Retinal examinations in infants after extracorporeal membrane oxygenation.

BACKGROUND: Ophthalmic examinations performed in infants undergoing extracorporeal membrane oxygenation (ECMO) are recommended because ocular abnormalities have been known to occur after this procedure. METHODS: We reviewed medical records of infants treated with ECMO was subsequently underwent routine ophthalmic examination prior to or immediately after hospital discharge. Examinations were performed in a fashion similar to that for retinopathy of prematurity screening. RESULTS: Eye examinations were recorded for 171 patients (342 eyes). Fundus examination was normal in 302 eyes (88%). Abnormal retinovascular findings such as venous dilation or intraretinal hemorrhages, when present, were not considered vision threatening and required no treatment. CONCLUSION: Clinically important retinal findings were not identified in our patients undergoing postECMO screening. Routine dilated fundus examination is probably not cost effective and places additional and potentially unnecessary stress on these infants.

Combined bilateral superior rectus muscle recession and inferior oblique muscle weakening for dissociated vertical deviation.

PURPOSE: Dissociated vertical deviation (DVD) is a common disorder that is often difficult to treat satisfactorily with extraocular muscle surgery. Weakening both elevators in a single eye is uncommonly performed because of possible severe upgaze deficiency or chin-up head posture postoperatively. METHODS: A retrospective review of medical records was performed that yielded 14 patients who had undergone bilateral superior rectus muscle recessions (mean 8.1 mm, range 5-10 mm) and bilateral inferior oblique muscle recession, myectomy, or anterior transposition in the treatment of DVD. Three additional patients with asymmetric inferior oblique muscle overaction or true hypertropia in primary gaze position were identified who had bilateral superior rectus muscle recessions combined with unilateral inferior oblique muscle weakening. RESULTS: Mild-to-moderate elevation deficiencies were common postoperatively but never exceeded -2 up-gaze limitation (scale 0 to -4) except in the immediate postoperative period and were not associated with persistent chin-up head posturing. Cosmetically objectionable upper eyelid retraction occurred in one patient after re-recession of a superior rectus muscle but before inferior oblique muscle surgery. Only three patients undergoing four vertical muscle surgeries had residual DVD >10 PD in primary gaze position, and none exhibited manifest dissociated strabismus warranting further treatment. CONCLUSION: Bilateral superior rectus muscle recession of up to 10 mm combined with inferior oblique muscle weakening appears to be a safe surgical approach in the management of patients with large angle or recurrent DVD. Our data further suggest that simultaneous four vertical muscle surgery may be preferred in some patients to weakening the superior rectus or inferior oblique muscles alone.