtain BSV compared with children operated at ≤2 years (AOR. 0.38, 95% C.I. 0.17–0.89, p=0.025). Patients operated on by OO MR rec.+ OO LR res. + OO IO rec.-ap. (intervention type 6) were about 11 times more likely to have BSV than those by OO rec.MR + unilateral res. LR (operation type 2); AOR.: 10.67, 95% C.I.: 1.34 – 85.29, p=0.026). Twenty-nine patients (12.1%) operated at ≤2 years of age underwent a reoperation, compared to 33 (8.6%) who underwent surgery after two years (p>0.05). Conclusions: Our findings suggest to perform EIE surgery between age 1 and 2 and, when indicated, to prefer a six-muscle approach in order to achieve a better sensory function.

Essential infantile esotropia with inferior oblique hyperfunction: long term follow-up of 6 muscles approach.

AIM To evaluate long term follow-up (10y) of 6 muscle surgical approach in essential infantile esotropia (EIE). METHODS A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique (IO) hyperfunction and lateral rectus (LR) pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach: bilateral medial recti (MR) recession (4-5 mm), bilateral LR resection (lower than 7 mm) and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥+30 prism diopters (PD) and IO hyperfunction were selected from larger cohort of patients (n=213, 103 females and 110 males) after excluding patients with: angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package (version 9.1, SAS Institute Inc., Cary, NC, USA). RESULTS Ten years follow up data analysis showed the following percentage of orthotropic patients: (0 PD): 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant (P<0.01), increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction (P=0.04). CONCLUSION Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.