Effects of extraocular muscle surgery in children with monocular blindness and bilateral nystagmus.

BACKGROUND: Monocular infantile blindness may be associated with bilateral horizontal nystagmus, a subtype of fusion maldevelopment nystagmus syndrome (FMNS). Patients often adopt a significant anomalous head posture (AHP) towards the fixing eye in order to dampen the nystagmus. This clinical entity has also been reported as unilateral Ciancia syndrome. The aim of the study was to ascertain the clinical features and surgical outcome of patients with FMNS with infantile unilateral visual loss. METHODS: In this retrospective case series, nine consecutive patients with FMNS with infantile unilateral visual loss underwent strabismus surgery to correct an AHP and/or improve ocular alignment. Outcome measures included amount of AHP and deviation at last follow-up. RESULTS: Eye muscle surgery according to the principles of Kestenbaum resulted in a marked reduction or elimination of the AHP. On average, a reduction of AHP of 1.3°/mm was achieved by predominantly performing combined horizontal recess-resect surgery in the intact eye. In cases of existing esotropia (ET) this procedure also markedly reduced the angle of deviation. A dosage calculation of 3 prism diopters/mm was established. CONCLUSIONS: We advocate a tailored surgical approach in FMNS with infantile unilateral visual loss. In typical patients who adopt a significant AHP accompanied by a large ET, we suggest an initial combined recess-resect surgery in the intact eye. This procedure regularly led to a marked reduction of the head turn and ET. In patients without significant strabismus, a full Kestenbaum procedure was successful, while ET in a patient with a minor AHP was corrected by performing a bimedial recession.

Changes of visual function and visual ability in daily life following cataract surgery.

PURPOSE: To examine best corrected visual acuity (BCVA), contrast sensitivity (CS) and functional visual complaints in early cataract and after the cataract surgery. PATIENTS AND METHODS: 53 eyes with early cataract (BCVA 20/30: Snellen charts) were examined before the surgery as well as 12 months after the surgery. BCVA was tested using logMAR chart. CS was examined using VCTS chart in 6 spatial frequencies. Influence of glare was tested using BAT. Patients' subjective visual functions were evaluted using a questionnaire (distance vision, near vision, mesopic vision and glare conditions). 22 subjects were examined as control group. RESULTS: BCVA was 0.52 (0.22-1.05) preoperatively and 0.83 (0.37-1.26) postoperatively. BCVA in patients in both terms was significantly lower compared to the control group. CS in patients before surgery was significantly lower compared to controls, postoperatively improved significantly and was only nonsignificantly lower compared to controls except for the highest spatial frequency. Glare had only nonsignificant influence. The questionnaire scores were correlated with visual performance in both terms. CONCLUSIONS: The significant improvement of both BCVA and CS suggest that cataract surgery improves quality of life in early cataract. Questionnaire should be considered as adjuncts to BCVA and CS in evaluating early cataract.

Effect of photorefractive keratectomy and laser in situ keratomileusis in high myopia on logMAR visual acuity and contrast sensitivity.

PURPOSE: To compare effect of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) on contrast sensitivity (CS) and best corrected visual acuity (BCVA) in high myopia. METHODS: 38 myopes (PRK) and 31 patients (LASIK) were examined before and 1, 3, 6, and 12 months postoperatively. Mean preoperative spherical equivalent was -8.0 +/- 1.7D (PRK) and -9.2 +/- 2.1D (LASIK). CS was tested on a computerized system of the Contrast Sensitivity 8010 Type at 6 spatial frequencies (0.74 and 29.55 c/deg), BCVA was measured on logMAR charts. RESULTS: At 12 months postoperatively, mean spherical equivalent was -0.6 +/- 1.0D (PRK) and -1.0 +/- 0.8D (LASIK). Postoperative values of CS were significantly higher in the PRK group, except for spatial frequencies of 3.69 and 7.39 c/deg up to 3 months postoperatively. The initial significant decrease of BCVA lasted up to 6 months after PRK. In the LASIK group BCVA was not significantly different from its preoperative level at the 3-months follow-up. CONCLUSIONS: The significant improvement of CS after PRK suggest that PRK can improve quality of vision in eyes with high myopia. Although recovery of BCVA after LASIK was faster than after PRK, there may be a persistent decrease in CS.