Refraction and keratometry in 40 week old premature (corrected age) and term infants.

AIM: To compare refraction and keratometry readings between premature and term babies at 40 weeks' postconceptional age (PCA), and the possible effect of birth weight (BW) and gestational age (GA) on ocular parameters. METHODS: 33 preterm babies hospitalised in the neonatal unit between January and March 2002 were matched with 33 term babies born within the same period and hospitalised in the same unit. The preterm group underwent funduscopy at 4-5 weeks after delivery. Ophthalmic examination at 40 weeks' PCA included cycloplegic retinoscopy, funduscopy, and keratometric measurements. Mean and standard deviation of refraction, astigmatic power (plus cylinder), axis of astigmatism, and keratometric reading were calculated and compared between groups and correlated with BW and GA in the premature babies. RESULTS: Retinopathy of prematurity (ROP) stage 1 or 2 was noted in 88% of the premature babies on the first funduscopy examination, but only in 36% by the corrected age of 40 weeks. Statistically significant between groups differences were found for cycloplegic refraction (p = 0.02 for both eyes) and keratometry (p = 0.001 for both eyes). GA and BW had no impact on the refractive and keratometric findings in the preterm babies. CONCLUSIONS: Babies with mild ROP at the corrected age of 40 weeks have mild hypermetropia compared to the moderate hypermetropia found in term babies (a difference of 50%), and they have higher and steeper keratometric values. The greater corneal curvature may contribute to the development of myopia. Ophthalmologists and parents need to be aware of the possibility of visual dysfunction already very early in life even in relatively older premature infants.

Combined resection and anterior transposition of the inferior oblique muscle for asymmetric double dissociated vertical deviation.

OBJECTIVE: To evaluate the efficacy of combined monocular resection and bilateral anterior transposition of the inferior oblique (IO) muscle for asymmetric double dissociated vertical deviation (DVD). DESIGN: Nonrandomized, comparative clinical trial. PARTICIPANTS: Twelve patients with asymmetric DVD and coexisting unequal IO overaction (IOOA). INTERVENTION: Six consecutive patients underwent combined graded monocular resection and bilateral anterior transposition of the IO muscle and six consecutive historical control patients underwent equal anteriorization of the IO muscle. MAIN OUTCOME MEASURES: Between-group comparison of the postoperative vertical deviation and reduction in IOOA. RESULTS: The mean difference of the asymmetric DVD in the primary position was reduced from 13.3 +/- 4.8 prism diopters (PD) to 2.2 +/- 1.8 PD in the study group (P = 0.001) and from 13.3 +/- 4.0 PD to 10.2 +/- 3.1 PD in the control group (P = 0.003). The difference in improvement between the groups was statistically significant (P = 0.004). The IOOA was significantly reduced in both groups. CONCLUSIONS: Bilateral IO anteriorization with monocular-graded IO resection should be considered as the treatment of choice in patients with asymmetric DVD with IOOA.

Slanted lateral rectus recession for exotropia with convergence weakness.

OBJECTIVE: To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exotropia (XT) with convergence weakness. DESIGN: Predesigned, nonrandomized, comparative trial. PARTICIPANTS: Twelve study patients and six control subjects with XT greater at near than at distance by > or =10 prism diopters (PD). INTERVENTION: Twelve consecutive patients underwent slanted LR recession, and six consecutive control subjects underwent standard LR recession. MAIN OUTCOME MEASURES: Between-groups comparison of the postoperative ocular alignment at distance and near, and the difference between them, as well as the stereopsis. RESULTS: Slanted LR recession reduced the XT to <8 PD in all patients at distance and in 11/12 patients at near. Additionally, the mean difference between the distance and near exodeviation was reduced from 14+/-4.5 PD preoperatively to 2.9+/-2.4 PD postoperatively. All patients in the control group demonstrated postoperative deviations of <8 PD at distance, but all had residual exodeviations >8 PD at near. Three of the study patients gained gross stereopsis postoperatively. CONCLUSIONS: Slanted recession of the LR is superior to standard recession in reducing both distance and near XT and in collapsing the difference between them. This technique may also have a positive impact on gross stereopsis.

Visual acuity, strabismus, and amblyopia in premature babies with and without retinopathy of prematurity.

One hundred eighty-seven premature babies, 48 of whom suffered from retinopathy of prematurity (ROP), were examined. A higher incidence of strabismus was found in the group with cicatricial ROP (23% vs. 9%). Amblyopia was present in 6% of the ROP group and in only 1.4% of babies without ROP. Myopia was found in 50% of the ROP group as compared with 15% in the nonROP group. Astigmatism and anisometropia were more common in the ROP group, but hypermetropia was equally represented in both groups.

Loss of accommodation produced by peristriate lesion in man?

We observed a bilateral accommodative paresis associated with a spontaneous parieto-occipital hematoma in a 37-year old patient. There was no clinical or computerized tomography (CT) evidence of transtentorial herniation or upper brainstem pathology. With resolution of the hematoma, accommodation returned to normal.

Myopia in premature babies with and without retinopathy of prematurity.

One hundred and fifty-five premature infants weighing 600-2000 g were followed up during 1974-80 for the presence of retinopathy of prematurity (ROP) and for the existence of myopia. 50% of the premature infants who had ROP were myopic, while only 16% myopic premature infants were found among those who did not have ROP. There was a positive correlation between the degree of myopia and the severity of cicatricial ROP. No difference existed in the frequency and degree of myopia between premature infants in which ROP cicatrised spontaneously and in those where it cicatrised after cryopexy.