Unilateral high myopia leading to asymmetric disc edema in idiopathic intracranial hypertension.

Asymmetrical disc edema in idiopathic intracranial hypertension (IIH) is an uncommon finding, with an unclear understanding. This report reinforces the importance of recognizing this entity in IIH diagnosis, and not misdiagnose the condition as unilateral disc edema. In this unique report, the causative association of asymmetric optic disc edema, with optic nerve kink, due to unilateral high myopia, is documented.

Spectacle prescription in children: Understanding practical approach of Indian ophthalmologists.

Purpose: The aim of this study is to survey the management approach, regarding spectacle prescription in children, among Indian ophthalmologists. Methods: A web-based, anonymous questionnaire (multiple choice questions dealing with practical aspects of pediatric refraction), was sent to available database of Indian ophthalmologists. The survey responses (depicted in %) were compared using the amount of pediatric clientele in one's practice (Group A: <25%, Group B: 25% or more). The responses were also analyzed in relation to the published concepts from literature. Results: Two hundred and ten ophthalmologists (2.74% response rate; 48% in Group A), from all over India, responded to the survey. There were wide discrepancies in the responses (both, in and among, Groups A and B; P > 0.05, Chi-square test), as to when and how much refractive error to prescribe in children, for a given situation. Conclusion: A wide gap exists between pediatric spectacle prescription patterns of Indian ophthalmologists, as compared to the recommended pediatric ophthalmology protocols. The management approach, for certain situations concerning the pediatric refraction, was better among those with higher pediatric clientele.

Exotropia-hypotropia complex in high myopia.

PURPOSE: To highlight the association of exotropia-hypotropia complex in cases of high myopia and its surgical outcome. METHODS: A retrospective study of 15 consecutive patients, diagnosed as having high myopia and exotropia-hypotropia, observed between January 2002 and May 2012 was performed. The main outcome measures were clinical presentation, orbital imaging features, and the surgical outcome of cases. RESULTS: Of the 15 patients, 9 were female. The median age was 23.5 years (range: 10 to 35 years). Thirteen cases had unilateral high myopia in the deviated eye. The mean axial length of the deviated eye was 29.43 ± 1.51 mm. Eight patients (53%) had a history of progressive eye deviation in adulthood. All patients had amblyopia of the deviating eye. The mean preoperative exotropia was 37.2 ± 8.72 prism diopters (PD) (range: 18 to 50 PD). The mean preoperative hypotropia was 12.73 ± 5.58 PD (range: 5 to 20 PD). An elevation deficit was noted in 6 patients (40%). On orbital imaging, high myopic eyes with deviation did not show significant displacement of rectus muscles in comparison to fellow eyes (P > .05, all rectus muscles). Eight cases (53%) were surgically managed with a median follow-up of 7 months. Intraoperatively, one case was found to have misplaced muscle insertion. Successful alignment was achieved by surgery on either horizontal rectus muscles alone (37%), or in combination with vertical muscles (62%). CONCLUSIONS: Exotropia-hypotropia complex can occur in association with high myopia. No specific etiologic factors, clinical or radiological, were identified in this study. Successful alignment may be achieved in these cases using tailor-made strabismus procedures.

Childhood pterygium: a descriptive study of 19 cases presented to a tertiary eye care center.

PURPOSE: To describe the demographic features, clinical characteristics, and management in cases of childhood pterygium. DESIGN: Observational case series. METHODS: A retrospective review was done of 19 children (total 26 eyes) under the age of 16 years, consecutively presenting with pterygium and evaluated at a single tertiary care center between January 2000 and August 2011. The main outcome measures were clinical features, associated ocular or systemic diseases, approach towards its management, and histopathology of operated cases. RESULTS: Of the 19 patients, 10 were girls and 9 were boys. The mean age at presentation was 10.63 ± 3.48 years (range 2-15 years). Seven patients (37%) had bilateral involvement. None of the cases had familial history. The median refractive astigmatism was found to be -0.5 diopter cylinder. All the eyes had primary pterygium, except 1, which was recurrent. The majority of the eyes (85%) were managed conservatively. Four eyes (15%) required surgery, where pterygium excision with conjunctival-limbal autograft with fibrin glue application was done. The follow-up of surgical cases ranged from 5 to 38 months (median 6 months). One operated case recurred 1 year after surgery. CONCLUSION: Development of pterygium is a possibility in younger age groups. No specific predisposing factors, either environmental or familial, were identified as contributing to childhood pterygium. The majority of the cases required conservative management.

Horizontal gaze palsy and progressive scoliosis due to a deleterious mutation in ROBO3.

PURPOSE: To describe a family with horizontal gaze palsy and progressive scoliosis with a deleterious mutation in the ROBO3 gene. METHODS: All family members had full ophthalmologic, neurologic, and orthopedic examinations and complete sequencing of the ROBO3 gene. RESULTS: Four affected members had complete loss of horizontal gaze with progressive scoliosis that varied between family members. ROBO3 sequencing revealed a novel 15 base deletion (c.2_16 delTGCTGCGCTACCTGC) in exon 1 that segregated in homozygous form with the phenotype and probably alters the shape and ionic charge of the extracellular immunoglobulin motif 1. This mutation was not detected in 100 control chromosomes. CONCLUSIONS: The novel ROBO3 mutation in this family may be among the most deleterious yet reported. Family members in general were severely affected, but comparison of this family to other families with ROBO3 mutations did not yield a definitive phenotype-genotype correlation.

Hang-back recession of inferior oblique muscle in V-pattern strabismus with inferior oblique overaction.

INTRODUCTION: Although hang-back recession has widely been used as a weakening procedure on extraocular muscles, its effectiveness has mostly been studied for rectus muscles. We report a surgical technique for recessing the inferior oblique muscle and evaluate its effectiveness in V-pattern strabismus with inferior oblique overaction (IOOA). METHODS: Fifteen patients with V-pattern strabismus and IOOA, 7 with V exotropia, and 8 with V esotropia underwent hang-back recession of inferior oblique muscle in addition to horizontal muscle surgery when required. The surgical technique consisted of free suspension of one or both inferior oblique muscles 10 mm along their physiological path using 6-0 polyglactin 910 sutures bridging the cut ends of muscle. RESULTS: The mean preoperative V pattern in the V-exotropia group was 22(Delta) +/- 6(Delta) and 25(Delta) +/- 7(Delta) in V-esotropia group. The mean correction of V pattern after a mean follow-up period of 8 +/- 1 months was 19(Delta) +/- 2(Delta) for the V-exotropia group and 22(Delta) +/- 7(Delta) months for the V-esotropia group. Mean correction of IOOA in the V-exotropia group was 18(Delta) +/- 5(Delta); in the V-esotropia group, mean correction was 20(Delta) +/- 6(Delta) in the right eye and 18(Delta) +/- 2(Delta) in the left eye. CONCLUSIONS: Hang-back recession of inferior oblique is another surgical procedure for correction of both V pattern and IOOA in V-pattern strabismus.

Malignant fibrous histiocytoma of the conjunctiva.

Fibrous histiocytomas are mesenchymal tumours composed of cells with fibroblastic to histiocytic differentiation. They can occur in any part of the body including the orbital tissues. To date, there are 18 cases of fibrous histiocytoma arising from the corneoscleral limbus reported in the literature. Eleven of these were classified as benign, and the rest were malignant fibrous histiocytomas. Benign fibrous histiocytomas have been reported in the orbit, eyelid, episclera and conjunctiva. Malignant fibrous histiocytoma has been well described in the orbit, but rarely as a primary conjunctival tumour. The rarity of the tumour makes its diagnosis and management a challenge. Herein, the clinicopathological features of a case of malignant fibrous histiocytoma are presented and its management with wide excision and cryotherapy followed by ocular reconstruction with amniotic membrane transplant is discussed.

Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery.

PURPOSE: To evaluate the functional outcomes of in-the-bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. SETTING: Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. METHODS: Forty-two eyes of 25 children were included in this prospective study. All eyes had in-the-bag implantation of an AcrySof IOL (Alcon). Twenty-five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS: The mean age of the patients was 78 months (range 36 to 144 months). The mean follow-up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow-up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits ) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. CONCLUSIONS: An optimal-sized ACCC followed by in-the-bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.

Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis.

OBJECTIVE: To present the clinical findings in 7 patients with preseptal cellulitis caused by tuberculosis. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Seven patients. METHODS: Review of clinical findings, course, diagnostic tools, and management of 7 cases with tubercular preseptal cellulitis. MAIN OUTCOME MEASURES: Healing of local and systemic lesions, cosmetic correction. RESULTS: The presenting features of tuberculosis included lid abscess formation in 5 cases, with spontaneous fistulization in 2 patients. Two cases were initially seen with a cicatricial ectropion of the upper lid. A history of a lid swelling with spontaneous fistulization was present in both cases. Nonresponsiveness of the lesions to systemic antibiotics led to a detailed evaluation of the patients, and evidence of an underlying active or healed systemic focus was present in all the cases. Acid-fast bacilli from pus from the discharging sinuses were identified in only 1 case, and in another patient, a biopsy specimen of the submandibular lymph node showed caseation necrosis. In the other cases, the diagnosis was presumptive from a strongly reactive Mantoux test, raised erythrocyte sedimentation rate, and the presence of a systemic focus. All the patients showed a dramatic response with antitubercular treatment, with complete healing of lesions. Two patients had a residual cicatricial ectropion, which was corrected surgically in both cases. CONCLUSIONS: Preseptal or lid involvement can be the presenting feature of tuberculosis and a marker for underlying systemic focus in children. Spontaneous fistulization of the abscess, minimal inflammatory signs, nonresponsiveness to antibiotic therapy, tethering to the underlying structures and skin, and the presence of a cicatricial ectropion should alert the clinician to look for an alternate diagnosis. The lid presentation might be a marker of an underlying systemic focus; therefore, awareness of the many faces of tuberculosis is important for ophthalmologists.

Efficacy of continuous wear PureVision contact lenses for therapeutic use.

PURPOSE: To evaluate the Bausch and Lomb PureVision contact lens as continuous wear contact lens for therapeutic and medical indications in a prospective open-ended non-randomized trial. METHODS: Patients who required therapeutic contact lens wear for various indications such as pain relief, corneal protection, persistent epithelial defects, corneal perforation and chemical burns were fitted with PureVision continuous wear contact lenses (balafilcon A, 36% water content). Success or failure of specific treatment indication was assessed in each case with evaluation of ocular and lens related complications. RESULTS: 30 eyes of 28 patients were fitted with PureVision continuous wear contact lenses. A successful fit was seen in 27 of 30 eyes with therapeutic success in 26 of 30 eyes. However, all patients reported symptomatic relief. Duration of lens use ranged from 3 days to 3 months. Dry eye was the most frequent cause of contact lens associated therapeutic failure. Complications included lens loss (two eyes), tight lens (one eye) and infective keratitis (two eyes). CONCLUSIONS: PureVision contact lenses were found to be safe and efficacious for continuous wear therapeutic use to a maximum of 90 days. The contact lens was also easier to handle by virtue of its resilient nature. There were no significant corneal complications of hypoxia, i.e. corneal oedema. Lens losses and deposits were minimal. The lens performance and fitting characteristics compares favorably with previous therapeutic lenses used by the investigators. This new lens may be considered as a safe and effective alternative for use as bandage contact lens.