Subject(s)
Diagnostic Imaging/methods , Hemangioma , Orbital Neoplasms , Age Distribution , Combined Modality Therapy/methods , Hemangioma/diagnosis , Hemangioma/epidemiology , Hemangioma/therapy , Humans , Incidence , Infant , Orbital Neoplasms/diagnosis , Orbital Neoplasms/epidemiology , Orbital Neoplasms/therapy , United States/epidemiologyABSTRACT
PURPOSE: To describe and to evaluate a novel application of magnetic resonance imaging (MRI) in determining the Ahmed glaucoma valve (AGV) function after implantation. METHODS: Retrospective interventional case series of all surgical glaucoma patients in one practice were identified and orbital MRI series were performed. Orbital MRI findings were evaluated in all children who had undergone Ahmed glaucoma valve insertion. RESULTS: A total of six patients were identified, ranging in age from 1 to 14 years. Mean follow-up time ranged from 1 to 3 years from the time of first tube insertion. Gadolinium enhancement MRIs showed an enhanced large cystic cavity over the plate in five patients, indicating partial to complete patency of the outflow of the tube. One MRI failed to show an enlarged enhanced bleb over the plate region, indicating potential obstruction of outflow. Surgical irrigation of the tube displayed obstruction. Ahmed tube exchange was performed. Enhanced cystic bleb showed compression of the extraocular muscles in four patients. These patients exhibited mild to moderate restrictive strabismus. No lenticular opacification was noted in the four phakic patients. CONCLUSIONS: Early and late AGV failure and subsequent intraocular pressure rise are of great concern after pediatric glaucoma shunt surgery. Orbital MRI series should be considered in the cases of possible AGV drainage failure. In cases of reoperation, orbital MRI findings could be of great clinical value to evaluate for functional patency as well as for the EOM surgical intervention approach. To avoid unnecessary surgical exploration/explantation, orbital MRIs with gadolinium-dye enhancement should be considered in evaluating postshunt glaucoma surgical patients.
Subject(s)
Glaucoma Drainage Implants , Glaucoma/diagnosis , Glaucoma/surgery , Magnetic Resonance Imaging/methods , Orbit/pathology , Adolescent , Aqueous Humor/metabolism , Child , Child, Preschool , Female , Humans , Intraocular Pressure , Male , Prosthesis Failure , Prosthesis ImplantationABSTRACT
PURPOSE: To discuss the ophthalmic findings and their clinical significance in 10 new cases of Jacobsen syndrome (mental retardation, craniofacial anomalies, congenital heart defects, and blood dyscrasias) and to review the ophthalmic findings in all previously reported cases in the literature. METHODS: Ten new cases of Jacobsen syndrome were collected and studied prospectively for detection of abnormal ophthalmologic examination findings. A total of 63 previously reported cases were identified from Medline and analyzed for ophthalmologic abnormalities. RESULTS: The most common ophthalmologic findings in the new cases of Jacobsen syndrome included strabismus (90.0%), refractive error (90.0%), and ptosis (70.0%). Facial dysmorphism was also common and included hypertelorism, epicanthal folds, and down-slanting palpebral fissures. Uncommon ophthalmic findings included 5 patients with retinal vascular tortuosity, 1 with glaucoma, and 3 with amblyopia. In 63 cases reviewed, 36 reported ophthalmologic abnormalities. The most common findings included facial anomalies and ptosis. Only 5 of the 63 patients had evidence of strabismus, and none were reported to have retinal vascular tortuosity. CONCLUSIONS: To prevent unnecessary vision loss in children with Jacobsen syndrome, proper screening for amblyogenic factors is imperative. We recommend a baseline complete ophthalmologic examination with subsequent follow-up examinations depending on the particular findings noted during the initial screening visit.
