Visual performance after congenital nystagmus surgery using extended hang back recession of the four horizontal rectus muscles.

PURPOSE: To evaluate the results of surgical correction of congenital nystagmus based on the use of extensive recessions of the four horizontal rectus muscles. The outcome of this procedure in terms of visual performance of the patients has been analyzed in follow-ups of at least 1 year. METHODS: Surgery was performed on 42 patients. An extended retroequatorial recession of the four horizontal rectus muscles was performed between 13 and 15 mm from the muscle insertion with hang back sutures in every case. Preoperatively, all cases showed either a horizontal pendular (4 cases) or jerk nystagmus (38 cases). RESULTS: After surgery, all cases showed full preservation of ductions in all gaze positions. Torticollis decreased in all cases. Binocular best-corrected vision improved in 19 (45.2%) patients and in the remaining 23 (54.8%) it remained unchanged. Consecutive exotropia was observed postoperatively in 7 patients. A second surgical procedure was performed in 9 cases (21.4%) and a botulinum injection in 3 cases (7%). All cases of diplopia resolved. Patient satisfaction was high in 38 cases (96%). CONCLUSIONS: Extended recession of horizontal rectus muscles using hang back sutures offers a good option for the surgical correction of sensorial and neuromuscular nystagmus, providing improvement in binocular best-corrected vision in 45% of the patients (21.4% more than 0.2 logMar units), a high satisfaction rate, and few associated complications. In patients with low vision this can be considered a success that may improve quality of life.

Reversal of myopic anisometropic amblyopia with phakic intraocular lens implantation.

PURPOSE: To report a case of reversal of myopic anisometropic amblyopia with phakic intraocular lens implantation. METHODS: A 6-year-old boy with anisometropic amblyopia with spherical equivalent refraction of right eye: -14.00 -3.00 x 100 degrees, left eye: -0.50 -3.25 x 90 degrees, was treated for 2 years with occlusion to the left eye, with poor results. Refractive surgery was planned because of contact lens intolerance at age 8 years. A -15.00-D iris claw Artisan intraocular lens (IOL) was implanted. RESULTS: Following surgery, treatment of the amblyopia and spectacle correction of -4.00 D cylinder at 85 degrees in the right eye and -3.50 D cylinder at 90 degrees in the left eye was necessary. Visual acuity 6 months after surgery was 20/25 in the right eye and 20/20 in the left eye, and has remained stable 18 months after surgery. CONCLUSION: Myopic anisometropic amblyopia in an 8-year-old boy was treated successfully with implantation of an Artisan iris claw phakic anterior chamber IOL, combined with occlusion therapy, and resulted in reversal of amblyopia.

Corneal sensitivity after photorefractive keratectomy and laser in situ keratomileusis for low myopia.

PURPOSE: To evaluate and compare the recovery of postoperative corneal sensitivity after laser in situ keratomileusis and photorefractive keratectomy for the correction of low myopia. METHODS: In a prospective study, 17 consecutive eyes (17 patients) underwent laser in situ keratomileusis to correct myopia ranging from -3.25 to -6.75 diopters, and another 18 consecutive eyes (18 patients) underwent photorefractive keratectomy to correct myopia from -3.12 to -7.00 diopters. Corneal sensitivity was tested preoperatively and 1 week and 1, 3, and 6 months postoperatively using the Cochet-Bonnet esthesiometer. Corneal sensitivity was tested at the center of the cornea, and in four additional central points 2 mm from the corneal center (nasal, inferior, temporal, and superior). RESULTS: Corneal sensitivity after laser in situ keratomileusis was reduced at the ablated zone during the first 3 months after surgery (Wilcoxon rank sum test, P < .05), and only after 6 months it returned to its preoperative values. However, corneal sensitivity recovered its preoperative values 1 month after photorefractive keratectomy (Wilcoxon rank sum test, P > .05), except for the central corneal point, where 3 months were required. Comparing both groups, corneal sensitivity was more depressed after laser in situ keratomileusis than after photorefractive keratectomy during the first 3 months (Mann-Whitney test, P < .05), except for the nasal central point, although no differences were found between both groups at 6 months (P > .05). CONCLUSIONS: In the correction of low myopia, corneal sensitivity at the ablated zone was more depressed after laser in situ keratomileusis than after photorefractive keratectomy during the first 3 months after surgery. Only after 6 months were corneal sensitivity values similar in both groups.

Photorefractive keratectomy for pediatric myopic anisometropia.

PURPOSE: To evaluate the visual results of excimer laser photorefractive keratectomy (PRK) to treat pediatric patients with amblyopic myopic anisometropia in whom conventional amblyopia treatments have failed. SETTING: Instituto Oftalmológico de Alicante, University of Alicante, Spain. METHODS: Six patients aged 5 to 7 years with amblyopic myopic anisometropia were treated by PRK in the more myopic eye using a VISX Twenty-Twenty excimer laser. Minimum preoperative refraction in the amblyopic eyes ranged from -4.00 to -13.00 diopters and best corrected visual acuity (BCVA), from 20/40 to 20/400. All cases completed a minimum of 2 years follow-up of antiamblyopic treatment. RESULTS: After PRK, preoperative BCVA was maintained without optical correction and complementary refraction resulted in increased BCVA in every case. One patient with high myopia developed severe haze. There were no other significant complications. CONCLUSION: Our results indicate that PRK may be an alternative for the correction of pediatric myopic anisometropia and an important aid in treating amblyopia. When other therapies have failed, using PRK in children of the ages in this study must be carefully evaluated; however, our results suggest a beneficial effect.

Flare-cell meter measurement of inflammation after uneventful cataract surgery with intraocular lens implantation.

PURPOSE: To determine whether intracapsular intraocular lens (IOL) implantation leads to less anterior chamber inflammation than sulcus implantation in eyes having uneventful extracapsular cataract extraction (ECCE). SETTING: Division of Ophthalmology, University of Alicante, Spain. METHODS: This study comprised 314 consecutive uneventful ECCEs with implantation of a rigid poly(methyl methacrylate) IOL performed by the same surgeon. Inflammation was assessed by evaluating aqueous flare and cells using a laser flare-cell meter. Flare and cells were measured in both eyes of all patients preoperatively and on postoperative days 1, 2, 3, 4, 5, 7, 10, and 15 and at the end of months 1, 2, and 3. In 131 eyes (41.7%), the haptics were in the bag and in 114 (36.3%), in the sulcus. In 69 eyes (22.0%), implantation was combined sulcus-bag. RESULTS: Flare and cell counts were high on day 1 regardless of the haptic placement. The counts were highest in eyes with sulcus implantation (32.4 +/- 3.6 [SD] flare; 31.8 +/- 3.2 cells) and lowest in eyes with in-the-bag implantation (27.5 +/- 4.7 flare; 22.3 +/- 2.8 cells). One day postoperatively, the difference between groups in cell count was statistically significant but not in flare measurements. There were no significant between-group differences on day 2 and thereafter. Thirty days postoperatively, flare and cell counts were similar in all eyes. CONCLUSION: Inflammation after uneventful ECCE with IOL implantation resolved within about 3 months of surgery, with flare and cell counts similar to those preoperatively. There was a small but detectable difference in flare and cell counts on the first day after surgery based on haptic location.

[Ocular toxoplasmosis in human immunodeficiency virus infected patients without concurrent central nervous system infection. Report of two cases]. / Toxoplasmosis ocular sin afectación del SNC en pacientes con infección por el VIH. Presentación de dos casos.

Ocular toxoplasmosis is an uncommon complication of acquired immunodeficiency syndrome (AIDS), and it is generally described associated with central nervous system (CNS) lesions. We describe two cases of ocular toxoplasmosis in human immunodeficiency virus (HIV) infected patients, without concurrent CNS infection. Both developed bilateral or unilateral choriorretinitis with favorable response to antitoxoplasma therapy. None of them presented toxoplasmosis of the CNS coexisting with ocular lesions. Ocular toxoplasmosis should be considered in HIV infected patients although no involvement of the CNS is found.

Laser flare-cell measurement of inflammation after uneventful extracapsular cataract extraction and intraocular lens implantation.

PURPOSE: To prospectively evaluate the inflammation response after uneventful extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, University of Alicante, Spain. METHODS: Using a Kowa laser flare-cell meter, we measured cell and flare for 3 months postoperatively in 550 eyes of 435 consecutive patients who had uneventful ECCE and IOL implantation. We compared the results in terms of the type of IOL implanted. RESULTS: The amount of inflammation varied, but not significantly, according to the IOL type. The highest level of flare and cell always occurred the day following surgery regardless of which IOL was used. A small increase in flare was observed on the 30th day. CONCLUSION: Inflammation after uncomplicated ECCE, as measured with a laser flare-cell meter, resolved by 3 months and was not significantly affected by the type of IOL implanted. More sensitive instruments should be developed to measure inflammation immediately after surgery.

High dose intravitreal foscarnet in the treatment of cytomegalovirus retinitis in AIDS.

The efficacy and tolerance of high dose intravitreal foscarnet for cytomegalovirus retinitis in patients with AIDS was studied. Foscarnet in a dose of 2400 micrograms was injected directly into the vitreous of 11 patients (15 eyes). Five patients had active retinitis (eight eyes, 53.3%), and received a 3 week induction therapy of six injections as the first step. Six patients had initial inactive retinitis (seven eyes, 46.7%), and received only maintenance therapy which consisted of a weekly injection. The main indications for intravitreal therapy were: myelosuppression, kidney toxicity, catheter related sepsis, or refusal of intravenous therapy. The patients were followed for a mean period of 16 weeks (range 8-28 weeks) and received a total of 304 injections. Vitreous foscarnet levels were measured by high performance liquid chromatography. After a 3 week course of induction therapy, complete resolution of the active retinitis was seen in 62.5% (5/8 cases), while 37.5% (3/8 cases) had partial resolution. No cases failed to respond or progress. The rate of relapse on maintenance therapy was 33% (five of 15 eyes) by 20 weeks, and two of these eyes did not respond to reinduction and progressed in involvement of the macula or optic nerve. Neither important local complications nor intraocular drug toxicity were observed. Vitreous foscarnet levels in two different patients were 896 mumol/l and 74.9 mumol/l at 22 3/4 hours and 42 1/2 hours after the injection. Intravitreal foscarnet appears to be a safe, effective, and useful alternative in patients with intolerance to intravenous and viral therapy.

Glutathione system of human retina: enzymatic conjugation of lipid peroxidation products.

The major aspects of the glutathione (GSH)-related antioxidant defense of human retina are presented. These include concentration of GSH and activities of some GSH-dependent enzymes: glutathione peroxidase, glutathione disulfide reductase, and glutathione S-transferase toward a broad spectrum substrate 1-chlor-2,4-dinitrobenzene and a toxic product of lipid peroxidation (4-hydroxynonenal). The presence of a relatively high GSH concentration, GSH peroxidase activity, and GSH S-transferase specific activity toward 4-hydroxynonenal in human retina might constitute a central defense mechanism in inflammation-promoted oxidative stress and subsequent lipid peroxidation. The use of different substrates for the determination of the GSH peroxidase activity showed no statistically significant difference, thus suggesting the lack of Se-independent GSH peroxidase in human retina. Large individual variations were obtained for GSH concentration and the different activities tested; the apparent correlation with age of these findings is currently under investigation.

Intravitreal foscarnet for cytomegalovirus retinitis in a patient with acquired immunodeficiency syndrome.

We treated a patient who had acquired immunodeficiency syndrome and cytomegalovirus retinitis of the left eye. After anesthetic had been topically administered, the patient received intravitreal injections of 1,200 micrograms of foscarnet. Plasma and vitreous foscarnet levels were measured by high-performance liquid chromatography. Systemic absorption of the drug was not evident. Elimination half-life from the vitreous after one injection was 54.0 hours. Vitreous levels remained above the mean 50% inhibition value for cytomegalovirus for approximately 56 hours and above the mean inhibition value for human immunodeficiency virus for approximately 241 hours. The patient's visual acuity improved from 20/30 to 20/25 in the left eye. Ophthalmoscopy showed the retinal lesion to have become inactive, and no reactivation occurred during the follow-up period of more than four months. The drug was well tolerated and no retinal toxicity was evident. We suggest an induction treatment regimen of two injections weekly for three weeks, followed by a maintenance treatment regimen of one injection weekly.