Ocular manifestations of congenital insensitivity to pain: a long-term follow-up.

AIM: To describe ocular manifestations in children with congenital insensitivity to pain with and without anhidrosis (CIPA and CIP). METHODS: We reviewed records of eye examinations of 39 children diagnosed with CIPA or CIP. We collected clinical data, with particular attention to ocular surface findings. Corneal sensitivity was tested by presence of a blink reflex upon touching the cornea. Statistical analysis assessed differences in manifestations between the two conditions, and relationships among corneal sensitivity, presence of corneal opacities and visual acuity (VA). RESULTS: CIPA was diagnosed in 32 children and CIP in 7. The median follow-up periods were 50 months (CIPA group) and 94 months (CIP group). Corneal opacities were present in 23% of CIPA eyes and in 57% of CIP eyes. A blink reflex was positive in 52% of CIPA eyes and in 33% of CIP eyes. We recorded VA ≥20/25 in 36% of CIPA eyes, whereas all patients with CIP had VA ≤20/30. For the whole cohort, we found a negative correlation between a preserved blink reflex and the presence of corneal opacities, and a positive correlation between a preserved blink reflex and VA ≥20/25. CONCLUSION: Children with congenital insensitivity to pain are prone to develop corneal scarring. Patients with CIP tend to have more severe ocular surface disease than those with CIPA, probably due to more prevalent loss of corneal sensation. In both groups, a preserved blink reflex correlated with good vision. Affected children should have close follow-up to promptly treat ocular surface disease and prevent vision loss.

Infantile cataract: comparison of two surgical approaches.

OBJECTIVE: To compare the results of 2 cataract extraction techniques with primary intraocular lens (IOL) implantation in children. DESIGN: Retrospective comparative case series study. METHODS: This study included children with congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis, and primary IOL implantation were performed. We compared 2 surgical approaches. In the first approach, after IOL implantation in the bag, posterior optic capture (OC) was performed without anterior vitrectomy (OC technique); in the second approach, anterior vitrectomy was performed without OC of the IOL (AV technique). Patient demographic data as well as ethnic origin, child's age at cataract diagnosis, child's age at surgery, axial length, IOL power in diopters, visual acuity, visual axis opacification, and complications were assessed. RESULTS: One hundred twenty-three eyes were included for surgical approach outcomes comparison; 21 eyes underwent the OC surgical approach and 102 the AV surgical approach. The mean patient age at surgery was 57.3 ± 47.1 months. The mean follow-up was 63.13 months (range 12-202 months). Epithelial lens reproliferation was the major adverse event in our series, affecting 21.1% of patients' eyes; the mean time to epithelial lens reproliferation development was 90 ± 9.70 months. There was no statistically significant difference between the two groups in best spectacle-corrected visual acuity or epithelial lens reproliferation incidence. CONCLUSIONS: In our case series we did not find any difference between surgical techniques.

New approach for pterygium removal using 20 % ethanol.

The aim of this study is to present a new method for pterygium removal using ethanol 20 % solution, applied to a retrospective consecutive case series conducted in the Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel. The technique adopted the following procedure. After subconjunctival bupivacaine hydrochloride 0.5 % injection, a metal ring well, as used in laser-assisted subepithelial keratectomy, was placed above the head of the pterygium. A few drops of ethanol 20 % were applied inside the well and maintained in place for 40 s. The ethanol was then washed with Balanced Salt Solution. Pterygium was easily separated starting at 2 mm central to the head using a spatula. The apex was excised with further separation of the fibrovascular tissue towards the base. The base was excised and mitomycin C 0.02 % applied for 2.5 min. The ocular surface was profusely washed leaving the bare sclera. Records were reviewed of all the patients who underwent pterygium removal with ethanol between May 2006 and March 2007. The results showed that 68 eyes from 64 patients were operated on. There were no intraoperative complications. During follow-up periods of at least 12 months, no serious side effects were detected and only two cases (2.9 %) of recurrence were observed. The results obtained show that the Pterygium removal using alcohol 20 % solution is a simple procedure, creates a clear separation plane between the pterygium and the underlying cornea, and is a safe procedure.

Microangiopathic Anemia of Acute Brucellosis - is it a True TTP?

Thrombotic thrombocytopenic purpura (TTP) is a severe disease, potentially fatal, if not diagnosed and treated promptly. TTP is clinically characterized by the pentad of thrombocytopenia, Coombs-negative hemolytic anemia, fever, renal abnormalities and neurological disturbances. Advances in recent years have delineated the molecular mechanisms of acquired and hereditary TTP.Many infectious organisms have been reported to be associated with TTP, especially mycoplasma, but few cases of Brucella infection associated with thrombotic microangiopathy have been reported.We describe a young woman who presented with TTP after acute infection with both Brucella melitensis and Brucella abortus. The patient completely recovered following aggressive therapy with plasmapharesis, high-dose corticosteroids and appropriate antimicrobial therapy.Since measurement of ADAMTS13 activity and neutralizing antibodies is now available, and none of the reported cases of brucellosis with thrombotic microangiopathy (including the present report) were tested, for better understanding of this rare association, we recommend this work-up in future cases.