Depth of strabismic amblyopia determined with neutral density filters.

We used a neutral density filter to assess motor responses in the fixation patterns of 25 patients, ranging in age from 5 to 54 years, with strabismic amblyopia. Shifts of fixation back to the preferred eye occurred when the visual acuity of the preferred eye through the filter was marginally better than that of the amblyopic eye. Thus, we were able to correlate the level of the filter at which this shift occurred with the level of amblyopia. This technique may be particularly helpful in the examination of preliterate children and in monitoring the progress in the treatment of amblyopia.

Ocular lesions caused by caterpillar hairs (ophthalmia nodosa).

The ocular reactions to caterpillar hairs are diverse in nature and location, ranging from a toxic reaction to the external foreign bodies, keratoconjunctivitis or the formation of conjunctival nodules, to intense iritis, vitritis or papillitis. Four cases are presented in this paper to illustrate the various degrees of ocular involvement. Included are clinical photographs of intravitreal and subretinal hairs. A classification of these reactions is suggested to facilitate the choice of treatment.

Congenital glaucoma with corneal cloudiness treated by thermal sclerostomy.

Thermal sclerostomy (the Scheie procedure) was performed on nine eyes with congenital glaucoma and corneal cloudiness. The intraocular pressure was controlled and the cornea cleared in six eyes, though two required a second sclerostomy for success. In two of the remaining three eyes the intraocular pressure did not fall to normal levels, but the cornea cleared sufficiently to permit goniotomy, which was successful in each case. The remaining eye failed to respond to two sclerostomies. Thermal sclerostomy is recommended as a primary form of treatment in cases of congenital glaucoma in which corneal opacification makes goniotomy unsafe. While trabeculotomy is useful in these circumstances and may be the procedure of choice in many cases, thermal sclerostomy is recommended for the surgeon who is more familiar with this technique and for cases in which distortion of the anterior chamber angle is expected to preclude trabeculotomy or goniotomy.

Filtering surgery in childhood glaucoma.

A review of 38 eyes of 24 patients receiving filtration surgery for childhood glaucoma is presented. A total of 54 procedures were performed, including both thermal sclerostomies and trabeculectomies. Successful control of intraocular pressure was obtained in 20 eyes (52%). Average follow-up time was four years, two months. Filtration surgery is seen as a useful technique in the treatment of childhood glaucoma when goniotomy fails. It also is useful in those conditions where the success rate of goniotomy is expected to be low.

Exposure of tantalum mesh orbital implants.

This retrospective study of 195 enucleations with tantalum mesh implants reviews the role of demographic, preoperative, and operative factors in subsequent implant exposure or extrusion. Fourteen implants (7.2%) became exposed, two of which subsequently extruded. Significant associations were found between implant exposure and history of prior orbital infection, and suturing of the inferior oblique to the lateral rectus muscle. The average age at enucleation was 20.4 years for those whose implant became exposed, which was significantly less than the average age of 38.7 years for those without exposure of the implant. No association was found between implant exposure and gender, preoperative diagnosis, proptosis, chemosis, sharp trauma to the orbit, orbital fracture, previous orbital surgery, implant size, closing of posterior Tenon's capsule, or muscles sutured to the implant. Because of the high exposure rate, it is recommended that the use of tantalum mesh implants be discontinued.