Outcomes of scleral buckling for stage 4 retinopathy of prematurity in Thai children.

OBJECTIVE: To evaluate the anatomical and visual results of a primary scleral buckling procedure for the treatment of stage 4A and 4B retinopathy of prematurity (ROP) in Thai patients. MATERIAL AND METHOD: The data of premature infants treated with a primary scleral buckling procedure for stage 4 ROP from December 2000 to May 2004 were retrospectively reviewed The outcomes measures were anatomical success, visual outcomes, and refractive error at the end of follow-up. RESULTS: Sixteen eyes of ten patients underwent a scleral buckling procedure and had the mean follow-up period of 17.3 months (range 3-44 months). The anatomical success was 100% (8 of 8 eyes) in stag 4A and 50% (4 of 8 eyes) in stage 4B. At the end of the follow-up, the buckle was removed in 92% (11 of 12 eyes) of retina-attached eyes and showed a mean myopic refraction of-8.68 diopters (range -4. 75 to 13.50). Favorable visual outcome was 50% (4 of 8 eyes) in stage 4A and 12.5% (1 of 8 eyes) in stage 4B. CONCLUSION: Scleral buckling appears to play a role in reducing the progression from stage 4 to stage 5 ROP The anatomical success rate was excellent but the visual results remain challenging for these cases.

Prevalence of abnormal vision in one-year-old Thai children, based on a prospective cohort study of Thai children (PCTC).

OBJECTIVES: To collect preliminary data on the prevalence of abnormal vision in one-year-old Thai children. MATERIAL AND METHOD: A retrospective study was conducted using data collected from a prospective cohort study of Thai children (PCTC) carried out during 2000-2002, to examine the prevalence of abnormal vision in one-year-olds. Data from five districts in five provinces were examined. One-year-old children in the present study underwent vision screening and eye examination performed by non-medical research assistants. RESULTS: There were records from 3,898 children in five districts, 49.7% females and 50.2% males. Their eye examinations showed very good vision in 77.8% (9.8 cy/cm at 38 cm), good vision in 21.5% (6.5 cy/cm at 38 cm), and fair vision in 0.7% (< or = 1.6 cy/cm at 38 cm). Normal ocular motility was found in 99.7% and 99.9% had normal anterior segment and lens. No strabismus was found in 99.4%, 99.9% had normal pupil light reflex, 99.8% had normal red reflex, 93.6% could fix and follow at 3 months of age, 85.7% could detect a falling object at 6 months, and 78.5% of mothers and 46.5% of fathers regularly played with the children. Logistic regression analysis indicated that some factors had statistical significance, such as "fix and follow" by 1 month of age, and lack of father-child interaction, but these were not clinically significant. Using Kappa analysis, the authors combined groups 1 (very good vision) and 2 (good vision) to create a "normal vision" category. If children had 2 abnormal eye examinations (eye exam for strabismus, cornea, anterior chamber, lens, pupil and red reflex), the authors recommended sending them to a specialist. The sensitivity and specificity of the visual screening and eye examination instruments were 19.23% and 99.38%, respectively. The Kappa statistic was 0.17. These instruments are not appropriate for eye screening in one-year-old children. CONCLUSION: More than 99% of the children examined had normal results. The majority of children could fix and follow from 2-3 months of age. The early fix and follow development may be related to better visual acuity. The interaction between father and child may be associated with eye development. However, eye screening of one-year-old children by assistant researchers may be inappropriate due to lack of expertise and experience.

Botulinum A toxin therapy on esotropia in children.

A prospective descriptive study was conducted to determine the results of Botulinum Toxin Type A (BTA) injection on esotropia in children, as this may be an alternative to incisional surgery for strabismus. Between September 1998 and February 2002, eleven patients (6 boys and 5 girls) with esotropia were treated with BTA at the Department of Ophthalmology, Songklanagarin Hospital. The average ages at the time of the first and second treatments were 26.8 months (range 14-40 months) and 32.3 months (range 19-54 months), respectively. An open sky procedure was used to inject the BTA. Alignment within +/- 10 prism of orthotropia was considered a successful outcome of BTA treatment in the patients. If the result of the first injection was an incomplete paralysis and the strabismus remained undercorrected, the subsequent dose was increased up to double the initial dose. The mean deviation angle was 40.4 prism diopter (PD) before the first injection and 24.5PD before the second injection. Eight of 11 (72.7%) cases had a sucessful outcome. BTA injection in childhood esotropia may be an alternative to incisional strabismus surgery.