Strabismus surgery outcome among children and young adults with Down syndrome.

PURPOSE: To evaluate postoperative alignment after strabismus surgery in children with Down syndrome. METHODS: A retrospective analysis of 15 consecutive cases of children with Down syndrome who underwent surgery for strabismus between 1990 and 2008. Follow-up was at least 6 months (range, 0.5-16 years). RESULTS: All children underwent surgery for esotropia. The mean preoperative angle of deviation was 37.6Delta. Of the 15 children, 14 underwent surgical procedure for strabismus according to standard surgical tables. Surgical success (within 10Delta of orthophoria) was achieved in 12 of 14 children (85.7%). The remaining 2 children (14.3%) had residual esotropia. CONCLUSIONS: Good surgical motor outcomes were achieved in children with Down syndrome after strabismus surgery following standard surgical tables. The tendency toward overcorrection reported in children with central nervous system disorders was not observed in our study. We suggest use of the same surgical calculations as used in children with normal development when treating children with Down syndrome and esotropia.

Treating amblyopia with liquid crystal glasses: a pilot study.

PURPOSE. To evaluate the use of liquid crystal glasses (LCG) for the treatment of amblyopia caused by refractive errors, strabismus, or both. METHODS. In this noncomparative, prospective, interventional case series, 28 children (age range, 4-7.8 years) with monocular amblyopia participated, of which 24 completed the study. In the LCG, the occluding and nonoccluding phases of the flicker were electronically set in all patients at a fixed rate. The rate was set so that accumulated occlusion was 5 hours during 8 hours' weartime. Occlusion was applied only to the good eye. All 24 children were followed up regularly for 9 months. Best corrected VA for distance and near, fixation patterns, and binocular function were measured. VA for distance was measured with the Snellen chart and for near with the Rossano/Weiss chart. RESULTS. Mean VA for distance at the end of the study (after 9 months) was 0.59 (SD, 0.16) compared with 0.27 (SD, 0.09) at the beginning (P < 0.001). Most of the children (92%) complied well with the treatment. (Good compliance was defined as wearing the LCG for at least 8 hours per day.) Stereopsis at the end of treatment was good (better than 60 sec arc) in 21% of the children compared with 8% at the beginning. No serious adverse events were recorded. CONCLUSIONS. The use of LCG in patients with amblyopia yielded an improvement in near and distance VA and in stereopsis. Treatment was well accepted by children and parents.

Uveitis and juvenile idiopathic arthritis: A cohort study.

OBJECTIVE: Assess the incidence of intraocular inflammation (uveitis) and ocular complications in children with various types of JIA in a single cohort of patients. PATIENTS: Included are 172 children (35 boys and 137 girls) diagnosed with JIA. All underwent thorough initial ophthalmologic examination and were followed for a minimum of 3 years. RESULTS: Of 172 children with JIA, 152 (88.4%) presented with arthritis. Uveitis was detected in 14 of the152 children (9.2%) during the first ophthalmic examination. In 17 additional patients of this group (11.2%), uveitis developed during the follow up period of up to 15 years. Twenty children out of the total of 172 (11.6%) presented initially with uveitis. In children developing uveitis before or along with arthritic manifestations, the ocular disease was chronic with a high rate of secondary complications (band keratopathy, glaucoma, posterior synechiae and cataract). In all affected eyes the initial ocular inflammation was typically confined to the anterior segment. On longer follow up however, most children developed binocular disease and posterior segment involvement. Dense cataract and amblyopia were the major cause of severe visual disabilities. CONCLUSION: Pauciarticular JIA is associated with intraocular inflammation (uveitis) early during the arthritic disease course. The ocular disease course is unpredictable. Therefore education of parents regarding its signs and symptoms is of utmost importance. To preserve functional vision, secondary ocular complications and amblyopia should be avoided.

Onchocerciasis among Ethiopian immigrants in Israel.

BACKGROUND: Onchocerciasis results from infestation by the nematode Onchocerca volvulus, and is characterized clinically by troublesome itching, skin lesions and eye manifestations. Since 1992, approximately 9,000 immigrants have arrived in Israel from the Kuwara province of northwest Ethiopia where the prevalence of onchocerciasis is particularly high. OBJECTIVES: To determine whether onchocerciasis is the cause of cutaneous and ocular symptoms among recent immigrants from the Kuwara province in Ethiopia. METHODS: We examined 1,200 recent immigrants from the Kuwara province residing at the Mevasseret Zion immigration center outside Jerusalem. Among them, patients with cutaneous signs suggestive of onchocerciasis underwent a skin-snip biopsy and a thorough eye examination. RESULTS: In the detailed skin examination performed in 83 patients, the most common skin finding was chronic papular onchodermatitis, found in more than 46 patients (55%); depigmentation and atrophy was found in 13 (15%) and 12 (14%), respectively. In 40 patients (48%), living microfilaria were detected in their skin snips. Of the 65 patients who underwent a through eye examination, 45 patients (66%) had ocular complaints. Corneal abnormalities were found in 55 of the 130 eyes (42%), active anterior segment intraocular inflammation and live microfilariae were found in 4 eyes (3%) and lens changes in 16 eyes (1%). Eleven eyes (9%) showed retinal or choroidal changes. CONCLUSIONS: Skin and eye manifestations associated with onchocerciasis are prevalent among symptomatic Ethiopians who immigrated to Israel from the Kuwara province.

Unilateral persistent hyperplastic primary vitreous: course and outcome.

PURPOSE: Improved surgical techniques enable more favorable results in the management of persistent hyperplastic primary vitreous (PHPV). The purpose of our study was to evaluate the outcome of PHPV eyes managed conservatively or after surgery (with or without intraocular lens implantation). METHODS: A total of 89 children (37 boys, 52 girls) with PHPV in one eye (mean follow-up of 6.3 +/- 5.7 years) were included. The children were subgrouped according to treatment modality. Twenty-eight (31.5%) children were managed conservatively (nonoperated). Cataract extraction combined with vitrectomy and removal of embryonic remnants was carried out in 61 eyes (68.5%). Intraocular lenses were implanted in 30 of the operated eyes (pseudophakic) and 31 eyes remained without lens (aphakic). RESULTS: Final evaluated visual acuity in the entire group was 6/15 or better in 12.6% (11 of 87) of the eyes. A total of 11.5% (10 of 87) had a visual acuity of 6/21 to 6/60, 46.0% (40 of 87) obtained 6/90 to light perception and 26 of 87 (29.9%) had no light perception in the involved eye. The rate of no light perception was significantly lower in patients with pseudophakia (10.0%) compared to those with aphakia (43.3%) or nonoperated (37.0%) eyes (P =.009). Intraocular pressure was adequately assessed repeatedly in 72 eyes. High intraocular pressure and glaucomatous changes were observed in 7 of 31 (22.6%) patients with aphakia, 2 of 24(8.3%) patients with pseudophakia and in 2 of 17(11.8%) nonoperated eyes (P =.34). Poor cosmetic outcome was seen in 12 of 31 (38.7%) children with aphakic eyes and 5 of 30 (16.7%) children with pseudophakic eyes (P =.08). Prosthesis or cosmetic shells were needed for 8 of 31 patients with aphakia, for none of the patients with pseudophakia and for 2 of 28 of the nonoperated children (P =.003). CONCLUSION: PHPV eyes have a potential for developing useful vision with favorable cosmetic outcome after surgery. Intraocular lens implantation may be a favorable and beneficial option for the management of children with unilateral PHPV.