Optic disc atrophy in children and neuroimaging findings.

Objective: To study the correlation of neuroimaging findings in children who presented with optic disc atrophy. Methods: Retrospective analysis of medical records of patients aged less than 17 years who presented with optic disc atrophy with neuroimaging examinations (magnetic resonance imaging or computed tomography) performed between January 1998 and December 2007 were included in the study. Results: Eighty cases were included for analysis. There were abnormal neuroimaging findings in 54 cases (67.50%) and normal findings in 26 cases (32.50%). Stratification of these patients in 3 age groups were shown: less than 6 years of age, between 6 and 12 years of age, and more than 12 years of age. In the less than 6 years of age group, central nervous system (CNS) malformations and hydrocephalus were the most common neuroimaging findings. In the 6 to 12 years age group, brain tumors were the most common findings. In the more than 12 years of age group, one case had hydrocephalus and another had encephalomalacia at the right temporal lobe. Conclusion: Children who presented with optic disc atrophy need neuroimaging examination to find life- threatening causes. CNS malformations and hydrocephalus are common findings in children aged less than 6 years and CNS tumors are common in children aged up to 12 years, especially in age group 6-12 years.

The outcomes of horizontal strabismus surgery and influencing factors of the surgical success.

OBJECTIVES: To evaluate the surgical outcomes of horizontal strabismus and identify the influencing factors of the surgical success. MATERIAL AND METHOD: The medical records of 304 patients who underwent their first strabismus surgery for treatment of horizontal deviation at Siriraj Hospital were reviewed retrospectively from January 1998 to December 2003. The main outcome measure for successful surgery was defined as eye deviation 10 prism diopters or less at 6 weeks post-surgery. The outcomes of postoperative binocular function and visual acuity improvement were also evaluated. The pre operative deviation, diagnosis, binocular function, visual acuity and age were analyzed as influencing factors of surgical success. The patients were divided into two groups, the first group was 6 years or less (161 cases) and the second group was older than 6 years (143 cases). The statistical methods for analysis the data were Chi-square test, Mann-Whitney U test and Logistic regression. RESULTS: The follow- up period was from 3 to 12 months. 187 patients (61.5%) for esotropia and 117 patients (38.5%) for exotropia were identified. Mean patient's age was 10.5 +/- 10.2 years (median 6, min 0.5, max 53), mean preoperative deviation was 44.9 +/- 16.6 prism diopters and mean VA was 20/30 (no PL, 20/20). The success rate was 62.0% for esotropia and 57.0% for exotropia. There was no statistical difference between the two groups of diagnosis. The average final deviation postoperative in the success group was 6 +/- 4.9 prism diopters. The comparison of difference visual acuity between pre and post-operation showed no statistical significance but the presence of binocular vision was increased in number of patient by two times. The complication rate was 0.7% (2/304), one case showed conjunctival wound dehiscence and the other had globe perforation. Re-operative rate was 12.9% (39/304) after one year. CONCLUSION: The surgical success rate of horizontal strabismus surgery was 60.2% and revealed no statistically significant improvement of visual acuity after surgery. The successful surgery was related to the age younger than 6 years and preoperative deviation less than 30 degrees.

Outcomes of cataract surgery in senile cataract patients at Siriraj Hospital: a prospective observational study.

The present study was done to assess the results of cataract surgery performed in Siriraj Hospital by comparing phacoemulsification and extracapsular cataract extraction techniques in senile cataract patients within a 3-month period. The prospective observational study of a representative sample of 379 patients (409 eyes) who underwent cataract surgery in Siriraj Hospital from January 1, 2004 to March 31, 2004. Identical clinical assessment protocol was used to compare the improvement of postoperative visual acuity and surgical complications between two surgical techniques and different surgeons. Of the 409 eyes, phacoemulsification was performed on 373 eyes (91.2%), and extracapsular cataract extraction was performed on 36 eyes (8.8%). Departmental staff operated on 326 eyes (79.7%) and ophthalmology residents operated on 83 eyes (20.3%). The primary outcome was postoperative visual acuity. Visual acuity was improved > or = 2 Snellen chart lines in 278 of 373 eyes (74.5%) in the phacoemulsification group, and > or = 2 lines in 31 of 36 eyes (86.1%) in the extracapsular cataract extraction group. A small risk of surgical complications was found in the present study. Posterior lens capsule rupture was the most frequent complication found (10/ 409 eyes), followed by corneal injury (9 of 409 eyes). Endophthalmitis was the most severe complication in the present study, occurring in 1 of 409 eyes. There was a significant difference in postoperative visual improvement between phacoemulsification and extracapsular cataract extraction techniques. Final visual acuity in the phacoemulsification group was better than in the extracapsular cataract extraction group.