A survey of the management of globe perforation during strabismus surgery in the United Kingdom.

INTRODUCTION: Globe perforation is a potentially devastating complication of strabismus surgery. The purpose of this study is to investigate the management of suspected globe perforation encountered during strabismus surgery in the United Kingdom. METHODS: A postal survey of all consultant ophthalmologists in the United Kingdom was undertaken. The questionnaire solicited data on the management and outcomes of globe perforation encountered during strabismus surgery. RESULTS: Five hundred and seventeen of 850 (60.8%) surgeons responded to the survey. Of these, 240 (46.4%) performed strabismus surgery, of whom 58.8% performed fewer than 50, 32.1% performed 50 to 100, and 8.3% performed more than 100 surgical procedures annually. Ninety-eight (40.8%) had suspected globe perforation during strabismus surgery, of whom 86 subsequently carried out dilated fundoscopy. There were 74 reported globe perforations. Fifty-four detailed treatment with cryopexy (50%), retinal laser (31.5%), both (9.3%), cautery (1.9%), and not reported (7.4%). In 27% of cases surgeons chose not to treat the perforation observed postoperatively. Thirty-five respondents prescribed additional antibiotics. Visual loss occurred in 6 cases, with 2 cases of endophthalmitis, 2 retinal detachments, 1 suprachoroidal hemorrhage, and 1 from a chorioretinal scar. DISCUSSION: Complications leading to visual loss were infrequent. Of the surgeons reporting globe perforations, approximately three quarters chose to treat the injury and one quarter chose to observe without treatment. Cryotherapy was the most popular intervention. Further prospective study is required to elucidate optimal management strategies.

Ocular findings in pediatric patients with partial agenesis of corpus callosum.

PURPOSE: To evaluate the ocular associations with corpus callosum agenesis. METHODS: All children who had corpus callosum agenesis diagnosed by computed tomography or magnetic resonance imaging scans during a 10-year period were included in the study. A complete ophthalmological assessment was undertaken. Data were collected for age, sex, neurological findings, visual acuity, refractive errors, ocular motility defects, and ocular abnormalities. There were no children with Aicardi syndrome in the study. RESULTS: Nineteen children with corpus callosum agenesis were identified, of whom 13 were examined. All had partial agenesis of the corpus callosum. Visual acuity was better than 20/60 in 5 children (38%), between 20/60 and 20/200 in 3 children (23%), and less than 20/200 in 5 children (38%). Refractive errors were present in 8 children (62%), strabismus in 6 children (46%), nystagmus in 2 children (15%), hypoplastic discs in 3 children (23%), and microphthalmos in 1 child (8%). CONCLUSION: Non-syndromic corpus callosum agenesis may be associated with several ocular defects. Poor visual acuity, refractive errors, and strabismus predominate and need to be appropriately addressed to optimize visual function in these children. Global developmental delay (62%) and epilepsy (46%) were the most common neurological associations in this series.

Amniotic membrane transplantation in children with symblepharon and massive pannus.

OBJECTIVE: To report our pediatric experience with amniotic membrane transplantation for ocular surface and forniceal reconstruction. METHODS: Retrospective case review of children who underwent superficial keratectomy, symblepharon lysis, and forniceal reconstruction using amniotic membrane transplantation. The underlying diagnosis, visual acuity, level of discomfort at first and last visits, and surgical details were noted. RESULTS: Four patients (5 eyes) were included. Two patients had epidermolysis bullosa (1 recessive dystrophic and 1 junctional), 1 had laryngo-onychocutaneous syndrome, and 1 had measles-related keratitis and was positive for human immunodeficiency virus. Their mean age when initially seen was 8.7 years (age range, 4-16 years), and mean follow-up was 18.25 months (range, 12-29 months). The mean visual acuity preoperatively was 1.1 logMAR (logarithm of the minimum angle of resolution) (range, 1-1.3), and postoperatively was 0.7 (range, 0.2-1.2). All patients experienced increased ocular comfort with anatomical restoration of corneal and conjunctival surfaces. Visual acuity improved in 3 eyes. Only the patient with laryngo-onychocutaneous syndrome had recurrence of granuloma, at 9 months after surgery. CONCLUSION: Amniotic membrane transplantation with symblepharon lysis is effective for ocular surface reconstruction in the management of epidermolysis bullosa and other conditions that cause corneal scarring and symblepharon in children. In this small series, children with epidermolysis bullosa fared better and the effects of surgery lasted longer compared with patients with other causes of symblepharon and massive pannus.

Adrenal suppression and failure to thrive after steroid injections for periocular hemangioma.

PURPOSE: To evaluate the effects of steroid injections for periocular capillary hemangioma on adrenal function and body composition. DESIGN: Noncomparative, interventional case series. PARTICIPANTS: Four patients with periocular hemangioma. METHODS: Four white female infants with sight-threatening periocular hemangiomata received a combination of steroid injections of triamcinolone and betamethasone. In the first 2 cases, injections were perilesional and in the other 2, intralesional. MAIN OUTCOME MEASURES: The infants were monitored by serial measurements of basal serum cortisol concentrations, responses to the Synacthen stimulation test, measurement of growth and of weight gain, and, in one case, more detailed anthropometric measures of body composition. RESULTS: Prolonged suppression of circulating serum cortisol concentrations and cortisol responses to the Synacthen stimulation test were noted in 3 cases, and marked failure to thrive was noted in all 4 cases. CONCLUSIONS: Adrenal suppression after steroid injection for periocular capillary hemangioma is a potentially life-threatening complication. Failure to thrive is also a frequent side effect of treatment. Ophthalmologists should undertake the above treatment in consultation with a pediatric endocrinologist.