Facilitation of amblyopia management by laser in situ keratomileusis in children with myopic anisometropia

To evaluate of the effects of Laser in situ keratomileusis in lowering anisomyopia in children and its validity in facilitating the treatment of the resultant anisometropic amblyopia. Laser in situ keratomileusis [LASIK] was performed to 18 eyes of 18 children having myopic anisometropia amblyopia not successfully treated with the standard amblyopia treatment for 6 months. Children were followed up at 1 week, 1, 2, 6, 12, 18 and 24 months. Postoperative amblyopia therapy was continued with occlusion of the dominant eye for 6 hours daily for the first 3 months and then for 4 hours per the synoptophore [combined with occlusion] was done to improve the binocular function. The mean spherical equivalent refraction in the operated eye had reduced significantly from-9.25 +/- 3.43 D preoperatively to 1.5 +/- 1.23 D 2 years postoperatively. The mean spherical equivalent in the non operated feNow eye was-1.0 +/- 1.18 D preoperatively and-2.25 +/- 1.05 D by 2 years. The mean spherical equivalent anisometropia was-7.75 +/- 2.34 D preoperatively and-0.5 +/- 0.31 D at 2 years, representing a 93.5% reduction in anisometropia. At 6 months, 14 eyes [77.8%] were within +/- 1.0 of the targeted refraction and at 2 years, 10 eyes [55.6%] were within +/- 1.0 D. The mean regression value was-2.25 +/- 1.7 D, however, 15 eyes [83.3%] were within 3.0 D of the fellow eye. The mean BCVA was significantly improved from 0.26 +/- 0.21 preoperatively to 0.82 +/- 0.17 by 2 years after surgery with amblyopia treatment. Binocular vision status had improved after 2 years follow up with part-time reduced occlusion treatment. No significant surgical or general anesthesia complications were noted. LASIK is a safe and effective alternative method for correcting myopic anisometropia facilitating treatment of amblyopia, not responding to conventional methods of treatment, with more better visual acuity and binocular vision. An important factor in treatment success is the compliance with the long-term amblyopia treatment regimen. It should be considered as a first-line treatment option, surpassing glasses and con tact lenses in eliminating anisometropia and aniseikonia

Outcome of ablation of thyroid remnants with l00mCi [3.7GBq] iodine-131 in patients with thyroid cancer

Aim of the study: to determine the efficacy of a 100mCi dose for ablation of thyroid remnants; the influence of pre-therapy scanning; correlation between cervical uptake and efficacy; and the necessity of diagnostic scan for the patients with low serum Tg in the follow-up after remnant ablation

Patients and Methods: a retrospective study was conducted on 98 patients with differentiated thyroid cancer without metastases who received an ablative dose of 100mCi [3.7GBq] of iodine- 131 after total thyroidectomy

Results: six months to one year after ablation, 81/98 patients [82.6%] had a negative scan. Diagnostic scanning with 5mCi [185MBq] performed 72h or 3 months before ablation did not interfere with treatment success compared to patients not submitted to pre-therapy scanning. Pre-ablation cervical uptake values <2 %wer e associated with a higher ablation efficacy [92.8%], from 2 to 5% showed 79% success and values >5%, 57.1 % [p<0.05]. There were no significant differences between the responsive and non responsive groups in terms of age, sex, histological type or size of the primary tumor. 10.5% of the patients with low stimulated Tg [<2ng/ml] presented discrete thyroid bed uptake on follow-up diagnostic scan [<0.5%] without definitive residual disease and 79.4% had negative uptake on scan. The patients with Tg >2ng/ml presented thyroid bed [46] or ectopic [216] uptake on followup diagnostic scan

Conclusion: an ablative dose of 100mCi shows a high rate of efficacy, especially when cervical uptake is <2%, no difference was noted between patients assessed by scan within 72h or 3 months before treatment and those not scanned; follow-up diagnostic scan can be avoided in low risk patients with stimulated Tg <2ng/ml