Purpose: To determine the value of serial personal photographs in timing the onset of unilateral cataracts in children over 6 months of age. Methods: Personal photographs from 11 children with unilateral cataracts who underwent CE and IOL implantation when ≥ 6 months of age were reviewed. Photographs were evaluated for changes in the red reflex which might indicate the presence of a cataract. Results: The children underwent cataract surgery at a mean age of 40.3 months. They were followed for a mean of 33.2 months. Nine children were diagnosed as having an acquired cataract by photographic review documenting a previously normal red reflex. The visual acuity in the affected eye of 4 of these 9 children improved to ≥ 20/60. Cataracts were visible on photographs prior to clinical diagnosis in 5 patients, from 0.5 to 22 months prior to clinical diagnosis, but visual outcomes were not correlated with the photographically documented duration of the cataract prior to treatment. Photographs were not helpful in timing the onset of cataract in two children due to the poor quality of the images. Conclusions: Serial personal photographs are helpful in determining whether cataracts are acquired. However, they have limited usefulness in predicting the visual outcome presumably because other factors such as compliance with patching therapy are also critical in achieving good visual outcomes.

Purpose: To evaluate the outcomes of 360-degree suture trabeculotomy in childhood glaucoma with poor prognosis. Subjects and Methods: A nonrandomized, retrospective chart review was performed on pediatric patients (under 18 years old) treated with a 360-degree suture trabeculotomy for glaucoma. The cases were categorized into the following groups: (1) primary congenital glaucoma with birth-onset presentation accompanied by corneal clouding noted at birth, (2) primary congenital glaucoma with onset or presentation after 1 year of age, (3) primary congenital glaucoma with prior failed goniotomy surgery, (4) infantile-onset glaucoma following congenital cataract surgery, and (5) infantile-onset glaucoma with associated ocular/systemic anomalies. Results: A total of 45 eyes of 33 patients were analyzed. The mean preoperative intraocular pressure (IOP) was 34.3 ± 6.7 mm Hg on an average of 1.5 medications. Median age at time of surgery was 7 months. Mean final IOP (median last follow-up or failure, 12 months) was 22.2 ± 7.1 mm Hg on an average of 1.5 medications. The probability of success according to time after surgery was 87% at 6 months, 63% at 1 year, and 58% at 2 years. Kaplan-Meier analysis of Groups 1-4 versus Group 5 failed to demonstrate a statistically significant difference (p = 0.13). Of 5 eyes with port wine mark–related glaucoma, 2 had a large (>50%), persistent postoperative hyphema and concurrent vitreous hemorrhage. Conclusions: Children with a wide range of ocular pathologies can be successfully treated with 360-degree suture trabeculotomy. Further evaluation of this surgical technique in primary congenital glaucoma and open-angle glaucoma following congenital cataract surgery is warranted.

Purpose: To report the outcomes after cataract extraction in eyes previously treated for retinoblastoma. Methods: We reviewed the medical records of consecutive patients treated with cataract extraction at our institution for radiation-induced cataract following retinoblastoma treatment between 1992 and 2007. Results: Twelve eyes of 11 patients were included. The median age at diagnosis of retinoblastoma was 7.4 months. The median quiescent interval before cataract surgery was 34.6 months (range: 17 - 240 months). All patients underwent limbal-based extracapsular cataract extraction with scleral-tunnel wound construction. Anterior vitrectomy and posterior capsulotomy were performed in seven eyes; an intraocular lens was placed in 10 eyes. A laser capsulotomy was subsequently performed in five eyes. No postoperative complications occurred. One patient underwent a vitrectomy for vitreous hemorrhage five years after cataract extraction. The median follow-up after surgery was 6.01 years (range: 1.1 - 12.3 years). Final visual acuity was between 20/20 and 20/60 in six eyes, between 20/70 and 20/200 in two eyes, and worse than 20/200 in four eyes. Every patient with documented preoperative vision (10 eyes) had improved vision at final examination. No intraocular recurrences or metastases occurred. Two patients developed secondary rhabdomyosarcomas, one of whom succumbed to their disease. Conclusions: Limbal-based cataract extraction in our series was not associated with tumor recurrence or metastasis. The optimal quiescent interval is not known, however, no tumor recurrences occurred in our series when a minimum 17 month quiescent period was achieved. Visual improvement was noted in every patient, although several patients only experienced modest gains.

Purpose: To examine the efficacy of a sequential tube shunt versus transscleral diode cyclophotocoagulation following failure of an initial tube shunt on maximal medical therapy in treatment of refractory childhood glaucoma. Methods: A nonrandomized retrospective chart review was conducted of 17 eyes of 14 pediatric patients (less than 18 years old) with refractory glaucoma treated with either sequential tube shunt (Group A) or diode cyclophotocoagulation (Group B) following initial failed tube shunt. Success was defined as an intraocular pressure (IOP) ≤22 mm Hg on medical therapy, no visually devastating complications, and no further glaucoma surgery performed or recommended. Results: Of the 17 eyes, 8 had a sequential tube shunt and 9 underwent diode cyclophotocoagulation as a secondary procedure. Kaplan-Meier analysis demonstrated a successful outcome of 75% and 62.5% at 12 months and 24 months, respectively, for Group A, and 66.7% at both 12 and 24 months for Group B (p = 0.48) Corneal decompensation or graft failure was noted in 3/8 eyes (38%) in Group A. Cataract surgery was performed in 2/5 phakic eyes (40%) in Group B. One eye in each group progressed to no light perception. Conclusions: Diode cyclophotocoagulation and sequential tube shunt following primary tube shunt failure in childhood glaucoma showed similar efficacy and complication rates. However, the small sample size of this study warrants further evaluation of these two procedures following failure of a tube shunt device in pediatric glaucoma.

Purpose: Ocular funduscopic examination is difficult in young children and is rarely attempted by nonophthalmologists. Our objective was to determine the feasibility of reliably obtaining high-quality nonmydriatic fundus photographs in children. Methods: Nonmydriatic fundus photographs were obtained in both eyes of children seen in a pediatric ophthalmology clinic. Ease of fundus photography was recorded on a 10-point Likert scale (10 = very easy). Quality was graded from 1 to 5 (1, inadequate for any diagnostic purpose; 2, unable to exclude all emergent findings; 3, only able to exclude emergent findings; 4, not ideal, but still able to exclude subtle findings; and 5, ideal quality). The primary outcome measure was image quality by age. Results: A total of 878 photographs of 212 children (median age, 6 years; range,1-18 years) were included. Photographs of at least one eye were obtained in 190 children (89.6%) and in both eyes in 181 (85.3%). Median rating for ease of photography was 7. Photographs of some clinical value (grade ≥2) were obtained in 33% of children <3 years and 95% >3 years. High-quality photographs (grade 4 or 5) were obtained in both eyes in 7% of children <3 years, 57% of children ≥3 to <7 years, 85% of children ≥7 to <9 years, and 65% of children ≥9 years. The youngest patient with high-quality photographs in both eyes was 22 months. Conclusions: Nonmydriatic fundus photographs of adequate quality can be obtained in children over age 3 and in some children as young as 22 months.