Changes in binocular function in anisometropic nonstrabismic children with optical correction and occlusion therapy.

PURPOSE: To identify factors that influence binocular function in anisometropic, nonstrabismic children before and after optical correction and amblyopia therapy. METHODS: This was a prospective observational study of consecutive patients with nonstrabismic anisometropia. Visual acuity and responses to the 4(Δ) base-out prism test, the Worth 4-dot test, and the TNO test were recorded after spectacle correction and every 3 months for 1 year. Factors affecting visual acuity and binocular function were analyzed using univariate and multiple stepwise regression analysis. RESULTS: A total of 118 subjects were enrolled. At the end of the first year, the mean improvement in visual acuity was 2.6 ± 2.3 lines. The percentage of patients showing a positive response to the 4(Δ) base-out prism test increased from 47% to 79%; fusion in the Worth 4-dot test, from 37% to 66%; and measurable stereopsis on TNO testing, from 59% to 80%. Better initial visual acuity and better final visual acuity were associated with better binocular function. Interocular refractive error difference was a predictor of poor binocular function in multiple regression analysis if the difference in spherical error exceeded 4 D. Patients with amblyopia showed significantly worse binocular function compared to those with no amblyopia. CONCLUSIONS: Binocular function of anisometropic children can be improved with refractive correction and amblyopia therapy.

Evaluation of intralesional propranolol for periocular capillary hemangioma.

BACKGROUND: The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangioma. METHODS: A prospective study was performed in 22 consecutive patients with periocular hemangioma. Twelve patients underwent intralesional propranolol injection and ten patients underwent intralesional triamcinolone injection. The size of the lesion was measured serially every week during the first month, every 2 weeks for the second month, and then monthly for another 2 months. The refractive error and degree of ptosis if present were measured before injection and at the end of the study. RESULTS: There was reduction in the size of hemangioma, astigmatic error, and degree of ptosis in both groups. The difference in outcome between both groups was not statistically significant. Rebound growth occurred in 25% of the propranolol group and 30% of the steroid group but responded to reinjection. No adverse effects were reported during or after intralesional propranolol injection. CONCLUSION: Intralesional propranolol injection is an alternative and effective method for treatment of infantile periocular hemangioma.

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract.

PURPOSE: To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. SETTINGS: Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. METHODOLOGY: Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). RESULTS: Improvement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001). CONCLUSION: Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.

The use of mitomycin C with autologous limbal-conjunctival autograft transplantation for management of recurrent pterygium.

PURPOSE: The purpose of this study is to evaluate and compare recurrence rates upon using mitomycin C (MMC) with limbal-conjunctival autograft for treating recurrent pterygia. METHODOLOGY: An interventional, prospective, comparative clinical study was performed in 30 eyes (26 patients) with recurrent pterygia, allocated into two groups: Group A (19 eyes) operated by pterygium excision and limbal-conjunctival autograft transplantation (L-CAT) without MMC and Group B (20 eyes) operated with injection of 0.1 mL of MMC 0.15 mg/mL 1 month before L-CAT surgery. Exclusion criteria included patients with symblepharon, cicatricial conjunctival diseases, limbal stem cell deficiency, and other intraocular diseases. RESULTS: A total of four cases of recurrences for Group A (P = 0.012) and one case of recurrence for Group B (P < 0.001) were recorded. CONCLUSIONS: Preoperative injection of MMC in low dose and concentration improves the results of L-CAT in recurrent pterygium.

Comparative performance of intraocular lenses in eyes with cataract and uveitis.

PURPOSE: To evaluate the postoperative outcomes in uveitic eyes after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter (19) international study. METHODS: This prospective randomized comparative interventional case series comprised 140 eyes of 140 patients who had phacoemulsification and implantation of IOLs of various materials: hydrophobic acrylic (n = 48), silicone (n = 44), poly(methyl methacrylate) (PMMA) (n = 26), or heparin-surface-modified PMMA (HSM PMMA) (n = 22). Preoperative and postoperative grading and control of intraocular inflammation were performed. Clinically significant observations, visual outcomes, and the incidence of postoperative complications were recorded. RESULTS: At the final follow-up, 64 eyes (46.3%) had a best corrected visual acuity of 20/40 or better, an improvement that was highly significant (P <.0001). One day after surgery, the acrylic group had the lowest inflammation values and the silicone group the highest (P =.02). The acrylic group continued to have the lowest inflammation grade values until the 3-month follow-up. The acrylic and HSM PMMA groups had the lowest incidence of relapses. Posterior capsule opacification developed in 48 eyes (34.2%), with the highest incidence in the silicone group. CONCLUSIONS: Phacoemulsification with IOL implantation in selected uveitic eyes was safe and effective. Acrylic IOLs provided a better visual outcome and lower complication rate than IOLs of other materials.

Comparison of corneal pachymetry using ultrasound and Orbscan II.

PURPOSE: To compare Orbscan II pachymetry with ultrasonic pachymetry in eyes having corneal refractive surgery. SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: In this comparative prospective study, 72 eyes (36 patients) were divided into 4 groups: Group 1, 16 eyes with haze after photorefractive keratectomy (PRK); Group 2, 12 eyes with no haze after PRK; Group 3, 24 eyes that had uneventful laser in situ keratomileusis; Group 4, 20 normal eyes. The corneal thickness was measured in all eyes by the Orbscan II (version 3.27.10, Orbtek Inc.) and then by ultrasonic pachymetry (DHC 500, Technology Inc.). RESULTS: The results between the 2 systems of pachymetry were significant in Group 1 (P < .0001) and not significant in Groups 2, 3, and 4 (P = .056, P = .051, and P = .68, respectively). A statistically significant correlation existed between the grade of haze and the decrease in Orbscan readings (C = -0.821, P < .0001). CONCLUSION: The Orbscan II pachymetry measurements correlated with the ultrasound measurements in eyes with clear corneas. Haze after PRK decreased the Orbscan pachymetry.