The Myopic Shift in Aphakic Eyes in the Infant Aphakia Treatment Study After 10 Years of Follow-up.

OBJECTIVES: To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years. METHODS: One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years. RESULTS: Thirty of 57 children randomized to aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye. CONCLUSIONS: The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.

Globe Axial Length Growth at Age 5 Years in the Infant Aphakia Treatment Study.

PURPOSE: To report the longitudinal change in axial length (AL) from the time of unilateral cataract surgery at age 1 to 7 months to age 5 years, and to compare AL growth of operated eyes with that of fellow unoperated eyes. DESIGN: Comparative case series. PARTICIPANTS: Infants enrolled in the Infant Aphakia Treatment Study (IATS). METHODS: The AL at baseline and age 5 years and change in AL were analyzed relative to treated versus fellow eye, visual outcome, and treatment modality (contact lens [CL] vs. intraocular lens [IOL]). Eyes with glaucoma or glaucoma suspect were excluded from primary analysis but reported separately. MAIN OUTCOME MEASURES: The AL growth from preoperative to age 5 years. RESULTS: Seventy patients were eligible; however, AL data for both eyes were available for 64 patients at baseline and 69 patients at age 5 years. The AL was significantly different between treated and fellow eyes preoperatively (18.1 vs. 18.7 mm, P < 0.0001) and at the final follow-up (21.4 vs. 22.1 mm, P = 0.0004). The difference in AL growth between treated and fellow eyes was not significant (3.3 vs. 3.5 mm, P = 0.31). The change in AL in eyes was similar with both treatments (CL 3.2 mm and IOL 3.4 mm, P = 0.53) and did not correlate with visual outcomes (P = 0.85). Eyes receiving additional surgery to clear the visual axis opacification grew significantly more compared with eyes not receiving surgery to clear the visual axis (3.8 vs. 2.7 mm, P = 0.013). Patients with glaucoma showed significantly more eye growth (5.7 mm) than those without glaucoma (3.3 mm) and glaucoma suspects (4.3 mm). CONCLUSIONS: Eyes treated for monocular cataract in infancy have axial growth similar to that of fellow eyes, despite having a shorter AL at the time of surgery. The change in AL in eyes was similar with both treatments (CL and IOL), did not correlate with visual outcomes, and was higher in eyes receiving additional surgery to clear the visual axis or eyes diagnosed with glaucoma.

Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study.

PURPOSE: To report the myopic shift at 5 years of age after cataract surgery with intraocular lens (IOL) implantation for infants enrolled in the Infant Aphakia Treatment Study (IATS). METHODS: Refractions were performed at 1 month and every 3 months postoperatively until age 4 years and then at ages 4.25, 4.5, and 5 years. The change in refraction over time was estimated by linear mixed model analysis. RESULTS: Intraocular lens implantation was completed in 56 eyes; 43 were analyzed (median age, 2.4 months; range, 1.0-6.8 months). Exclusions included 11 patients with glaucoma, 1 patient with Stickler syndrome, and 1 patient with an IOL exchange at 8 months postoperatively. The mean rate of change in a myopic direction from 1 month after cataract surgery to age 1.5 years was 0.35 diopters (D)/month (95% confidence interval [CI], 0.29-0.40 D/month); after age 1.5 years, the mean rate of change in a myopic direction was 0.97 D/year (95% CI, 0.66-1.28 D/year). The mean refractive change was 8.97 D (95% CI, 7.25-10.68 D) at age 5 years for children 1 month of age at surgery and 7.22 D (95% CI, 5.54-8.91 D) for children 6 months of age at surgery. The mean refractive error at age 5 years was -2.53 D (95% CI, -4.05 to -1.02). CONCLUSIONS: After IOL implantation during infancy, the rate of myopic shift occurs most rapidly during the first 1.5 years of life. Myopic shift varies substantially among patients. If the goal is emmetropia at age 5 years, then the immediate postoperative hypermetropic targets should be +10.5 D at 4 to 6 weeks and +8.50 D from 7 weeks to 6 months. However, even using these targets, it is likely that many children will require additional refractive correction given the high variability of refractive outcomes.

Intraocular pressure in pediatric patients during prone surgery.

BACKGROUND: Intraoperative intraocular pressure (IOP) in the prone position and IOP changes over time have not been evaluated in pediatric surgical patients. We sought to determine time-dependent changes in IOP in children undergoing surgery in prone position. METHODS: Thirty patients undergoing neurosurgical procedures in prone position were included. Using a pulse-mode pneumatonometer, IOP was measured in supine position after induction and before emergence of anesthesia and in prone position before the start and after the end of surgery. IOP changes over time in the prone position were assessed with a linear mixed model (i.e., random slope and intercept model) to adjust for the within-patient correlation. RESULTS: IOP in prone position increased by an average of 2.2 mm Hg per hour (P < 0.001). Sixty-three percent of patients (95% confidence interval [CI], 46%-81%) had at least 1 IOP value exceeding 30 mm Hg, and 13% (95% CI, 1%-25%) had at least 1 IOP value exceeding 40 mm Hg while prone. Mean IOP increased 7 mm Hg (95% CI, 6-9) during the position change from supine to prone (P < 0.001) and decreased 10 mm Hg (95% CI, 9-12) after changing the position from prone back to supine (P < 0.001). CONCLUSIONS: Changing position from supine to prone significantly increases IOP in anesthetized pediatric patients. Moreover, the IOP continued to increase during surgery and reached potentially harmful values, especially when combined with low mean arterial blood pressures that are common during major surgery.

Dose-Response of Primary Bilateral Medial Rectus Resection in Infantile Exotropia.

PURPOSE: To evaluate the dose-response relationship for primary bilateral medial rectus resection in children with exotropia, based on outcomes with this procedure. METHODS: Dose-response at both distance and near were calculated as prism diopters correction per millimeter (PD/mm) of rectus resection. All surgeries were performed under general anesthesia through a fornix incision, using doubled-armed 6-0 polyglactin sutures. The resection amount ranged from 5 to 8 mm in each eye, according to the surgical dosage based on the largest angle of preoperative deviation. RESULTS: The mean surgical dose-response for all procedures was 2.83 ± 1.03 PD/mm of resection at distance and near. The overall success rate was 53% at the final examination after a mean follow-up of 21.9 months. Patients with moderate angles (25 to 45 PD) had a higher success rate than those with 50 PD or greater deviation. CONCLUSIONS: Primary bilateral medial rectus resection should be considered as a surgical alternative in childhood exotropia, particularly for moderate and constant deviations. [J Pediatr Ophthalmol Strabismus. 2022;59(1):24-27.].

Normative Values, Testability, and Validity for a New Preferential Looking Stereoacuity Test.

Introduction: Age norms and testability for 3-5 year old children have been reported for the PASS III stereotest using a pointing response. We aimed to expand the normative data to children as young as 6 months, assess testability, and evaluate validity use of the PASS III as a preferential-looking test for younger children and children with special needs. Methods: 68 control children, 362 children with eye conditions, and 167 children with special needs were tested with the PASS III. Percent testable was calculated for children with and without special needs, normal tolerance limits were determined, and test validity was assessed. Results: In controls, mean PASS III stereoacuity improved from 371 arcsec at 12 months to 174 arcsec at 24 months, and 87 arcsec at 36 months. Testability in the 12, 24, and 36 months age groups were 81%, 87%, and 97% respectively and 92% for special needs children. Comparison to previously published norms and testing in a known nil stereoacuity cohort supported PASS III test validity. Compared to gold standard stereoacuity tests, accuracy of the PASS was 89%. Conclusion: Overall, preferential-looking tests using the PASS III provide a sensitive and specific measure of stereoacuity with high testability for young children and children with special needs.

Globe Axial Length Growth at Age 10.5 Years in the Infant Aphakia Treatment Study.

PURPOSE: To report the change in globe axial length (AL) from the time of unilateral cataract surgery at age 1-7 months to age 10.5 years for infants enrolled in the Infant Aphakia Treatment Study, and to compare AL growth of operated eyes with that of fellow unoperated eyes. DESIGN: Comparative case series. METHODS: AL growth was analyzed relative to treated vs fellow eye, contact lens (CL) vs intraocular lens (IOL), visual acuity (VA) outcome, and the need for surgery for visual axis opacification. Eyes with glaucoma or glaucoma suspect were excluded from the primary analysis but reported separately. RESULTS: Fifty-seven patients have reliable AL data available at both visits. AL was shorter in treated eyes preoperatively (P < .0001) and at 10.5 years of age (P = .021) but AL growth was not different (4.7 mm, P = .99). The growth (70.2% up to age 5 and 29.8% from age 5 to 10.5) was similar in the CL and the IOL group (P = .79). Eyes grew 4.4 mm when visual acuity (VA) was better than 20/200, and 5.2 mm when VA was 20/200 or worse (P = .076). Eyes receiving additional surgery grew more than eyes not receiving additional surgery (P = .052). Patients with glaucoma showed significantly more eye growth (7.3 mm) than those without glaucoma (4.7 mm) and glaucoma suspects (5.1 mm) (P < .05). CONCLUSIONS: Eyes with glaucoma or poor VA often grew longer than the fellow eye. Overall, treated eyes grew similarly in the IOL and CL groups and also kept pace with the growth of the fellow eyes.

Long-term Effect of Intraocular Lens vs Contact Lens Correction on Visual Acuity After Cataract Surgery During Infancy: A Randomized Clinical Trial.

Importance: Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy. Objective: To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy. Design, Setting, and Participants: This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019. Interventions: Intraocular lens implantation at the time of cataract surgery. Main Outcomes and Measures: Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis. Results: Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46; P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was -0.54 to 0.47). Conclusions and Relevance: As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT00212134.

Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years.

OBJECTIVE: To assess the stability of visual acuity improvement during the first year after cessation of amblyopia treatment other than spectacle wear in children aged 7 to 12 years. METHODS: At the completion of a multicenter randomized trial during which amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving treatment (other than spectacle wear) for 1 year. MAIN OUTCOME MEASURE: Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following treatment discontinuation. RESULTS: During the year following cessation of treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting treatment. CONCLUSION: Visual acuity improvement occurring during amblyopia treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing treatment other than spectacle wear. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00094692.

Surgical findings with the tinted AcrySof intraocular lens in children.

INTRODUCTION: The AcrySof foldable acrylic intraocular lens (IOL) has become an accepted and frequent means of treating pediatric aphakia. A new version of this lens with blue-light filtering properties purports to offer superior retinal protection. We describe our experience with this tinted lens and compare it to findings with the standard, nontinted IOL. METHODS: A chart review identified 29 eyes of 21 children (tinted lens group; age 11 months to 13 years) who had the tinted IOL implanted. The standard lens group consisted of 38 eyes (31 patients; age 11 months to 15 years). Most eyes had an intact posterior capsule at the time of implantation. RESULTS: The incidence of postoperative inflammation was fairly high in both groups (71% in the tinted lens group, 60% in the standard lens group). The tinted lens group showed a higher incidence of transient inflammation than the standard lens group (p=0.03) but the rates of nontransient sequelae (posterior synechiae, iris synechiae, membranes formation, capsule, or IOL opacification) were similar (66% versus 47%; p=0.11). Posterior capsule opacification occurred in 15 eyes in the tinted lens group and 16 eyes in the standard lens group (p=0.15) but was visually significant in only 10 and 11 eyes, respectively (p=0.77). CONCLUSIONS: Transient inflammation is higher with implantation of tinted versus nontinted IOLs, but long-term inflammatory sequelae are roughly equal, as is the rate of posterior capsule opacification. The question as to whether the chromophore in the tinted lens caused the higher incidence of transient inflammation is unresolved.

The effectiveness of Nd:YAG laser capsulotomy for the treatment of posterior capsule opacification in children with acrylic intraocular lenses.

INTRODUCTION: Acrylic intraolcular lenses (IOLs) may result in lower rates of posterior capsular opacification (PCO) than poly(methyl methacrylate) lenses in children. Nonetheless, PCO frequently occurs eventually, especially in younger children. Here, we evaluated the success of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy for the management of PCO after acrylic IOL implantation without primary capsulectomy. METHODS: We reviewed 73 eyes in 57 children (age 23 months to 12 years; median, 6.4 years) who underwent Nd:YAG laser capsulotomy after AcrySof IOL implantation and who had at least 3 months follow-up (range, 3-92 months; median, 25 months). The effectiveness of laser treatment was evaluated in terms of the need for repeat laser procedures or intraocular surgery to clear the visual axis. RESULTS: Fifty-one eyes (70%) maintained a clear visual axis after a single Nd:YAG procedure, 10 eyes (84% cumulative) after 2 Nd:YAG procedures, and another 3 eyes (88% cumulative) after 3 Nd:YAG procedures. Six eyes (8%) required pars plana membrane removal to clear the visual axis, whereas 3 eyes (4%) continue to need treatment. Life table analysis showed that the probability of continuing success after 24 months with a single Nd:YAG procedure is 68% (95% confidence interval 53-83%). In younger children (age<4 years), this rate probability was lower than in older children (35% vs. 74%; P=0.022). Two eyes developed mild transient elevated intraocular pressure. In 1 eye, the IOL was dislocated and replaced. DISCUSSION: Nd:YAG laser capsulotomy is an acceptable option for the management of PCO after AcrySof IOL implantation in children and produces complications infrequently.

Risk factors for accommodative esotropia among hypermetropic children.

PURPOSE: Identification of risk factors for accommodative esotropia may help to determine which children with hyperopia may benefit from early spectacle correction or preventive therapy. METHODS: Participants in the family history study were 95 consecutive patients, aged 18 to 60 months, with accommodative esotropia. Participants in the binocular sensory function study were a subgroup of 41 children enrolled in the family history study within 1 month of onset, while the esodeviation was still intermittent. Participants in the hypermetropia study were 345 consecutive patients, ages 12 months to 8 years, with refractive error of +2.00 D or greater and no esodeviation before age 12 months. RESULTS: In the family history study, 23% of children with accommodative esotropia had an affected first-degree relative, and 91% had at least one affected relative. In the binocular sensory function study, random-dot stereoacuity was abnormal in 41% of children, whereas an abnormal motion VEP, Worth 4-dot, or positive 4-PD base-out prism responses were present in 4% or less of the children. In the hypermetropia study, patients with a mean spherical equivalent of < +3.00 D and significant anisometropia had a 7.8-fold increased risk for accommodative esotropia over nonanisometropic patients. CONCLUSIONS: A positive family history, subnormal random-dot stereopsis, and hypermetropic anisometropia each pose a significant risk for the development of accommodative esotropia. Assessment of these risk factors in conjunction with refractive screening should help to identify those children who are most likely to benefit from early spectacle correction or preventive treatment.

Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children.

OBJECTIVE: To compare patching and atropine sulfate as treatments for moderate amblyopia in children 18 months after completion of a 6-month randomized trial. METHODS: In a randomized, multicenter (47 sites) clinical trial, 419 children younger than 7 years with amblyopia (20/40 to 20/100 in the affected eye) were assigned to receive either patching or atropine eye drops for 6 months. Between 6 months and 2 years, treatment was at the discretion of the investigator. Main Outcome Measure Visual acuity in the amblyopic eye and sound eye after 2 years. RESULTS: At 2 years, visual acuity in the amblyopic eye improved from baseline a mean of 3.7 lines in the patching group and 3.6 lines in the atropine group. The difference in visual acuity between treatment groups was small: 0.01 logMAR (95% confidence interval, -0.02 to 0.04). In both treatment groups, the mean amblyopic eye acuity was approximately 20/32, 1.8 lines worse than the mean sound eye acuity, which was approximately 20/20. CONCLUSIONS: Atropine or patching for 6 months followed by best clinical care until 2 years produced similar improvement of moderate amblyopia in children between 3 and 7 years of age at enrollment. However, on average the amblyopic eye acuity was still approximately 2 lines worse than the sound eye.

Pre-operative stability of infantile esotropia and post-operative outcome.

PURPOSE: To define the prevalence and time course of significant changes in angle of deviation during the first months after the diagnosis of infantile esotropia and to determine whether long-term alignment and sensory outcomes differ when surgical alignment is performed on infants with stable vs unstable angles of deviation. DESIGN: Prospective cohort study. METHODS: setting: Institutional and clinical practice. patient population: Newly diagnosed patients with infantile esotropia (N = 208). observation procedure: Preoperative measurements of the angle of deviation on the initial visit and at approximate six-week intervals until surgery was performed. main outcome measures: Ocular alignment at six weeks, one year, and four years postoperative and stereoacuity at age five to nine years. RESULTS: Overall, 57% of infants had an esodeviation on the second visit that was within 10 prism diopters (p.d.) of the deviation measured on the initial visit (stable group), 33% had an increase of 10 p.d. or more (unstable group), and 11% had a decrease of 10 p.d. or more. Among the 127 patients with additional preoperative visits, many switched between the stable and unstable categories during follow-up. Long-term, stable and unstable preoperative alignment groups had similar postoperative motor alignment, re-operation rates, rates of prescription of hyperopic, or bifocal spectacle correction and stereoacuity. CONCLUSIONS: It may not be necessary to wait for a "stable" angle of esodeviation before surgery since both alignment and sensory outcomes were similar for stable and unstable groups.

Use of AcrySof acrylic foldable intraocular lens for secondary implantation in children.

PURPOSE: Secondary intraocular lens (IOL) implantation is an increasingly viable option in the management of pediatric aphakia. We report our experience of secondary IOL implantation in pediatric patients using the AcrySof (Alcon Surgical, Fort Worth, Texas) 3-piece foldable lenses through a small incision. METHODS: We reviewed the records of all our patients < 18 years undergoing secondary IOL implantation of the AcrySof lens from 1997 to 2001. All patients with a minimum of 6 months follow-up were included. Records were analyzed for age at surgery, postoperative acuity change, postoperative refractive error and anisometropia, surgical complications, and length of follow-up. RESULTS: Fifty-five eyes of 36 patients were included in the review. Mean age at surgery was 7.4 years (1.1 to 15.4), and mean follow-up was 28 months (6.3 months to 5 years). Vision decrease > 2 lines was noted in 3 eyes (5.8%) during the follow-up period. Complications included IOL decentration in 3 eyes (5%), wound leak in 3 eyes (5%), secondary membrane formation in 5 eyes (9%), pupillary block glaucoma in 1 eye (2%), and ptosis in 1 eye (2%). Four eyes (7%) required reoperation for complications. Mean postoperative refractive error was -0.1 +/- 3.2 diopters (D), and mean anisometropia was 2.01 +/- 1.44 D. Glaucoma subsequently developed in 6 eyes (11%), 2 of which required surgical correction. CONCLUSIONS: Secondary placement of the AcrySof IOL in the ciliary sulcus is a safe and effective method to correct aphakia in pediatric patients with adequate capsular support. The incidence of complications requiring reoperation is low.

The association between myopic shift and visual acuity outcome in pediatric aphakia.

PURPOSE: The advent of intraocular lens implantation after pediatric cataract surgery necessitates an increased understanding of refractive development. The significant variation in rate and amount of refractive change among eyes, both aphakic and pseudophakic, is well recognized, although the causes of such variation remain unclear. The purpose of this study was to determine if a correlation exists between the rate of refractive growth (RRG) and visual acuity outcome in pediatric aphakia. METHODS: Multicenter, retrospective observational case series. One hundred and twenty-five eyes of 85 patients with cataract surgery before 1 year of age and a minimum of 3 years of follow-up were analyzed. RRG was calculated for each eye using the logarithmic model of ocular growth and compared with final logMAR acuity using linear regression. RESULTS: The correlation of RRG with final logMAR acuity was statistically significant (r(2) = 0.10; P <.01), ie, 10% of variance in RRG is related to acuity outcome. The correlation was higher in unilaterally aphakic patients (n = 44; r(2) = 0.19; P <.01) than in bilaterally aphakic patients (n = 81; r(2) = 0.08; P <.01). Eyes with visual acuity of 20/60 or better had a significantly lower RRG than those with poorer acuity (4.1 v 5.4 diopters (D); P <.01). CONCLUSIONS: RRG in aphakia is correlated with visual acuity outcome. Eyes with poorer acuity have a greater RRG.

Long-term rates of PCO following small incision foldable acrylic intraocular lens implantation in children.

PURPOSE: To evaluate the long-term incidence of postoperative posterior capsular opacification (PCO) in children undergoing small incision foldable acrylic lens implantation with at least 2 years of follow up. METHODS: In 18 children, 26 eyes underwent small incision cataract extraction with posterior chamber foldable acrylic lens implantation. The posterior capsule was left intact in all patients at the time of surgery. RESULTS: With a mean follow up of 2.75 years and a mean age at surgery of 8.25 years, 13 of 26 eyes (50%) developed visually significant PCO requiring intervention. In the group of children under 4 years of age, 5 of 5 eyes (100%) developed visually significant PCO, while 8 of 21 eyes (38%) in the group of children over 4 years of age developed opacification. Four of 26 eyes (15%) required two procedures (either repeat Nd:YAG laser capsulotomy or pars plana secondary membrane removal) to clear the visual axis. CONCLUSION: In this study, the incidence of PCO following small incision acrylic lens implantation in children over 4 years of age is lower than those rates reported by conventional large incision rigid lens techniques with a minimum of 2 years follow up. This technique has advantages over conventional techniques in older children because it offers less surgical intervention, a lower cost to patients, and less risk of vitreous and retinal complications.

Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis.

PURPOSE: To report our experience using Ozurdex (Allergan, Irvine, CA), a biodegradable intravitreal implant containing of 0.7 mg of dexamethasone approved for use in adults with noninfectious uveitis in adults, in the treatment of pediatric uveitis. METHODS: The medical records of consecutive patients with noninfectious posterior uveitis who were unresponsive to standard treatment and subsequently received the Ozurdex implant from March 2011 to March 2013 were retrospectively reviewed. RESULTS: A total of 14 eyes of 11 patients (mean age, 10.1 years; range 4-12) received 22 Ozurdex implants during the study period. Of the 11 patients, 7 had idiopathic intermediate or posterior uveitis, 1 had sympathetic ophthalmia, 2 had juvenile idiopathic arthritis, and 1 had sarcoidosis. All patients were uncontrolled with standard treatment, including topical or sub-Tenon's or systemic corticosteriods and/or immune-modulation. Visual acuity improved after Ozurdex implant in 5 of 8 patients (63%). Intraocular inflammation was controlled or improved after 17 of 22 of implants (12 eyes [77%]). The frequency of topical corticosteroids was decreased and/or discontinued after 18 of 22 implants (12 eyes [82%]). Complications included implant migration into the anterior chamber (4 aphakic eyes), increased intraocular pressure (5 eyes), and progression of a preexisting cataract (1 eye). The uveitis reoccurred in 57% of eyes at 4.3 months (2-7 months) after injection. CONCLUSIONS: The Ozurdex implant in combination with systemic immunomodulatory therapy resulted in improved visual acuity, control of intraocular inflammation, and a decrease in corticosteroid use. In the majority of eyes the uveitis reoccurred around 4 months after injection. The adverse events in our study are similar to those identified in adult studies.