Primary intraocular lens implantation in the first two years of life: safety profile and visual results.

PURPOSE: To study the safety profile of primary intraocular lens (IOL) implantation in the first two years of life. MATERIALS AND METHODS: A prospective nonrandomized, interventional study was done at the tertiary care center. Forty-five eyes of 27 children (aged three weeks to two years) with congenital cataract who underwent phacoaspiration with continuous curvilinear capsulorrhexis combined with primary posterior capsulotomy and anterior vitrectomy with in the bag placement of IOL at primary surgery were included. Outcome measures were clarity of visual axis, postoperative inflammation, fixation pattern and retinoscopy. RESULTS: The mean IOL power was 23.95 +/- 0.87 diopter (D) (range 22D to 27D). Follow-up ranged from 12 months to 48 months (mean 18 +/- 9.13 months). In infants, hypermetropia decreased from 6.60D +/- 2.64D at one week postoperatively to 3.03D +/- 2.53D at one year following surgery and 4.78D +/- 1.93D to 2.56D +/- 1.5D in children older than one year at the time of surgery. Re-opacification of the central visual axis was observed in six eyes (13.3%). Significant posterior synechiae due to irido-capsular adhesion was seen in seven eyes (15.6%). Five of these seven eyes also had significant posterior capsular opacification. CONCLUSIONS: Meticulously performed primary IOL implantation and primary posterior capsulorrhexis with anterior vitrectomy in the first two years of life is a safe and effective method of aphakic correction.

Efficiency of occlusion therapy for management of amblyopia in older children.

PURPOSE: To analyse results of full time occlusion therapy for amblyopia in children older than 6 years. MATERIALS AND METHODS: This was a retrospective consecutive case series analysis of children treated for amblyopia at a tertiary care center. All children received full time occlusion (FTO) for the dominant eye. RESULTS: Eighty-eight children older than 6 years at the time of initiation of therapy were included. Age at initiation of therapy ranged from 6 to 20 years (9.45 +/- 3.11 years). Forty-two children (47.7%) had strabismic amblyopia, 37 (42.0%) had anisometropic amblyopia and 9 (10.2%) had a combination of strabismic and anisometropic amblyopia. Eighty out of 88 eyes (90.0%) had improvement in visual acuity following FTO. Visual acuity (VA) improved from 0.82 +/- 0.34 at presentation to 0.42 +/- 0.34 (P < 0.001) after FTO. In children with strabismic amblyopia, VA improved from 0.81 +/- 0.42 to 0.42 +/- 0.39 (P <0.001). In children with anisometropic amblyopia, visual acuity of the amblyopic eye improved fron 0.82 +/- 0.24 to 0.36 +/- 0.29 (P< 0.001) following FTO. Out of 13 children older than 12 years, only 6 children (46.1%) had improvement in VA. Mean follow-up after complete stoppage of occlusion was 8.37 +/- 1.78 months. CONCLUSION: Occlusion therapy yields favorable results in strabismic and/or anisometropic amblyopia, even when initiated for the first time after 6 years of age. After 12 years of age, some children may still respond to occlusion of the dominant eye.

Anterior ischaemic optic neuropathy at high altitude.

High altitude retinopathy with various manifestations is common after exposure to high altitude. Inadequate autoregulatory response of the retinal vascular system is thought to be responsible for this. We report a case of anterior ischaemic optic neuropathy following exposure to high altitude.