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.

Unilateral vertical nystagmus: the Heimann-Bielschowsky phenomenon.

OBJECTIVE: To present clinical feature of Heimann-Bielschowsky phenomenon and strabismus association. DESIGN: Retrospective case series. MATERIAL AND METHOD: Medical records of cases between January 2004 and January 2008 were reviewed. Eight cases met the criteria. Age, sex, visual acuity, and eye examination data were collected. RESULTS: Six cases were male and two cases were female. Age at presentation ranged from 4 to 45 years old. Seven cases had vision of 6/60 or worse. Only one case had visual acuity 6/36. Strabismus was seen in five cases (exotropia 4 cases and esotropia 1 case). No one had symptoms of diplopia or oscillopsia. All cases had unilateral coarse, slow, pendular vertical oscillations occurring in the poor vision eye. CONCLUSION: Monocular vertical oscillation may develop in an eye with reduced vision. It may be a common condition but under diagnosed.

Visual electrophysiology in congenital nystagmus with normal fundus.

OBJECTIVE: To identify the ophthalmic causes of congenital nystagmus with normal eye examination by visual electrophysiologic tests. MATERIAL AND METHOD: Medical records of patients who presented with nystagmus and no other neurological sign before 6 months of age with normal eye examination, between February 2004 and February 2005, were reviewed Complete ophthalmic examination and visual electrophysiologic tests were performed to identify the ophthalmic causes of congenital nystagmus. RESULTS: Thirty-four patients had met the criteria. Leber's congenital amaurosis was diagnosed in 13 patients (38.2%) by non-recordable electroretinography (ERG) and normal visual evoked potential (VEP). Idiopathic infantile nystagmus was diagnosed in 12 patients (35.3%) by normal ERG and VEP. Achromatopsia was diagnosed in 8 patients (23.5%) by flat retinal cone ERG but normal rod ERG and VEP. Rod-cone dystrophy was diagnosed in one patient (3%) by abnormal rod and cone ERG CONCLUSION: Visual electrophysiologic study is helpful to identify the ophthalmic causes of congenital nystagmus. Leber's congenital amaurosis is a common cause in congenital nystagmus.

Treatment of cytomegalovirus (CMV) retinitis with intravitreous ganciclovir in HIV-infected children.

OBJECTIVES: To evaluate the efficacy, visual outcomes, and complications of intravitreous ganciclovir treatment in cytomegalovirus (CMV) retinitis in HIV-infected children. MATERIAL AND METHOD: The medical records of HIV-infected children who were screened for CMV retinitis from February 2002 to February 2005 were reviewed. The children with CD4+ < 15%, or with clinical category C would have complete ophthalmic examination every 3 months. Ganciclovir (4 mg/0.04 ml) was administered intravitreously to the eye with CMV retinitis every 2 weeks under general anaesthesia. After injection, fundi were examined immediately, 1 day, 14 days and every 2 weeks until the lesions were stable. RESULTS: Six (9 eyes) out of 45 children (13%) aged 2-12 years were found to have CMV retinitis. All CMV retinitis lesions were "cheese and ketchup like" (retinal hemorrhage and exudate) lesions and presented in the posterior pole. Bilateral CMV retinitis were found in 3 children. Intravitreous ganciclovir was injected in 4 children (5 eyes). The average number of intravitreous injections for each patient was 5.6 (3-7) times. All of the children received antiretroviral therapy and 3 children also received intravenous ganciclovir CMV retinitis lesions were improved in every eye. The visual acuity (VA) remained stable in 4 eyes, but endophthalmitis developed in one eye a few days after injection. The average duration of follow-up was 13.5 months (3-23 months). CONCLUSION: CMV retinitis was not uncommon. The authors found that intravitreous ganciclovir was effective but may cause complications. This treatment should be considered in a resource-limited setting.

Clinical manifestations and treatment outcomes in dissociated strabismus complex (DSC) patients.

Objective: To demonstrate clinical manifestations and treatment outcomes in dissociated strabismus complex patients. Methods: Charts of patients who attended the Muscle Clinic at Siriraj Hospital from July 1998 to June 2002 were reviewed. Information regarding the patient’s age, sex, eye deviation, visual acuity, binocular function, head posture, degree of dissociated vertical deviation (DVD), dissociated horizontal deviation (DHD), dissociated torsional deviation (DTD), inferior oblique overaction (IOOA) and the treatments were obtained. Results: Seventy-three subjects from 1,335 strabismic patients were included in the study (5.5% of all strabismic patients attended the Muscle Clinic during the study time). The mean age of DSC patients was 8 years old. Among all DSC patients, 65.8% had esodeviation; 23.2% had exodeviation; and, 11% had isolated DSC. Latent nystagmus was found in 11% of the patients. Abnormal head posture was found in 16.4% of the patients. About fifteen percent of DSC patients had binocular function. All DSC patients had DVD but only 5 patients had DHD; no DTD was found. The treatment of DHD was correction of the horizontal deviation that coexisted with vertical deviation. As for DVD, there were many surgical procedures for correction such as superior rectus muscle (SR) recession, inferior oblique muscle (IO) recession, inferior oblique muscle anteriorization and inferior rectus muscle (IR) resection. Both unilateral and bilateral surgeries were performed. Regardless of the procedures, the total success rate was 78.4% (the residual of hyperdeviation was 10 prism diopters (PD) or less).The group of patients, who had surgical correction in only one eye, had a significant deviation in the non-operated eye after the surgical treatment. Conclusions: DSC was composed of DVD, DHD, DTD and latent nystagmus. DVD was the predominant manifestation in most cases of DSC. DSC was usually bilateral and was seen in subnormal binocular function patients. Esotropia was the most common deviation associated with DSC patients. Many surgical procedures were used to correct DVD such as bilateral large SR recession or IO anteriorization. In unilateral surgery, the manifestation of the deviation in the non-operated eye was always be found. Bilateral surgery was suggested but may be performed in asymmetrical degree. In this study, the overall success rate was 78.4%.

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.

Comparison of topical prednisolone acetate, ketorolac tromethamine and fluorometholone acetate in reducing inflammation after phacoemulsification.

AIMS: To compare the efficacy and ocular adverse effects of topical prednisolone acetate, ketorolac tromethamine, and fluorometholone acetate in reducing inflammation after phacoemulsification. METHOD: One hundred and twenty eyes were enrolled in a prospective, investigator-masked, randomized controlled trial. Each drug was prescribed 4 times a day for 28 days. The following data were recorded weekly: visual acuity, intraocular pressure, slit lamp biomicroscopy, grading of cells and flare in the anterior chamber, and ocular symptoms. RESULTS: The number of eyes with a minimal amount of cells in the anterior chamber in the ketorolac group was less than the prednisolone group on day 7 (11:20, p = 0.008) and day 14 (23:31, p = 0.015), and than fluorometholone group on day 7 (11:21, p = 0.011). Intraocular pressure in the prednisolone group was higher than the ketorolac group on day 21 (14.6:12.2 mmHg, p = 0.016). One eye in the prednisolone group had intraocular pressure of 32 mmHg. Burning sensation was reported frequently in the ketorolac group. CONCLUSION: All 3 drugs were effective in reducing post-operative inflammation. The efficacy of prednisolone acetate and fluorometholone acetate was comparable. Ketorolac tromethamine showed less efficacy than corticosteroids, however, it did not induce ocular hypertension.