Silicone Oil for Complicated Retinal Detachment in the Pediatric Population

We presented our results with silicone oil in vitreoretinal surgery in pediatric patients. The retinas reattached in 58% but corneal opacification occurred in 75% and glaucoma in 25%. Our results indicate that silicone oil should be considered in otherwise hopeless cases of retinal detachment surgery in children.

Axial Length, Refractive Error, and Keratometry in Patients with Branch Retinal Vein Occlusion

Purpose

To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO).

METHODS

This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 ±1.57 years (range 1–6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test.

Results

Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings.

CONCLUSIONS

The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.

Congenital horizontal gaze paralysis, foacial hemiatrophy, and situs inversus of the opitc disc. A case report

A case of congenital horizontal gaze paralysis in association with facial hemiatrophy and situs inversus of the optic discs is described. Except for the presence of deafness on the side of the atrophic face no other neurologic abnormality was present. To our knowledge, no similar case has been reported.

Pupil size in Jewish theological seminary students

PURPOSE

To investigate the authors' clinical impression that pupil size among myopic Jewish theological seminary students is different from pupil size of similar secular subjects.

METHODS

This cross-sectional study was conducted on 28 male Jewish theological seminary students and 28 secular students or workers who were matched for age and refraction. All participants were consecutively enrolled. Scotopic and photopic pupil size was measured by means of a Colvard pupillometer. Comparisons of various parameters between the groups were performed using the two-sample t-test, Fisher exact test, a paired-sample t-test, a two-way analysis of variance, and Pearson correlation coefficients as appropriate.

RESULTS

The two groups were statistically matched for age, refraction, and visual acuity. The seminary students were undercorrected by an average of 2.35 diopters (D), while the secular subjects were undercorrected by only 0.65 D (p<0.01). The average pupil size was larger in the religious group under both scotopic and photopic luminance. This difference was maintained when the two groups were compared according to iris color under both conditions, reaching a level of statistical significance (p<0.0001). There was a significant difference in photopic pupil size between dark and light irises (p=0.049), but this difference was not maintained under scotopic conditions.

CONCLUSIONS

The average pupil size of young ultraorthodox seminary students was significantly larger than that of matched secular subjects. Whether this is the result of intensive close-up work or of apparently characteristic undercorrection of the myopia is undetermined.

Capsular bag distension associated with sulcus implantation of intraocular lenses

Capsular bag distension syndrome after endophacoemulsification and in-the-bag intraocular lens (IOL) implantation has been reported. We describe 2 cases in which sulcus implantation of a posterior chamber IOL caused marked capsular bag distension. Both cases resolved with conservative treatment or a neodymium:YAG posterior capsulotomy.

Iris retraction syndrome associated with nonrhegmatogenous retinal detachment

PURPOSE

To present the first documentation of iris retraction syndrome in eyes with nonrhegmatogenous retinal detachment.

PATIENTS AND METHODS

One patient with age-related macular degeneration and another with panuveitis developed exudative retinal detachment with iris retraction configuration. Ultrasound biomicroscopy was performed to investigate the anatomic relationship of structures in the anterior segment of the eye.

RESULTS

Ultrasound biomicroscopy demonstrated a severe backward bowing of the peripheral iris with irido-ciliary body and irido-zonular contact as well as broad iris lens touch. The iris retraction syndrome resolved after pupil dilation and disruption of the pupillary adhesions in both cases. The retinal detachment resolved several months later, without surgery.

CONCLUSION

Iris retraction syndrome appears not to be exclusive to rhegmatogenous retinal detachment but can present in eyes with exudative - nonrhegmatogenous retinal detachment. Thus, when the configuration of the iris shows bowing in patients with retinal detachment, iris retraction syndrome should be considered and prompt pupil dilation should be carried out.

Treatment for 'A' or 'V' pattern esotropia by slanting muscle insertion

BACKGROUND

Patients with 'A' or 'V' pattern esotropia without vertical muscle overaction have traditionally been treated with medial rectus recession and vertical transposition of the muscle insertions.

METHOD

Seven cases are presented treated by slanting muscle insertions, whereby the lower margin of the medial rectus is preferentially recessed more than the upper margin in esotropia, and the upper margin is recessed more than the lower margin in A esotropia.

RESULTS

All seven patients had their A or V patterns eliminated, with six achieving good alignment in all positions of gaze.

CONCLUSION

The slanting muscle insertion should be considered as an alternative technique in all cases of A or V pattern esotropia.

Tono-Pen tonometry in normal and in post-keratoplasty eyes

Oculab Tono-Pen tonometry was compared with Goldmann applanation tonometry in 82 eyes of 82 patients with normal corneas and in 54 eyes of 54 patients who had undergone penetrating keratoplasty and whose corneas did not preclude the use of Goldmann tonometer. We found that the intraocular pressure (IOP) in 48% of the eyes with normal corneas and in 57% after keratoplasty has different measurements with Goldmann and Tono-Pen pressures of 3 mm Hg or more. Despite the correlation between the Goldmann tonometer and the Tono-Pen in the group of eyes with normal corneas (r = 0.83) as well as in the group of eyes after keratoplasty (r = 0.79) the Tono-Pen tended to significantly overestimate the Goldmann tonometer reading (p < 0.0001). The mean difference between the two instruments was highest across the lower IOP range (< 9 mm Hg) in the group of eyes after keratoplasty. Because the mean absolute values of the paired differences between Goldmann and Tono-Pen measurements varied significantly across all IOP intervals it was not possible to establish a correction factor which could be used when comparing the two measurements. Based on this study the Tono-Pen consistently overestimated the actual IOP in an unpredictable manner. Where possible Goldmann measurements of the IOP are still to be preferred.

Atropine in keratoplasty for keratoconus

A prospective study of 83 eyes in 76 consecutive patients undergoing keratoplasty for keratoconus is presented in which 1% atropine was routinely given at the end of surgery. No case of permanent mydriasis was seen. The syndrome described in the literature of fixed, dilated pupil after the use of atropine in keratoplasty no longer seems to exist and the warning against strong mydriatics appears unwarranted.

Pigmented pupillary pseudomembranes as a complication of argon laser iridotomy

Two cases are reported in which pupillary pigment occlusion occurred after argon laser iridotomy, reducing visual acuity and preventing fundus visualization. Laser-induced inflammation and subsequent long-term miotic therapy are probably responsible for this complication. Periodic pupillary dilatation is recommended in eyes that require miotics to control their intraocular pressure after laser iridotomy.

Orbital haemorrhage induced by labour

A case of acute orbital haemorrhage induced by labour is reported in a woman giving birth for the eighth time. The diagnosis was confirmed by computed tomography. The haemorrhage subsided spontaneously within three weeks. The mechanism of orbital haemorrhage following certain kinds of strain is discussed.

Clearing of corneal argyrosis by YAG laser

A 75-year-old woman with corneal argyrosis was treated by a Q-switched Nd-YAG laser iridotomy after acute angle closure glaucoma. Each laser shot caused clearance of the argyrotic deposits anterior to the iridotomy site. The same effect was seen when a preventive iridotomy was performed in the other eye. The areas of clear cornea remained unchanged for a follow-up period of eight months.

Pterygium and basic tear secretion

In order to investigate the correlation between the occurrence of pterygium and dryness of the eyes, a Schirmer's No. 1 test was done on both eyes in 60 patients with unilateral pterygia. No difference was found between the mean basic secretion of tears in the diseased eyes (15.33 +/- 8.09 mm) and the fellow eyes (15.65 +/- 7.89 mm), and both were in the normal range for this test. This data suggest that dryness of the eyes cannot be regarded as the cause of pterygium.

Bilateral Duane's syndrome associated with crocodile tears

The rare association of two syndromes of paradoxical innervation, bilateral Duane's retraction syndrome and congenital crocodile tears is presented. This association assumes a central localization to explain both anomalies.

Trabeculotomy in late onset congenital glaucoma

All eyes of children above the age of 1 year referred because of glaucoma were treated with trabeculotomy as the primary procedure. The surgery was modified by the excision of a rectangle of tissue in the deep scleral bed under the scleral flap instead of the classical radial incision. This serves to exteriorise Schlemm's canal while thinning the scleral tissue, without, however, entering the anterior chamber. A total of 7 eyes in 5 children between the ages of 1 and 9 years were operated upon. In 6 of the 7 eyes intraocular pressure has remained under 20 mmHg without treatment after follow-up of between 18 months and 4 years. In the seventh eye intraocular pressure was controlled for 2 years but has since required epinephrine drops twice daily for the maintenance of pressure below 20 mmHg. In 4 of the 7 eyes flat, diffuse conjunctival filtering blebs are present, but no complications have been encountered. We consider that trabeculotomy may be recommended for children with late-onset congenital glaucoma.

Optic atrophy after irrigation of the lacrimal ducts with chloramphenicol

A case is presented of permanent visual loss and optic atrophy following irrigation of the lower canaliculus after probing, with a 20% solution of chloramphenicol. A false passage had apparently been created allowing the solution to gain access to the orbital tissues. The ensuing orbital edema probably caused a central retinal artery occlusion. This is a previously unreported complication of a common ophthalmologic procedure.

Optociliary veins, visual loss, and disc pallor in a child with a 22 year follow-up

A case of optociliary veins, disc pallor, and long-standing visual loss in an eye of a patient followed from age two to age 25 is presented. A review of the literature indicates the above triad to be usually suggestive of sphenoidal ridge meningioma. Our case, the youngest thus far reported in the literature, also developed ocular hypertension in this eye and exophthalmos. The patient has refused further diagnostic workup.

A proposed pilocarpine therapeutic test

For the pilocarpine therapeutic test that we have devised, one drop (0.1 ml) of 2% pilocarpine hydrochloride (an arbitrarily chosen concentration) is instilled in the glaucomatous eye to be treated, and the intraocular pressure is measured hourly for four hours. If the IOP does not fall below 24 mm Hg, which is our chosen pressure limit, the response is considered to be inadequate therapeutically. Our study showed that if an inadequate therapeutic response is obtained, initiation of treatment with 2% pilocarpine is not indicated, since in patients with such a response, continued treatment with 2% pilocarpine will be ineffective in controlling IOPs on subsequent clinical visits. In only those cases of patients with an adequate response to the pilocarpine therapeutic test (with a fall in pressure below 24 mm Hg) was there the likelihood of having the glaucoma controlled with continued 2% pilocarpine treatment.

Two special indications for intraocular lens implantation

Two cases with special indications for intraocular lens implants are presented. The first case was of a 60-year-old monocular patient with congenital absence of the external nose and multiple limb deformities. The second case was of a young Bedouin girl with bilateral developmental cataracts who had poor living conditions and social objections to wearing spectacles. Intraocular lenses restored good vision.

Orbital fibrous histiocytoma in an infant

A case of fibrous histiocytoma of the orbit occurred in a 1-year-old infant. The tumor was excised, and no recurrence has been evident.

The effect of corneal section on early increased intraocular pressue after cataract extraction

Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We compared a series of patients operated on through a limbal section to a series operated on through a corneal section. The incidence of increased IOP was significantly lower in the corneal section group. This supports the theory that trabecular damage is a major factor in causing early increased IOP after cataract extraction.

Ketamine anesthesia in strabismus surgery

Because of the conflicting opinions in the ophthalmic literature concerning the efficacy of Ketamine anesthesia in strabismus surgery, we decided to report out experience in 44 children operated upon between the ages of six months and six years. Satisfactory anesthesia was achieved in all cases except two who required intubation and inhalation technique in order to complete the surgery. No serious side effects were observed during or after the surgery. Its ease of administration, freedom from side effects, and satisfactory anesthesia, make Ketamine our primary anesthetic choice for strabismus surgery in children.

Solar retinopathy: visual prognosis in 20 cases

A report of 20 cases of solar retinopathy associated with watching an eclipse of the sun is presented. Visual prognosis was generally good and most patients had good vision at the end of six months. Paramacular scotomata, image distortion and macular changes were, however, still present in the majority of patients. Transmission of energy through various protective devices was measured with a fluxmeter. The finding of retinal damage after exposure of even short duration through protective devices that reduce the incident irradiance of the sun up to 5,000 times indicates that the damage observed may be other than thermal in nature. It is concluded that no safe method for directly viewing a solar eclipse is generally available, and that the public, especially schoolchildren and their children, should be better acquainted with this hazard.

Congenital mobile vitreous cyst

A case of a mobile vitreous cyst occurring in an asymptomatic five-year-old child is presented. A review of the literature shows this to be an uncommon finding best explained as a remnant of the primary vitreous. We believe our patient in this case to be the youngest reported, and supports the congenital, nonpathologic nature of the cyst.

Echothiophate iodide for flat anterior chamber following cataract extraction

Three cases are presented of late flat anterior chambers which were cured by echothiophate iodide treatment. Two of the cases required repeated instillations to achieve permanent restoration of normal chamber depth. We now recommend that echothiophate treatment be considered in cases of late flat anterior chamber unresponsive to standard medical treatment.

Bilateral cataract: extraction in classic haemophilia with retrobulbar anaesthesia and peripheral iridectomy

A 47-year-old factor VIII deficient haemophiliac successfully underwent bilateral cataract extraction. The use of cryoprecipitates to achieve haemostasis permitted retrobulbar anaesthesia and a peripheral iridectomy without complication. We consider that the use of cryoprecipitated factor VIII concentrate allows safe elective ocular surgery in patients with classic haemophilia.

Subconjunctival dislocation of intraocular lens implant

Eight weeks after intracapsular cataract extraction with implantation of a Binkhorst iris-clip lens joined with a suture to a peripheral iridectomy at the 12 o'clock position, a 52-year-old woman struck the right side of her head. The corneoscleral wound ruptured for three fourths of its length and the artificial lens was located in the subconjunctiva in the superior-nasal quadrant of the eye. The lens was removed, the iris reposited, and the anterior chamber reformed, and the wound resutured. Her vision was 6/12 (20/40) at the time of discharge.

Colchicine suppression of corneal healing after strabismus surgery

Two patients who had previously undergone uneventful operations for strabismus showed healing of corneal dellen and erosion after withdrawal of colchicine therapy. It is suggested that the exhibition of colchicine therapy for familial Mediterranean fever in these two cases was responsible for initial persistence of these two postoperative complications.

Iris plane pseudophakoi (Copeland lens): prevention of synechiae formation

The iris plan Copeland lens was inserted in 56 cases. A high incidence of synechiae and retrolental membrane formation was noted. This could be prevented or reduced in severity by the controlled use of pupil dilatation in the postoperative period.

The effect of acetazolamide on early increased intraocular pressure after cataract extraction

Increased intraocular pressure in the immediate postoperative period commonly occurs after cataract extraction. We administered acetazolamide (Diamox) to 24 of 49 eyes with increased IOP in 49 patients. All pressures returned to normal within six to eight days. No difference was found between treated and untreated eyes.

New Tyndall photometer

An instrument is described that can accurately measure delicate changes in the Tyndall phenomenon in the anterior chamber of the eye. An important feature is its use of an external light source and its simple adaptation to the slit lamp.