Management of ectopia lentis in children.

Marfan syndrome, homocystinuria, trauma, and simple ectopia lentis are the most common causes of pediatric lens subluxation. Many patients are best treated with a careful refraction of the phakic or aphakic pupillary axis. For those patients not achieving satisfactory refractive results, endocapsular lensectomy using modern automated vitreous cutting devices is relatively safe and successful. Given the lack of postoperative capsular support and our current level of intraocular lens technology, postoperative optical correction is most safely achieved with aphakic contact lenses or spectacles.

Endocyclophotocoagulation for management of difficult pediatric glaucomas.

INTRODUCTION: Experience with endoscopic diode laser cyclophotocoagulation remains limited. We report the efficacy and safety profile of this glaucoma surgery technique in the pediatric population. METHODS: Retrospective review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery was performed by using the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system. Patients were followed-up for a minimum of 6 months or until declared treatment failures. Treatment success is defined as a postoperative intraocular pressure of < or = 21 mm Hg, with or without adjunctive glaucoma medications. RESULTS: Baseline mean pretreatment intraocular pressure was 35.06 +/- 8.55 mm Hg. Final postoperative intraocular pressure was 23.63 +/- 11.07 mm Hg (30% decrease) after an average of 1.42 +/- 0.87 endolaser procedures and 19.25 +/- 19.36 months of follow-up. Success rate of the initial procedure at last follow-up was 34%. Nine eyes (25%) were retreated at least once. Cumulative success rate after all procedures at last follow-up was 43%. Mean cumulative arc of treatment was 260 degrees +/- 58 degrees of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. CONCLUSIONS: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment.

Relationship of dissociated vertical deviation and the timing of initial surgery for congenital esotropia.

PURPOSE: To clarify the incidence of dissociated vertical deviation (DVD) among patients with congenital esotropia and to identify any relationship between the time when patients undergo their initial strabismus surgery and the time when they may subsequently have DVD develop. DESIGN: Noncomparative case series. PARTICIPANTS: One hundred five consecutive patients undergoing surgery for congenital esotropia over a 10-year period. METHODS: All patients underwent bimedial rectus recession before 24 months of age. MAIN OUTCOME MEASURES: Patients were followed postoperatively to note the age at onset of clinically evident DVD. RESULTS: By 6 years of age, 92% of available patients had DVD. The mean age at onset was 2.81 +/- 1.37 years. There was no significant difference between patients surgically aligned before 6 months of age compared with those aligned between 6 and 12 or 12 and 24 months of age. CONCLUSIONS: DVD occurs in almost all patients with surgically treated congenital esotropia, and its development is unrelated to the timing of surgical intervention during the first 24 months of life.

Intermediate-term results of endoscopic diode laser cyclophotocoagulation for pediatric glaucoma.

INTRODUCTION: Endoscopic diode laser cyclophotocoagulation (EDLC) is a new treatment modality for glaucoma. Experience with this surgical procedure in children is limited. We report our results after 3 years of follow-up and review the safety of this procedure in pediatric patients. METHODS: EDLC was performed on 10 eyes of 8 children who had either aphakic glaucoma or refractory congenital glaucoma. Patients were treated in 2 groups. An initial group of 5 eyes with poor visual prognosis underwent a conservative treatment of no more than 180 degrees of ciliary processes. After an observational period, a second group of 5 eyes with better visual potential was treated more aggressively. Most eyes in the second group received cyclophotoablation to 270 degrees of ciliary processes. Patients were followed up until time of failure or for a minimum of 3 years. RESULTS: At 3 years of follow-up, 50% of eyes that received a single treatment of endolaser had an intraocular pressure (IOP) of < or =22 mm Hg with or without glaucoma medications. Twenty percent had an IOP < or =22 mm Hg without any glaucoma medications. Five eyes were treated successfully with a mean IOP of 17.8 +/- 3.4 mm Hg at 36 months of follow-up. The remaining 5 eyes were considered treatment failures with postoperative IOPs >22 mm Hg, despite adjunctive glaucoma medications. Mean time to treatment failure was 10.5 months (range, 3.7-22.2 months). No sight-threatening complications occurred. None of the eyes became hypotonus or caused undue discomfort during the postoperative period. CONCLUSION: EDLC is a relatively safe and effective procedure for the management of difficult pediatric glaucoma. Results are comparable to other cyclodestructive modalities. Although not observed in this study, it should be cautioned that phakic eyes might be at increased risk for surgical complications.

Nystagmus.

Nystagmus continues to be a complex subject of study. Our ability to characterize nystagmus has improved, but our comprehension of the oculomotor control process underlying this condition remains vague. We review recent advances in the characterization, classification, and treatment of nystagmus. Congenital forms of nystagmus, nystagmus associated with strabismus, and available therapeutic options for congenital and acquired nystagmus are emphasized.