Long-term visual function outcomes of congenital cataract surgery with intraocular lens implantation in children under 5 years of age.

PURPOSE: To evaluate the long-term visual function outcomes of intraocular lens (IOL) implantation after congenital cataract surgery in children. METHODS: Forty children who had congenital cataract surgery with IOL implantation and at least 5 years follow-up and were 5 years or younger at the time of surgery were included. There were 18 children in the bilateral cataract group (36 pseudophakic eyes) and 22 children in the unilateral cataract group (22 pseudophakic eyes). The examination for the prospective part of this study included the recording of visual acuity, refraction, stereopsis, and intraocular pressures; preoperative, intraoperative, and postoperative details were obtained from the notes. RESULTS: Mean final best-corrected visual acuity for the bilateral group was 0.57 logMAR (range 0.18 -1.06) and for the unilateral group 0.91 logMAR (range 0.18 -1.40). Nystagmus was recorded in 10 children (56%) of the bilateral group and 5 children (23%) of the unilateral group. Strabismus was recorded in 14 children (78%) of the bilateral group and 19 children (86%) of the unilateral group. Glaucoma was diagnosed in one child. There was a significant myopic shift in the unilateral group. CONCLUSIONS: Reasonably good postoperative visual acuity was achieved in the bilateral cataracts group, but relatively poor acuity in the unilateral cataract group. Poor stereopsis was recorded in both groups. One child developed glaucoma. None of the children developed retinal detachment. The expected myopic shift in the unilateral group compared with the bilateral group was demonstrated. Elective primary capsulotomy and elective anterior vitrectomy are mandatory to keep a clear visual axis.

Angle closure glaucoma and lens subluxation secondary to eye rubbing in a patient with mycosis fungoides.

We report an unusual case of angle closure glaucoma in a patient with the skin lymphoma mycosis fungoides. Constant eye rubbing led to bilateral lens subluxation and uncontrolled intraocular pressure.

A bundle improves eye care in PICU.

BACKGROUND: Intensive care patients are susceptible to developing painful corneal epithelial deficits. Provision of eye care to prevent deficits was limited in our paediatric intensive care unit (PICU) population. INTERVENTIONS: A new eye care bundle was introduced, comprising a guideline for eye care, the addition of eye lubricants to the electronic prescribing order set for new admissions to PICU and staff education on the importance of eye care. Weekly examinations over a 2-month period following implementation of the bundle evaluated eye care provision and presence of corneal epithelial deficits on ophthalmic examination. RESULTS: Provision of formal eye care improved from 19% to 96%. The incidence of deficits was lower than previously, simple eye ointment reduced the risk of deficits, even in incompletely closed eyes. CONCLUSIONS: Use of an eye care bundle, together with a multidisciplinary team approach to eye care, improves the provision of eye care in PICU.

Changes in axial length growth after congenital cataract surgery and intraocular lens implantation in children younger than 5 years.

PURPOSE: To study the axial length (AL) changes in children who had unilateral or bilateral congenital cataract surgery and intraocular lens (IOL) implantation when they were younger than 5 years. SETTING: Bristol Eye Hospital, Bristol, United Kingdom. METHODS: Axial length measurements were obtained preoperatively and at the final follow-up. Axial length values were compared with those in a control group of children without cataract. RESULTS: Congenital cataract surgery and IOL implantation were performed in 18 patients (36 eyes) with bilateral cataract and 18 patients (18 eyes) with unilateral cataract. There was no statistically significant difference in AL growth between the operated eyes and the fellow eyes (P = .12, Wilcoxon signed rank test) or between the final AL in operated eyes and the AL in the age- and sex-matched control group (P = .69, Mann-Whitney U test). There was no statistically significant difference in AL growth between the right eyes of children with bilateral pseudophakia and the operated eyes of children with unilateral pseudophakia (P = .26, Mann-Whitney U test). There was no statistically significant difference between the final AL in the right eyes of children with bilateral pseudophakia and the AL in the age- and sex-matched control group. CONCLUSIONS: No significant retardation or acceleration of axial growth occurred after congenital cataract surgery and IOL implantation. The AL in this group of patients followed a normal pattern, although the difference in AL between operated unilateral cataract eyes and control eyes and between operated unilateral cataract eyes and operated bilateral cataract eyes showed a trend toward significance.

Subperiosteal orbital hemorrhage following self-strangulation.

Subperiosteal orbital hematomas are uncommon. The delayed presentation of such an event is described in an anticoagulated patient who attempted self-strangulation. Despite the initial presence of a relative afferent pupillary defect, excellent visual recovery occurred, demonstrating the importance of prompt recognition and treatment. The causes, mechanism of visual loss, radiographic diagnosis, and treatment of subperiosteal hemorrhages are discussed.