Adrenal Suppression in Infants Treated with Topical Ocular Glucocorticoids.

PURPOSE: To analyze the incidence of adrenal suppression and the glucocorticoid (GC) dose per kilogram body weight given in infants treated with standard protocol for topical ophthalmic GCs after congenital cataract surgery. DESIGN: Retrospective, consecutive case series. PARTICIPANTS: All children younger than 2 years of age who underwent operation for congenital cataract between January 2011 and May 2015 in 1 center. METHODS: Patient charts were reviewed to collect data on results and timing of a standard corticotropin (adrenocorticotropic hormone [ACTH]) stimulation test and GC dose per kilogram body weight. MAIN OUTCOME MEASURES: Incidence of adrenal suppression in children tested on GC treatment. Glucocorticoid dose per kilogram body weight. RESULTS: Among 26 consecutive infants, 15 (58%) were tested while they were still on GC treatment. Ten of these 15 infants (67%) had adrenal suppression, 2 of whom had obvious clinical signs of Cushing's syndrome and 1 of whom had signs of Addisonian crises during general anesthesia. Eleven of the 26 infants (42%) were tested at a median time of 21 days (range, 6-89) after treatment cessation, and they all had normal test results. Children with suppressed adrenal function had received cumulative GC doses per body weight that were significantly higher the last 5 days before testing compared with children with normal test results. Infants with adrenal suppression were treated with hydrocortisone replacement therapy. Adrenal function recovered after a median of 3.1 months (range, 2.3 months to 2.3 years). CONCLUSIONS: Two thirds of the infants tested during treatment with a standard GC protocol after congenital cataract surgery showed adrenal suppression. There was a significant association between the cumulative daily dose of GCs and the test result. Because adrenal suppression is a serious but treatable condition, we recommend a systematic assessment of adrenal function in infants treated with doses of topical ocular GCs comparable to our regimen and careful evaluations of other treatment regimens.

[Ammonia burns of the eyes are easily overlooked]. / Salmiakspiritusætsning i øjnene er let at overse.

In recent years, an increasing number of eye injuries caused by ammonia burns have been observed at two Danish major hospitals. In other countries the number of assaults using chemicals as weapons seems to be growing, but to our knowledge, this is not described in Scandinavia. Immediate irrigation is the most important therapy in order to reduce damages after ammonia burns.

Longterm incidence of rhegmatogenous retinal detachment and survival in a defined population undergoing standardized phacoemulsification surgery.

PURPOSE: To determine the longterm risk of pseudophakic retinal detachment (PRD) in a defined population undergoing standardized phacoemulsification surgery at a single centre. DESIGN: We carried out a register-based, retrospective, consecutive, uncontrolled study. All 6352 eyes that underwent cataract surgery at our institution during the years 1996-1998 were included in the study. The main outcome measure was the incidence of surgery for PRD. METHODS: Cataract-operated eyes were identified by a search in the local hospital registry. Eyes that subsequently underwent surgery for PRD were identified by a search in the Danish Patients Registry (LPR). Follow-up ended by 31 December 2003. Eyes in patients who died before that date were censored. RESULTS: The 8-year cumulated incidence of PRD after phacoemulsification was 0.93 per eye (95% CI 0.65-1.33). This is 8.77 (95% CI 7.12-10.72) times higher than expected in eyes that do not undergo cataract surgery. The incidence rate for retinal detachment was significantly higher in pseudophakic eyes than in the background population for at least 6 years after surgery. Patient mortality was slightly increased for men, but no different for women from that of the background population. CONCLUSION: For eyes undergoing phacoemulsification surgery, the cumulated incidence of PRD continues to increase for at least 8 years after surgery. Comparison of the cumulated incidence of PRD between different studies requires equal lengths of follow-up.

Retinal detachment after phacoemulsification cataract extraction.

PURPOSE: To estimate the incidence of retinal detachment (RD) after phacoemulsification cataract extraction in an unselected group of patients. SETTING: Herlev University Hospital, Copenhagen, Denmark. METHODS: This retrospective review comprised 6521 cataract patients who had phacoemulsification over a 3-year period. The incidence of postoperative RD and the risk factors were assessed. RESULTS: During the 15- to 52-month observation period, 22 cases of RD in 21 patients were observed, with an estimated risk (Kaplan-Meier) of 0.41% (95% confidence limit, 0.25%-0.57%) at 52 months. The results confirmed recognized preoperative risk factors for RD such as an axial length greater than 25.0 mm (P<.001), age younger than 65 years (P<.001), and male sex (P<.02). In 18 eyes, the retina was reattached after 1 operation. CONCLUSIONS: The incidence of RD after phacoemulsification cataract extraction in an unselected group of patients was low. A long axial length, young age, and male sex were confirmed as risk factors.