Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study.

Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.

Superior limbic keratoconjunctivitis causing chronic ocular irritation in a child.

Superior limbic keratoconjunctivitis (SLK) is an uncommon, painful inflammation of the ocular surface localized to the superior sectors of the cornea, limbus, and conjunctiva. The clinical course tends to be chronic, with alternating periods of remission and exacerbation. Many patients experience severe ocular discomfort for long periods. Corneal involvement may induce scarring, astigmatism, and ultimately decreased vision. SLK typically occurs in woman between 20 and 60 years of age. Little is known about the features of SLK in young children because the earliest age described in the literature is adolescence. We report the clinical presentation and management of SLK in a 7-year-old boy who responded well to topical steroids and lubricants.

Comparison between macular pigment optical density measurements using two-wavelength autofluorescence and heterochromatic flicker photometry techniques.

PURPOSE: The association of macular pigment (MP) with age-related macular degeneration has been extensively studied in recent years, and interest in a rapid, objective, and accurate technique to measure MP optical density (MPOD) has increased. The purpose of this study was to compare the MPOD values at specific loci around the fovea using the heterochromatic flicker photometry (HFP) and the two-wavelength autofluorescence (AF) methods in a young, healthy population. METHODS: Ten patients (20 eyes) were enrolled. Subjects with any ocular or systemic disease were excluded. All patients underwent HFP and AF examination. The AF examination was performed using a modified scanning laser ophthalmoscope. Values for both devices were measured at four eccentricities around the fovea (0.25 degrees , 0.5 degrees, 1.0 degrees, and 1.75 degrees). Each eye was tested three times with each METHOD: Statistical analysis was based on paired t-test and linear regression analysis. RESULTS: At all retinal eccentricities, the HFP values were consistently lower than the HRA values (P < 0.001). There was, however, a significant correlation at almost all locations. The strongest correlation between two methods was found at 1.75 degrees from the center of the fovea (r = 0.73). CONCLUSIONS: The modified-HRA AF method for MPOD generated results that were highly correlated with the standard HPF method but consistently higher at all eccentricities. These findings suggest that HRA can be reliably used in patients unable to perform HPF, which is important for wider clinical application of MP testing.

Corneal curvature and axial length values in children with congenital/infantile cataract in the first 42 months of life.

PURPOSE: To evaluate corneal curvature (K(m)) and axial length (AL) of eyes of term-born children aged <3.5 years with uncomplicated congenital cataract and provide age-specific estimates. METHODS: This was a retrospective review of patients undergoing cataract extraction from January 1994 to December 2006. Exclusion criteria were preterm birth, microphthalmia, microcornea, megalocornea, glaucoma, traumatic or complicated cataract, retinal disease. Keratometric readings were taken with an autokeratometer before surgery. Linear regression with the logarithm of the patient's age as an independent variable was used to model the relationship between the patient's age and biometric and keratometric readings. RESULTS: All unilateral cataractous eyes (n = 69) and a randomly selected eye in bilateral cases (n = 111) were included in the analysis, for a total of 180 eyes. Mean age was 15.5 +/- 11.8 months; mean AL, 20.03 +/- 2.25 mm; mean K(m), 45.07 +/- 3.00 D. K(m) was significantly greater and AL shorter in younger children (P < 0.001). No differences according to sex were found. As a group, eyes from unilateral cataract had significantly longer AL than those from bilateral cases (P = 0.029). In a small subgroup of unilateral cataract patients for which readings from the clear lens eye were available (n = 39), K(m) of the affected eye was significantly greater than that of the fellow healthy eye (P = 0.007). CONCLUSIONS: In the first 42 months of age, K(m) and AL are significantly different according to age. These findings have implications for the calculation of intraocular lens power in children.