Primary congenital glaucoma outcomes: lessons from 23 years of follow-up.

PURPOSE: To determine in primary congenital glaucoma whether age of presentation influences surgical success, the degrees of angle surgery needed to achieve glaucoma control, and whether there are critical ages where glaucoma progresses, requiring further surgical management. DESIGN: Retrospective cohort study. METHODS: The medical records of patients with primary congenital glaucoma over a 23-year period were reviewed: 192 procedures were performed on 117 eyes (70 patients). The number and age of angle procedures and final visual acuity was analyzed. Surgical success was defined as stable intraocular pressure and optic disc appearance. RESULTS: Procedures involving 83 of the 110 eyes (75.5%) undergoing angle surgery were successful, with 2-, 4-, 6-, and 10-year success rates of 92%, 86%, 84%, and 75%, respectively. Subgroup analysis (<3 months; 3-6 months; >6 months) comparing age of diagnosis to visual outcome (<20/200, 20/200-20/40, >20/40) was significant (P = .04). The age at first operation (P = .94), the number of angle operations (P = .43), and their effect on angle surgery success was not significant. Seven of 192 operations were performed after the age of 8 years (3.6%). After the initial angle surgeries within the first year of life, the third procedure occurred at a median age of 2.4 years (interquartile ratio [IQR] 0.6-3.8 years) and the fourth procedure occurred at a median age of 5.3 years (IQR 2.5-6.1 years). CONCLUSIONS: Children diagnosed at <3 months of age had a visual outcome of <20/200 despite successful glaucoma control. Age of presentation did not affect surgical success. A total of 78.9% of cases undergoing primary trabeculotomy were controlled with 1 operation: 4 clock hours of angle (120 degrees). Analysis of glaucoma progression suggests critical ages where further glaucoma surgery is required at around 2 and 5 years of age.

Clinician versus potential acuity test predictions of visual outcome after cataract surgery.

BACKGROUND: The aim of this study was to compare the ability of potential vision tests and clinical judgement to predict postoperative visual acuity after uneventful cataract surgery. METHODS: Sixty-two subjects (median, 74.5 years) were included in the study. Preoperative measurements included a clinical judgement prediction (based on case history and ocular examination alone), 2 super-illuminated pinhole techniques (distance and near), Potential Acuity Meter and interferometer. Postoperative visual acuity was used as the outcome measure to evaluate the accuracy of the preoperative predictions. RESULTS: Subjects were categorized as follows: (a) moderate cataract (N = 25); (b) moderate cataract and comorbidity (N = 18), and (c) advanced cataract (N = 19). Preoperative predictions within 2 lines of the postoperative visual acuity were as follows (a, b, and c respectively): clinical judgement (92%, 72%, 58%), super-illuminated pinhole distance (96%, 100%, 21%), super-illuminated pinhole near (92%, 78%, 26%), Potential Acuity Meter (72%, 67%, 21%), and interferometer (56%, 61%, 37%). CONCLUSIONS: Based on the preoperative predictions above, none of the potential vision tests was useful compared with the clinical judgement in the advanced cataract group. The super-illuminated pinhole (distance) provided additional information beyond clinical judgement in the moderate cataract subgroup. The Potential Acuity Meter and interferometer were inaccurate even in the presence of moderate cataract, and this and other recent findings suggest they should no longer be considered adequate for potential vision assessment.

Retinopathy of prematurity treatment and vitreous hemorrhage.

Two cases of hemorrhagic retinopathy of prematurity associated with thrombocytopenia are presented. The negative prognosis of vitreous hemorrhage in retinopathy of prematurity and the option of platelet transfusions are discussed.