ABSTRACT
A 10-year-old boy presented with a complete left oculomotor cranial nerve palsy. Diagnostic evaluation, including neuroimaging and cerebral angiography revealed a small intracranial aneurysm compressing the third nerve. Neurosurgical clipping of the aneurysm produced resolution of the third nerve palsy. The rarity of this presentation in a young patient is discussed, along with the importance of rapid diagnosis and treatment.
Subject(s)
Diplopia/etiology , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnosis , Nerve Compression Syndromes/etiology , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve/pathology , Cerebral Angiography , Child , Humans , Intracranial Aneurysm/surgery , Magnetic Resonance Angiography , Male , Nerve Compression Syndromes/diagnosis , Oculomotor Nerve Diseases/diagnosisABSTRACT
BACKGROUND: Infection after strabismus surgery is uncommon and its cause remains unanswered. The source of the bacteria and the manner in which it enters the eye is often unknown. Most pediatric ophthalmologists now use 5% povidone-iodine to reduce the bacterial population before surgery. The needles used during strabismus surgery may be a source of bacterial contamination. METHODS: One hundred six needles were cultured after their use in strabismus surgery. RESULTS: Sixteen of 106 needles (15.1%) and 15 of 61 cases (24.6%) were culture positive. The organisms recovered closely resembled indigenous bacterial flora. CONCLUSION: This study suggests that the needles used during strabismus surgery may be the source of bacteria that can lead to infections after strabismus surgery.
Subject(s)
Bacteria/isolation & purification , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Needles/microbiology , Postoperative Complications/microbiology , Strabismus/surgery , Adolescent , Adult , Child , Child, Preschool , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , Female , Humans , Infant , Male , Microbiological Techniques , Postoperative Complications/prevention & control , SterilizationABSTRACT
PURPOSE: To report results of secondary posterior chamber intraocular lens (IOL) implantation in previously aphakic pediatric patients. METHODS: In 19 pediatric patients, 19 aphakic eyes (11 after infantile and eight after traumatic cataract surgery) received secondary sulcus-fixated posterior chamber IOL implants. RESULTS: Visual acuity of 20/40 or better was achieved with IOL implantation and overrefraction in three of 11 infantile (27%) and six of eight traumatic cataract patients (mean follow-ups, 18.1 months [range, 8 to 29 months] and 18.0 months [range, 6 to 28 months]), respectively. Eighteen of 19 patients (95%) demonstrated postoperative vision equal to or better than preoperative levels; 15 of 19 patients (79%) showed improved vision after IOL implantation. The mean +/- SD difference between actual and predicted postoperative refraction at 1 month was -0.97 +/- 0.96 diopter. Average refractive error at last examination was -0.40 +/- 2.43 diopters. Amblyopia therapy was performed in 14 patients. One IOL required repositioning 8 months postoperatively. Strabismus was present in 14 patients before and 13 patients after IOL implantation, requiring surgery in four patients. CONCLUSIONS: Secondary IOL implantation can be performed successfully in carefully selected pediatric patients. Visual acuity results are better in eyes with a history of traumatic cataract and are influenced by patient compliance. The short-term risks of the procedure appear no greater than those of primary IOL implantation, and complications resemble those seen in adults.
Subject(s)
Lenses, Intraocular , Cataract/etiology , Cataract Extraction , Child , Child, Preschool , Evaluation Studies as Topic , Eye Injuries/complications , Humans , Infant , Postoperative Complications , Reoperation , Treatment Outcome , Visual AcuityABSTRACT
PURPOSE: We examined the efficacy of intraocular lens implantation (IOL) in children younger than 4 years of age for unilateral aphakic visual rehabilitation. METHODS: Twenty-one patients underwent unilateral cataract extraction, IOL placement, posterior capsulotomy, and anterior vitrectomy between 1990 and 1994. Postoperative vision, refractive change, and complications were monitored prospectively. Two cataract subgroups were analyzed: 12 patients with infantile (congenital and developmental) cataracts, and nine patients with posttraumatic cataracts. RESULTS: Overall age at surgery averaged 26 months (range 9 to 44 months), with follow up of 5 to 55 months. Fifty-two percent achieved 20/40 or better vision: 42% in the infantile group and 67% in the traumatic group. IOL power averaged 22.6 diopters (D). The difference between predicted and actual postoperative refraction was less than 1 D in 70%. After 6 months, the average change in refraction was 0.50 D (21 patients). An increasing myopic shift of 1.10 D at 12 months (14 patients), 1.80 D at 18 months (nine patients), and 2.90 D after 24 months (eight patients) was noted. This trend was greater in the infantile group. Amblyopia treatment was implemented in 18 patients. Half have completed occlusion successfully, one third continue therapy, 17% are treatment failures, and 11% (two patients) were lost to follow up. Six patients required strabismus surgery; five had infantile cataracts. Postoperative complications occurred in four eyes, two infantile and two traumatic; they consisted of posttraumatic temporal IOL dislocation, corectopia, partial pupillary capture of an IOL, and partial pupillary membrane. CONCLUSION: Primary IOL implantation is an effective way to rapidly achieve aphakic visual rehabilitation in preschool children. We continue to evaluate the long-term safety and effects of pediatric pseudophakia.
