Outcome of optical iridectomy in Peters anomaly.

PURPOSE: Optical iridectomy creates a defect in the iris to allow an alternative clear visual axis in cases of central corneal opacities occluding the pupillary axis. The purpose of this study is to evaluate the outcomes of optical sector iridectomy in children with Peters anomaly. METHODS: Retrospective case series. The medical records of all patients diagnosed with Peters anomaly who underwent optical iridectomy during the years 2002-2014 were reviewed. Data collection included surgical and visual acuity outcomes. RESULTS: Twenty-nine eyes (22 patients) were included in the study. Mean age at the time of surgery was 15.6 ± 26.3 months. Eighteen (81.8%) patients had bilateral disease. No intraoperative complications occurred. A red reflex was obtained in 28 (96.6%) eyes after surgery. Mean visual acuity improved from 2.5 ± 0.3 to 1.8 ± 0.6 in logMAR (p < 0.001). Vision improved in 21 (72.4%) eyes, remained stable in 5 (17.2%) eyes, and deteriorated in 3 (10.3%) eyes. Postoperatively visual acuity improved significantly in the patients with the bilateral disease (p < 0.05), but not in the unilateral group (p = 0.056). Mean follow-up time was 41.6 ± 43.8 months. During the follow-up period, five (17.2%) eyes were diagnosed with glaucoma, two (6.9%) eyes underwent PK, one (3.4%) eye underwent an additional sector iridectomy, and one (3.4%) eye underwent keratoprosthesis. CONCLUSIONS: In this largest series published of optical iridectomy for Peters anomaly, it was found to be a safe procedure. Improvement in visual acuity is expected, particularly in bilateral cases. The utility of optical iridectomy in unilateral cases necessitates further studies.

Prevalence of Visual Impairment among 4- to 6-years-old Children in Khon Kaen City Municipality, Thailand.

Objective: To evaluate the prevalence of visual impairment of children aged four to six years in Khon Kaen City Municipality, Thailand. Material and Method: The visual acuity test was performed on 1,286 children in kindergarten schools located in Khon Kaen Municipality. The first test of visual acuity was done by trained teachers and the second test by the pediatric ophthalmologist. The prevalence of visual impairment of both tests was recorded including sensitivity, specificity, likelihood ratio, and predictive value of the test by teachers. The causes of visual impairment were also recorded. Results: There were 39 children with visual impairment from the test by the teacher and 12 children from the test by the ophthalmologist. Myopia is the single cause of visual impairment. Mean spherical equivalence is 1.375 diopters (SD = 0.53). Median spherical equivalence is 1.375 diopters (minimum = 0.5, maximum =4). The detection of visual impairment by trained teachers had a sensitivity of 1.00 (95% CI 0.76-1.00), specificity of 0.98 (95% CI 0.97-0.99), likelihood ratio for a positive test 44.58 (95% CI 30.32-65.54), likelihood ratio for a negative test 0.04 (95% CI 0.003-0.60), positive predictive value of 0.31 (95% CI 0.19-0.47), and negative predictive value of 1.00 (95% CI 0.99-1.00). Conclusion: The prevalence of visual impairment among children aged four to six year old is 0.9%. Trained teachers can be examiners for screening purpose.

Comparisons of Amplitude Reduction of Pattern Visual Evoked Potential (VEP) and Flash VEP between Using Srinagarind Eye Patch and Commercial Eye Patch in Normal Subjects.

OBJECTIVE: To compare the difference of amplitude reduction of pattern VEP and flash VEP between occluding eye with Srinagarind eye patches and commercial eye patches in normal subjects. MATERIAL AND METHOD: Fifteen subjects (7 males and 8 females) who had normal eye examinations were enrolled. Amplitude of pattern VEP was recorded for each individual subject as baseline data. Right eyes were occluded with Srinagarind eye patches and fellow eyes with commercial eye patches (3M) and then the VEP were retested (pattern and flash VEP). The reduction of amplitude in pattern and flash VEP was recorded. RESULTS: The commercial eye patch significantly reduced the amplitude of retinal stimulation by pattern reversal stimuli on pattern VEP better than the Srinagarind eye patch 1.68 µV (95% CI 0.48-2.87). The commercial eye patch group had amplitude of retinal stimulation by light stimulation on flash VEP greater than the Srinagarind eye patch 3.92 µV (95% CI -9.25-1.41), but not statistically significant. There was also no report of any serious side effects in either group. CONCLUSION: This is the first study aiming to demonstrate the ability of the Srinagarind eye patch to reduce the retinal stimulation compared with the commercial eye patch by using the VEP test. Further study is needed to test the effectiveness of the Srinagarind eye patch.

Accuracy of Intraocular Lens Calculation by SRK/T Formula in Pediatric Cataracts.

OBJECTIVE: To examine the accuracy of the intraocular lens calculation by SRK/T formula in pediatric cataract patients, by means of the prediction error after the cataract surgery. MATERIAL AND METHOD: A retrospective review of pediatric patients requiring cataract extraction with intraocular lens implantation, between January 2006 and December 2013 was performed. Post-operative spherical equivalent was compared with the predicted calculation value from pre-operative SRK/T measurement, defined as prediction error (PE). RESULTS: 139 eyes from 106 patients were studied. The median age of patients at surgery was 4.56 years (IQR, 14). The two most common causes of cataract were idiopathic and traumatic; 85 eyes (61.2%) and 36 eyes (25.9%), respectively. Primary intraocular lens (IOL) implantation was performed in 87 (62.6%) eyes. The mean PE was -1.32±1.89 D (-7.78, 2.24). At one to three months after surgery, the mean PE of IOL in bag and sulcus were -0.87 D and -2.02 D, respectively. In non-traumatic group, the mean PE of IOL in bag and sulcus were -1.1 D and 2.28 D, respectively, whilst the traumatic group was -0.33 D and -1.16 D, respectively. Post-operative PE within ±1 diopter was found in 30 eyes (37.97%) at one to three months of follow-ups. CONCLUSION: The majority of post-operative refraction was more myopic than the taigeted refractive error, which was calculated by SRK/T formula. Aiming for a more hyperopic target and IOL implantation in the bag would decrease the post-operative prediction error in the use of the SRK/T formnula in pediatric cataract patients.

Bilateral medial rectus recession with or without posterior fixation in large-angle infantile esotropia: a randomized controlled trial.

PURPOSE: To compare the results of bilateral medial rectus recession (BMRc) versus bilateral medial rectus recession with Faden operation (BMRF) in the treatment of large-angle infantile esotropia. STUDY DESIGN: A double blinded, parallel, randomized controlled trial. METHODS: Patients with large-angle infantile esotropia (≥ 60 prism diopters, [PD]) aged between 3 and 15 years old were included and assigned to either the BMRc or BMRF group. Mean difference and mean reduction of angle deviation between the two groups were compared at 1 week, 1, 3, and 6 months by using generalized estimating equations analysis. Surgical success rates, defined as an esodeviation ≤ 10 PD at near fixation, were evaluated at 6 months postoperatively. Complications from the surgical procedures were observed. RESULTS: Of 40 enrolled patients, the mean (SD) age of the patients in the BMRc group was 3.4 (1.9), and in the BMRF group, 5.2 (3.8) years old. The overall mean differences of angle reduction between both groups were not significant (-6 PD, 95%CI -14 to 2, P = .12). The surgical success rate at 6 months in the BMRF group (72%) was not different compared to BMRc group (84%, P = .45). Overall consecutive exotropia was 5%, not different between groups (P > .99). There was no difference of complications between the two groups (P = .51). CONCLUSION: BMRF and BMRc approaches show no difference in treatment of large-angle infantile esotropia. Nevertheless, a long-term assessment for consecutive exotropia should be considered for both surgical procedures.

Botulinum Toxin Injection versus Extraocular Muscle Surgery for Acute Acquired Comitant Esotropia.

Purpose: To compare the success rate of extraocular muscle surgery and botulinum toxin injection for treatment in patients with acute acquired comitant esotropia (AACE). Patients and Methods: This is a retrospective cohort study in which we treated 34 patients of AACE with botulinum toxin compared with 80 patients who had been treated with surgery. The data included angle of deviation in prism diopter (PD) at baseline and one, three, and six months after treatment. The main outcome was the success rate in each treatment group. Results: In the surgery group, mean esodeviation angles at baseline and one, three, and six months after treatment were 50.8 ± 18.3 PD, 4.9 ± 8.3 PD, 4.6 ± 9.5 PD, and 5.5 ± 10.3 PD, whereas those in the botulinum toxin group were 51.2 ± 14.3 PD, 13.9 ± 17.4 PD, 22.0 ± 19.3, and 31.3 ± 23.8 PD, respectively. There was a statistically significant difference in the deviation angles between the two groups (p < 0.001). The success rate in the surgery group at one, three, and six months was 81%, 84%, and 79%, whereas that in the botulinum toxin group was 50%, 27%, and 27%. Conclusion: Botulinum toxin injection was not as effective as conventional extraocular muscle surgery in AACE patients. However, the treatment is safe, fast-acting, and improves both cosmetic appearance and quality of life. This may be considered as a chance for patients not preferring surgery.

Diagnostic accuracy of a digital fundus photographic system for detection of retinopathy of prematurity requiring treatment (ROP-RT).

OBJECTIVES: To evaluate the diagnostic accuracy of a digital fundus photographic system that consists of taking fundus photographs by a trained technician using a RetCam® shuttle and interpreting fundus images by an expert to detect Retinotapthy of Prematurity requiring treatment (ROP-RT) which defined as type I ROP according to the Early Treatment for ROP study (ETROP). MATERIALS AND METHODS: One hundred infants were examined by (1) an expert ophthalmologist experienced in ROP care using indirect ophthalmoscopy; (2) digital wide-field imaging by a trained technician using a RetCam® shuttle and images were sent remotely for interpretation by two ophthalmologists experienced in ROP care (Reader A, and Reader B); and (3) local ophthalmologists using indirect ophthalmoscopy. The diagnostic acurracy consisting of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated. Agreement between all examiners and readers were evaluated. RESULTS: A total of 100 infants (mean gestational age 31.1 weeks, mean birth weight 1,511.1 grams) participated in the study. Nine infants were classified as ROP-RT. Reader A and B had very good agreement in detection of ROP- RT (Kappa 1.00, 95% CI 1.00, 1.00). For reader A, diagnostic performance parameters (95% confidence intervals) for detecting ROP-RT were; sensitivity 100.0% (66.4, 100.0), specificity 97.8% (92.1, 99.7), PPV 81.8% (48.2, 97.7), NPV 100.0% (95.8, 100.0), LR+ 44.5 (11.3, 175.2), and LR- 0.1 (0.0, 0.8). For reader B these were; sensitivity 100.0% (66.4, 100.0), specificity 95.6% (89.0, 98.8), PPV 69.2% (38.6, 90.9), NPV 100.0% (95.8, 100.0), LR+ 22.5 (8.6, 58.6), LR- 0.1 (0.0, 0.8). No adverse events were reported. CONCLUSIONS: Diagnosis of ROP-RT from RetCam® images taken by trained technicians and evaluated remotely by an expert ophthalmologist had good diagnostic accuracy for screening purposes.

Evaluation of Postoperative Povidone-Iodine in Adjustable Suture Strabismus Surgery to Reduce Suture Colonization: A Randomized Clinical Trial.

IMPORTANCE: Although the association between suture colonization and postoperative infections remains hypothetical, measures to reduce perioperative suture colonization may minimize postoperative infections. The suture colonization rate in adjustable suture strabismus surgery is not well defined, and the effect of povidone-iodine use on suture colonization is unknown. OBJECTIVE: To assess whether povidone-iodine application at the end of adjustable suture strabismus surgery decreases the suture colonization rate. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial designed in 2015 and performed from June 1 through October 31, 2015, a total of 65 adjustable and 43 control suture specimens from 65 demographically similar adults undergoing adjustable suture strabismus surgery were studied. A random sampling assigned participants into group 1 (with povidone-iodine) or group 2 (without povidone-iodine) at the end of surgery. A control suture specimen was obtained if ipsilateral nonadjustable surgery was performed. Both groups received antibiotic ointment at the end of the procedure. No patients refused participation or withdrew. Data analysis was performed from October 1 to December 31, 2015. Observers were unaware of patient grouping. INTERVENTIONS: One drop of 5% povidone-iodine directly over the sliding noose of the adjustable suture at the end of surgery. MAIN OUTCOMES AND MEASURES: The suture colonization rate after adjustment in group 1, group 2, and the control group. RESULTS: Of 65 adults undergoing surgery, there were 17 men (49%) and 18 women (51%) in group 1 and 10 men (33%) and 20 women (67%) in group 2, as well as 20 men (47%) and 23 women (53%) in the control group. The mean (SD) age of the patients was 48.5 (16.8) years in group 1, 46.6 (18.1) years in group 2, and 47.7 (17.0) years in the control group. There was no difference in the colonization rate between group 1 (57%) and group 2 (47%) (relative risk [RR], 1.1; 95% CI, 0.6-1.7; P = .80), group 1 and the control group (44%) (RR, 1.0; 95% CI, 0.5-1.8; P > .99), or group 2 and the control group (RR, 1.3; 95% CI, 0.8-2.1; P = .62). Eleven bacterial species were identified. Staphylococcus epidermidis was the predominant isolate (40 of 56 [71%]). A longer interval between the end of surgery and adjustment was associated with higher culture positivity (6.3 hours in positive vs 4.4 hours in negative cultures, P = .001); however, there was no difference in bacterial growth between the groups. No adverse effects of povidone-iodine were observed. CONCLUSIONS AND RELEVANCE: This study was not able to demonstrate that povidone-iodine at the end of adjustable suture strabismus surgery reduces the suture colonization rate. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02424357.

Anterior Segment Optical Coherence Tomography Imaging of Haab Striae.

The authors present a case series demonstrating the anterior segment optical coherence tomography (AS-OCT) findings of Haab striae in three patients with congenital glaucoma. The use of AS-OCT in the assessment of Haab striae in pediatric glaucoma is novel, previously undescribed, and possibly allows differentiation between acute and chronic corneal changes.