Chemical preparation of the eye in ophthalmic surgery. III. Effect of povidone-iodine on the conjunctiva.

A half-strength povidone-iodine (Betadine) solution was used topically as part of the preoperative chemical preparation of the eye. Aerobic and anaerobic bacterial cultures of the conjunctiva were taken before and after the chemical preparation in 30 consecutive patients; the second eye served as a control. In the control eyes, no significant change in the number of colonies or species of bacteria was found. In the povidone-iodine-treated eyes, the numbers of colonies decreased 91% and the number of species decreased 50% (statistically significant). We therefore recommend that a half-strength povidone-iodine solution be used as part of the chemical preparation of the eye for surgery.

Congenital cataract and intraocular lenses.

We implanted nine intraocular lenses for the aphakic correction of congenital monocular cataracts in eight children (eight eyes). During follow-up periods ranging from 18 to 50 months in six children, there were no major complications connected to the surgery. Parental cooperation with treatment for amblyopia was satisfactory in all cases. The degree of strabismus, the fixation pattern, and the optokinetic nystagmus responses improved postoperatively in all six. Three children old enough to cooperate during visual testing had visual acuities better than 20/200 and two of these had visual acuities of 20/40. In all six children the sound eye is still patched for three to six hours a day. All six attend regular kindergartens and participate in their normal activities without difficulty.

Torsion and elevation under general anesthesia and during voluntary eyelid closure (Bell phenomenon).

The amount and interrelationship of ocular torsion and elevation was measured in 30 patients under general anesthesia; half received muscle relaxants (pancuronium bromide) during induction and half did not. Similar measurements were made in 20 patients during voluntary eyelid closure (Bell phenomenon). The mean amount of excycloduction was between 2.0 degrees and 2.5 degrees when the patients were under general anesthesia, whether or not muscle relaxants were used, and during voluntary eyelid closure. No statistically significant difference in the amount of torsion was found among the three groups. Elevation was significantly greater during voluntary eyelid closure (mean 5.3 mm) than during general anesthesia (p less than 0.01). No statistically significant difference in ocular elevation was found in patients under general anesthesia whether they were given a muscle relaxant (mean 1.5 mm) or not (mean 1.2 mm).

Amniotic band syndrome and strabismus.

Three patients with various manifestations of the amniotic band syndrome associated with strabismus are presented and discussed. All three cases demonstrate a paralytic strabismus due to a unilateral paresis-paralysis of the medial rectus in one case and of the superior rectus in another. The third case showed a bilateral lateral rectus paralysis. In two cases, the strabismus was accompanied by other ocular manifestations, while in one patient strabismus and amblyopia were the sole ophthalmological findings. In two of the cases, a direct association between the mesodermal bands and the strabismus could be established, while in one case this association might have been incidental. Careful ophthalmological followup and treatment of these cases prevented needless loss of vision while appropriate muscle surgery restored acceptable cosmetic appearance in one case.

Ocular findings in arthrogryposis multiplex congenita.

Close ophthalmological follow-up of a case of arthrogryposis multiplex congenita disclosed a progressing paresis of the lateral recti, a gradual decrease in the corneal blinking reflex by the age of eight weeks and a clear deterioration of the visual evoked responses by the first 16 weeks of life along with preservation of normal ERG responses. These observations are believed to represent the gradual affection of the motor and sensorial cranial nerves occurring post-natally in this case of AMC.

Infantile leukocoria caused by posterior lenticonus.

Posterior lenticonus--a bulging of the posterior capsule and cortex--is an acquired lens abnormality, which becomes increasingly opaque. We report an unusual case of bilateral posterior lenticonus in an infant, who initially presented with leukocoria and was referred with a diagnosis of retinoblastoma. Careful physical examination and ultrasound analysis were important in the diagnosis. Ultrasound also aids the surgeon in planning therapy. Posterior lenticonus should be considered in the differential diagnosis of retinoblastoma.