Ophthalmic manifestations of Linear Nevus Sebaceous/Organoid Nevus Syndrome

Linear Nevus Sebaceous Syndrome [LNSS] is a rare sporadic oculoneurocutaneous disorder, also classified as Organoid Nevus Syndrome. It consists of a triad of midline facial linear nevus sebaceous, central nervous system and ocular abnormalities. To the best of authors' knowledge ophthalmic features of LNSS have never been reported in Pakistani population. We report two cases of LNSS, associated with multiple cutaneous nevus sebaceous lesions, complex ocular choristomas and rare bilateral presentation in one patient. Ocular choristomas included limbal dermoids, dermolipomas at superior fornices and chroidal choristoma. Ocular surface was successfully reconstructed by excision of limbal dermoids, partial keratectomy and amniotic membrane transplant

Visual improvement in children with low vision using low vision devices

To observe the effect of low vision devices [LVDs] i.e. 2.5x vista view, 4x telescope and magnifying glasses on distance visual acuity of children with low vision. This observational study was conducted in the department of Pediatric Ophthalmology and Low Vision Clinic at Al-Shifa Trust Eye Hospital. 40 children with impaired visual acuity from ages 5 to 18 years were included in the study. All children had detailed anterior and posterior segment examination by pediatric ophthalmologists while LVDs were prescribed in low vision clinic. All children fulfilling WHO criteria for low vision were provided with 2.5 X vista view, 4x telescopes and magnifying glasses for improving far vision. ANOVA was used to find out which low vision device is more effective in visual improvement either glasses or telescopes i.e. vista view and 4X. Out of 40 children 20[50%] children were males and 20 [50%] were females. Main cause of low vision in our study came out to be albinism. Our study states that 4x telescope is the most effective device to improve distant visual acuity in children with low vision. Low vision aids are essential and effective for the children with low vision. They not only improve the visual acuity but also help in the education through visual rehabilitation

Prediction of refractive error after intraocular lens implantation in pediatric patients at Al-Shifa trust eye hospital Rawalpindi

To determine the amount of refractive error in children after cataract surgery with intraocular lens [IOL] implantation to evaluate success in achieving postoperative target refraction and to determine the factors which affect the prediction of refractive error in pseduphakic pediatric patient. Retrospective observational case study. The children were assigned into three groups depending on age at time of surgery: Group A, 1-4 years old; Group B, 4-8 years old; Group C, 8-15 years old. Multiple regression analysis was used to create a formula for expected myopic shift and to find out which variables were associated with a higher absolute prediction error. Children of group A of age 1-4 years experienced higher myopic shifts and a larger mean rate of refractive change per year compared with older children. We found higher myopic shifts in younger children at time of surgery and children with unilateral cataract. Absolute prediction error was significantly higher in Group A compared with Group B and C. Multiple regression analysis showed that corneal radius was the only variable significantly associated with absolute prediction error. Our data demonstrate the complexity in predicting the postoperative refraction in children of 2-3 years old and show that age at surgery and laterality are factors to consider when deciding which IOL power to implant in children

Post operative refractive outcomes in scleral fixated intraocular lenses

Purpose: To compare the predicted and actual postoperative refractive outcomes in patients with scleral fixation of intra ocular lenses [SF-IOL]

Subjects and Methods: 20 eyes of 14 patients having inadequate posterior capsular support were included in the study. The pre operative spherical equivalent was recorded and patients were divided into 2 groups on the basis of hyperopic [pupil mostly rendered aphakic] or myopic refractive error [milder subluxation with phakic part in visual axis]. SF-IOL was implanted and group wise comparison was made with spherical equivalent of post operative refractive error. Target refraction and actual post operative refraction were also compared between these groups. Similarly the change in astigmatic correction was also compared

Results: In the group of patients having preoperative myopic refractive error due to subluxated lens still in the pupil area this difference was 1.100 +/- 2.157 diopters. It was 1.207 +/- 1.465 diopters in the group of patients having pre operative hyperopic refractive error due to aphakic pupil area. Comparison of target refraction and actual post operative spherical equivalent between these groups was not statistically significant [p=0.384 and p=0.039 respectively]. Pre operative cylinder correction in the myopic group ranged from 0.00 to -6.0 DC [mean -1.00 +/- 2.23DC] compared to post op cylindrical correction in this group ranging from -1.0 to 1.50 DC [mean 0.14 +/- 1.18 DC] with p=0.328. The preoperative astigmatic correction in the hypermetropic refraction group ranged from 0.00 to 1.5 [mean 0.13 +/- 0.45 DC] compared to post operative reading ranging from 0.00 to -5.0 [mean -1.75 +/- 1.85 DC] with a significant difference of p=0.009

Conclusion: Our study shows a moderate agreement between the predicted and actual postoperative refractive result in children with SF-IOL

Cyclic oculomotor spasm and third nerve palsy

In the present report, cyclic oculomotor spasm occurring in a patient with third nerve paresis is described, which is a rare occurrence. An 11 year old female presented with decreased vision of the right eye and drooping of the right upper lid since early childhood. Third nerve paresis was seen with limited adduction and elevation. During examination the right exotropic eye became esotropic, over which the patient had no voluntary control. After orthoptic assessment, right superior oblique resection and transposition close to the medial rectus, with a large lateral rectus recession was done

visual outcomes and complications of intraocular lens implantation in children aged 1 year or less

To present the visual outcomes and complications of intraocular lens [IOL] implantation in children aged 1 year or less. A total of 30 consecutive eyes of 19 children undergoing cataract removal combined with IOL implantation at less than I year of age were evaluated. SRK-T formula was used to calculate the IOL power and emmetropic power was under corrected by 20%. After aspiration of the lens matter and posterior capsule polishing, acrylic hydrophilic foldable or PMMA rigid IOL was implanted by a paediatric Ophthalmologist. Visual acuity, refractive status and postoperative complications were recorded throughout the 12 months of follow up. Data was analyzed using SPSS version 13.0, Out of 19 children, 8 [42.1%] had unilateral cataract [8 eyes], and 11 [57.9%] had bilateral cataracts [22 eyes]. Mean age at the time of surgery was 8.7 [ +/- 2.5] months. Foldable IOL implantation in capsular bag was achieved in 17 [56.7%] eyes while sulcus fixation of IOL was done in 13 [43.3%] eyes. Mean post-operative refraction was +5.97 [ +/- 2.60] DS. Postoperative fibrinous reaction was seen in 4 [13.3%] eyes, visually significant PC0 requiring surgical posterior capsulotomy developed in 2 [6.66%] eyes while 24 eyes [80%] retained a clear visual axis during the follow up period. Lens matter aspiration combined with IOL implantation in children less than 1year of age resulted in better visual outcomes with acceptable risk to benefit ratio. 101, power calculations and refractive outcomes were predicted satisfactorily using SRK-T formula with 20% under correction