Incidence and predisposing factors of intraocular Lens tilt following secondary ciliary sulcus implantation in children: An ultrasound biomicroscopic study.

PURPOSE: To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal. METHODS: A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt. RESULTS: Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position. CONCLUSION: The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation.

Outcome of intraocular lens exchange for the management of myopic shift in pseudophakic children.

PURPOSE: To evaluate the visual outcome of intraocular lens (IOL) exchange for the management of myopic shift in pseudophakic children. METHODS: The medical records of children who underwent IOL exchange for myopic shift were examined. The preoperative data, operative details and the postoperative outcome were analyzed. RESULTS: Twenty-one eyes (16 patients) were identified. Mean age at cataract extraction was 20 ± 26 months (range, 2-84 months). Twelve patients (6 unilateral, 6 bilateral) had primary IOL implantation. Mean age at IOL exchange was 7.3 ± 3.2 years. Mean spherical equivalent (SE) at IOL exchange was -14 ± 5 D (range, -7 to -21 D): Mean SE at IOL exchange was -13.64 ± 4.99 D, -12 ± 1.53 D, and -15.5 ± 4.7 D in unilaterally pseudophakic cases (8 patients), in the eye that underwent unilateral IOL exchange (3 patients) in bilaterally pseudophakic cases, and in bilateral IOL exchange cases (5 patients), respectively. Mean axial length at IOL exchange was 24 ± 1.3 mm (range, 23 to 27 mm). Following IOL exchange, mean SE was reduced to -2 ± 1.8 D (range, -4 to +2.5 D). An average of three logMAR line improvement in the best-corrected visual acuity was observed in 12/16 eyes of patients for whom pre- and post-exchange visual acuity were available, while visual acuity remained unchanged in 4 eyes. Mean logMAR visual acuity improvement was 0.35 and 0.49 in unilateral and bilateral pseudophakic cases, respectively. CONCLUSIONS: IOL exchange is a safe procedure that should be considered to improve visual rehabilitation in pseudophakic patients with myopic shift.

Convergence Excess Esotropia: Review.

Convergence excess esotropia is a condition characterized by an esotropia which is greater for near fixation than for distance fixation after full hypermetropic correction with a single focus lens. Convergence excess esotropia may be classified according to the AC/A ratio into two subtypes: accommodative type and non-accommodative type. Bifocal glasses are a suitable option for the management of patients with a high AC/A ratio and for the hypoaccommodative type. However, the overall success rate with bifocals is still low even in selected patients. Surgery is often eventually needed for most patients with convergence excess esotropia. Surgical options that do not directly address the variability of the angle of deviation entail medial rectus recession with the target angle based on the distance deviation, the near deviation, an augmented formula based on an intermediate angle, or on a prism adaptation test. Surgical options that directly address the variability of the angle include partial myotomy, medial rectus muscle posterior scleral fixation with or without recession, pulley fixation, slanting recession, Y-splitting, or combined recession-resection of the medial rectus muscle. The review article summarizes the surgical outcome of these strategies and suggests an algorithm for the management of patients with convergence excess esotropia.

Comparison between bupivacaine injection and mini-tenotomy in the management of horizontal small angle strabismus in children.

PURPOSE: To compare the outcome of bupivacaine (BUP) injection vs mini-tenotomy of extra-ocular muscles in treating small angle horizontal strabismus in children. METHODS: A prospective comparative study that included a total of 40 patients. Twenty patients received 3 ml of 0.75% Bupivacaine (BUP) injection in both medial recti in case of exotropia and in both lateral recti in case of esotropia. MRI orbit was performed before and 30-60 days' post injection of bupivacaine to estimate changes in muscle size. Mini-tenotomy was done in the other 20 patients, performed on both lateral recti in case of exotropia and on both medial recti in case of esotropia. RESULTS: Mean change of alignment at the end of 6 months in exotropic patients in bupivacaine group was 5.50 ± 4.10 PD and in esotropia patients 4.00 ± 3.38 PD with an average increase in muscle thickness of 0.12 mm ± 0.08 and 0.13 mm ± 0.09 in exotropia and esotropia, respectively. There was an average increase in volume 23 mm3 ± 17.3 and 17.00 mm3 ± 9.50 in exotropia and esotropia, respectively, as measured with MRI. The mean change of alignment in mini-tenotomy was 5.33 ± 4.12 PD, 5.75 ± 4.95 PD in exotropia and esotropia, respectively. CONCLUSION: Bupivacaine and mini-tenotomy are safe and effective alternative treatment, that improved eye alignment in 65% of patients with small angle horizontal deviation.

Gonioscopy-Assisted Transluminal Trabeculotomy following Failed Glaucoma Surgery in Primary Congenital Glaucoma: One-Year Results.

Purpose: To evaluate the one-year outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) with a history of prior glaucoma surgery. Methods: A retrospective chart review was performed to identify all PCG patients ≤ 16 years who underwent GATT surgery at Cairo University Children's Hospital from January 2016 to March 2022. Pre- and postoperative intraocular pressure (IOP) and glaucoma medications were collected at 1, 3, 6, 9, 12, and last follow-up visits. Success was defined as IOP ≤ 21 mmHg without (complete) or with (qualified) glaucoma medications at the last follow-up. Results: Seven eyes of 6 subjects were included in the study. The mean IOP was statistically significantly reduced from 25.7 ± 5.9 mmHg preoperatively to a mean IOP of 12 ± 1.5 mmHg (P = 0.001) at 12 months and 11.5 ± 1.2 mmHg (P = 0.001) at the last follow-up visit. Six eyes (85.7%) achieved complete success, and one eye (14.2%) achieved qualified success. No patients required further glaucoma procedures. No serious intra- or postoperative complications were identified. Conclusions: Our early experience highlights that GATT can be performed as an alternative procedure before considering conjunctival or scleral glaucoma surgeries.

Childhood glaucoma profile in a tertiary centre in Egypt according to the childhood glaucoma research network classification.

PURPOSE: To describe the prevalence and clinical characteristics of a large cohort of childhood glaucoma patients that presented to a tertiary Egyptian children's hospital using the childhood glaucoma research network (CGRN) classification. METHODS: A retrospective review of the medical records of all patients ≤ 14 years with a diagnosis of childhood glaucoma or glaucoma suspects who presented to Children's Hospital between January 2014 to December 2019 was conducted. Data collected included age at the time of diagnosis, gender, laterality, prenatal history, parental history, including consanguinity, intraocular pressure, horizontal corneal diameter, and cup-to-disc ratio. RESULTS: A total of 1113 eyes of 652 patients with diagnoses of either childhood glaucoma or glaucoma suspects were included in the study. Six hundred and sixteen patients (94%) were born full-term. A history of positive parental consanguinity was identified in 334 patients (51.2%). Almost 60% of patients were males. Primary congenital glaucoma (PCG) was the most prevalent diagnosis (68.2%), followed by glaucoma suspects (10.4%) and glaucoma following cataract surgery (GFCS) (8.4%). Juvenile open-angle glaucoma was the least prevalent category (0.3%). Other categories including glaucoma associated with non-acquired systemic disease, glaucoma associated with non-acquired ocular disease, and glaucoma associated with acquired conditions represented 5.8%, 4.7%, and 1.9%, respectively. CONCLUSIONS: PCG is the most common form of glaucoma in Egypt. More than half of the pediatric glaucoma patients had a positive history of parents' consanguinity.

Overcorrection after vertical muscle transposition with augmentation sutures in sixth nerve palsy.

PURPOSE: To report a series of cases, who developed consecutive exodeviation after vertical muscle transposition (VRT) performed for sixth nerve palsy, describe their management and analyse their outcome. DESIGN: Retrospective case series. METHODS: This is an institutional study on patients who developed consecutive exotropia following VRT for sixth nerve palsy in two different centres. The age, gender, cause, and time to surgery were reviewed. Ductions, versions and angles of misalignment were analysed. In those who developed an exotropia >10 PD after surgery, a second surgery was performed. The time to the second surgery, intra-operative findings, surgical procedure and outcome were studied. RESULTS: A total of 164 cases of VRT for sixth nerve palsy were identified. Nine patients developed consecutive exotropia >10 PD (5.5%). There were no significant differences in the characteristics of those who developed overcorrection compared to those who did not. Five patients had full-tendon muscle transposition, three patients had Hummelsheim procedure and one patient had Jensen procedure. The average angle of consecutive exotropia was 26 ± 9 Δ (range 10-40 Δ). After the second surgery, angle of exotropia decreased to 21 ± 15 PD. Seven patients still had residual exotropia ≥10Δ and the exotropia was corrected in the remaining two patients. The time to second surgery in those two patients was much shorter than the other seven patients. CONCLUSIONS: Patients who undergo VRT should be followed up in the early post-operative period and revisiting the transposition should be done immediately in case of consecutive exotropia to avoid permanent overcorrection.

Central corneal thickness profile in relation to pediatric cataract morphology.

Several studies have demonstrated that central corneal thickness (CCT) increases in pediatric eyes after cataract extraction with or without intraocular lens (IOL) implantation. This thickening has been hypothesized to be the result of endothelial dysfunction caused by direct trauma during surgery, toxic effects of irrigating fluids, or postoperative inflammation. Limited literature is available regarding the preoperative profile of CCT in pediatric cataract eyes. The purpose of the current study was to evaluate the differences in the mean preoperative CCT in eyes with pediatric cataract related to the presence or absence of persistent fetal vasculature.

Predictive Value of Intraocular Lens Power Calculation Formulae in Children.

PURPOSE: To compare the accuracy of IOL power calculation formulae in a large cohort of children who underwent IOL implantation. SETTING: Cairo University Children Hospital. DESIGN: Retrospective, case series. METHODS: A retrospective chart review of all children <14 years, who underwent primary or secondary IOL implantation in Cairo University Children Hospital from January 2016 to December 2019, was performed. Absolute prediction error (APE) was calculated for SRKII, SRK/T, Holladay I and Hoffer-Q formulae using the patients' AL, keratometric (K) readings, implanted IOL power and refraction done two months postoperatively. RESULTS: The study included 308 eyes of 255 patients with a mean age of 4.74 ± 3.19 years at the time of surgery. The mean K-reading was 43.42 ± 3.57 diopters (D) and mean AL was 22.01 ± 1.93 mm. The percentage of eyes with APE within 0.5D was 27.7% (85 eyes), 32.2% (99 eyes), 30.6% (94 eyes) and 25.4% (78 eyes) with SRK II, SRK/T, Holladay I and Hoffer-Q formulae, respectively. APE was significantly lower with the SRK/T formula (P≤0.004) and significantly higher with the Hoffer-Q formula (P≤ 0.002). There was a negative correlation between the age of the patient and the APE of the SRK II formula (P=0.02). Moreover, the SRK/T, Holladay and Hoffer-Q formulae APEs were affected by the average k-readings (P=0.019, 0.005 and 0.035) respectively. CONCLUSION: The SRK/T and Holladay I formulae were the most predictable formulae in IOL power calculation in pediatric eyes.

Kahook Dual Blade Ab-interno Trabeculectomy Compared With Conventional Goniotomy in the Treatment of Primary Congenital Glaucoma: 1-Year Results.

INTRODUCTION: Kahook dual blade (KDB) removes a strip of the trabecular meshwork from the angle, which may make it superior to simple goniotomy in treating the angle anomaly in primary congenital glaucoma (PCG). This prospective study compares KDB ab-interno trabeculectomy to conventional goniotomy in PCG. METHODS: Forty-two eyes of 29 patients with PCG underwent ab-interno trabeculectomy using a KDB or conventional goniotomy using a 25-G irrigating needle, targeting 100 to 120 degrees of the nasal iridocorneal angle. Patients were seen at 1, 3, 6, and 12 months postoperatively. Success was defined as intraocular pressure (IOP) ≤21 mm Hg at 1-year follow-up visit, with no evidence of glaucoma progression. RESULTS: The KDB group included 21 eyes of patients with a median age of 6 months (interquartile range: 4 to 8.5 mo) and the goniotomy group included 21 eyes of patients with a median age of 5 months (interquartile range: 3 to 9.5 mo). There was a significant reduction in IOP in both groups at all follow-up visits. The reduction in the number of glaucoma medications was significant at 1, 3, and 6 months postoperatively in the KDB group, and at 1 month in the goniotomy group. There was no significant difference in IOP or glaucoma medications between both groups at any follow-up visit. Success was achieved in 12 eyes (57.1%) in each group, with no eyes developing any serious complications. CONCLUSION: One-year results show that KDB ab-interno trabeculectomy is at least as effective as goniotomy in the treatment of PCG. Eyes with bilateral glaucoma had a tendency to fail both procedures.

One-year results of two-site trabeculotomy in paediatric glaucoma following cataract surgery.

PURPOSE: The management of glaucoma following cataract surgery (GFCS) in children is challenging. This study looks at the results of two-site trabeculotomy in paediatric aphakic/pseudophakic glaucoma, 1-year post operatively. METHODS: This prospective, institutional study was performed on 33 eyes with GFCS in patients aged ≤14 years. Patients underwent two-site trabeculotomy using the rigid-probe trabeculotome, through a superonasal and an inferotemporal scleral flap. Intraocular pressure (IOP), medications, complications and success rates at 1 year were reported. Success was defined as IOP < 23 mmHg or 30% IOP reduction, on the same or fewer number of medications at 1 year, without the need for another glaucoma procedure. RESULTS: Trabeculotomy was performed on average 3.5 years after the cataract surgery. Patients were aged 5.73 ± 1.79 years. We excluded four eyes in which >180° incision could not be achieved. A 360° incision was achieved in 14 eyes (48%). There was a significant reduction in IOP and medications at 1, 3, 6 and 12 months (p < 0.001). At 1 year, mean IOP reduction was 48.2 ± 31.5%. Success was achieved in 26 eyes (89.6%), of which 15 were controlled without medications. There was no significant difference in IOP, medications or success between aphakic and pseudophakic eyes nor between eyes that had 360° trabeculotomy and eyes that had a 180-270° incision. Three eyes (10.3%) required another glaucoma procedure. One eye required core vitrectomy for vitreous haemorrhage. CONCLUSIONS: Two-site trabeculotomy can be used as an effective and safe first-line procedure in paediatric GFCS eyes that do not have extensive peripheral anterior synechiae.

Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction.

PRECIS: Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months. PURPOSE: The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes. PATIENTS AND METHODS: A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed. RESULTS: Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively). CONCLUSIONS: Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.

Augmented medial rectus muscle recession versus medial rectus recession with posterior scleral fixation in partially accommodative esotropia: a randomized clinical trial.

PURPOSE: To compare the postoperative alignment after medial rectus muscle posterior scleral fixation versus augmented recession in children with partially accommodative esotropia (PAET) without convergence excess. METHODS: In this prospective study, 60 children with PAET without convergence excess were randomly assigned to either augmented medial rectus recession, based on the average of distance angle with correction and near angle without correction, or medial rectus recession, based on distance angle with correction, combined with posterior scleral fixation. The ductions, versions, angles of deviation, and difference between angles were analyzed before and 6 months after surgery. Complete success was defined as orthotropia to within 8Δ of esophoria/tropia for both distance and near, with spectacle correction, at 6 months. Patients who developed any exophoria/tropia with their original spectacles and needed reduction of their hyperopic correction to achieve successful outcome were defined as qualified successes. RESULTS: Of the 60 children, 25 in the augmented group and 28 in the posterior fixation group completed follow-up. The mean age at surgery was 4.90 ± 2.34 years. The complete success rate was 48% and 64% in the augmented and posterior fixation groups, respectively (P = 0.15); the qualified success rate was 80% and 92.9%, respectively (P = 0.17). Success rate was significantly higher (P = 0.04) in the posterior fixation group (56%) than in the augmented group (18%) when the preoperative angle disparity was ≥20Δ. CONCLUSIONS: Medial rectus posterior scleral fixation can improve the success rate in PAET with large angle disparity.

A Comparative Study of Prism Adaptation and the Augmented Surgery Formula in the Management of Acquired Comitant Esotropia.

PURPOSE: To compare two methods of surgical augmentation (prism adaptation and the augmented surgery formula) in the management of acquired comitant esotropia. METHODS: Forty patients were included in this prospective study and assigned to either the prism adaptation (20 patients) or augmented surgery (20 patients) group. After preoperative prism adaptation, patients in the prism adaptation group were classified as prism adaptation responders (fusers) or non-responders (non-fusers). All patients in the prism adaptation group underwent surgery for the prism-adapted angle. Patients in the augmented surgery group underwent surgery based on the augmented surgery formula, defined as the average of the near deviation without correction and the distance deviation with correction. RESULTS: In the prism adaptation group, 6 patients (30%) were prism responders, whereas 14 (70%) were non-responders. The 3-month motor success rate was significantly higher in the prism adaptation group (90%) than the augmented surgery group (55%) (P = .013). The 6-month motor success rate was not significantly higher in the prism adaptation group (95%) than the augmented surgery group (80%) (P = .151). The improvement in the 6-month outcome was mainly attributed to hyperopic spectacle power reduction after 3-month postoperative evaluation to correct consecutive exotropia. CONCLUSIONS: Although prism adaptation is superior in precisely determining the surgical target angle, the success rates were comparable between the two groups after hyperopic spectacle power reduction. This obviates the need for prism adaptation, except in cases of non-accommodative esotropia. To maximize the benefit of prism adaptation, it is recommended that all patients with prism adaptation (responders and non-responders) undergo surgery for the prism-adapted angle. [J Pediatr Ophthalmol Strabismus. 2020;57(2):108-119.].

Factors associated with early and late failure after goniotomy for primary pediatric glaucoma.

PURPOSE: To analyze the risk factors associated with early and late failure after goniotomy for primary pediatric glaucoma. METHODS: A retrospective study was done on infants who underwent goniotomy as the initial surgical procedure for primary pediatric glaucoma, and had a follow-up period ⩾48 months after surgery. Early and late failures were defined as intraocular pressure ⩾18 mmHg or signs of glaucoma progression before and after the end of first year, respectively. RESULTS: A total of 81 eyes of 47 children were included. The mean age at the time of surgery was 6.1 ± 6.7 months, 34 children (72.3%) were bilateral. The mean follow-up was 5.9 ± 2.8 years. Of the included eyes, 41 eyes (50.6%) showed success, 25 eyes (30.9%) showed an early failure, and 15 eyes (18.5%) showed a late failure. The mean survival time was 43 months. However, only surgery before the end of the first month and positive consanguinity of the parents (P < 0.01 for both) were independent risk factors for early and late failure of goniotomy for primary pediatric glaucoma. Patients with late failure showed a statistically significant lower preoperative intraocular pressure (P = 0.02). A larger preoperative corneal diameter and a male gender were associated with higher but statistically insignificant failure rates. There were no differences in the early or late failure rates between unilateral and bilateral cases. CONCLUSION: A positive consanguinity of the parents and surgery before the end of the first month are the major predictors of failure of goniotomy.

Circumferential Schlemm's Canal Surgery in Adult and Pediatric Glaucoma.

Purpose: Although trabeculectomy, and to a less extent glaucoma drainage devices are currently the gold standard in glaucoma surgery, there is a rising interest in addressing the more physiological pathway of aqueous outflow through surgeries that target Schlemm's canal (SC). These surgeries have the advantage of a lower risk of hypotony and bleb-related complications commonly associated with conventional glaucoma surgery.In this article we review new developments and the different techniques of circumferential angle surgery in adult and pediatric glaucoma, as well as procedures which target the canal circumferentially without incising it, such as canaloplasty and Visco360.Methods: A comprehensive literature search of various electronic databases was performed.Results: Angle surgery, namely goniotomy and trabeculotomy, have been well established as standard procedures in pediatric glaucoma, yet their results in the management of adult glaucoma have not been as promising. In recent years, ab-interno trabeculectomy using Trabectome and Kahook dual blade have yielded variable results in adult glaucoma. As growing evidence suggests that bigger extent incisions into SC result in increased lowering of intraocular pressure than conventional 120 to 180-degree incisions, several procedures have been developed to create a circumferential incision into SC. Circumferential SC incision using sutures, microcatheters, TRAB360 or the rigid probe trabeculotome, through an ab-interno or ab-externo approach, have yielded promising results in both adult and pediatric glaucoma by reducing the resistance to aqueous outflow through the inner wall of SC over 360 degrees of the angle.Conclusions: Various techniques of circumferential Schlemm's canal surgery is effective in management of different adult and pediatric glaucomas. Further long-term comparative studies would be useful in evaluating safety and efficacy of these procedures.

Novel CYP1B1 mutations and a possible prognostic use for surgical management of congenital glaucoma.

AIM: To identify CYP1B1 gene mutations and evaluate their possible role as a prognostic factor for success rates in the surgical management of Egyptian congenital glaucoma patients. METHODS: Totally 42 eyes of 29 primary congenital glaucoma patients were operated on with combined trabeculotomy/trabeculectomy with mitomycin-C and followed up at 1d, 1wk, 1, 6 and 12mo postoperatively. Genomic DNA was extracted from peripheral blood leukocytes. Coding regions of CYP1B1 gene were amplified using 13 pairs of primers, screened for mutations using single-strand conformation polymorphism followed by sequencing of both strands. Efficacy of the operation was graded as either a success [maintaining intraocular pressure (IOP) less than 21 mm Hg with or without anti-glaucoma medication], or a failure (IOP more than 21 mm Hg with topical antiglaucoma medications). RESULTS: Seven novel mutations out of a total of 15 different mutations were found in the CYP1B1 genes of 14 patients (48.2%). The presence of CYP1B1 gene mutations did not correlate with the failure of the surgery (P=0.156, odds ratio=3.611, 95%CI, 0.56 to 22.89); while the positive consanguinity strongly correlated with failure of the initial procedure (P=0.016, odds ratio=11.25, 95%CI, 1.57 to 80.30). However, the Kaplan-Meier survival analysis revealed a significantly lower time of IOP control in the subgroup with mutations in CYP1B1 versus the congenital primary glaucoma group without mutations (log rank test, P=0.015). CONCLUSION: Seven new CYP1B1 mutations are identified in Egyptian patients. Patients harboring confirmed mutations suffered from early failure of the initial surgery. CYP1B1 mutations could be considered as a prognostic factor for surgery in primary congenital glaucoma.

Transscleral sutureless intraocular lens versus retropupillary iris-claw lens fixation for paediatric aphakia without capsular support: a randomized study.

PURPOSE: To compare results of sutureless transscleral intraocular lens (IOL) fixation to retropupillary iris-claw lens implantation in cases of paediatric aphakia without capsular support. METHODS: Thirty eyes of children with insufficient capsular support for IOL implantation were randomized to undergo sutureless transscleral IOL fixation or iris-claw lens fixation. The primary outcome was best-corrected visual acuity (BCVA). Secondary outcomes included operative time, astigmatism, central corneal thickness, endothelial cell count (ECC), IOL decentration and tilt, central foveal thickness and complications. RESULTS: There was a significant improvement in BCVA at all follow-up visits, with no significant difference between both groups. 53.3% in the transscleral-fixated IOL group and 80% in the iris-claw IOL group had a final BCVA ≥0.3. The operative time was significantly shorter in the iris-claw IOL group (p = 0.001). IOL decentration and tilt were higher in the transscleral-fixated IOL group, but the difference was not significant. The ECC was reduced by 14.6% in the transscleral-fixated IOL group and 11% in the iris-claw group at 6 months, with no significant difference between both groups (p = 0.5). In the transscleral-fixated IOL group, two eyes developed ocular hypertension and two eyes had IOL decentration, while in the iris-claw IOL group, 1 eye developed glaucoma, three eyes had haptic disenclavation, and one eye had retinal detachment. CONCLUSION: Both techniques yielded a comparable visual outcome. Retropupillary iris-claw lens fixation is a shorter procedure and technically easier than sutureless transscleral fixation, but the risk of disenclavation should be considered especially in younger age groups. Scleral fixation is the only option in case of severe iris damage, but may be associated with more endothelial cell loss.

Agreement profiles for rebound and applanation tonometry in normal and glaucomatous children.

OBJECTIVES: To investigate agreement between intraocular pressure measurements by the rebound tonometer and handheld Perkins applanation tonometer in children with and without primary congenital glaucoma and test agreement with intraocular pressure and age variations. MATERIALS AND METHODS: A prospective non-interventional comparative study done on 223 eyes of 115 children, 161 normal eyes, and 62 eyes with primary congenital glaucoma. Intraocular pressure measurements were obtained in the upright position by rebound tonometer first, followed by installation of topical anesthetic eye drops (benoxinate), then measured by Perkins applanation tonometer. RESULTS: For all eyes, mean difference between Perkins applanation tonometer and rebound tonometer was -0.59 ± 2.59 mmHg, p = 0.001. Regression analysis with (r) = 0.9, (r2) = 0.79, and p < 0.001. In primary congenital glaucoma: there was a mean difference of -.79 ± 2.82 (p = 0.032), a good correlation with (r) = 0.94, (r2) = 0.87%, and 95% level of agreement: -6.34 to +4.76. In normal eyes: mean difference was -.52 ± 2.5 (p = 0.01), correlation: (r) = 0.8, (r2) = 0.64, and p = 0.001. The 95% level of agreement -5.41 and +4.36 mmHg. In intraocular pressure ⩽ 15 mmHg: mean difference -0.89 ± 2.15 mmHg, 95% level of agreement between -5.1 and +3.32 mmHg, p < 0.001. In intraocular pressure >15 mmHg: mean difference was 0.04 ± 3.28 mmHg, 95% level of agreement -6.38 and +6.46 mmHg, p = 0.914. CONCLUSION: There is a good correlation between rebound tonometer and Perkins applanation tonometer in children with and without primary congenital glaucoma; however, rebound tonometer overestimates the intraocular pressure, and in intraocular pressure >15 mmHg there is less agreement between the two devices. Hence, in higher intraocular pressure measurement caution should be taken when interpreting rebound tonometer readings, and a confirmatory measurement using Perkins applanation tonometer is advised.

Long-term follow-up of cryopreserved amniotic membrane transplant during strabismus reoperations: Up 85 months' follow-up.

PURPOSE: To evaluate the long-term effect of cryopreserved human amniotic membrane transplant during strabismus reoperations. METHODS: A total of 15 patients with persistent strabismus were included in a prospective study to evaluate the effect of wrapping the extra-ocular muscles with cryopreserved amniotic membrane during strabismus reoperations. The study end-point was the last follow-up visit. A successful outcome was defined as 0-10∆ of horizontal tropia and 0-4∆ of vertical tropia, with no limitation of ductions exceeding -1. A cosmetically acceptable outcome was defined as a tropia of 0-15∆. RESULTS: Maximum follow-up was 85 months (mean: 25.4 ± 25.5 months). At the last follow-up visit, a successful outcome was achieved in 46.7%, a cosmetically acceptable outcome was achieved in 66.7%, and the mean ocular deviation angles improved from 38.60 ± 14.63∆, preoperatively, to 10.6 ± 11.08∆. Motility limitation on the final follow-up visit exceeded -1 in only 4/180 muscles (2.2%). CONCLUSION: The effect of cryopreserved amniotic membrane transplantation on the success of strabismus reoperations was moderate in terms of ocular alignment. Its effect was more pronounced in terms of ocular motility. The latter better reflects the level of adhesions. No long-term complications were documented, denoting safety of cryopreserved amniotic membrane usage during strabismus reoperations.