Cystoid macular edema in pediatric aphakia.

The presence of cystoid macular edema (CME) after cataract extraction in the pediatric age group could adversely affect rapid visual rehabilitation of the eye by contributing to irreversible amblyopia. Several previous studies, including one by our group, have addressed this problem. Hoyt's observations of CME in ten of 27 eyes undergoing lensectomy-vitrectomy procedures have stirred renewed interest in this topic. The current study includes 12 eyes undergoing lensectomy-vitrectomy procedures, five eyes undergoing manual extracapsular procedures (ECCE) with discission of the posterior capsule, three eyes undergoing ECCE without discission of the posterior capsule, and three eyes undergoing secondary discissions. No CME was found angiographically on postoperative evaluation.

Superior oblique overaction in patients with true Brown's syndrome.

The charts of all patients with the diagnosis of congenital Brown's syndrome seen between July 1983 and June 1984 were examined retrospectively. In the past, overaction of the ipsilateral superior oblique (OAISO) was felt by most authors to be absent or minimal. Our study revealed that separate observers consistently documented the presence of an OAISO in about one-fifth of the selected patients. The presence of OAISO has not been emphasized previously and still remains controversial. We felt that an extremely tight superior oblique might cause an OAISO. We therefore statistically compared its presence to the presence of a downshoot. The presence of an OAISO to abnormal head tilt, abnormal chin position, amblyopia, and abnormal stereo was also compared statistically. Finally, we emphasize a technique of forced ductions that differentiates Brown's syndrome from an inferior oblique palsy, but which also alerts the examiner to the presence of an inferior rectus restriction or other posteriorly located restrictions.

Congenital absence of the superior oblique tendon in craniofacial dysostosis.

Absence of each of the extraocular muscles as a rare cause of strabismus has been reported. Helveston suggests that a significant horizontal deviation with suppression and/or amblyopia in a patient with the preoperative diagnosis of congenital superior oblique palsy should alert one to a possible absence of the superior oblique tendon. We present and discuss two patients with craniofacial dysostosis in whom extensive surgical exploration showed an absence of the superior oblique tendon.

Anterior segment anomalies associated with the fetal alcohol syndrome.

Anterior segment anomalies were noted in eight children diagnosed as having the fetal alcohol syndrome. Peters' and Axenfeld's anomalies were among the specific defects noted. Four children have maintained clear corneal grafts. A teratogenic action of alcohol during a critical period of development of anterior chamber structures is suggested as an etiologic factor. It is proposed that the varied types and severity of abnormalities noted might result from differences in blood alcohol levels, timing of the insult, and genetic background of the fetus. The observation of various types of malformations thought to share a similar pathogenesis lends additional support to the assumption that there is an interrelationship among these types of congenital segment pathology.

Extraocular muscle involvement in Wegener's granulomatosis.

A 44-year-old man with Wegener's granulomatosis involving the upper and lower respiratory tracts developed a diplopia with involvement of three extraocular muscles of one eye and one extraocular muscle of the other eye. The ocular and orbital examinations were otherwise normal, as were computerized tomography (CT) scans of the brain and orbits. The patient was treated with systemic Cytoxan and Prednisone and the respiratory and extraocular muscle abnormalities cleared within 1 month. Because of the bilateral extraocular muscle involvement, the absence of central nervous system or orbital findings, and the rapid and complete resolution after Cytoxan and Prednisone therapy, a diffuse vasculitis affecting the extraocular muscles was implicated as the etiology of the diplopia.

A combined surgical approach to bilateral superior oblique palsy.

In two cases of bilateral superior oblique palsy the vertical component of the deviation was more prominent in one eye and the excyclotorsion more prominent in the fellow eye. A tuck of the superior oblique was performed on one eye and an adjustable Harada-Ito procedure on the fellow eye. This combined approach was used to reduce both the torsional and vertical components in these patients with complicated bilateral superior oblique palsies while effecting a more exact resolution of the torsional component.

Deficits in luminous flux discimination by cats with lesions of the superior colliculus-pretectum.

(1) Intact cats and cats relearning or initially learning after bilateral ablation of the superior colliculus-pretectum were trained on a simple flux discrimination in a straight maze where the stimuli were either immediately side by side at the end of the runway or were separated by an opaque barrier. (2) After ablation of the superior colliculus-pretectum, each preoperatively trained cat had a significant deficit in retention of the luminous flux discrimination regardless of whether or not the stimuli were separated by a barrier or whether the correct stimulus was darker or lighter than the incorrect stimulus. (3) Under each of the different training conditions, every cat learning the flux discrimination initially after ablation of the superior colliculus-pretectum was retarded in comparison with intact cats. (4) The severity of the postoperative learning deficit correlated highly with the total extent of the lesion in the superior colliculus and pretectum.