Change in refractive error after unilateral levator resection for congenital ptosis.

PURPOSE: To analyze refractive change in children with congenital ptosis who have undergone unilateral levator resection. METHODS: All charts of patients with congenital ptosis who underwent one levator resection performed by 2 pediatric ophthalmologists at the University of Minnesota from 1981 through 1995 were reviewed. Postoperative refractive changes were analyzed within the group of eyes that underwent ptosis repair and within the group of fellow eyes that served as age-matched controls. The preoperative and postoperative refractive error of each operated eye was also compared with its paired unoperated eye. RESULTS: Complete preoperative and postoperative refractive data were available for 28 patients with congenital ptosis requiring only one levator resection. The mean age at surgery was 3 years 8 months. The preoperative mean ptosis was 3.5 mm (range, 1.5-6 mm). At the last postoperative visit (mean, 20 months; SD, 11 months), the mean refractive change in the operated eye was 1.23 D sphere (range, 0-3.50 D; P =.061) and 0.83 D cylinder (range, 0-3.00 D; P =.002). Within the group of control eyes, no significant mean spherical or cylindrical changes were found at the last postoperative visit. Fourteen eyes with preoperative ptosis had a cylindrical change of 0.75 D or more, compared with a similar change in 4 control eyes. When refractive errors were compared interocularly, no statistically significant differences were found. CONCLUSIONS: Our results showed significant cylindrical change in eyes that underwent levator resection for unilateral congenital ptosis. Careful refraction is necessary after unilateral levator resection.

Bilateral inferior rectus muscle recession for correction of hypotropia in dysthyroid ophthalmopathy.

PURPOSE: The restrictive myopathy of dysthyroid ophthalmopathy frequently results in strabismus and diplopia. The most common deviation is hypotropia. Ipsilateral inferior rectus muscle recession, the generally accepted treatment, may lead to a progressive marked overcorrection. The purpose of this study is to evaluate the results of bilateral asymmetric inferior rectus muscle operations with regard to late progressive overcorrection. METHODS: A retrospective review of all patients undergoing bilateral inferior rectus muscle recession for dysthyroid ophthalmopathy between 1993 and 1997 found 8 patients with hypotropia resulting from dysthyroid ophthalmopathy. Alignment and motility were assessed preoperatively and postoperatively in all patients. Bilateral asymmetric inferior rectus muscle recession was performed on all patients with an adjustable suture performed on the hypotropic eye. A successful, long-term, postoperative result was defined as orthophoria or a vertical misalignment of less than or equal to 5 PD in primary gaze. RESULTS: Data were collected from 8 patients at 4 to 6 weeks postoperatively. Six patients had successful alignment, and 2 patients remained undercorrected. Seven patients were successfully aligned, and 1 patient was undercorrected at the latest postoperative examination (mean, 18 months). CONCLUSION: In our series, bilateral asymmetric inferior rectus muscle recession resulted in successful correction of hypotropia without late postoperative overcorrections in patients with dysthyroid ophthalmopathy.

Sleep disorders in children with congenital anophthalmia and microphthalmia.

PURPOSE: The increased incidence of sleep disorders among blind patients has been documented in the sleep medicine literature. Blind patients lack the normal regulatory control of retinal input over their circadian rhythms, which can lead to abnormalities in their sleep-wake cycles. Our study was conducted to determine the incidence of sleep disorders in children with anophthalmia or microphthalmia and to offer therapeutic alternatives. METHODS: A 13-question survey was distributed to families of children with anophthalmia, microphthalmia, or both identified through the Anophthalmia/Microphthalmia Registry in Philadelphia, Pennsylvania. The survey included questions regarding the children's medical and ocular histories and any sleep disorders they may have experienced. Questions regarding daily schedules, family history, and social history were also included. RESULTS: Surveys were returned from 13 children with bilateral anophthalmia or microphthalmia. Ten of 13 (77%) anophthalmic/microphthalmic children were reported to have frequent early-morning waking and extensive daytime sleeping. Specific medical and social problems did not appear to be associated with the development of these sleep disorders. Strict daily schedules were often helpful in entraining the children's sleep-wake cycles. CONCLUSION: Without the contribution of retinal input to help regulate circadian rhythms, most children with bilateral anophthalmia or microphthalmia will experience sleep disorders. These children may benefit from the introduction of strict daily schedules, medical therapy (melatonin), or both. An attempt should also be made to preserve any existing light perception.