Involution of retinopathy of prematurity after laser treatment: factors associated with development of retinal detachment.

PURPOSE: To identify specific features during the process of involution of retinopathy of prematurity after treatment at threshold that are associated with development of a retinal detachment. DESIGN: Retrospective case series. METHODS: The evolution of retinal detachments over time was analyzed retrospectively in 262 treated eyes of 138 infants. Specific features hypothesized to be associated with development of a retinal detachment were analyzed, including vitreous organization defined as clinically important, active stage 3 disease and active plus disease more than 21 days after treatment, and vitreous hemorrhage defined as clinically important. RESULTS: A retinal detachment developed in 36 (13.7%) of 262 eyes. Vitreous organization meeting our clinically important definition was associated with a 31-fold (confidence interval [CI] 5.37-183.63; P < .0001) and 13-fold (CI 2.97-58.59; P < .0001) increase in the odds for retinal detachment for right and left eyes, respectively. Vitreous hemorrhage defined as clinically important was associated with a 38-fold (CI 2.69-551.19; P = .007) and 15-fold (CI 1.65-144.12; P = .02) increase in the odds for retinal detachment for right and left eyes, respectively. The timing of retinal detachment relative to vitreous hemorrhage was not determined. Prolonged activity of Stage 3 disease or plus disease more than 21 days after treatment was not associated with development of a retinal detachment. CONCLUSIONS: Clinically important vitreous organization and vitreous hemorrhage were predictive for development of a retinal detachment. Evaluation of preemptive reintervention strategies for eyes at highest risk for developing a retinal detachment may be reasonable.

Nasolacrimal outflow drainage anomalies in Down's syndrome.

PURPOSE: To describe structural abnormalities of the lacrimal drainage system and outcomes after treatment for lacrimal outflow obstruction in children with Down's syndrome. DESIGN: Retrospective comparative interventional case series. PARTICIPANTS: Thirty-eight eyes of 22 consecutive Down's syndrome patients who underwent surgical treatment for nasolacrimal drainage obstruction (mean age, 32 months) and 59 eyes of 44 non-Down's syndrome patients who underwent surgical treatment after 2 years of age. MAIN OUTCOME MEASURES: Resolution of symptoms after surgery and presence of anatomic abnormalities of the lacrimal drainage system other than persistent Hasner's membrane. RESULTS: Among the Down's syndrome eyes, complete or partial resolution was noted in 34 (89%) of 38 eyes; 7 (18%) eyes underwent more than 1 procedure. Twenty-eight (74%) of 38 eyes had anatomic anomalies other than persistent Hasner's membrane; anomalies proximal to the nasolacrimal sac predominated. In comparison, 50 (85%) non-Down's syndrome eyes experienced complete or partial resolution, and 19 (32%) had anatomic abnormalities other than persistent Hasner's membrane; anomalies distal to the nasolacrimal sac predominated. CONCLUSIONS: Compared with older non-Down's syndrome patients, nasolacrimal outflow obstruction in Down's syndrome patients is more often complicated by anomalies of the lacrimal drainage system proximal to the lacrimal sac. Despite this, surgery can be similarly successful. Awareness of the possible peculiarities of lacrimal outflow obstruction in Down's syndrome patients may allow better selection and use of available treatment options.

Up-slanting palpebral fissures and oblique astigmatism associated with A-pattern strabismus and overdepression in adduction in spina bifida.

PURPOSE: To describe the spectrum of adnexal and ophthalmologic features in spina bifida. METHODS: A retrospective review of the medical records of 73 patients was conducted. Data concerning ocular motility, palpebral fissure orientation, presence and axis of astigmatism, visual acuity, amblyopia, and stereopsis were analyzed. RESULTS: Forty-three (59%) of the 73 patients had strabismus: 28 (65%) had esotropia, 12 (28%) had exotropia, and 3 (7%) had orthotropia in primary gaze and a significant A-pattern. Of the strabismic patients, 20 (47%) had an A-pattern, of which 13 (65%) demonstrated overdepression in adduction. Twenty-seven (84%) of the 32 patients with documented palpebral fissure orientation had exaggerated up-slanting palpebral fissures. Forty-nine (77%) of 64 patients exhibited astigmatism greater than 0.75 D in at least 1 eye, with a mean power of 1.6 D. The axis of cylinder was oblique in 76% of these patients. The astigmatic axis was consistently oriented perpendicular to the eyelid fissure orientation in the group of patients with up-slanting palpebral fissures, with the mean axis of cylinder being incyclorotated (OD axis, 77; OS axis, 108). Up-slanting palpebral fissures were associated with a 15-fold increased chance that the axis of cylinder would be incyclorotated (P =.07, chi-square test). An orbital computed tomographic (CT) scan of a spina bifida patient with A-pattern esotropia, overdepression in adduction, and up-slanting palpebral fissures demonstrated significant incyclorotated extraocular muscle pulley heterotopy. CONCLUSIONS: Exaggerated up-slanting palpebral fissures are a prominent feature in spina bifida. Up-slanting palpebral fissures in spina bifida patients are associated with incyclorotated oblique astigmatism, A-pattern strabismus, and overdepression in adduction. These associations might be related to an anomaly of orbital skeletal or extraocular muscle pulley development. Further prospective study is encouraged.

Surgical management of the lens and retrolenticular fibrotic membranes associated with persistent fetal vasculature.

PURPOSE: To evaluate a surgical technique that allows safe, effective, near-total removal of retrolenticular fibrotic membranes in eyes with persistent fetal vasculature syndrome (PFVS). SETTING: Pediatric ophthalmologist's academic practice. METHODS: This retrospective review comprised 5 children (6 eyes) who had excision of a retrolenticular fibrovascular membrane during cataract surgery over a 6-month period. Long, spoke-like radial incisions of the membrane were made to the ciliary processes, resulting in wedge-shaped segmentation of the membrane. A vitrector was used to excise each wedge and perform an anterior vitrectomy. RESULTS: The mean age at time of surgery was 8 months (range 1 to 24 months) and the mean follow-up, 9 months (range 2 to 13 months). The membrane was successfully removed in all eyes. One eye of a patient who did not comply with the postoperative medical regimen or follow-up developed pupillary block glaucoma requiring pupilloplasty and trabeculectomy. CONCLUSION: This anterior surgical technique to remove tenacious retrolenticular membranes associated with PFVS was effective, allowing near-total removal of the offending fibrovascular membrane.