ABSTRACT
Surgically induced necrotizing scleritis (SINS) is an uncommon but devastating complication that may occur days to years after ocular surgery. We report the case of a 32-year-old man who underwent uncomplicated strabismus surgery for large-angle exotropia and developed SINS characterized by painless scleral inflammation, choroidal exposure, and globe ectasia within days of surgery. Work-up revealed no associated infectious process or underlying systemic inflammatory condition. Clinical resolution occurred with oral immunosuppression alone, without need for graft.
Subject(s)
Exotropia , Ophthalmology , Scleritis , Male , Humans , Adult , Scleritis/diagnosis , Scleritis/drug therapy , Scleritis/etiology , Ophthalmologic Surgical Procedures/adverse effects , Sclera/transplantation , Exotropia/surgeryABSTRACT
BACKGROUND: Strabismus is common in children after glaucoma drainage device (GDD) implantation, but the risk factors for postoperative strabismus remain speculative. The purpose of this study was to investigate possible risk factors for strabismus following GDD implantation for refractory childhood glaucoma. METHODS: The medical records of consecutive patients who underwent GDD implantation for refractory childhood glaucoma at Duke Eye Center from 2005 to 2016 were reviewed retrospectively. Pre- and postoperative motility and alignment, best-corrected visual acuity, and demographic and surgical data were extracted from the record for analysis. RESULTS: A total of 81 patients (mean age, 7.9 ± 4.8 years) met inclusion criteria. The most common glaucoma type was glaucoma following cataract surgery (GFCS), and the most common GDD was a Baerveldt 250 mm2 device. Before GDD surgery, 38 patients (47%) had documented strabismus. After GDD implantation, 25 (31%) had new or worsened strabismus, with vertical (16% of new/worsened), horizontal strabismus (exotropia, 48% of new/worsened; esotropia, 12% of new/worsened) and vertical and horizontal (24% of new/worsened) noted. New motility limitation occurred in 32 of 81 (40%) patients. Risk factors including age, type/location/number of GDD, revision, motility limitation, glaucoma type, asymmetric visual acuity, and visual impairment were not significantly associated with new or worsened post-GDD strabismus. CONCLUSIONS: Children with refractory childhood glaucoma are at high risk for strabismus, which increases after GDD implantation; this study identified no clear risk factors for new or worsened post-GDD strabismus.
Subject(s)
Glaucoma Drainage Implants/adverse effects , Glaucoma/surgery , Intraocular Pressure/physiology , Ophthalmologic Surgical Procedures/adverse effects , Postoperative Complications , Strabismus/etiology , Visual Acuity , Child , Eye Movements/physiology , Female , Follow-Up Studies , Glaucoma/physiopathology , Humans , Male , Retrospective Studies , Risk Factors , Strabismus/physiopathology , Treatment OutcomeABSTRACT
PURPOSE: To evaluate outcomes of strabismus surgery performed subequent to or concomitant with glaucoma drainage device (GDD) implantation for refractory childhood glaucoma. METHODS: The medical records of children who underwent strabismus surgery after or concomitantly with GDD implantation were reviewed retrospectively. Included were surgeries with motility and alignment data measured preoperatively and ≥3 months postoperatively. The following data were collected: demographics, visual acuity, glaucoma diagnosis, GDD type/location, pre- and postoperative sensorimotor/alignment measurements, and surgical details. Motor success was defined as ≤10Δ horizontal and ≤4Δ vertical residual heterotropia postoperatively. RESULTS: A total of 25 children were included: 11 in the post-GDD group and 14 in the concomitant-GDD group. In the former, peri-GDD capsule dissection was required in 9 of 11 patients (82%). All cases had preoperative motility restriction or intraoperative scarring. Mean preoperative deviation (26.7Δ ± 14.6Δ) decreased by 41% postoperatively, with improved alignment in 7 patients (64%). No patients met strict motor alignment criteria for success. In the concomitant-GDD group, mean preoperative deviation (28.5Δ ± 10.0Δ) decreased by 39% postoperatively, with improved alignment in 11 of 14 patients (79%). Four patients (29%) met strict criteria for success. There were no surgical complications in either group. CONCLUSIONS: Strabismus surgery in eyes with existing or planned GDDs for childhood glaucoma usually improves alignment but often does not result in success based on strict motor alignment criteria. Eyes with childhood glaucoma pose surgical technical challenges related to small orbits and exuberant GDD capsule-muscle scarring and postoperative challenges of poor vision and limited binocular function, that likely limit succcess.
Subject(s)
Glaucoma Drainage Implants , Glaucoma/surgery , Ophthalmologic Surgical Procedures/methods , Strabismus/surgery , Child , Chronic Disease , Female , Humans , Male , Oculomotor Muscles/surgery , Prosthesis Implantation/methods , Retrospective Studies , Treatment OutcomeABSTRACT
Congenital alacrima is a form of primary lacrimal deficiency characterized by aplasia or hypoplasia of the lacrimal gland. The puncta and salivary glands may also be aplastic. The case of a 5-year-old girl with congenital alacrima secondary to lacrimal gland agenesis and hypoplasia without punctal or salivary gland involvement and without other systemic comorbidities is reported.
