Painful Ophthalmoplegia Following Dental Procedure.

This case report is about a 26-year-old patient complaining of painful diplopia shortly after a dental procedure. Magnetic resonance imaging demonstrated a mass lesion in the cavernous sinus that responded well to oral corticosteroids. The possible side effect of the intraoral local anaesthetic injection used during the dental procedure was questioned.

Hydroxyzine Dihydrochloride Premedication Is a Necessity for Pediatric Patients Undergoing Strabismus Surgery: An Observational Prospective Clinical Trial.

Objective: In this single-blind, observational prospective clinical trial, we aimed to determine and compare the effects of premedication with hydroxyzine plus midazolam and midazolam alone on the incidence of oculocardiac reflex (OCR). Methods: Forty-five patients were divided into three groups. Group M received 0.5 mg/kg midazolam alone, Group H received 0.5 mg/kg hydroxyzine plus 0.5 mg/kg midazolam, and Group HM received 1 mg/kg hydroxyzine plus 0.5 mg/kg midazolam. The Ramsay Sedation Scale (RSS), the heart rates (HR1: after induction of anesthesia; HR2: before retraction of orbital muscle; and HR3: right after retraction of orbital muscle), the muscles with OCR, and the incidence of OCR (20% decrease of the HR right after the traction) were recorded and compared between the three groups. Results: The mean HR1, HR2, and HR3 values were significantly increased (p=0.002, p < 0.001, p < 0.001) and the incidence of OCR (p=0.004) was significantly decreased in Group H and in Group HM (for all, p < 0.01) compared to Group M. The most common orbital muscle in which OCR occurred was the rectus medialis. Conclusion: Premedication with a combination of 0.5 or 1 mg hydroxyzine with 0.5 mg midazolam significantly reduced the incidence of OCR compared to premedication with midazolam alone. This study was registered on https://clinicaltrials.gov/ with number NCT03806270.

Long term motor and sensory outcome after surgery for infantile esotropia and risk factors for residual and consecutive deviations.

Purpose: To present long-term motor and sensory outcomes after surgery for infantile esotropia and assess risk factors for residual and consecutive deviations.Methods: Data of infantile esotropia patients operated between 2002 and 2016 with minimum follow-up of 2 years were retrospectively reviewed.Results: Among a total of 62 patients, 35 had a successful motor outcome (alignment within 10 PD from orthotropia) after one surgery (Group A), while 27 required horizontal reoperation (Group B). Patients with residual esotropia had larger preoperative angle of deviation (P = .005) and younger age at first surgery (P = .01), while consecutive exotropia was associated with longer follow-up (P = .03) and higher rate of DVD (P = .003) compared to patients in Group A. Stereopsis was present in 30.3% of patients in Group A and associated with younger age at first surgery (P = .03).Conclusions: Successful motor alignment may be obtained with single surgery in infantile esotropia; however, reoperations are common. Younger age at first surgery may be associated with both higher rate of stereopsis and risk of reoperation. Careful preoperative assessment and surgical timing, with long-term postoperative follow-up is required to achieve satisfactory outcome.

Role of Botulinum Toxin Type A in Cyclic Esotropia: A Long-Term Follow-up.

PURPOSE: To describe two patients with childhood cyclic esotropia 8 and 9 years after they underwent botulinum toxin type A treatment to report its long-term outcome. METHODS: Two patients with sudden onset cyclic esotropia aged 2 and 4 years were included. Botulinum toxin type A injections were performed on the appropriate muscles. RESULTS: The first patient was a 2-year-old boy with left dominant alternating esotropia on a cyclic basis. His strabismus ranged from 25 to 45 prism diopters (PD) at near and distance. A botulinum toxin type A injection into the left medial rectus muscle revealed orthotropia at near and distance with a stereopsis of 60 seconds of arc (arcsec). During the 9 years of follow-up, he remained stable. The second patient was a 4-year-old girl who complained of double vision and strabismus. Her deviation was 40 PD at near and 35 PD at distance on a cyclic pattern. She became orthotropic with glasses after a bimedial botulinum toxin A injection. During the 8 years of follow-up, she remained stable with a stereo-acuity of 120 arcsec. CONCLUSIONS: Considering the consecutive and recurrent deviations with surgical treatment in previous reports, botulinum toxin type A is an appropriate first-line option for the treatment of cyclic deviations, despite its limitations. The results suggest that botulinum toxin type A is an effective method to break the cycle in cyclic esotropia permanently. [J Pediatr Ophthalmol Strabismus. 2019;56(6):360-364.].

Myopia in preterm children at 12 to 24 months of age.

PURPOSE: To examine biometric factors that may influence the high incidence of myopia in pre-term children at 12 to 24 months of age. PATIENTS AND METHODS: Fifty eyes of 25 patients with myopia and 70 eyes of 35 patients with emmetropia at 12 to 24 months of age were selected from a group of preterm children who had been screened for retinopathy of prematurity and returned for follow-up examinations. Forty eyes of 20 full-term children of the same age were also included in the study as a control group. A-scan ultrasonography was performed to measure axial length, lens thickness, and anterior chamber depth in the three groups. RESULTS: The myopic group had a significantly greater axial length than did the other groups. However, the three groups did not differ in lens thickness or anterior chamber depth. The degree of myopia increased with the increase in axial length and the decrease in anterior chamber depth. CONCLUSIONS: The development of myopia in preterm children 12 to 24 months of age appears to be influenced mainly by axial length, whereas the degree of myopia seems to be related to axial length and anterior chamber depth. Among refractive components, axial length plays a major role in myopia occurring at this age in preterm patients.

External Dacryocystorhinostomy for the Treatment of Functional Nasolacrimal Drainage Obstruction.

OBJECTIVES: To determine the outcome and long-term efficacy of external dacryocystorhinostomy (ext-DCR) with or without bicanalicular silicon intubation in patients with functional nasolacrimal drainage obstruction (FNLDO). MATERIALS AND METHODS: Patients with epiphora and patent lacrimal systems on nasolacrimal irrigation were prospectively enrolled in the study. Each patient was assessed with lacrimal scintigraphy to differentiate drainage abnormalities as presac (proximal) or postsac (distal) delays. All patients underwent ext-DCR; bicanalicular silicone intubation was performed only in presac delay cases. On follow-up examinations patients were asked to report their symptoms as none, mild, moderate or unchanged. Success was defined as lacrimal patency to irrigation and no or mild epiphora at the end of the follow-up period. RESULTS: Twenty-six lacrimal systems of 23 patients were eligible for inclusion. There were 9 presac delay and 17 postsac delay cases. Average follow-up time was 72.85 weeks (47-88 weeks). A successful outcome was achieved in 76.9% of the operated lacrimal systems. Success rate was 55.5% among presac obstructions and 88.2% among postsac obstructions. CONCLUSION: The long-term efficacy of ext-DCR in FNLDO patients is confirmed with our overall successful outcome of 76.9%. In preoperative assessment, lacrimal scintigraphy is helpful to determine the surgical approach and to predict the surgical outcome.

Macular Thickness in Highly Myopic Children Aged 3 to 7 Years.

PURPOSE: To compare the macular thickness and volume of highly myopic children with healthy controls, using third generation optical coherence tomography (OCT). METHODS: OCT was performed on highly myopic (cycloplegic spherical equivalent refraction > -6.00 diopters [D]) children aged 3 to 7 years old and healthy controls (spherical equivalent refraction -2.00 to +4.00 D) between 2011 and 2013. OCT measurements of the average thicknesses of the fovea (central 1 mm) and inner (1 to 3 mm) and outer (3 to 6 mm) parafovea in superior, temporal, inferior, and nasal quadrants and total volume of the macular scan area were recorded. The differences between the two groups were tested with the Mann-Whitney U test. RESULTS: There were 15 patients with high myopia and 11 controls. Foveal thickness (central 1 mm) was significantly greater in the high myopia group. The parafoveal thicknesses in all quadrants of the inner and outer circles were significantly thinner in the high myopia group. The average macular volume of the highly myopic eyes was significantly smaller than the control eyes. CONCLUSIONS: Anatomic changes in the retina occur even in young children with high myopia. Macular thickness characteristics of highly myopic children may influence the interpretation of data obtained with OCT.

Myopia, visual acuity and strabismus in the long term following treatment of retinopathy of prematurity.

The purpose of this retrospective study is to evaluate the long-term ophthalmological outcome in children with retinopathy of prematurity (ROP) who were treated for threshold disease with indirect laser photocoagulation. 107 eyes of 56 patients with threshold ROP treated with indirect laser photocoagulation and 202 eyes of 101 control patients with spontaneously regressed ROP were included. Fixation pattern, ocular motility findings, visual acuity, anterior segment examination, cycloplegic refraction and indirect ophthalmoscopic dilated fundus examination findings of all the included subjects were recorded. The incidence of unfavorable visual outcome defined as Snellen acuity of < 0.2, esotropia, strabismus surgery, nystagmus, myopia (≥ -0.50 D) and astigmatism (≥ 1.50 D) was significantly higher in the treated group than in the control group. These results indicate that premature babies with threshold ROP treated with indirect laser photocoagulation require frequent and long-term follow-up in order to determine refractive status and the presence of ocular motility disorders over time.

Simple alternative to the Wright needle in frontalis sling surgery.

The Wright needle is a widely used instrument for insertion of fascia lata or a synthetic material during frontalis suspension surgery; however, difficulties in handling this instrument are frequently encountered by many surgeons. We describe an 18-gauge needle with a 4/0 monofilament polypropylene suture as an alternative to the Wright needle for placement of the sling material in frontalis suspension surgery. Less slippage and easier control of the needle's direction and depth of tissue penetration result in more accurate placement of the material and a reduction in damage to the surrounding tissues.

Isoametropic amblyopia in highly hyperopic children.

PURPOSE: The purpose of this study was to evaluate the visual outcome and associated findings in isoametropic amblyopia due to high hyperopia. METHODS: Children with > or = 5 D spherical equivalent hyperopia and < or = 1.5 D anisometropia and < or = 1.5 D cylinder in both eyes were selected. Data were collected on the magnitude of spherical equivalent hyperopia, corrected visual acuity (VA) with the Snellen or Tumbling E charts, age at correction, duration of correction, ocular motility and strabismus. Children who had VA of < or = 0.4 in both eyes were defined as having isoametropic amblyopia. Associations between isoametropic amblyopia and factors affecting VA were analysed. RESULTS: A total of 160 children met the criteria. The mean follow-up was 55.8 months. In all, 31 of the children had isoametropic amblyopia. The mean age at presentation was significantly higher (5.5 years versus 4.1 years; p < 0.05) and strabismus was significantly less prevalent (p = 0.001) in the isoametropic amblyopes than in the high hyperopia group as a whole. A total of 83.9% of the isoametropic amblyopes had best corrected VA > 0.5 at the last visit. The duration of optical correction was positively correlated with the last recorded VA measurement. CONCLUSION: Isoametropic amblyopia is not rare among highly hyperopic children. Visual acuity improves satisfactorily with spectacle correction. The duration of optical correction seems to be an important factor in visual prognosis.

Implant infection in porous orbital implants.

PURPOSE: To analyze implant infection in patients with porous orbital implants. METHODS: A retrospective analysis of 212 patients with one of five types of porous orbital implants (bone-derived hydroxyapatite [HA], coralline HA, synthetic HA, porous polyethylene, and aluminium oxide) was conducted. Reasons for surgery, type of surgery, type of implant, peg system used, time of pegging, problems before and after pegging, treatment, and follow-up duration were recorded for all patients, along with additional data including time of onset of infection, microorganism cultured, antibiotics used, patient response to antibiotic therapy, additional interventions, and final status for patients with infection. RESULTS: Of the 212 patients with porous orbital implants, 116 (54.72%) were pegged. Implant infection was observed in 11 of 116 patients (9.48%) with pegs, whereas 0% of unpegged implants was infected (p = 0.001). The interval between pegging and the onset of infection was 3 to 83 months (average, 36.27 +/- 29.12 months). Implant exposure was noted in 5 of the 11 patients with infection. Symptoms resolved completely with antibiotic treatment in 7 patients. One patient required implant removal as the result of frequent exacerbations. The remaining 3 patients presented with hemorrhagic, purulent discharge and/or pyogenic granuloma on their last visits after being free of symptoms for 5 to 6 months. CONCLUSIONS: Implant infection is a serious problem that requires additional patient visits, intensive antibiotic therapy, surgery, or some combination of these. Existence of a peg system appears to play a role in implant infection. Infection may develop as late as 6 to 7 years after pegging, and the patient should be cautioned about potential late-onset problems. It is possible to control the infection with appropriate antibiotic therapy; removal should be reserved for refractory cases.