Optic Capture Without Anterior Vitrectomy in Pediatric Cataract Surgery.

PURPOSE: To compare outcomes of 2 surgical techniques in children undergoing cataract surgery with intraocular lens (IOL) implantation: optic capture of IOL without anterior vitrectomy (AV) or in-the-bag IOL with AV. DESIGN: Prospective randomized controlled trial. METHODS: Patients were randomized to 2 groups: optic capture without AV (group 1) or in-the-bag implantation with AV (group 2). The following variables were compared: visual axis opacification (VAO), inflammatory deposits on IOL surface, anteroposterior synechia, IOL tilt and decentration, lenticular astigmatism, refractive prediction error, and posterior segment complications. RESULTS: Fifty-one eyes of 37 children were investigated with a mean follow-up of 20.1±8.5 months. Group 1 and group 2 had mean ages of 59.2±32.6 and 46.5±21.9 months, respectively (P = .104). Three eyes in group 1 and 2 eyes in group 2 developed VAO (P = .656). Two eyes in group 1 and 5 eyes in group 2 developed anteroposterior synechia (P = .291). Six eyes in group 1 and 11 eyes in group 2 had inflammatory deposits on the IOL (P = .233). Both groups had similar IOL tilt and decentralization (for all meridians, P > .05). The absolute refractive prediction error was 0.55±0.34 diopter (D) and 0.53±0.3 D, respectively (P = .294). Each group had 1 eye with intraocular hypertension (P = .932). CONCLUSION: The optic capture method was similar to the conventional technique in the quantitative evaluation of comprehensive data such as visual axis opacification, inflammatory sequelae, refractive outcomes, and IOL stability. The optic capture technique is an appealing option for pediatric cataract surgery because it eliminates the requirement for vitrectomy.

Evaluation of Choroidal Vascular Index in Amblyopic Patients.

Objectives: To compare subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) in patients with hyperopic refractive and strabismic amblyopia and healthy subjects. Materials and Methods: The study included 17 patients with strabismic amblyopia (Group 1), 29 patients with hyperopic refractive amblyopia (Group 2), and 16 eyes of 16 healthy volunteers (Group 3). Best corrected visual acuity was noted in all patients and volunteers. In addition to detailed anterior and posterior segment examinations, macular images were obtained by enhanced-depth imaging mode of optical coherence tomography (OCT). SFCT measurements were made from these images and CVI was calculated using the Image J program. Results: No significant difference was found between the groups in terms of age, gender, and intraocular pressure (p=0.27, 0.64, and 0.85, respectively). Mean BCVAs in Group 1 were 0.57±0.16 (0.3-0.8) in the amblyopic eyes, 0.94±0.08 (0.8-1.0) in the fellow eyes, and in Group 2 were 0.61±0.17 (0.2-0.8) in amblyopic eyes, 0.92±0.1 (0.8-1.0) in fellow eyes. BCVA in Group 3 was 1.0±0 (1.0-1.0). Mean SFCT of the amblyopic eyes in Groups 1 and 2 was 341.50±60.4 (277-481) and 370.06±65.3 (247-462), respectively, and in the healthy eyes of Groups 1 and 2 and Group 3 was 321.92±68.26 (251-440), 330.35±74.00 (194-502), and 327.62±40.79 (238-385), respectively. SFCT was significantly greater in the amblyopic eyes of Group 2 compared to Group 3 (p=0.01). Mean CVI was 0.681±0.032 (0.642-0.736) in the amblyopic eyes and 0.685±0.054 (0.587-0.788) in the fellow eyes of Group 1 patients; 0.664±0.033 (0.592-0.719) in the amblyopic eye and 0.707±0.039 (0.625-0.779) in the fellow eye in Group 2 patients; and 0.689±0.031 (0.612-0.748) in Group 3 patients. CVI was significantly lower in the amblyopic eyes of Group 2 compared with fellow eyes (p=0.02) and Group 3 (p=0.025). Conclusion: Morphological changes may be seen in the choroid in amblyopic eyes. We observed that the choroidal stromal component is increased in hyperopic amblyopic patients especially.

Stereoacuity, Fusional Vergence Amplitudes, and Refractive Errors Prior to Treatment in Patients with Attention-Deficit Hyperactivity Disorder

Objectives: To evaluate stereoacuity, fusional vergence amplitudes, and refractive errors in patients with attention-deficit hyperactivity disorder (ADHD). Materials and Methods: Twenty-three patients who were newly diagnosed as having ADHD and had not started medication, and 48 children without ADHD were included. Retrospective data analysis of comprehensive eye examination, stereoacuity, and fusional vergence amplitudes of the patients were performed. Results: The mean age at ADHD diagnosis was 10.68±2.34 (7-16) years in the ADHD group (14 male, 9 female) and 12.23±2.16 (7-15) years in the control group (25 male, 23 female) patients (p=0.605). The mean stereoacuity was 142.14±152.65 (15-480) sec/arc in patients with ADHD and 46.3±44.11 (15-240) sec/arc in the control group (p<0.001). For ADHD patients, the mean convergence and divergence amplitudes at distance were 19.87±8.40 (6 to 38) prism diopter (PD) and -9.09±-4.34 (-4 to -25) PD, and 37.30±12.81 (14 to 70) PD and -13.13±-3.45 (-4 to -20) PD at near, respectively. The mean cycloplegic spherical equivalent was 1.06±1.13 (-1 to 4.63) diopter in ADHD patients, with 6 patients having significant refractive errors (hyperopia in 4 patients, astigmatism in 2 patients). There were no significant differences between groups in terms of spherical equivalents (p=0.358) or convergence and divergence amplitudes at distance (p=0.289 and p=0.492, respectively) or near (p=0.452 and p=0.127, respectively). Conclusion: Fusional vergence amplitudes did not present significant difference, while the mean value of stereoacuity was significantly lower in newly diagnosed ADHD patients prior to treatment.

Functional and morphological assessment of ocular structures and follow-up of patients with early-stage Parkinson's disease.

PURPOSE: To evaluate and follow-up of functional and morphological changes of the optic nerve and ocular structures prospectively in patients with early-stage Parkinson's disease. MATERIALS AND METHODS: Nineteen patients with a diagnosis of early-stage Parkinson's disease and 19 age-matched healthy controls were included in the study. All participants were examined minimum three times at the intervals of at least 6 month following initial examination. Pattern visually evoked potentials (VEP), contrast sensitivity assessments at photopic conditions, color vision tests with Ishihara cards and full-field visual field tests were performed in addition to measurement of retinal nerve fiber layer (RNFL) thickness of four quadrants (top, bottom, nasal, temporal), central and mean macular thickness and macular volumes. RESULTS: Best corrected visual acuity was observed significantly lower in study group within all three examinations. Contrast sensitivity values of the patient group were significantly lower in all spatial frequencies. P100 wave latency of VEP was significantly longer, and amplitude was lower in patient group; however, significant deterioration was not observed during the follow-up. Although average peripapillary RNFL thickness was not significant between groups, RNFL thickness in the upper quadrant was thinner in the patient group. While there was no difference in terms of mean macular thickness and total macular volume values between the groups initially, a significant decrease occurred in the patient group during the follow-up. During the initial and follow-up process, a significant deterioration in visual field was observed in the patient group. CONCLUSION: Structural and functional disorders shown as electro-physiologically and morphologically exist in different parts of visual pathways in early-stage Parkinson's disease.

Treatment results in aphakic patients with glaucoma following congenital cataract surgery.

PURPOSE: To evaluate the clinical findings and possible risk factors of patients with aphakic glaucoma following congenital cataract surgery and identify the factors affecting response to glaucoma treatment. METHODS: A retrospective chart review of 173 patients was performed who underwent congenital cataract surgery before the age of 12 months and 40 eyes of 25 patients with aphakic glaucoma were enrolled. Age of the patients at the time of the cataract surgery, postoperative complications, additional ocular pathologies and the type of glaucoma treatment needed were investigated. RESULTS: Mean age of 25 patients at the time of cataract surgery was 3.31 ± 2.28 (range 1-11) months with a mean follow-up period of 79 ± 30.5 (32-176) months. Out of 40 eyes, medical therapy was effective in 20 (50%) eyes, whereas 20 (50%) eyes needed surgery for glaucoma. In these 20 eyes, 6 (30%) eyes underwent only 1, 4 (20%) eyes underwent 2 and 10 (50%) eyes underwent 3 or more procedures. Age at the time of cataract surgery, pupillary membrane formation and additional ocular pathologies were not significantly associated both with the need for glaucoma surgery or the number of operations (p ≥ 0.05). CONCLUSION: Aphakic glaucoma following congenital cataract surgery is a serious complication which requires surgery in half (50%) of the patients. Usually, more than one surgical procedure (70%) is needed. It can be detected even years after cataract surgery (range 0.3-94 months), so long-term careful follow-up is necessary.

TGFB1 and LAMA1 gene polymorphisms in children with high myopia.

OBJECTIVE: To investigate TGFB1 and LAMA1 gene polymorphisms in children with high myopia in order to determine the genetic basis of large myopic shifts causing severe visual impairment and complications. METHODS: Seventy-four children with high myopia (≥6 diopters [D]; study group) and 77 emmetropic children (±0.5D; control group) were included. Genetic and polymorphism analyses were performed in the Medical Genetics Laboratory using DNA purified from the patients' blood samples. RESULTS: Mean ages of the patients were 7.1±3 (3-13) and 9.6±1.8 (6-13) years in the study and control groups, respectively. Mean refraction in the high myopia group were -10.1±4.3D in the right and -8.9±3.6D in the left eye. LAMA1 gene analysis of the study group revealed heterozygous mutations in 34 patients (45.9%), homozygous mutations in 25 patients (33.8%), and no mutations in the remaining 15 patients (20.3%). In the control group, there were 31 subjects (40.3%) with heterozygous, 27 (35.1%) with homozygous LAMA1 mutations, and no mutations in 19 (24.7%) (p=0.73). TGFB1 gene analysis showed heterozygous mutations in 32 (43.2%) and homozygous mutations in 10 patients (13.5%) in the study group, while 32 patients (43.2%) had no mutations. In the control group, 35 subjects (45.5%) had heterozygous, 8 (10.4%) had homozygous, and 34 (44.1%) had no TGFB1 mutations (p=0.36). CONCLUSION: This is the first study to simultaneously examine two genes in high myopia in a Turkish population. However, we observed no significant differences in TGFB1 and LAMA1 gene polymorphisms in patients with high myopia compared to healthy subjects.

Long-term Results in Pediatric Developmental Cataract Surgery with Primary Intraocular Lens Implantation.

OBJECTIVES: The aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation. MATERIALS AND METHODS: Patients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre- and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients' charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases. RESULTS: A total of 101 eyes of 65 patients were included. The average age at time of surgery was 76±40 months and the average follow-up period was 44±30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed ≥2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity. CONCLUSION: Good visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups.

CHN1 gene mutation analysis in patients with Duane retraction syndrome.

PURPOSE: To investigate CHN1 (chimerin 1) gene mutations in patients with isolated nonsyndromic Duane syndrome and accompanying positive familial history, bilaterality, or various systemic disorders. METHODS: Patients with Duane retraction syndrome (DRS) and a positive family history of congenital ocular motility disturbance or bilateral involvement or accompanying any congenital disorder(s) seen consecutively at a single center from 2013 to 2016 were enrolled. All subjects underwent full ophthalmologic examination, including refraction, best-corrected visual acuity, ocular alignment and motility, globe retraction, and biomicroscopic or fundus evaluation. DNA samples were investigated by direct sequencing of the coding regions of the CHN1 gene. RESULTS: A total of 30 patients (15 males) were included (mean age, 11.8 ± 10.4 years; range, 2-45 years): 8 cases presented with bilateral DRS; 22, with unilateral DRS. Family history of ocular motility abnormality was positive in 16 patients. Eleven cases had an additional congenital disorder. In 2 patients, 2 different mutations were detected in the CHN1 gene: p.E313K (c.937G>A) and p.N224S (c.671A>G). CONCLUSIONS: CHN1 mutations were identified in 2 bilateral cases and in 1 parent of 1 affected case. One mutation is novel and occurred with additional vertical gaze abnormalities. Additional genetic studies evaluating chimerin 1 (CHN1) and its role in the development of the ocular motor axis are needed to provide new data about these mutations and phenotypic variations.

The effect of convergence and divergence stress on near stereoacuity.

The aim of this study was to evaluate the effect of convergence and divergence stress on near stereoacuity in healthy individuals. In this experimental study, 38 subjects with fine stereoacuity (≤30 arcsec in TNO test, 17th edition) were enrolled. Near fusional convergence and divergence amplitudes were measured. Near stereoacuity was evaluated at different levels of convergence and divergence stress induced with base-in and base-out prisms. The amount of base-in and base-out prisms that cause a decreased stereoacuity level of >240 and >60 arcsec were noted for each subject. There were 21 female and 17 male visually normal adults (aged 25-32 years) in the study. The mean near convergence amplitude of the subjects was 37.7 ± 6.9 (25-54) prism dioptres (PD), and the mean near divergence amplitude was 16.5 ± 2.8 (10-25) PD. The mean convergence stress that decreased the stereoacuity level to >240 and >60 arcsec were 20.1 ± 7.9 (4-35) PD and 13.9 ± 5.4 (4-30) PD, respectively. The mean divergence stress that decreased the stereoacuity levels to >240 arcsec was 11.5 ± 2.9 (4-18) PD, and to >60 arcsec was 8.7 ± 2.9 (4-18) PD. Decreased stereoacuity is an important criterion for judging deterioration for patients with intermittent deviations. However, it is not clear what might be occurring in these deteriorating patients. We specifically determined that short periods of prism-induced convergence and divergence are accompanied by a decrease in fine near stereoacuity in visually normal adults. Controlling intermittent deviations by using vergence system could be the simple cause of decreased stereoacuity in these patients.

Multiple Pathological Ocular Findings in a Patient With PHACE Syndrome.

The authors describe a 2-year-old girl diagnosed as having posterior fossa malformations, hemangiomas, arterial anomalies, cardiac anomalies, and eye abnormalities (PHACE) syndrome that presented with a large facial hemangioma of the forehead and eyelid, ptosis, microphthalmia, persistent pupillary membrane and pupillary ectopia, congenital oculomotor nerve palsy of the affected eye, and bilateral optic disc dysplasia. [J Pediatr Ophthalmol Strabismus. 2016;53:e72-e74.].

Massive iatrogenic orbital cysts following glaucoma drainage implant and strabismus surgery.

We describe 2 paediatric patients who developed large orbital conjunctival epithelium-lined inclusion cysts postsurgery. Case 1 underwent Ahmed glaucoma valve implant surgery 8 months ago and case 2 underwent strabismus surgery 7 years ago. Both cases had either symptomatic strabismus or a mass causing some degree of proptosis or incomitance due to lesions in the intraorbital space. Following total excision of the cysts all associated symptoms were resolved. Conjunctival cysts following ocular surgery can develop anywhere in the anterior segment; however, large orbital cysts following anterior segment surgery are quite rare. We think that implantation cysts should be considered in the differential diagnosis of patients that have signs of orbital mass with a history of previous anterior segment surgery. Complete excision of the cysts results in resolution of all associated signs and symptoms.

Unilateral phthiriasis palpebrarum infestation in a child during occlusion therapy for amblyopia: Case report.

An 8-year-old mentally retarded boy is brought to the hospital because of itching and burning at his right eye for 10 days. He was on full time right eye occlusion therapy for left amblyopia. Slit lamp examination revealed nits and adult lice anchored to the eyelashes in his occluded eye. Eyelashes and all detected lice and nits were mechanically trimmed, and sent for parasitological examination, which confirmed the diagnosis. Upon familial evaluation for additional infestation, the father was also found to have genital phthiriasis pubis and received appropriate treatment. While phthiriasis palpebrarum in children may signify sexual abuse, a detailed investigation by a child psychiatrist was performed and revealed no sign of abuse. Since the infestation was at only on occluded eye, the most possible explanation for the transmission was evaluated as the misusage of the adhesive patch in our case. In conclusion, sexual abuse should be excluded in children with phthiriasis palpebrarum and parents of amblyopic children on occlusion therapy should be warned about the importance of the hygiene of the patching in order to avoid any kind of infection and infestation.

Evaluation of the anatomic and refractive differences in hyperopic anisometropia.

The purpose of this study was to investigate the interocular symmetry of ultrasonic biometric characteristics and anterior segment measurements between the fellow eyes of hyperopic anisometropes. Forty-two healthy hyperopic anisometropic cases (1 D mean spherical equivalent difference between eyes) without strabismus were recruited. A range of refractive and ultrasonic biometric parameters were measured in both eyes of each subject including keratometry, mean spherical equivalent, anterior chamber depth (ACD), lens thickness, vitreous depth (VD), axial length (AL), and anterior segment parameters (central corneal thickness (CCT), ACD, anterior chamber volume (ACV)) with Pentacam. Mean spherical equivalent anisometropia was 2.66 ± 1.233 (range 1.125 and 6.25) D, and there was a strong correlation between the degree of anisometropia and the interocular difference in AL (r = 0.632, P < 0.001). A total of 61.3 % of the anisometropia was related with AL (50.7 %) and mean keratometry (10.6 %). Every 1 mm change in AL and every 1 D change in mean keratometry caused a total of 2.82 D and 2.14 D refractive difference, respectively. Among Pentacam parameters, ACD was correlated with ACV (r = 0.528; P < 0.001) and AL (r = 0.510; P = 0.001); ACV was correlated with VD (r = 0.358; P = 0.020); and CCT was correlated with ACV (r = 0.510; P = 0.001) and AL (r = 0.318; P = 0.040). Among ultrasonographic measurements, ultrasonic-ACD was correlated with CCT (r = 0.510; P = 0.001) and lens thickness (r = -0.556; P < 0.001), and VD was correlated with AL (r = 0.937, r 2 = 0.877, P < 0.001). The hyperopic and the fellow eyes displayed a high degree of interocular symmetry for the other measured parameters. AL and mean keratometry are the leading causes of hyperopic anisometropia. However, ACD as measured with Pentacam also shows difference in hyperopic anisometropic eyes.

Strabismus in infants following congenital cataract surgery.

PURPOSE: This study aimed to determine the incidence and characteristics of strabismus following congenital cataract surgery in infants. MATERIALS AND METHODS: Patients aged <12 months who underwent surgery for congenital cataract and were followed-up for ≥1 years were included. Patients that had strabismus prior to surgery were excluded. Data regarding gender, cataract laterality, morphology, and density, age at the time of cataract surgery, ocular motility post surgery, and the presence of nystagmus were retrospectively obtained from the patients' records. RESULTS: The study included 79 patients (48 male and 31 female). Unilateral surgery was performed in 14 of the patients, versus bilateral surgery in 65. Strabismus did not occur post surgery in 32 (40.5 %) of the patients (group 1), whereas 47 (59.5 %) (group 2) developed strabismus following surgery. The patients in group 1 were followed-up for a mean 50.7 ± 38.5 months, versus 50.3 ± 39 months in group 2. Mean age at the time of cataract surgery in groups 1 and 2 was 3.6 ± 1.9 years and 4.6 ± 3.2 months respectively. Mean duration of time between cataract surgery and the development of strabismus was 13.3 ± 13 months (range: 1-60 months). Unilateral cases were more prone to develop strabismus, which was statistically significant (p = 0.028). Age at the time of cataract surgery, gender, cataract density, the occurrence of aphakic glaucoma, the presence of nystagmus, and additional ocular surgery were not significantly associated with the development of strabismus. CONCLUSION: Strabismus develops more frequently in children undergoing cataract surgery. In the present study strabismus occurred in more of the patients that underwent unilateral surgery. Based on the present findings, we think that long-term careful follow-up to monitor the development of strabismus is required in all infants undergoing cataract surgery, especially unilateral cases.

The impact of prism adaptation test on surgical outcomes in patients with primary exotropia.

BACKGROUND: We aimed to determine the impact of the preoperative prism adaptation test (PAT) on surgical outcomes in patients with primary exotropia. METHODS: Thirty-eight consecutive patients with primary exotropia were enrolled. Pre-operative PAT was performed in 18 randomly selected patients (Group 1). Surgery was based on the angle of deviation at distance measured after PAT. The remaining 20 patients in whom PAT was not performed comprised Group 2. Surgery was based on the angle of deviation at distance in these patients. Surgical success was defined as ocular alignment within eight prism dioptres (PD) of orthophoria. RESULTS: Satisfactory motor alignment (± 8 PD) was achieved in 16 Group 1 patients (88.9 per cent) and 16 Group 2 patients (80 per cent) one year after surgery (p = 0.6; chi-square test). There were no statistically significant differences in demographic parameters, pre-operative and post-operative angle of deviation between the two groups (p > 0.05; Mann-Whitney U and chi-square tests). Nine patients in Group 1 (50 per cent) and two patients in Group 2 (10 per cent) had increased binocular vision one year post-operatively. A statistically significant difference was determined in terms of change in binocular single vision between the two groups (p = 0.01; chi-square test). CONCLUSION: Although the prism adaptation test did not lead to a significant increment in motor success, it may be helpful in achieving a more favourable functional surgical outcome in patients with primary exotropia.

Transient subretinal hemorrhage after photodynamic therapy of subfoveal choroidal osteoma.

PURPOSE: To report a case of choroidal osteoma that developed subretinal hemorrhage after photodynamic therapy (PDT). METHODS: Interventional case report. RESULTS: An 8-year-old boy was brought to our attention because of mild visual loss in his left eye. The visual acuity was 20/25. A subfoveal yellow-orange-colored lesion, measuring 5.0 mm × 4.5 mm in base diameter was detected in the left eye. B-mode ultrasonography showed an acoustically solid 2.0-mm-thick mass with orbital shadowing. Orbital computed tomography confirmed the presence of calcium, and choroidal osteoma was diagnosed. As there was a decrease in the best-corrected visual acuity (20/30) and the lesion showed growth (6.0 mm × 6.0 mm), PDT was performed at 6 months follow-up. The day after PDT, the visual acuity was counting fingers at 1 m and a subretinal hemorrhage over the lesion was detected. Two weeks after PDT, subfoveal hemorrhage dissappeared with some retinal pigment epithelial hyperplasia and visual acuity increased back to 20/30. CONCLUSION: Although PDT can induce decalcification in choroidal osteomas, it should not be performed in subfoveal osteomas unless there is evidence to treat the lesion such as the presence of choroidal neovascularization.

Influences of cyclopentolate hydrochloride on anterior segment parameters with Pentacam in children.

PURPOSE: To investigate the effects of cyclopentolate hydrochloride 1% on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in children. SETTING: Ege University Faculty of Medicine, Department of Ophthalmology. METHODS: Pentacam measurements of 50 (23 boys and 27 girls) children before and after 45 min of cyclopentolate hydrochloride 1% instillation were performed and compared with 31 (17 boys and 14 girls) no medication instilled control group. Measurements of the control group (cycloplegia-free) were taken at two separate sessions with 45-min intervals. For comparison of the test parameters, paired t-test in the groups and unpaired t-test in between the groups were used. RESULTS: Mean ages in the study and control groups were 10.06 ± 2.87 (range 6 and 16 years) and 9.87 ± 2.72 (range 6 and 16 years), respectively, and the difference was statistically insignificant (p > 0.05). In the study group, measurements between two sessions were significantly different for the parameters of anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) (p < 0.05), whereas none of the parameters was different between two sessions for control group. CONCLUSIONS: Cyclopentolate hydrochloride 1% instillation leads to significant decrement in CCT. ACD and ACV are the other important refractive parameters that increase significantly after cycloplegia. Effects of cycloplegia on these parameters for Pentacam measurements should be regarded for proper clinical interpretation in children.

The effect of optical correction on refractive development in children with accommodative esotropia.

PURPOSE: To compare the effects of partial or full hyperopic optical correction on refractive development in children with accommodative esotropia. METHODS: Children with accommodative esotropia and hyperopia >3 D were enrolled in this prospective, nonrandomized study. All children underwent an ophthalmologic examination, including refraction, keratometry, and axial length. Subjects were divided into either full- or partial-correction groups according to their tolerance of the full hyperopic correction. Routine follow-up examinations were performed for at least 3 years. The main outcome measure was cycloplegic spherical equivalent at the end of the study period. RESULTS: A total of 120 children were enrolled. The mean cycloplegic spherical equivalent, corneal radius, and axial length were significantly (p < 0.05) different between the first and last visits in both groups. However, when all the measurements were adjusted for the age difference between groups, only the difference in axial length between the first and last visits was statistically significant (p < 0.05). Partial or full optical correction in age-adjusted cohorts with accommodative esotropia did not result in a significant change in refraction, keratometry, or axial length between the first and last visits. CONCLUSIONS: Partial or full optical correction of hyperopia had similar effects on refractive development of the eye in children with accommodative esotropia. Treatment of accommodative esotropia in children older than age 5 did not appear to impair refractive development.