Diode laser treatment of retinopathy of prematurity: anatomical and refractive outcomes.

PURPOSE: To examine the anatomical and refractive outcomes of infrared diode laser photocoagulation (DLPC) for the treatment of threshold retinopathy of prematurity (ROP). METHODS: The charts of all consecutive premature neonates with ROP treated by DLPC at our tertiary center from December 1, 1996, to December 31, 2004, were reviewed. RESULTS: The group included 100 neonates (194 eyes) with a mean birth weight +/- SD of 833.9 +/- 250.3 g and a mean gestational age +/- SD of 26 +/- 1.9 weeks. Sixty-two percent of neonates had zone I or posterior zone II ROP. Each eye received a mean +/- SD of 1,740 +/- 990 laser applications, and 21% of eyes received an additional 1 to 2 rows posterior to the ridge. Neonates treated after December 2003 (cutoff date of the Early Treatment of Retinopathy of Prematurity study) underwent a significantly greater number of laser applications (mean +/- SD, 2,286 +/- 1,087) than did neonates treated earlier. Anatomical results of laser treatment were favorable for 179 eyes (92.3%) at a mean follow-up +/- SD of 33.6 +/- 27.2 months. After vitreoretinal surgery, partial or total retinal detachment was documented for 2.5% of patients who received posterior-to-the-ridge laser treatment and 3.8% of patients treated only on the avascular retina. Refractive data were available for 134 eyes: 55.2% had myopia of -5 diopters (31.3%) or greater (23.9%). Strabismus was found in 21 (28.8%) of 73 neonates tested. Gestational age was correlated with corrected age at treatment, zone of ROP, number of laser applications, and spherical equivalent. Snellen visual acuity of 6/12 or more occurred in 17 of 24 patients who complied with testing. CONCLUSION: DLPC is a safe and effective treatment for ROP. Neonates of lower gestational age and birth weight require earlier and more aggressive laser treatment and may have a higher refractive error.

Early structural status of the eyes of healthy term neonates conceived by in vitro fertilization or conceived naturally.

PURPOSE: To evaluate the effects of in vitro fertilization (IVF) on early development of the eye in full-term healthy infants. METHODS: A case-control study was performed. The study sample included full-term infants born from March 1 to August 14, 2006, in the Neonatal Department of Helen Schneider Women's Hospital, Rabin Medical Center. Data were collected on sex, gestational age, birth weight, Apgar score, head circumference, body length, and mode of conception (IVF/natural). A full ophthalmologic examination was performed, including measurement of intraocular pressure, keratometry, ultrasound biometry, pachymetry, and funduscopy. RESULTS: Sixty-six infants (132 eyes) were examined; 32 were conceived by IVF, and 34 were conceived naturally. Girls accounted for 56% of the IVF group and 44% of the natural conception group. There were no statistically significant differences between the groups in sex, gestational age, head circumference, intraocular pressure, axial length, anterior chamber depth, and lens thickness. The IVF infants had lower birth weight and body length than the infants born by natural conception (P = 0.032, t-test). Their keratometric and pachymetric values were also higher, but when birth weight and length were controlled, this difference remained statistically significant only for infants with a birth weight of less than 3000 g and a body length of less than 48.5 cm. CONCLUSIONS: IVF apparently has no effect on early development of the eyes in full-term infants. The steeper corneal curvature and greater central corneal thickness in a subset of smaller IVF infants may reflect delayed corneal maturation.

Full vertical rectus muscle transposition combined with medial posterior fixation sutures for patients with adduction deficiency.

PURPOSE: To compare the surgical and functional results of full tendon rectus muscle transposition to the medial rectus muscle augmented with posterior medial fixation sutures in patients with adduction deficiency (ADD) and Duane's syndrome type 2. DESIGN: Retrospective nonconcurrent interventional comparative case series. PARTICIPANTS: Twelve consecutive patients with ADD and Duane's syndrome type 2. INTERVENTIONS: Six patients treated by the full tendon rectus muscle transposition procedure alone were compared with 6 patients treated by the full tendon rectus muscle transposition combined with posterior medial fixation sutures. MAIN OUTCOME MEASURES: Postoperative ocular alignment, duction improvement, binocular functions, and reoperation. RESULTS: In the augmented surgery group, mean distance and near deviation decreased by 74.5% and 74%, respectively, versus 56% and 59%, respectively, in the control group (P = 0.007 and 0.02, between-group comparison for distance and near deviation, respectively). Mean duction improved in 73% of the study group compared with 52% of controls (P = 0.025). No postoperative complications or duction anomalies were observed during follow-up in the entire cohort; reoperation was needed in 1 patient in the study group and in all 6 patients in the control group. CONCLUSIONS: The augmented full vertical rectus muscle procedure is a beneficial surgical approach for patients with ADD and Duane's retraction syndrome type 2, reducing the need for multiple extraocular muscle surgery.

Decompensation of exodeviation after corneal refractive surgery for moderate to high myopia.

BACKGROUND AND OBJECTIVE: To evaluate strabismus and binocular decompensation of exodeviation and their surgical treatment following corneal refractive surgery. PATIENTS AND METHODS: A retrospective study of a noncomparative case series was conducted. Seven patients whose strabismus worsened after photorefractive keratectomy or laser in-situ keratomileusis for correction of myopia underwent orthoptic evaluation before and after refractive surgery, as well as after corrective strabismus surgery. The motor alignment and regaining of binocularity after strabismus surgery to correct the misalignment following refractive corneal surgery were evaluated and compared at three time points. RESULTS: After corneal refractive surgery, there was a deterioration in mean distance exodeviation from 7.1 +/- 5.2 to 25.7 +/- 10.1 prism diopters (PD) (P = .028) and in mean near exodeviation from 7.1 +/- 5.1 to 29.7 +/- 8.1 PD (P = .18), with loss of binocular function in 6 of the 7 patients. Following strabismus surgery, the mean distance exodeviation was reduced from 25.7 +/- 10.1 to 2.0 +/- 1.8 PD (P = .027) and the mean near exodeviation from 29.7 +/- 8.1 to 3.7 +/- 1.5 PD (P = .028). Five of the six patients regained binocular function. CONCLUSIONS: All at-risk patients with exophoria and exotropia should undergo a thorough orthoptic evaluation before corneal refractive surgery. Patients with ocular motility and misalignment problems should be warned preoperatively of the risk of decompensation of their strabismus.