Efficacy of Müller's Muscle-conjunctival Resection With or Without Suturing for the Correction of Ptosis.

PURPOSE: The purpose of this study was to compare the efficacy of Müller muscle-conjunctival resection (MMCR) with or without suturing for the correction of ptosis. METHODS: A retrospective chart review was performed of 30 patients (56 eyelids) undergoing sutureless (sMMCR) (34 eyelids) or conventional MMCR (cMMCR) (22 eyelids). Primary outcome measures were the change in MRD1 and vertical eyelid height (VLH). Secondary outcome measures were the amount of resection of MMCR (rMMCR) and postoperative symmetry of 1 mm or less. RESULTS: In total, 49 eyelids (87.5%) had involutional ptosis and 7 (12.5%) had contactlens induced ptosis. The age and follow up between the sMMCR and cMMCR groups was, respectively, 65.1 ± 11.0 versus 65.5 ± 11.0 years and 4.0 ± 2.5 versus 6.5 ± 2.1 months. Preoperatively there were no significant differences noted between the sMMCR and cMMCR groups. Postoperatively there was a statistically significant difference in change of MRD1 between the sMMCR and cMMCR groups, 2.74 ± 0.20 mm and 2.02 ± 0.25 mm ( p = 0.026). The difference in change of VLH and rMMCR was not significant between the sMMCR and cMMCR groups, 2.28 ± 0.13 mm and 2.14 ± 0.15 mm ( p = 0.49) and 9.29 ± 2.14 versus 9.46 ± 1.97 mm ( p = 0.83). There were no significant differences in postoperative symmetry. CONCLUSION: The sMMCR and cMMCR techniques demonstrated equal effectiveness for the correction of ptosis. The rapid sMMCR could become the procedure of choice for the correction of involutional and contact lens induced ptosis.

Eye colour and skin pigmentation as significant factors for refractive outcome and residual accommodation in hypermetropic children: a randomized clinical trial using cyclopentolate 1% and tropicamide 1.

PURPOSE: To compare the refractive outcome and residual accommodation with respect to various degrees of iris and skin pigmentation in hypermetropic children using 2 drops of cyclopentolate 1% (C + C) or 1 drop of cyclopentolate 1% and 1 drop of tropicamide 1% (C + T). METHODS: Two hundred fifty-one hypermetropic children were classified according to iris and skin pigmentation (light, medium, dark) and received randomized and double-blind C + C or C + T. Refractive error (spherical equivalent, SEQ) was determined using the Retinomax-K + 3. In 204 subjects, residual accommodation (RA) was determined using the PlusoptiX PowerRefractor. RESULTS: A linear mixed model with a light-irided and light skin-pigmented reference group receiving C + T (mean SEQ +3.10 ± 1.87D) indicated significant less hypermetropia in subjects with a dark iris having a medium- and dark-pigmented skin in C + T, -1.02 ± 0.29 (-1.59/-0.45) and -1.53 ± 0.30 (-2.10/-0.95); and in subjects having a light-, medium- and dark-pigmented skin in C + C, -0.74 ± 0.34 (-1.41/-0.06), -1.26 ± 0.30 (-1.85/-0.66) and -1.84 ± 0.30 (-2.42/-1.26). Similar findings were present for RA. Our model with a light-irided and light skin-pigmented reference group receiving C + T (mean RA +0.84 ± 0.61D) indicated significantly higher RA in dark-irided subjects with medium- and dark-pigmented skin in C + T, +1.05 ± 0.19 (+0.67/+1.43) and +1.35 ± 0.20 (+0.9/+1.74), and in C + C, +1.13 ± 0.21 (+0.71/+1.55) and +1.90 ± 0.19 (+1.51/+2.28). CONCLUSIONS: We found solid evidence that skin pigmentation rather than iris pigmentation is the decisive factor for effectiveness of cycloplegics. Awareness of the limitations of cycloplegic regimens in dark-irided/pigmented children is needed. Our study showed that cyclopentolate 1% combined with tropicamide 1% provides more accurate refractive outcomes both statistically and clinically integrating the factor skin pigmentation for dark-irided subjects.

A randomized clinical trial using atropine, cyclopentolate, and tropicamide to compare refractive outcome in hypermetropic children with a dark iris; skin pigmentation and crying as significant factors for hypermetropic outcome.

Purpose: To evaluate the refractive outcome and influencing factors following atropine 0.5% eye-drops applied twice daily during 2 ½ days at home and two drops of cyclopentolate 1% (C+C) and one drop of cyclopentolate 1% and one drop of tropicamide 1% (C+T) applied in an outpatient clinic, in hypermetropic children with a dark iris. Methods: Double-blind randomized study including 67 3-6-year-old children receiving C+C in one eye and C+T in the other eye. Two weeks later followed by atropine 0.5% in both eyes. Primary outcome measures were: spherical equivalent (SEQ) following C+C, C+T and atropine, and secondarily SEQ with respect to sex, ethnicity, skin pigmentation (light, medium, dark) and crying. Data on atropine are divided in those with C+C (CC) or C+T (CT) as a first intervention. Results: Mean SEQ±SD for C+C, C+T, atropine-(CC) and atropine-(CT) was +1.74 ± 1.35, +1.77 ± 1.34, +2.15 ± 1.43 and +2.10 ± 1.38 diopter (D). Atropine 0.5% revealed significantly more hypermetropia than C+C and C+T; +0.41 ± 0.43, 95%CI +0.31 to +0.52D and +0.33 ± 0.39, 95%CI +0.24 to +0.34D. No significant difference was present between C+C and C+T; -0.03 ± 0.56, 95%CI -0.16 to +0.11D. Ethnicity and skin-color were strongly associated (r = 0.84, p < .001). Sex was not affecting outcomes (p = .101). Ethnicity was borderline significant (p = .049). Skin-color was a highly significant factor (p = .002). A statistical model combining intervention and skin-color, with light-pigmented subjects receiving atropine-(CC) as reference group (mean SEQ +2.61 ± 1.46D), indicated borderline significantly less hypermetropia in atropine-(CC)-dark: mean decrease (95%CI): -0.81 (-1.66 to +0.05)D and atropine-(CT)-dark -0.87 (-1.70 to -0.03)D, furthermore significantly less hypermetropia in C+C-dark: -1.15 (-1.97 to -0.32)D; C+T-dark: -1.21 (-2.03 to -0.39)D, C+C-medium: -1.02 (-1.81 to -0.24)D and C+T-medium: -0.86 (-1.64 to -0.08)D. Adding crying to the model significantly less hypermetropia was found for subjects crying in all interventions; -0.53 (-0.98 to -0.09)D. Within the interventions, with light-pigmented non-crying subjects as reference group (mean SEQ in atropine, C+C, respectively, C+T: +2.62 ± 1.41, +2.33 ± 1.20 and +2.32 ± 1.20D), showed significantly less hypermetropia in dark-pigmented crying subjects in each individual intervention: atropine -1.10 (-2.01 to -0.19), C+C -1.28 (-2.14 to -0.42) and C+T -1.34 (-2.20 to -0.48)D. For medium pigmented crying subjects this was present in atropine: -0.82 (-1.61 to -0.03)D and C+C: -0.86 (-1.68 to -0.04)D, but not in C+T: -0.58 (-1.25 to +0.09)D. Conclusions: Atropine 0.5% revealed a slight significantly higher hypermetropia. A dark-pigmented skin, especially when crying upon application, resulted in lower hypermetropia in all interventions. C+T provided clinically better results in medium pigmented crying subjects compared to C+C, and equal results compared to atropine 0.5%.

Adverse reactions following routine anticholinergic eye drops in a paediatric population: an observational cohort study.

OBJECTIVES: To investigate the presence, nature and relationship to age, sex, ethnicity and body mass index (BMI) of adverse reactions following routine cycloplegic eye drops in children. DESIGN: Prospective observational cohort study. SETTING: Ophthalmology outpatient clinic Dutch metropolitan hospital; February, March and April 2009. PARTICIPANTS: Children aged 3-14-year-old children receiving two drops of cyclopentolate 1% (C+C) or one drop of cyclopentolate 1% and one drop of tropicamide 1% (C+T). Patients were categorised by age (3-6, 7-10 and 11-14 years), sex, ethnicity and body mass index (BMI) (low, normal or high). OUTCOME MEASURES: Rate and nature of adverse reactions reported at 45 min following treatment. Crude and adjusted ORs for reporting an adverse reaction using stepwise regression analysis with BMI, age, ethnicity and sex. RESULTS: 912 of 915 eligible patients participated (99.7%). Adverse reactions were reported for C+C in 10.3% and in C+T in 4.8% (42/408 and 24/504, p=0.002), respectively. Central effects were present in 95% in C+C and in 92% in C+T. Compared to C+T, an increased risk was present in C+C (crude OR 2.3 (1.4 to 3.9), p=0.002). Forward adjustment showed BMI to be an influencing factor in treatment (OR 3.1 (1.7 to 5.6), p<0.001). In a multivariate model, a dose of cyclopentolate remained associated with adverse reactions. Analysis per BMI and regime and age category and regime, indicated associations with low BMI (OR C+C 21.4 (6.7 to 67.96), p<0.001, respectively, C+T 5.2 (2.1 to 12.8), p<0.001) and young age (OR C+C 8.1 (2.7 to 24.8), p<0.001). CONCLUSIONS: Adverse reactions were common and almost exclusively involved the central nervous system. Both presence and severity were associated with repeated instillation of cyclopentolate 1%, low BMI and young age. In specific paediatric populations, a single dose of cyclopentolate must be considered. Vital function monitoring facilities are advisable. Adjustment of guidelines is recommended.

Comparison of wavefront-guided photorefractive keratectomy and foldable iris-fixated phakic intraocular lens implantation for low to moderate myopia.

PURPOSE: To compare and evaluate the visual and refractive outcomes of myopic wavefront-guided photorefractive keratectomy (PRK) and foldable phakic intraocular lens (pIOL) implantation for myopia. SETTING: Department of Ophthalmology, Haaglanden Medical Center, The Hague, The Netherlands. DESIGN: Comparative case series. METHODS: The differences in visual acuity and residual refractive outcomes after wavefront-guided PRK and Artiflex foldable pIOL implantation were compared in eyes with low to moderate myopia (spherical error -4.0 to -7.0 diopters [D]; maximum cylinder 2.25 D). One-year follow-up results are presented. RESULTS: At 1 year postoperatively, the mean decimal Snellen uncorrected distance visual acuity was 1.05 ± 0.21 (SD) in the PRK group (60 eyes) and 1.04 ± 0.21 in the pIOL group (33 eyes) and the mean corrected distance visual acuity (CDVA), 1.21 ± 0.18 and 1.24 ± 0.13, respectively. In the PRK group, 21.7% of eyes lost 1 to 3 lines of CDVA and 11.7% of eyes gained 1 or 2 lines. In the pIOL group, no eye lost lines of CDVA and 42% gained 1 or 2 lines. At 1 year, 80.0% of eyes in the PRK group and 90.9% of eyes in the pIOL group were within ± 0.50 D of the spherical equivalent. CONCLUSION: There were no statistically significant differences in safety and efficacy between the pIOL group and the PRK group at 1 year. However, the percentage of eyes that gained lines of CDVA was significantly higher in the pIOL group.

Anterior chamber iris-fixated phakic intraocular lens for anisometropic amblyopia.

We report a child who had implantation of an iris-fixated Artisan phakic intraocular lens (IOL) to correct high unilateral myopia to support the therapy of anisometropic amblyopia. After IOL implantation, the patient continued occlusion therapy to further treat the amblyopic eye. One year postoperatively, the best corrected visual acuity in the amblyopic eye was 1.00 and binocular stereovision had developed. The visual acuity remained stable through 3 years of follow-up. There were no complications, although postoperative endothelial cell loss was significant.