Virender Sachdeva

Accuracy of intraocular lens power calculation formulae in children less than two years.

PURPOSE To assess the accuracy of IOL power calculation formulae in children less than 2 years of age. DESIGN Retrospective, comparative study, comprising of 128 eyes of 84 children. METHODS We analyzed records of children less than 2 years with congenital cataract who underwent primary IOL implantation. Data were analyzed for prediction error using the 4 commonly used IOL power calculation formulae. We calculated the absolute prediction error with each of the formulae and the formula that gave least variability was determined. The formula that gave the best prediction error was determined. RESULTS Mean age at surgery was 11.7 ± 6.2 months. Absolute prediction error was found to be 2.27 ± 1.69 diopters (D) with SRK II, 3.23 ± 2.24 D with SRK T, 3.62 ± 2.42 D with Holladay, and 4.61 ± 3.12 D with Hoffer Q. The number of eyes with absolute prediction error within 0.5 D was 27 (21.1%) with SRK II, 8 (6.3%) with SRK T, 12 (9.4%) with Holladay, and 5 (3.9%) with Hoffer Q. Comparison between different formulae showed that the absolute prediction error with SRK II formula was significantly better than with other formulae (P < .001). Prediction error with SRK II formula was not affected by any factor such as age (P = .31), keratometry (P = .32), and axial length (P = .27) of the patient. Axial length influenced the absolute prediction error with Holladay (P = .05) and Hoffer Q formulae (P = .002). Mean keratometry influenced prediction error (P = .03) with SRK T formula. CONCLUSION Although absolute prediction error tends to remain high with all present IOL power calculation formulae, SRK II was the most predictable formula in our series.

Duane Retraction Syndrome: Series of 441 Cases

PURPOSE To determine the demographic and clinical profile of various subtypes of Duane retraction syndrome (DRS). METHODS Retrospective case series of 441 patients. RESULTS Of the total 441 patients, 389 (88.2%) and 52 (11.8%) patients had unilateral and bilateral involvement, respectively. In both unilateral and bilateral cases, type I was the most common subtype, followed by types III and II. Mean age of presentation of type I DRS was significantly less (13.3 years) compared with types II (23 years) and III (21.9 years) (P < .05). Unilateral disease was significantly more common in females (57. 6%, P = .006), whereas there was no gender predilection in bilateral cases (P = .77). Type 1 DRS was significantly more common among females (57.96%, P = .003) compared with males, whereas there was no such gender predilection in types II and III. The left eye was more commonly involved in patients with types I and III (P < .05), whereas in type II there was no such predilection for any eye involvement. Esotropia was more common in patients with bilateral disease (53.8%) and exotropia was predominant ocular deviation in patients with types II and III (70% and 66.67%, P = .03). There was no difference in the type of deviation in patients with type I (P > .05). Upshoots and downshoots were more common in unilateral disease and types I and III compared with type II. CONCLUSION Unilateral and bilateral DRS show considerable differences in gender distribution, associated ocular deviation, overshoots, and ocular and systemic associations.

Comparison of augmented superior rectus transposition with medial rectus recession for surgical management of esotropic Duane retraction syndrome.

BACKGROUND Medial rectus recession (MRc) and vertical rectus transpositions are procedures used to treat esotropic Duane retraction syndrome. Recently superior rectus transposition (SRT) combined with MRc has also been shown to improve primary alignment and abduction. The purpose of this study is to compare the results of augmented (ie, with scleral fixation) SRT with or without MRc with either unilateral or bilateral MRc for treatment of esotropic Duane syndrome. METHODS The medical records of patients who underwent surgery for esotropic Duane syndrome between May 2007 and February 2013 were retrospectively reviewed. Success was defined as alignment within 8(Δ) of orthotropia and abnormal head posture of <5°. RESULTS There were 8 patients in the SRT group (6 of whom had additional ipsilateral MRc) and 13 in the MRc group (6 unilateral and 7 bilateral). In the SRT group, the mean preoperative deviation was 20(Δ) of esotropia; the mean postoperative deviation, 3(Δ). In the MRc group, the mean preoperative deviation was 24(Δ) of esotropia; the mean postoperative deviation, 4(Δ). The success rate was 87% in the SRT group; 77%, in MRc group (P = 0.98). Mean abduction limitation improved from -3.6 to -2.4 units in the SRT group and from -3.6 to -3.3 units in the MRc group (P = 0.003). Induced vertical deviation or subjective torsion was not seen. Three patients in each group developed adduction limitation postoperatively. CONCLUSIONS Although both the procedures successfully correct esotropia in Duane syndrome, SRT with or without MRc has the additional advantage of improving abduction.

Choroidal thickness profile in healthy Indian children

Purpose: The purpose was to study choroidal thickness and its profile based on location in healthy Indian children using enhanced depth spectral-domain-optical coherence tomography (SD-OCT). Methods: In this cross-sectional observational study 255 eyes of 136 children with no retinal or choroidal disease were consecutively scanned using enhanced depth SD-OCT. Eyes with any ocular disease or axial length (AXL) >25 mm or < 20 mm were excluded. A single observer measured choroidal thickness from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-microns intervals up to 2500 microns temporal and nasal to the fovea. Generalized estimating equations were used to evaluate the correlation between choroidal thickness at various locations and age, AXL, gender and spherical equivalent (SEq). Results: Mean age of the subjects was 11.9 ± 3.4 years (range: 5–18 years). There were 62 Females and 74 males. The mean AXL was 23.55 ± 0.74 mm. Mean subfoveal choroidal thickness was 312.1 ± 45.40 μm. Choroid was found to be thickest subfoveally, then temporally. Age, AXL and SEq showed a significant correlation with choroidal thickness, whereas gender did not affect choroidal thickness. Conclusion: Our study provides a valid normative database of choroidal thickness in healthy Indian children. This database could be useful for further studies evaluating choroidal changes in various chorioretinal disorders. Age and AXL are critical factors, which negatively correlated with choroidal thickness.

Efficacy of split hours part-time patching versus continuous hours part-time patching for treatment of anisometropic amblyopia in children: a pilot study

Aim To compare efficacy of ‘split hours part-time patching’ and ‘continuous hours part-time patching’ for the treatment of anisometropic amblyopia. Methods We designed a prospective, interventional, non-randomised, comparative pilot study involving children between 4 and 11 years of age with anisometropic amblyopia who were treated with either continuous wear (Group A) or split hours part-time patching (Group B) as per parents wish, after appropriate discussion with the parents. Children were followed-up for the improvement in visual acuity and the compliance at each follow-up visit. Results 44 and 24 children were recruited in Group A and Group B, respectively (mean±SD baseline BCVA of the amblyopic eye: 0.99±0.32 and 0.95±0.23 logMAR, respectively). BCVA (adjusted for baseline BCVA and age) at 3 months in Group A (0.59±0.24) was comparable (p=0.08) with that in Group B (0.71±0.24). This was same even at 6 months (0.51±0.25 in Group A and 0.59±0.25 in Group B, p=0.25). The improvement in BCVA at 3 months was also comparable (p=0.06) in Group A (0.39±0.23) and Group B (0.26±0.23). The improvement in BCVA at 6 months was also comparable (p=0.14) in Group A (0.47±0.26) and Group B (0.37±0.26). Conclusions Both patching regimens lead to significant and comparable improvement in BCVA in anisometropic amblyopia up to 6 months of follow-up.

Burkholderia cepacia endophthalmitis: clinico-microbiologic profile and outcomes.

Background: To report the clinical presentations, antibiotic sensitivities, and outcomes of Burkholderia cepacia endophthalmitis. Methods: Retrospective, consecutive, noncomparative, interventional case series. We reviewed case records of culture-proven B. cepacia endophthalmitis from the endophthalmitis registry between January 2003 and December 2008. Data collected included the cause of endophthalmitis, time of presentation, presenting visual acuity, initial surgical procedures performed, clinical response, secondary interventions, antibiotic sensitivity of the organism, and final visual acuity. Results: Burkholderia cepacia was the causative agent in 14 (1.8%) of the 744 culture-positive cases. Endophthalmitis occurred after cataract surgery in nine, penetrating keratoplasty in one, and trauma in four patients. Acute- and delayed-onset postoperative endophthalmitis presentation was noted in eight and two patients, respectively. Susceptibility of isolates to ceftazidime and ciprofloxacin was 78.6%. Of the isolates, 50% were sensitive to amikacin. Secondary interventions were carried out in 12 eyes. Final best-corrected visual acuity was 20/200 or better in 6 (41.66%) of 14 eyes. Conclusion: Burkholderia cepacia can present as posttraumatic, acute-onset and delayed-onset postoperative endophthalmitis. Oral ciprofloxacin and intravitreal ceftazidime may be administered while awaiting the sensitivity reports. Recurrence and/or persistence of infection are not uncommon. Like other gram-negative organisms causing endophthalmitis, it is also associated with poor visual outcomes.

Surgical management of strabismus in Duane retraction syndrome

SUMMARY While Duane retraction syndrome (DRS) is relatively common, surgical management of the associated strabismus can be challenging because of the lack of abduction/adduction, the variable severity of muscle contracture, and the variety of clinical presentations. In this workshop a panel of experienced surgeons provide their perspective and practical tips on the management of strabismus in patients with DRS.

Etiology and clinical profile of childhood optic nerve atrophy at a tertiary eye care center in South India

Background: Optic nerve atrophy is an important ophthalmological sign that may be associated with serious systemic conditions having a significant bearing on the overall morbidity of the child. Studies specific to etiology of childhood optic atrophy are scarce, this being the first such study from India to the best of our knowledge. Aim: The aim was to analyze the clinical features and etiology of diagnosed cases of optic nerve atrophy in children <16 years of age. Materials and Methods: Retrospective review of records of children diagnosed with optic nerve atrophy between the ages of 0 and 16 years from 2006 to 2011. Results: A total of 324 children (583 eyes) were identified. Among these 160 (49%) presented with defective vision, 71 (22%) with strabismus, 18 (6%) with only nystagmus. Rest had a combination of two or three of the above symptoms. Sixty-five patients (20%) had a unilateral affection. Hypoxic ischemic encephalopathy seen in 133 patients (41%) was the most frequent cause of childhood optic atrophy, followed by idiopathic in 98 (30%), hydrocephalus in 24 (7%), compressive etiology in 18 (5%), infective in 19 (6%), congenital in 6 (2%), inflammatory in 5 (2%) patients, respectively. Conclusion: Hypoxic ischemic encephalopathy appears to be the most common cause of optic atrophy in children in this series. The most common presenting complaint was defective vision.

Surgical management of bilateral esotropic Duane syndrome

PURPOSE To describe the indications and outcomes of surgery for bilateral esotropic Duane syndrome. METHODS The medical records of consecutive patients with bilateral esotropic Duane syndrome who underwent surgery from January 1999 to December 2008 were retrospectively reviewed. Data for surgical indications and outcomes were analyzed. Success was defined as postoperative orthotropia with eso- or exodeviation <8(Δ). RESULTS A total of 14 patients with esotropic bilateral Duane Syndrome underwent surgery: 12 had bilateral medial rectus muscle recession; 1 had unilateral medial rectus muscle recession; and 1 had bilateral asymmetrical medial rectus and lateral rectus muscle recessions. The mean preoperative esodeviation was 38.14(Δ) ± 13.24(Δ), (range, 14(Δ)-70(Δ)). The mean medial rectus recession was 5.7 mm in the right eye and 5.5 mm in the left eye. The mean follow-up period was 11.7 months (range, 3-37 months). Success was achieved in 12 of 14 patients (85.71%); 2 patients had a residual esotropia of 15(Δ). In all patients who underwent surgery, there was satisfactory improvement in associated globe retraction and head turn. None of the patients developed consecutive exodeviation. CONCLUSIONS Bilateral medial rectus muscle recession can provide a good outcome for patients with bilateral esotropic Duane syndrome. The mean amount of medial rectus muscle recession required may be greater than what is generally recommended for similar sized esodeviations in patients with infantile esotropia.

Childhood Pterygium: A Descriptive Study of 19 Cases Presented to a Tertiary Eye Care Center

PURPOSE To describe the demographic features, clinical characteristics, and management in cases of childhood pterygium. DESIGN Observational case series. METHODS A retrospective review was done of 19 children (total 26 eyes) under the age of 16 years, consecutively presenting with pterygium and evaluated at a single tertiary care center between January 2000 and August 2011. The main outcome measures were clinical features, associated ocular or systemic diseases, approach towards its management, and histopathology of operated cases. RESULTS Of the 19 patients, 10 were girls and 9 were boys. The mean age at presentation was 10.63 ± 3.48 years (range 2-15 years). Seven patients (37%) had bilateral involvement. None of the cases had familial history. The median refractive astigmatism was found to be -0.5 diopter cylinder. All the eyes had primary pterygium, except 1, which was recurrent. The majority of the eyes (85%) were managed conservatively. Four eyes (15%) required surgery, where pterygium excision with conjunctival-limbal autograft with fibrin glue application was done. The follow-up of surgical cases ranged from 5 to 38 months (median 6 months). One operated case recurred 1 year after surgery. CONCLUSION Development of pterygium is a possibility in younger age groups. No specific predisposing factors, either environmental or familial, were identified as contributing to childhood pterygium. The majority of the cases required conservative management.