No abstract

Patients with submacular PFCL can remain stable for many years. In patients with significant visual loss, surgical removal of subfoveal PFCL can be considered.

Introduction: Treatment of capillary hemangiomas is initiated when there is amblyogenic anisometropic astigmatism, when there is pupillary occlusion, or when rapid growth of the hemangioma threatens to occlude the pupil. The goal of this study was to determine whether treatment of hemangiomas results in resolution or prevention of occlusion or decrease of astigmatism. Methods: The records of 55 patients who underwent treatment for reduction in size of a capillary hemangioma in two pediatric ophthalmology practices were reviewed. Indication for treatment, age at first visit, cycloplegic refraction at the initial and final visits, type of treatment, need for patching or spectacles, and final visual acuity were recorded. Results: This is the largest case series of children with capillary hemangiomas with recorded pretreatment and posttreatment cycloplegic refraction who were followed through the duration of treatment. Twelve patients were treated for pupillary occlusion. Occlusion resolved in all cases. Of the six patients with a final measurable visual acuity (FMVA), two had a vision of 20/100 or worse. Thirty patients were treated for anisometropic astigmatism. The average amount of pretreatment astigmatism was 2.68 D, while the average amount of posttreatment astigmatism was 0.53 D. All 15 patients with an FMVA had a vision of 20/40 or better. The 13 patients treated for threatened occlusion of the visual axis did not develop occlusion. The six patients with a FMVA all had vision of 20/30 or better. Conclusion: Treatment to reduce the size of capillary hemangiomas results in resolution of occlusion, reduction in astigmatism, and prevention of pupillary occlusion. Those with occlusion are at higher risk for severe residual amblyopia and require more aggressive treatment.

Posterior retinopathy of prematurity (ROP) is unusual in its atypical features and its aggressive, rapidly progressive course. It is more difficult to recognize and to treat, with many of these eyes progressing to retinal detachment despite multiple treatments with laser or cryotherapy. The authors present a case of aggressive posterior ROP refractory to multiple laser treatment. This patient was successfully treated with intravitreal bevacizumab, but required repeat treatment 4 months later. The second injection with bevacizumab was followed by progression to retinal detachment requiring surgery. The patient remains stable after surgery.

Refractive outcomes after silicone oil removal and secondary IOL implantation are fairly accurate, with most ending up slightly myopic. Measurement by PCI may be more accurate than biometry. The IOL power should be selected to yield a target refraction about 0.5 D to 1.25 D more hyperopic than desired, depending on the method used to measure it.