Speciality
Spotlight

 




 


Ophthalmology


 

 





Paediatric
Ophthalmology

    

  • SK
    McClatchey, MM Parks (Naval Med Ctr, San Diego,
    Calif; Children’s Natl Med Ctr, Washington, DC)

    Theoretic Refractive Changes
    After Lens Implantation in Childhood
    .

    Ophthalmology 104:1744-1751, 1997.

      

    Ninety-three
    eyes were eligible for the above study where the
    criteria were – (a) cataract removal before the age
    of 10 yrs, (b) Not more than 3 months had elapsed
    between cataract removal and postoperative
    refraction (c) At least 7 years of follow-up data
    between first and last refractions were available.

      

    As
    the children grew, the myopic shift was
    significantly greater in children whose surgery was
    performed before 2 years of age (11.9D) than in
    those whose surgery was performed later (4.7D).

      

    Myopic shift was less when the IOL was implanted to
    give moderate hyperopia than emmetropia.

        

  • RM
    Robb (Harvard Med School, Boston)

    Success
    Rates of Nasolacrimal Duct Probing at Time Intervals
    After 1 year of Age
    .

    Ophthalmology
    105: 1307-1310, 1998

      

    Some controversy exists over the timing of
    probing procedures for congenital nasolacrimal duct
    (NLD) obstruction. Some
    physicians prefer to do probing during the first
    year, when it can be done under local anaesthesia.
    Many cases resolve spontaneously by the age
    of one year. Hence other physicians prefer to wait
    for one year.

      

    Records
    of 303 NLD probings in 252 children older than one
    year were reviewed. Adequate
    follow-up was available for 280 probings in this
    series.

      

    The
    main conclusion drawn in this group of children over
    the age of one year, was that cure rate did not
    decrease with advancing age (upto 36 months).
    The overall cure
    rate in this group was 92.1%.

      

  • JS
    Mehta, GGW Adams (Strabismus and Paediatric Service, Moorfields Eye Hospital, London)

    Recombinant tissue plasminogen activator following paediatric cataract surgery.

    Br.J.Ophthalmol 2000; 84: 983-986.

      


    Recombinant Tissue Plasminogen Activator was used safely and effectively at a dose of 25 mg for the treatment of severe fibrinous membranes following paediatric cataract extraction.

      


    It aided visual recovery and allowed a reduction of topical steroid therapy (used postoperatively).

      

  • Nicoline E Schalij-Delfos, Mieke E L de Graaf, et al, (Institute of Ophthalmology, University Hospital, Utrecht, Netherlands).

    Long term follow up of premature infants: detection of strabismus, amblyopia and refractive errors.

    Br.J Ophthalmol 2000; 84: 963-967.

       


    The authors rationalize the need for long term ophthalmological follow up of prematurely born infants.

      


    130 infants with a gestational age (GA) < 37 weeks were enrolled in a prospective study about the development of strabismus, amblyopia and refractive errors (SAR). Infants were subdivided into three groups according to GA—-A—less than 28 weeks, B ³ 28 to £ 32 weeks, C > 32 ¾ < 37 weeks.

      


    Ophthalmological assessment was done at the post conceptional age of 32 weeks, at term and at 3,6,12 and 30 months post term. At the age of five years parents received a questionnaire and a majority of the children were reexamined.

      


    Statistical analysis showed that gestational age, duration of supplementary oxygen, and duration of hospitalization were important predictive variables for the development of SAR at the age of five years.

      


    Infants with a GA £ 32 had a significantly higher risk of developing SAR than infants with a GA > 32 weeks. Hence these infants (GA < 32 weeks) should be screened at the age of 1 year, in the 3rd year of life and just before school age (including testing of visual acuity with optotypes).

      


    Strabismus developed mainly in the first year of life and at the age of 5 years. Most infants with amblyopia were detected at the age of 2-3 years. Refractive errors were found in the first year of life and at the age of 2.5 and 5 years.

        

  • M O’Keefe, Namir Kafil-Hussain, et al (National Children’s Eye Centre, The Children’s Hospital, Dublin Ireland)

    Ocular significance of intraventricular haemorrhage in premature infants.

    Br. J.Ophthalmol, March 2001, 85: 357-359

       

    Sixty-eight preterm infants with intraventricular haemorrhage (IVH) were examined. ROP occurred in 33 infants (48.5%), strabismus in 30 infants (44.1%).

       

    Infants with high grade IVH were at greater risk than infants with low grade IVH for the development of optic atrophy and hydrocephalus.

        

  • ED
    Griener, E Dahan, SR Lambert (Emory Univ, Atlanta,
    Ga)

    Effect of Age at Time of Cataract Surgery on
    Subsequent Axial Length Growth in Infants Eyes


    J Cataract Refract Surg 25: 1209-1213, 1999

        

    In a study of eleven infants aged 2 to 4 months who
    had a unilateral lensectomy along with a posterior
    chamber IOL in the sulcus, it was found that 70% of
    the pseudophakic eyes had diminished axial growth
    after surgery.

        

    Older children in other studies had minimal growth
    differences between pseudophakic and normal eyes.
    This indicates that there may be a critical period
    of growth after which the removal of the lens has no
    effect on ocular growth.

        

    Implantation of an IOL tends to inhibit axial length
    when compared with the contralateral phakic eye.
    This has far reaching implications for the
    calculation of appropriate IOL power.

         

  • SE
    Dorey, GGW Adams, et al (Moorfields Eye Hospital, UK)

    Intensive occlusion therapy for amblyopia

    Br J Ophthalmol March 2001, 85: 310-313

      

    This is a retrospective study of 39 children admitted to a paediatric ophthalmic ward for five days of supervised intensive occlusion therapy. These patients had previously failed to respond to outpatient occlusion.

      

    67% gained at least one line of visual acuity in their amblyopic eye. 13% gained 3 or more lines of the Snellen’s chart.

       

    Intensive occlusion, under supervision is only possible during in patient treatment, even in children where occlusion failed earlier during outpatient management.

      

  • I.
    Anteby, E. Cohen, et al (Hadassah University Hospital, Jerusalem, Israel)


    Ocular Manifestations in Children Born After In Vitro Fertilization 


    Arch Ophthalmol., October 2001, Vol. 119(10) Pg. 1525-1529

       


    47 children (25 girls and boys) born after in vitro fertilization pregnancy were included in the study.

         

    Of 70 eyes among NONVERBAL children, visual acuity (V.A.) was “normal for age” in 86%, “fair” in 6% and “poor” in 9%.

         


    Visual acuity in 24 eyes in VERBAL children ranged from 6/6 to no light perception, with 17% having poor vision.

         


    Major ocular malformations were seen in 12 (26%) of 47 children. These included Coat’s disease, congenital cataract, congenital glaucoma, hypoplastic optic nerve head, idiopathic optic atrophy, coloboma with microphthalmos and
    retinoblastoma.

          

  • Recchia FM, Baumal CR, et al (Thomas Jefferson Univ, Philadelphia; New England Eye Ctr, Boston)

    Endophthalmitis After Pediatric Strabismus Surgery

    Arch Ophthalmol 118: 939-944, 2000

       

    The authors describe the clinical findings and final outcomes of 6 patients with pediatric endophthalmitis (PE) over a 15-year period.

      

    A retrospective review was conducted of the initial signs, clinical findings, culture results, treatment and visual and anatomical outcomes for 6 children treated for PE between 1983 and 1998.

      

    4 boys and 2 girls ranged in age from 8 months to six years. In all cases, lethargy and asymmetric eye redness with or without lid oedema or fever developed within 4 days of strabismus surgery. Periorbital swelling, redness and leukocoria caused by vitritis were seen. Hypopyon was seen in some patients.

      

    All patients underwent pars plana vitrectomy and received intravitreal and systemic antibiotics. Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus were grown on vitreous cultures.

      

    Within 6 months of strabismus surgery, there was no light perception in any of the 6 eyes (3 of which had to be enucleated). The use of preoperative prophylaxis with topical povidone-iodine solution is recommended.

       

  • Young TL, Conahan BM, et al (Univ of Minnesota, Minneapolis; Creighton Univ, Omaha, Neb)

    Anterior Transposition of the Superior Oblique Tendon in the Treatment of Oculomotor Nerve Palsy and Its Influence on Postoperative Hypertropia

    J Pediatr Ophthalmol Strabismus 37: 149-155, 2000

      

    In a patient with severe IIIrd nerve palsy, the affected eye is aligned in a characteristically abducted and depressed position due to the unopposed action of the lateral rectus and superior oblique.

      

    In a retrospective review 8 patients were found with IIIrd nerve palsy. They had undergone anterior transposition of the superior oblique tendon, without trochleotomy or vertical rectus muscle surgery.

      

    The superior oblique tendon was cut at the medial border of the superior rectus muscle in each patient and placed 1 mm to 3.5 mm anterior to the medial insertion of the superior rectus muscle in all patients. The lateral rectus was weakened. There was no resection of the vertical
    recti.

      

    In this way alignment of the eyes in the primary position of gaze was improved. None of the patients experienced significant postoperative restrictive hypertropia or new postoperative paradoxical ocular movements.

      

  • El Mallah MK, Chakravarthy U, et al (Queen’s Univ, Belfast, Northern Ireland)

    Amblyopia: Is Visual Loss Permanent?

    Br J Ophthalmol 84: 952-956, 2000

      

    Though it is believed that occlusion therapy should be initiated between 6 months and 9 years of age, several recent reports have shown that some improvement in visual function can occur in an amblyopic eye when the nonamblyopic eye has lost vision.

      

    Records were reviewed for 465 patients with age-related macular degeneration, who attended a specialist macular clinic between 1990 and 1998.

      

    Out of 12 patients who had improved vision in the nonaffected eye, 9 had a history of amblyopia. The authors conclude that it is possible for older persons (with a history of amblyopia) to recover vision in the amblyopic eye in case of gross visual loss in the nonamblyopic eye.

        

 



 

 

Speciality Spotlight

 

 

Paediatric Ophthalmology
    

  • SK McClatchey, MM Parks (Naval Med Ctr, San Diego, Calif; Children’s Natl Med Ctr, Washington, DC)
    Theoretic Refractive Changes After Lens Implantation in Childhood.
    Ophthalmology 104:1744-1751, 1997.
      
    Ninety-three eyes were eligible for the above study where the criteria were – (a) cataract removal before the age of 10 yrs, (b) Not more than 3 months had elapsed between cataract removal and postoperative refraction (c) At least 7 years of follow-up data between first and last refractions were available.
      
    As the children grew, the myopic shift was significantly greater in children whose surgery was performed before 2 years of age (11.9D) than in those whose surgery was performed later (4.7D).
      
    Myopic shift was less when the IOL was implanted to give moderate hyperopia than emmetropia.
        

  • RM Robb (Harvard Med School, Boston)
    Success Rates of Nasolacrimal Duct Probing at Time Intervals After 1 year of Age.
    Ophthalmology 105: 1307-1310, 1998
      
    Some controversy exists over the timing of probing procedures for congenital nasolacrimal duct (NLD) obstruction. Some physicians prefer to do probing during the first year, when it can be done under local anaesthesia. Many cases resolve spontaneously by the age of one year. Hence other physicians prefer to wait for one year.
      
    Records of 303 NLD probings in 252 children older than one year were reviewed. Adequate follow-up was available for 280 probings in this series.
      
    The main conclusion drawn in this group of children over the age of one year, was that cure rate did not decrease with advancing age (upto 36 months). The overall cure rate in this group was 92.1%.
      

  • JS Mehta, GGW Adams (Strabismus and Paediatric Service, Moorfields Eye Hospital, London)
    Recombinant tissue plasminogen activator following paediatric cataract surgery.
    Br.J.Ophthalmol 2000; 84: 983-986.
      
    Recombinant Tissue Plasminogen Activator was used safely and effectively at a dose of 25 mg for the treatment of severe fibrinous membranes following paediatric cataract extraction.
      
    It aided visual recovery and allowed a reduction of topical steroid therapy (used postoperatively).
      

  • Nicoline E Schalij-Delfos, Mieke E L de Graaf, et al, (Institute of Ophthalmology, University Hospital, Utrecht, Netherlands).
    Long term follow up of premature infants: detection of strabismus, amblyopia and refractive errors.
    Br.J Ophthalmol 2000; 84: 963-967.
       
    The authors rationalize the need for long term ophthalmological follow up of prematurely born infants.
      
    130 infants with a gestational age (GA) < 37 weeks were enrolled in a prospective study about the development of strabismus, amblyopia and refractive errors (SAR). Infants were subdivided into three groups according to GA—-A—less than 28 weeks, B ³ 28 to £ 32 weeks, C > 32 ¾ < 37 weeks.
      
    Ophthalmological assessment was done at the post conceptional age of 32 weeks, at term and at 3,6,12 and 30 months post term. At the age of five years parents received a questionnaire and a majority of the children were reexamined.
      
    Statistical analysis showed that gestational age, duration of supplementary oxygen, and duration of hospitalization were important predictive variables for the development of SAR at the age of five years.
      
    Infants with a GA £ 32 had a significantly higher risk of developing SAR than infants with a GA > 32 weeks. Hence these infants (GA < 32 weeks) should be screened at the age of 1 year, in the 3rd year of life and just before school age (including testing of visual acuity with optotypes).
      
    Strabismus developed mainly in the first year of life and at the age of 5 years. Most infants with amblyopia were detected at the age of 2-3 years. Refractive errors were found in the first year of life and at the age of 2.5 and 5 years.
        

  • M O’Keefe, Namir Kafil-Hussain, et al (National Children’s Eye Centre, The Children’s Hospital, Dublin Ireland)
    Ocular significance of intraventricular haemorrhage in premature infants.
    Br. J.Ophthalmol, March 2001, 85: 357-359
       
    Sixty-eight preterm infants with intraventricular haemorrhage (IVH) were examined. ROP occurred in 33 infants (48.5%), strabismus in 30 infants (44.1%).
       
    Infants with high grade IVH were at greater risk than infants with low grade IVH for the development of optic atrophy and hydrocephalus.
        

  • ED Griener, E Dahan, SR Lambert (Emory Univ, Atlanta, Ga)
    Effect of Age at Time of Cataract Surgery on Subsequent Axial Length Growth in Infants Eyes
    J Cataract Refract Surg 25: 1209-1213, 1999
        
    In a study of eleven infants aged 2 to 4 months who had a unilateral lensectomy along with a posterior chamber IOL in the sulcus, it was found that 70% of the pseudophakic eyes had diminished axial growth after surgery.
        
    Older children in other studies had minimal growth differences between pseudophakic and normal eyes. This indicates that there may be a critical period of growth after which the removal of the lens has no effect on ocular growth.
        
    Implantation of an IOL tends to inhibit axial length when compared with the contralateral phakic eye. This has far reaching implications for the calculation of appropriate IOL power.
         

  • SE Dorey, GGW Adams, et al (Moorfields Eye Hospital, UK)
    Intensive occlusion therapy for amblyopia
    Br J Ophthalmol March 2001, 85: 310-313
      
    This is a retrospective study of 39 children admitted to a paediatric ophthalmic ward for five days of supervised intensive occlusion therapy. These patients had previously failed to respond to outpatient occlusion.
      
    67% gained at least one line of visual acuity in their amblyopic eye. 13% gained 3 or more lines of the Snellen’s chart.
       
    Intensive occlusion, under supervision is only possible during in patient treatment, even in children where occlusion failed earlier during outpatient management.
      

  • I. Anteby, E. Cohen, et al (Hadassah University Hospital, Jerusalem, Israel)
    Ocular Manifestations in Children Born After In Vitro Fertilization 
    Arch Ophthalmol., October 2001, Vol. 119(10) Pg. 1525-1529
       
    47 children (25 girls and boys) born after in vitro fertilization pregnancy were included in the study.
         
    Of 70 eyes among NONVERBAL children, visual acuity (V.A.) was “normal for age” in 86%, “fair” in 6% and “poor” in 9%.
         
    Visual acuity in 24 eyes in VERBAL children ranged from 6/6 to no light perception, with 17% having poor vision.
         
    Major ocular malformations were seen in 12 (26%) of 47 children. These included Coat’s disease, congenital cataract, congenital glaucoma, hypoplastic optic nerve head, idiopathic optic atrophy, coloboma with microphthalmos and retinoblastoma.
          

  • Recchia FM, Baumal CR, et al (Thomas Jefferson Univ, Philadelphia; New England Eye Ctr, Boston)
    Endophthalmitis After Pediatric Strabismus Surgery
    Arch Ophthalmol 118: 939-944, 2000
       
    The authors describe the clinical findings and final outcomes of 6 patients with pediatric endophthalmitis (PE) over a 15-year period.
      
    A retrospective review was conducted of the initial signs, clinical findings, culture results, treatment and visual and anatomical outcomes for 6 children treated for PE between 1983 and 1998.
      
    4 boys and 2 girls ranged in age from 8 months to six years. In all cases, lethargy and asymmetric eye redness with or without lid oedema or fever developed within 4 days of strabismus surgery. Periorbital swelling, redness and leukocoria caused by vitritis were seen. Hypopyon was seen in some patients.
      
    All patients underwent pars plana vitrectomy and received intravitreal and systemic antibiotics. Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus were grown on vitreous cultures.
      
    Within 6 months of strabismus surgery, there was no light perception in any of the 6 eyes (3 of which had to be enucleated). The use of preoperative prophylaxis with topical povidone-iodine solution is recommended.
       

  • Young TL, Conahan BM, et al (Univ of Minnesota, Minneapolis; Creighton Univ, Omaha, Neb)
    Anterior Transposition of the Superior Oblique Tendon in the Treatment of Oculomotor Nerve Palsy and Its Influence on Postoperative Hypertropia
    J Pediatr Ophthalmol Strabismus 37: 149-155, 2000
      
    In a patient with severe IIIrd nerve palsy, the affected eye is aligned in a characteristically abducted and depressed position due to the unopposed action of the lateral rectus and superior oblique.
      
    In a retrospective review 8 patients were found with IIIrd nerve palsy. They had undergone anterior transposition of the superior oblique tendon, without trochleotomy or vertical rectus muscle surgery.
      
    The superior oblique tendon was cut at the medial border of the superior rectus muscle in each patient and placed 1 mm to 3.5 mm anterior to the medial insertion of the superior rectus muscle in all patients. The lateral rectus was weakened. There was no resection of the vertical recti.
      
    In this way alignment of the eyes in the primary position of gaze was improved. None of the patients experienced significant postoperative restrictive hypertropia or new postoperative paradoxical ocular movements.
      

  • El Mallah MK, Chakravarthy U, et al (Queen’s Univ, Belfast, Northern Ireland)
    Amblyopia: Is Visual Loss Permanent?
    Br J Ophthalmol 84: 952-956, 2000
      
    Though it is believed that occlusion therapy should be initiated between 6 months and 9 years of age, several recent reports have shown that some improvement in visual function can occur in an amblyopic eye when the nonamblyopic eye has lost vision.
      
    Records were reviewed for 465 patients with age-related macular degeneration, who attended a specialist macular clinic between 1990 and 1998.
      
    Out of 12 patients who had improved vision in the nonaffected eye, 9 had a history of amblyopia. The authors conclude that it is possible for older persons (with a history of amblyopia) to recover vision in the amblyopic eye in case of gross visual loss in the nonamblyopic eye.
        

 

 

By |2022-07-20T16:41:07+00:00July 20, 2022|Uncategorized|Comments Off on Paediatric Ophthalmology

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