Outcome of delayed adjustable strabismus surgery in children using a bow-tie optional adjustable technique

Purpose:

The aim of this article is to study the feasibility of a delayed adjustable technique of strabismus surgery in children using an optional adjustable suture technique.

Methods:

The retrospective study included patients <12 years of age. Recessions were done using an optional adjustable bow-tie technique and resections were done by the conventional technique. Patients were evaluated on the third postoperative day and adjustments done when needed. Statistical analysis was done using Microsoft Excel 2010®.

Results:

The study included 11 patients with exotropia and 16 patients with esotropia. The mean age of the patients was 5.2 years (range 1–11 years). The mean preoperative distance deviation was 46.7 ± 10.4 prism diopters (PD) for exotropic patients and 47.1 ± 16.9 PD for esotropic patients. The mean preoperative near deviation was 46.6 ± 11 PD for exotropic patients and 52.4 ± 17.1 PD for esotropia. Two patients with exotropia (18.2%) and four patients with esotropia (25%) were adjusted under intravenous ketamine in the operating room under anesthetist supervision. No difficulty was encountered in advancing/recessing the muscles. The success rate at 1 month was 100% for exotropia and 87.5% for esotropia. The success rate at the final follow-up was 81.8% for patients with exotropia and 68.7% for patients with esotropia.

Conclusions:

This delayed optional adjustable strabismus surgery technique provides good short-term results and lower adjustment rates.

Sensitivity and specificity of teachers for vision screening among primary school children in South India

AIMS:

This study aims to determine the sensitivity and specificity of vision screening by school teachers among primary school children.

SETTINGS AND DESIGN:

Prospective nonrandomized clinical trial.

SUBJECTS AND METHODS:

The study was carried in primary school children of Madurai, Tamil Nadu from April 2007 to October 2007. Sixty-five primary school teachers from 57 schools around Madurai, Tamil Nadu, India, underwent a half-day training programme at the hospital. Each teacher on return to the school screened around a hundred children using the tumbling E. All screened children were subsequently screened by a team from the hospital. The optometrists used tumbling E (Snellen's 20/30 and Early Treatment of Diabetic Retinopathy Study (ETDRS) 20/32) to check the vision of all children. Any child complaining of defective vision or noted to have defective vision on screening underwent a comprehensive ophthalmic evaluation. The sensitivity and specificity of teacher screening was assessed based on the data obtained.

RESULTS:

Screening was completed for 5150 children. The prevalence of vision <20/30 was 2.82%. Teacher screening was noted to have a sensitivity of 24.8% and a specificity of 98.65%. Tumbling E ETDRS screening by the optometrist had the highest sensitivity of 94.48% and specificity of 97.09%.

CONCLUSIONS:

Our study shows that vision screening by trained optometrists is a very useful tool to identify visual impairment in primary school children. Measures need to be taken to improve the sensitivity of teacher screening before recommending its generalized use.

Situational Restriction of Elevation in Adduction Relieved by Faden on the Medial Rectus

We describe a patient with situational restriction of elevation in adduction in his left eye. Clinical examination pointed to instability of the left medial rectus pulley. This was corrected by Faden on the medial rectus. The importance of this relatively new concept in identifying and treating orbital pulley instability is discussed.

Oral epithelial cells transplanted on to corneal surface tend to adapt to the ocular phenotype

To understand the response of oral epithelial cells, transplanted on corneal surface to the ocular cues in vivo. The corneal button obtained after penetrating keratoplasty (PK) of an eye of a patient with total limbal stem cell deficiency (LSCD), previously treated with cultured oral mucosal epithelial transplantation (COMET) was examined by immunohistochemistry for the expression of keratins, p63, p75, PAX6, Ki-67, CD31, and CD34. COMET followed by optical-PK has improved visual acuity to 20/40 and rendered a stable ocular surface. The excised corneal tissue showed the presence of stratified epithelium with vasculatures. The epithelial cells of the corneal button expressed K3, K19, Ki-67, p63, p75 and the cornea-specific PAX6 and K12. This study confirms that the oral cells, transplanted to corneal surface, survive and stably reconstruct the ocular surface. They maintain their stemness at the ectopic site and acquire some of the corneal epithelial-like characters.

Cataract surgery in juvenile xanthogranuloma: case report and a brief review of literature

There is limited literature on the management of cataracts in juvenile xanthogranuloma (JXG). A 2-month-old girl presented to us with hyphema, secondary glaucoma OU and skin nodules suggestive of JXG. She developed bilateral cataracts during her follow-up and was treated successfully with cataract surgery and aphakic rehabilitation.

Completion rates of anterior and posterior continuous curvilinear capsulorrhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic

Context:

Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful.

Aims:

The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic.

Settings and Design:

Nonrandomized observational study.

Materials and Methods:

Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008–May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag.

Results:

33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%.

Conclusions:

2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.

Transient Reversal of a Face Turn (an Abnormal Head Posture, AHP) due to Manifest Latent Nystagmus, after Eye Muscle Strabismus Surgery for the Associated Infantile Esotropia

Patients with infantile esotropia and manifest latent nystagmus adopt a face turn towards the fixing eye as a nystagmus dampening mechanism. The surgical plan should aim to correct both the face turn and the strabismus. Reversal of the face turn after surgery for the strabismus can be (i.e. was) distressing for both the surgeon and the patient and has not been reported previously to the best of our knowledge. We report our patient with a transient reversal of face turn after surgery.

Inferior rectus paresis and medial rectus overaction following retrobulbar anesthesia for cataract surgery

Strabismus is a well recognized complication of retrobulbar anesthesia for cataract surgery. This may manifest as either paresis or sometimes contracture (overaction) in the late stage. Management of the patient is tailored to the individual case. Herein, we report a patient with inferior rectus paresis and medial rectus overaction after retrobulbar anesthesia. The presenting symptom was diplopia increasing on downgaze, which improved with medial rectus recession and plication of the inferior rectus.

Osler-Weber-Rendu syndrome: a case report with familial clustering

Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder manifested by telangiectases of the skin and mucous membranes and arteriovenous malformations of various organ systems. We present a case of Osler-Weber-Rendu syndrome with 11 affected members in her family.

Optic nerve cysticercosis: case report and review of current management

The authors present a case of optic nerve cysticercosis in a 32-year-old patient who presented with sudden blurring of vision in the left eye and a transient visual improvement on systemic steroids. The ocular findings were unremarkable other than a relative afferent pupillary defect (RAPD). An ultrasound of the orbit, CT and MRI scans revealed a cystic lesion in the orbital portion of the optic nerve close to the eyeball. A presumed diagnosis of optic nerve cysticercosis was made on the basis of imaging and a positive serum ELISA. The patient improved dramatically on a 4-week therapeutic trial of albendazole and oral steroids. The post-treatment ultrasound and CT scan showed an involution of the cyst with some residual thickening of the optic nerve.

Improving the quality of industrially important enzymes by directed evolution

Directed evolution is a new process for developing industrially viable biocatalysts. This technique does not require a comprehensive knowledge of the relationships between sequence structure and function of proteins as required by protein engineering. It mimics the process of Darwinian evolution in a test tube combining random mutagenesis and recombination with screening or selection for enzyme variants that have the desired properties. Directed evolution helps in enhancing the enzyme performance both in natural and synthetic environments. This article reviews the process of directed evolution and its application to improve substrate specificity, activity, enantioselectivity and thermal stability.

Abdominal aortic aneurysm repair in a patient with bilateral autotransplanted kidneys

The case is presented of a 38-year-old male who presented with a large 10 cm x 8 cm pulsatile swelling in his abdomen. Thirteen years before, internal iliac arteries had been used to treat long segment occlusions and diseased state of both renal arteries. At the same time both kidneys had been transplanted to the iliac fossae. Digital subtraction angiography revealed a huge abdominal aortic aneurysm. Both kidneys were fully functional. As the renal transplants had been done extraperitoneally an easy transperitoneal approach was now possible. The maximum diameter of the aneurysm was 12 cm. An inclusion graft repair was carried out using a 16-mm woven Dacron graft. In the light of the favourable circumstances it was decided not to take any special protective measures against renal ischemia apart from keeping the aortic cross-clamp time short. The patient could be discharged with patent and normally functioning kidneys 10 days after surgery.