Effect of Cycloplegia on Optical Biometry in Pediatric Eyes.

PURPOSE: To study the effect of cycloplegia on optical biometry parameters in pediatric eyes using the Lenstar LS 900 (Haag-Streit, Koeniz, Switzerland). METHODS: In this observational and comparative study, 56 normal eyes and 20 cataractous eyes in children between 5 and 15 years of age were included. Measurements were taken before and after cycloplegia using 2% homatropine drops. Parameters studied were axial length, central corneal thickness, keratometry, anterior chamber depth, and lens thickness. The Wilcoxon test was used to compare the effects of cycloplegia on all parameters. RESULTS: Cycloplegia resulted in a statistically significant decrease in axial length (P < .05), central corneal thickness (P < .05), and lens thickness (P < .001) and an increase in the anterior chamber depth (P < .001) in normal eyes. In the cataract group, cycloplegia resulted in an increase in anterior chamber depth (P < .001) and decrease in lens thickness (P < .001). CONCLUSIONS: Biometry measurements have to be carefully interpreted in pediatric eyes where cycloplegia is an important part of the examination. [J Pediatr Ophthalmol Strabismus. 2018;55(4):260-265.].

Assessment of the safety and efficacy of primary retropupillary fixation of iris-claw intraocular lenses in children with large lens subluxations.

PURPOSE: To evaluate whether retropupillary fixation of the iris-claw intraocular lens (IOL) is a safe and effective treatment option in children with large lens subluxations. METHODS: Fourteen eyes of children between the ages of 8-17 years with lens subluxations more than 7 clock hours underwent pars plana lensectomy-vitrectomy with implantation of the iris-claw IOL in the retropupillary position as a primary procedure. The best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial count (EC) and the lens position using ultrasound biomicroscopy (UBM) were assessed pre- and postoperatively. RESULTS: Postoperatively, all patients had an increase in the BCVA with a mean of 0.351 ± 0.154 log MAR units which was statistically significant as compared to the preoperative value of 0.771 ± 0.132 log MAR units (p = 0.003). The difference between the mean preoperative IOP (13.642 ± 2.437 mmHg) and the mean postoperative intraocular pressure at the end of 6 months (13.5 ± 2.244 mmHg) was not statistically significant (p = 0.671). The mean EC decreased by 0.99% from 2838.42 ± 474.76 cells/mm2 preoperatively to 2810 ± 461.24 cells/mm2 at the end of 6 months postoperatively (p = 0.117). The lens position was analyzed using UBM and was found to be parallel to the iris plane in all cases at the end of 6 months. CONCLUSIONS: Our study shows that primary retropupillary iris-claw IOL implantation can be a safe and efficacious option for children with large (>7 clock hours) lens subluxations that is at least comparable to scleral-fixated PCIOLs.

Serum Nevirapine and Efavirenz concentrations and effect of concomitant rifampicin in HIV infected children on antiretroviral therapy.

OBJECTIVE: To determine factors affecting serum levels of Efavirenz and Nevirapine and analyze the effect of Rifampicin on Nevirapine drug levels. METHODS: A cross-sectional study was conducted on 30 HIV infected children on Antiretroviral therapy (ART) with Nevirapine or Efavirenz. Patients on simultaneous Rifampicin and Nevirapine were given higher doses of Nevirapine with regular monitoring of liver function tests. Trough levels (before morning dose of Nevirapine) and levels after 2 hours of administration of Nevirapine and levels of Efavirenz were assessed using HPLC and were checked to see if they fall within the therapeutic range. RESULTS: Thirty patients (14 males) were enrolled in the study with 20 on Nevirapine and 10 (33.3%) on Efavirenz. Seven (23.3%) patients were simultaneously taking rifampicin. The mean Nevirapine dose given to the patients was 350.9±59.8 mg/m2/day (on simultaneous rifampicin) and 309.2±54.6 mg/m2/day (not on concurrent rifampicin). Thirteen (81.3%) of the 16 patients with trough Nevirapine had values in the normal range, 1 (6.3%) had low Nevirapine trough levels and 2 (12.5%) had high Nevirapine trough levels. Of the post 2 hours Nevirapine levels, 1 (5%) had low levels and 3 (15%) had high Nevirapine blood levels. Factors like age (P=0.4, P=0.4087), nourishment (P=0.2679, P=0.4132), ART combination (P=0.4199, P=0.4132), form of the drug (tablet/syrup) (P=0.1964, P=0.4696) or if it was being given as single or in a fixed dose combination (P=0.4179, P=0.4696) and even concurrent rifampicin administration (P=0.284, P=0.472) did not significantly affect the trough and post 2 hours Nevirapine values, respectively. All the five patients being given concurrent rifampicin had normal trough and post 2 hours levels of Nevirapine. The Efavirenz drug levels were 1.9±1.1 g/mL. Of the 10 patients on Efavirenz, 2 (20%) had high and 1 (10%) had low blood levels. CONCLUSION: Concurrent Rifampicin administration does not alter blood levels of Nevirapine; provided the dose of Nevirapine is increased by 20-30%. Formulation of drugs does not alter the blood levels provided drug administered is in the recommended dose.