Descemet's stripping automated endothelial keratoplasty (DSAEK) has rapidly become the standard of care for endothelial dysfunction of the cornea in adults. There are few reports of DSAEK in children and infants, mainly because most pediatric corneal opacities are full-thickness and therefore not amenable to lamellar procedures but also because of the unique difficulties of performing this procedure in the youngest patients. We report the case of an 8-month-old girl who underwent DSAEK for congenital hereditary endothelial dystrophy. At 24 months' follow-up, her visual acuity was 20/40 in the operated eye. To our knowledge, this is the first report of an objective visual outcome in a child with DSAEK performed in infancy.
Purpose: To report the clinical and histopathological findings associated with congenital fibrovascular pupillary membranes.
Design: Case series.
Participants: Seven infants; six with a unilateral congenital pupillary membrane and one with classic persistent fetal vasculature (PFV).
Methods: Patients underwent a membranectomy, pupilloplasty and/or a lensectomy. Histopathological examination was performed on the excised membranes.
Main Outcome Measures: Visual acuity and pupil size.
Results: Four of the 6 patients with a unilateral congenital pupillary membrane had one or more recurrences after a membranectomy and pupilloplasty. The most recent pupil size ranged from 2 to 5 mm in the affected eye. When last tested, the vision in the affected eye was excellent in 4 of the 6 patients. The two patients without recurrences of the pupillary membranes underwent multiple iris spincterotomies at the time of the initial surgery. Histopathological examination of two primary pupillary membranes showed fibrovascular tissue that did not stain for neuron specific enolase. Smooth muscle actin was only present in vascular walls. In contrast, histopathology of a recurrent pupillary membrane revealed collagenized fibrovascular tissue that was immunoreactive for smooth muscle actin. Finally, histopathology of the retrolenticular membrane excised from an infant with classic PFV was similar to the latter aside from hypercellularity.
Conclusions: Congenital fibrovascular pupillary membranes in infants are likely a variant of PFV that may recur if incompletely excised. The risk of these membranes recurring may be reduced by excising as much as the membrane as possible and enlarging the pupil with iris spincterotomies. A lensectomy should be avoided if possible.
Purpose: To determine whether measurements obtained by partial coherence interferometry (PCI) correlate well with measurements obtained using immersion ultrasound (US) in children.
Setting: Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Design: Evaluation of a diagnostic test or technology.
Methods: The charts of pediatric patients who had cataract surgery from August 2008 to September 2009 were reviewed. Axial length (AL) measurements in the operative eye were obtained using PCI at the preoperative clinic visit and then using immersion US in the operating room before surgery. The data were compared to determine the degree of agreement.
Results: The charts of 18 patients (27 eyes) were reviewed. Preoperative AL measurements by PCI were obtained in 21 eyes (78%). On average, the PCI-measured ALs were 0.1 mm less than the immersion US values (95% confidence interval, −0.2 to −0.1; P = .002). All eyes with an AL of 23.5 mm or less had lower PCI values than immersion US values. There was no systematic pattern of 1 measurement being greater or less than the other in eyes with an AL longer than 23.5 mm.
Conclusions: There is a systematic difference in AL measurement between PCI and immersion US, with PCI tending to give lower values, particularly in eyes with an AL longer than 23.5 mm. Depending on the length of the eye, a 0.1 mm error in AL measurement could result in a 0.25 to 0.75 diopter difference in intraocular lens calculation that could be clinically significant in some patients.
Infantile cataracts remain one of the most treatable causes of lifelong visual impairment. While the chance of improving vision for children with infantile cataracts has never been better, significant global and socioeconomic disparities still exist in their early management. Recent epidemiological studies reveal a stable prevalence of infantile cataracts in high-income countries and highlight challenges in determining the prevalence of infantile cataracts in low-income countries. Detailed descriptions of cataract morphology may inform us as to etiology, provide guidance with regards to surgical approach, and have prognostic value. Molecular genetics is providing new insights into the hereditary bases and potential systemic associations of infantile cataracts. For visually significant infantile cataracts requiring surgery to clear the visual axis, surgical techniques continue to evolve based on the experiences and research efforts of skilled teams worldwide. The most common complications of cataract surgery performed in infancy are visual axis opacification and, in about a third of patients, the long-term development of glaucoma. Children with unilateral cataracts generally see well given the presence of a healthy fellow eye. Better visual outcomes in operated eyes, however, are achieved in the setting of early presentation, bilateral infantile cataracts, absence of nystagmus or strabismus, and consistent amblyopia therapy. While intraocular lenses for infants less than 6 months can result in good visual outcomes, contact lenses may be preferred in situations in which they are available and practical. Many studies have demonstrated the benefits of early surgery for infantile cataract. We must strive for the continued evolution of technologies and strategies that have the potential to further improve these outcomes.
We report 3 cases of bilateral cataract secondary to self-inflicted blunt eye trauma in children with autism spectrum disorder (ASD). All 3 children hit their foreheads, orbits, or globes repeatedly for long periods of time and developed cataracts. Clinicians must be aware of this phenomenon to diagnose ocular pathology early and to provide adequate education, counseling, and services to affected patients and their families and to put appropriate postoperative care mechanisms in place to prevent permanent ocular damage.
Background: Horizontal strabismus due to a weak rectus muscle can be treated with an augmented Hummelsheim procedure, in which both vertical rectus muscle tendons are split, resected by 4 mm, and reattached to the sclera adjacent to the weak rectus muscle. Compared with vertical rectus transposition, the procedure spares two ciliary vessels and does not require placement of augmentation sutures. In this study, we evaluated binocular alignment and ocular motility in patients with abducens nerve palsy treated with an augmented Hummelsheim procedure. Methods: The medical records of consecutive patients with complete abducens nerve palsy who underwent the augmented Hummelsheim procedure, usually combined with medial rectus muscle recession, were retrospectively reviewed. Binocular alignment, ocular motility, and complications were analyzed. Results: Ten patients (age range, 12-57 years) met inclusion criteria for the study, of whom 9 of 10 had simultaneous medial rectus recession. Follow-up ranged from 1 week to 24 months. The augmented Hummelsheim procedure improved esotropia from 43Δ ± 5 Δ preoperatively to 6Δ ± 7 Δ postoperatively (P < 0.0001) and reduced abduction deficits from -4 to -3 (P < 0.0001). One patient with coexisting oculomotor nerve palsy developed consecutive exotropia; 2 had induced vertical deviations. There were no cases of anterior segment ischemia. Conclusions: The augmented Hummelsheim procedure combined with medial rectus muscle recession reduced mean primary position esotropia and improved abduction in patients with complete abducens nerve palsy.
We report a case of intraocular lacrimal gland choristoma presenting very early in a preterm infant with hyphema, a mass lesion and raised intraocular pressure. Enucleation of the involved eye, which is the treatment in most cases, was performed and prosthesis was fitted successfully. An interesting additional finding in our patient was a choroidal defect, not reported to date with other cases in the literature.