Spontaneous resolution of stage 4B retinopathy of prematurity.

An unfavorable outcome occurs in 31% of cases of treated severe threshold retinopathy of prematurity (ROP) and includes a retinal detachment of the posterior pole. Early treatment with laser of high risk prethreshold or type 1 ROP has significantly reduced this complication. However, despite prompt laser treatment, retinal detachments continue to be seen. Treatment of tractional partial retinal detachments involving the posterior pole (stage 4B ROP) is surgical. Successful reattachment of stage 4B ROP with a lens-sparing vitrectomy is high. The authors describe an infant who had spontaneous reattachment after stage 4B ROP.

The effect of laryngeal mask airway insertion on intraocular pressure measurement in children receiving general anesthesia.

PURPOSE: To study changes in intraocular pressure (IOP) in children while under general anesthesia before and after laryngeal mask airway (LMA) insertion. DESIGN: Prospective, comparative study. METHOD: IOP was measured in children after induction and one minute after LMA insertion. Children younger than 16 years who were scheduled to undergo elective ophthalmic surgery while receiving a general anesthetic were included. Children with a history of glaucoma or previous intraocular surgery were excluded. Data were collected on the age of the child, IOP, heart rate (HR), end tidal CO2, and blood pressure (BP) before and after LMA insertion. RESULTS: Sixty-six children with a mean age of 5.5 +/- 3.6 years (range, four months to 16 years) were included in the study. The mean IOP was 13.6 +/- 3.9 mm Hg and 13.6 +/- 3.6 mm Hg in right and left eyes, respectively, before LMA insertion and 15.5 +/- 3.8 mm Hg and 15.2 +/- 3.8 mm Hg in right and left eyes, respectively, after LMA insertion (P = .001). A decrease in BP was significantly associated with an increase in IOP (P = .008), and the interaction between the change in the BP, HR, and CO2 affected the change in IOP measured after insertion of the LMA (P = .04). There was no correlation between the age of the child and the change in IOP measured after insertion of the LMA. CONCLUSIONS: In our study, a small but significantly higher IOP was found after LMA insertion than before. It is recommended that the measurement of IOP in children receiving a general anesthetic is carried out before the insertion of the LMA.

Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants.

Apraclonidine, a selective alpha(2)-agonist, was developed to lower intraocular pressure and minimize the systemic side effects associated with the use of its parent drug, clonidine.(1) An investigation of the site of action of apraclonidine incidentally uncovered a reversal of anisocoria in patients with absent sympathetic innervation of one pupil (Horner syndrome) due to its alpha(1)-effect on a pupil with denervation supersensitivity.(2) It has been used as a diagnostic test for Horner syndrome.(3,4) We report adverse effects of topical apraclonidine when used in the diagnosis of Horner syndrome in infants.

Validity and ease of use of a computerized Hess chart.

PURPOSE: To investigate agreement between computerized and conventional methods for obtaining Hess charts and to compare relative ease of use of both methods. METHODS: Hess charts of 65 patients were obtained by the use of the computerized Assaf Ocular Motility Analyzer (OMA) and the conventional Lees screen method. The Hess charts produced by each method were compared with a previously described scoring system. Patients compared the ease of testing by using a 5-point Likert scale. RESULTS: For horizontal deviations of the right eye, the OMA provided a significantly larger (P = 0.0001) deviation (301° ± 267°) than the Lees screen (204° ± 306°). The Lees screen gave a significantly larger score for vertical deviations of the left eye (117° ± 158° vs 96° ± 129°; P = 0.003). Vertical deviations of the right eye and horizontal deviations of the left eye did not differ significantly between tests. Patients required the same amount of time to complete both tests, but the OMA was slightly easier to perform than the Lees screen (Likert score, 1.2 ± 0.5 vs 1.3 ± 0.4; P = 0.046). CONCLUSIONS: The scores measured were larger with OMA in the horizontal and smaller in the vertical direction than with the Lees screen in some directions. Although the OMA did not save time, patients found it easier to perform than the Lees screen. The OMA may be considered a useful alternative to the Lees screen.