No abstract

(BrJ Ophthalmol 1993; 77: 642-645)

. Purpose:  The purpose of this study was to evaluate the visual outcome and associated findings in isoametropic amblyopia due to high hyperopia. Methods:  Children with ≥ 5 D spherical equivalent hyperopia and ≤ 1.5 D anisometropia and ≤ 1.5 D cylinder in both eyes were selected. Data were collected on the magnitude of spherical equivalent hyperopia, corrected visual acuity (VA) with the Snellen or Tumbling E charts, age at correction, duration of correction, ocular motility and strabismus. Children who had VA of ≤ 0.4 in both eyes were defined as having isoametropic amblyopia. Associations between isoametropic amblyopia and factors affecting VA were analysed. Results:  A total of 160 children met the criteria. The mean follow‐up was 55.8 months. In all, 31 of the children had isoametropic amblyopia. The mean age at presentation was significantly higher (5.5 years versus 4.1 years; p < 0.05) and strabismus was significantly less prevalent (p = 0.001) in the isoametropic amblyopes than in the high hyperopia group as a whole. A total of 83.9% of the isoametropic amblyopes had best corrected VA > 0.5 at the last visit. The duration of optical correction was positively correlated with the last recorded VA measurement. Conclusion:  Isoametropic amblyopia is not rare among highly hyperopic children. Visual acuity improves satisfactorily with spectacle correction. The duration of optical correction seems to be an important factor in visual prognosis.

Implant infection is a serious problem that requires additional patient visits, intensive antibiotic therapy, surgery, or some combination of these. Existence of a peg system appears to play a role in implant infection. Infection may develop as late as 6 to 7 years after pegging, and the patient should be cautioned about potential late-onset problems. It is possible to control the infection with appropriate antibiotic therapy; removal should be reserved for refractory cases.

Anatomic changes in the retina occur even in young children with high myopia. Macular thickness characteristics of highly myopic children may influence the interpretation of data obtained with OCT.

Objectives:To determine the outcome and long-term efficacy of external dacryocystorhinostomy (ext-DCR) with or without bicanalicular silicon intubation in patients with functional nasolacrimal drainage obstruction (FNLDO).Materials and Methods:Patients with epiphora and patent lacrimal systems on nasolacrimal irrigation were prospectively enrolled in the study. Each patient was assessed with lacrimal scintigraphy to differentiate drainage abnormalities as presac (proximal) or postsac (distal) delays. All patients underwent ext-DCR; bicanalicular silicone intubation was performed only in presac delay cases. On follow-up examinations patients were asked to report their symptoms as none, mild, moderate or unchanged. Success was defined as lacrimal patency to irrigation and no or mild epiphora at the end of the follow-up period.Results:Twenty-six lacrimal systems of 23 patients were eligible for inclusion. There were 9 presac delay and 17 postsac delay cases. Average follow-up time was 72.85 weeks (47-88 weeks). A successful outcome was achieved in 76.9% of the operated lacrimal systems. Success rate was 55.5% among presac obstructions and 88.2% among postsac obstructions.Conclusion:The long-term efficacy of ext-DCR in FNLDO patients is confirmed with our overall successful outcome of 76.9%. In preoperative assessment, lacrimal scintigraphy is helpful to determine the surgical approach and to predict the surgical outcome.

The cardio-facio-cutaneous (CFC) syndrome is an uncommon multiple congenital anomalies/mental retardation syndrome whose major manifestations are congenital heart defects, relative macrocephaly, stunted growth, ectodermal dysplasia, characteristic facial appearance, and psychomotor developmental delay. All described cases were sporadic and cytogenetically normal. We report three additional patients with this diagnosis. All three patients developed strabismus, requiring extraocular muscle surgery. Two of our patients also had nystagmus. Combining the 18 previously reported cases with our additional 3, 9 of 21 had strabismus, 10 of 21 had ptosis, and 6 of 21 had nystagmus. Ophthalmic craniofacial abnormalities of hypoplastic supraorbital ridges, prominent epicanthal folds, and antimongoloid slant of the palpebral fissures were also common features contributing to the characteristic facies described for this syndrome. The ophthalmologist could aid in the diagnosis and treatment of these patients because of the prominent ophthalmologic symptomatology of the CFC syndrome.

Purpose: To describe two patients with childhood cyclic esotropia 8 and 9 years after they underwent botulinum toxin type A treatment to report its long-term outcome. Methods: Two patients with sudden onset cyclic esotropia aged 2 and 4 years were included. Botulinum toxin type A injections were performed on the appropriate muscles. Results: The first patient was a 2-year-old boy with left dominant alternating esotropia on a cyclic basis. His strabismus ranged from 25 to 45 prism diopters (PD) at near and distance. A botulinum toxin type A injection into the left medial rectus muscle revealed orthotropia at near and distance with a stereopsis of 60 seconds of arc (arcsec). During the 9 years of follow-up, he remained stable. The second patient was a 4-year-old girl who complained of double vision and strabismus. Her deviation was 40 PD at near and 35 PD at distance on a cyclic pattern. She became orthotropic with glasses after a bimedial botulinum toxin A injection. During the 8 years of follow-up, she remained stable with a stereo-acuity of 120 arcsec. Conclusions: Considering the consecutive and recurrent deviations with surgical treatment in previous reports, botulinum toxin type A is an appropriate first-line option for the treatment of cyclic deviations, despite its limitations. The results suggest that botulinum toxin type A is an effective method to break the cycle in cyclic esotropia permanently. [ J Pediatr Ophthalmol Strabismus . 2019;56(6):360–364.]