Changes in intraocular pressure control in the first year after secondary intraocular lens implantation in children.

PURPOSE: To compare intraocular pressure (IOP) control before and during the first year after secondary intraocular lens (IOL) implantation in children. METHODS: This was a retrospective chart review of children who received secondary IOL implantation. We analyzed IOP and antiglaucoma medications before and after implantation. The latest exam with IOP measurement found within the 2-15 month period after IOL implantation was used for the postoperative data. Failure to maintain IOP control was defined as either the addition of antiglaucoma medication(s) or a rise in IOP > 4 mm Hg. Statistical analyses were performed to assess risk factors for failure to control IOP after surgery, namely age at IOL implantation, preoperative glaucoma status, and IOL fixation location. RESULTS: A total of 100 eyes were included. The mean duration of follow-up was 7.74 months (SD = 3.11). Twenty-three of one hundred eyes failed to maintain IOP control according to our definition. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). No other risk factors were found to have statistical significance. CONCLUSION: Secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk.

Unplanned returns to the operating room within three months of pediatric cataract-related intraocular surgery: indications and risk factors.

PURPOSE: To evaluate the indications and associated risk factors for unplanned returns to the operating room within 90 days of pediatric cataract-related surgery. METHODS: The medical records patients undergoing either cataract extraction or secondary intraocular lens (IOL) implantation at a single center from 1991 to 2018 were reviewed retrospectively. RESULTS: A total of 1,392 eyes of 989 patients were included, with 48 unplanned reoperations in 46 eyes of 43 patients, yielding a reoperation rate of 3.3% (46/1392) for one reoperation and 0.14% (2/1392) for two within 90 days of surgery. Of the 48 reoperations, indications for reoperation were as follows: lens cortex reproliferation (n = 14), elevated intraocular pressure (n = 11), inflammatory pupillary membranes (n = 7), vitreous wick to the cataract surgery wound (n = 6), synechiae (n = 3), uveitis (n = 3), posterior capsule opacification in an eye with intact posterior capsule (n = 1), retained cortex (n = 1), traumatic iris prolapse (n = 1), and foreign body in anterior chamber (n = 1). Risk factors for an unplanned reoperation included a history of traumatic cataract (relative risk, 2.55) or age <1 year at time of first surgery (relative risk, 3.02). In the absence of these risk factors, the reoperation rate was 1.1%. CONCLUSIONS: Unplanned reoperations after pediatric cataract surgery are uncommon, but when they occur it is often in the setting of trauma or surgery performed before the age of 1 year.

Use of Cyanoacrylate Glue Casting for Stabilization of Periocular Skin Grafts and Flaps.

PURPOSE: To examine a novel technique for periocular skin graft and flap stabilization using cyanoacrylate glue applied to the host bed around the perimeter of the graft or flap to create an immobile cast in the immediate postoperative period to promote successful graft take and stable anatomic position. METHODS: Retrospective review was performed of a single surgeon's patients who underwent periocular skin graft or flap between August 1, 2011, and February 29, 2016, in which cyanoacrylate glue was applied postoperatively for graft stabilization. Data examined included indication for procedure, location and size of graft, postoperative complications, and length of follow up postoperatively. RESULTS: Of 164 cases reviewed, 9 cases were identified in which cyanoacrylate glue was used as the sole means of graft or flap stabilization. Indications for surgery included repair of cicatricial ectropion (3 cases) and repair of Mohs defect status after excision of basal or squamous cell carcinoma (6 cases). All cases involved reformation of the lower eyelid. Five cases employed full-thickness skin grafts and 4 cases employed adjacent tissue rearrangement. Size of defect repaired ranged from 8 mm to 35 mm when largest diameter was measured. Complications included mild residual ectropion or mild punctal ectropion in 2 patients who was asymptomatic and did not require further surgery. No cases were complicated by hematoma, infection, or graft necrosis. CONCLUSION: Cyanoacrylate glue can be used to successfully stabilize skin grafts and flaps in the immediate postoperative period.

Exposure to maternal overnutrition and a high-fat diet during early postnatal development increases susceptibility to renal and metabolic injury later in life.

Overnutrition during pre- and postnatal development both confer increased susceptibility to renal and metabolic risks later in life; however, whether they have an additive effect on the severity of renal and metabolic injury remains unknown. The present study tested the hypothesis that a combination of a pre- and postnatal diet high in fat/fructose would exacerbate renal and metabolic injury in male offspring later in life. Male offspring born to high fat/high-fructose-fed mothers and fed a high-fat/high-fructose diet postnatally (HF-HF) had increased urine albumin excretion (450%), glomerulosclerosis (190%), and tubulointerstitial fibrosis (101%) compared with offspring born to mothers fed a standard diet and fed a standard diet postnatally (NF-NF). No changes in blood pressure or glomerular filtration were observed between any of the treatment groups. The HF-HF offspring weighed ∼23% more than offspring born to mothers fed a high-fat/high-fructose diet and fed a normal diet postnatally (HF-NF), as well as offspring born to mothers fed a standard diet regardless of their postnatal diet. The HF-HF rats also had increased (and more variable) blood glucose levels over 12 wk of being fed a high-fat/high-fructose diet. A combination of exposure to a high-fat/high-fructose diet in utero and postnatally increased plasma insulin levels by 140% compared with NF-NF offspring. Our data suggest that the combined exposure to overnutrition during fetal development and early postnatal development potentiate the susceptibility to renal and metabolic disturbances later in life.