Traumatic and spontaneous scleral rupture and uveal prolapse in osteogenesis imperfecta.

Three cases of severe globe injuries due to scleral fragility in osteogenesis imperfecta patients between the ages of 4 and 15 years are reported. Patient 1 had complete loss of vision. Patients 2 and 3 suffered non-sight-threatening scleral perforation. All 3 patients had no previous knowledge of recommendation for eyewear protection.

Ahmed glaucoma valve implants in the pediatric population: the use of magnetic resonance imaging findings for surgical approach to reoperation.

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.

Safety and efficacy of 2% pirenzepine ophthalmic gel in children with myopia: a 1-year, multicenter, double-masked, placebo-controlled parallel study.

OBJECTIVE: To evaluate the safety and efficacy of the relatively selective M(1) antagonist pirenzepine hydrochloride in slowing the progression of myopia in school-aged children. METHODS: This was a parallel-group, placebo-controlled, double-masked study in healthy children, aged 8 to 12 years, with a spherical equivalent of -0.75 to -4.00 diopters (D) and astigmatism of 1.00 D or less. Patients underwent a baseline complete eye examination and regular examinations during a 1-year period. The setting was 13 US academic clinics and private practices. Patients were randomized in a 2:1 ratio to receive 2% pirenzepine ophthalmic gel or a placebo control twice daily for 1 year. RESULTS: At study entry, the spherical equivalent was mean +/- SD -2.098 +/- 0.903 D for the pirenzepine group (n = 117) and -1.933 +/- 0.825 D for the placebo group (n = 57, P = .22). At 1 year, there was a mean increase in myopia of 0.26 D in the pirenzepine group vs 0.53 D in the placebo group (P < .001). No patients in the placebo group and 13 (11%) of 117 patients in the pirenzepine group discontinued participation in the study because of adverse effects (5 [4%] of 117 due to excessive antimuscarinic effects). CONCLUSIONS: Pirenzepine is effective and relatively safe in slowing the progression of myopia during a 1-year treatment period.

Ocular findings in Jacobsen syndrome.

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.