Amniotic membrane transplants in the pediatric population.

PURPOSE: To investigate the indications for and results of amniotic membrane transplantation (AMT) for the treatment of ocular disease in pediatric patients at a single institution. METHODS: The medical records of patients <18 years of age who underwent AMT for ocular disease between January 1, 2003, and September 1, 2015, were reviewed retrospectively. Patients were determined to have reached a clinical endpoint if there was resolution of the ocular condition being treated after AMT placement, no additional surgery required for treatment of the ocular condition, and no active disease at most recent follow-up. RESULTS: A total of 48 records were reviewed. Of these, 32 patients (67%) received AMT for treatment of ocular disease related to Stevens Johnson syndrome (SJS), 29 (94%) of whom reached the clinical endpoint. The remaining 16 patients (33%) underwent AMT for indications other than SJS, including difficult-to-treat corneal epithelial defects and ulcers, conjunctival reconstruction, and scarring after strabismus surgery. Of these, 80% reached the clinical endpoint. There were no adverse effects related to AMT in either group. CONCLUSIONS: In our series, AMT was used successfully and without complications.

Ophthalmic manifestations and outcomes after cavernous sinus thrombosis in children.

PURPOSE: To review the causes, treatment, and outcomes of cavernous sinus thrombosis (CST) in children. METHODS: The medical records of children (<18 years of age) diagnosed with thrombophlebitis of an intracranial venous sinus were reviewed to identify cases of CST presenting to Children's Hospital Colorado from January 2000 through January 2013. Cases were evaluated for etiology, symptoms, imaging characteristics, treatment, and outcomes. RESULTS: A total of 110 children with a venous thrombus of an intracranial sinus were included. Of these, 9 had a CST. All cases were confirmed by magnetic resonance imaging. All 9 had sinusitis, 4 had orbital involvement, and 1 resulted from a nasal septal abscess. Eight cases presented with ophthalmoplegia, and 5 presented with decreased vision. Every patient underwent sinus surgery: 4 underwent orbitotomy for abscess drainage, and 1 required bilateral exenteration. Cultures were inconclusive in 2 cases, and 2 cases were culture positive rhino-orbital mucormycosis. There was 1 case of methicillin-resistant Staphylococcus aureus. Of the 9 cases, 4 returned to normal vision and ocular motility; 5 had permanent ophthalmoplegia and vision loss. There were no cases of mortality. CONCLUSIONS: CST is a rare complication of orbital and sinus disease. High clinical suspicion, early neurologic imaging, and a multidisciplinary approach to management are key factors in reducing morbidity and mortality from CST in children.