Long-term refractive changes in children following ptosis surgery: a case series and a review of the literature.

The purpose of the study was to evaluate the long-term changes in refractive error in children with congenital ptosis managed with unilateral levator resection, and to provide a brief literature review and discuss the possible mechanisms for refractive change in the post-operative period. We present a retrospective consecutive case series of children (4-11 years old) who underwent unilateral levator resection, performed by a single ophthalmic surgeon to manage congenital ptosis between 1998 and 2001 at Maidstone Hospital, Kent. Cycloplegic refraction data were obtained prior to surgery and at the last clinic visit post surgery (minimum follow-up 12 months). The refractive changes in the non-operated contralateral eye were used as age-matched controls. Data were analysed for changes in refractive sphere and cylinder. Forty-three patients underwent levator resection during this 3-year period. Complete refraction data were available for 13 patients. The mean age at the time of levator resection was 6.7 years. The refractive error was greater on the side with the ptosis (61 %). At the last clinical follow up (mean 36.3 months; SD 34 months), the mean spherical change in the operated eye was 0.41D (range 0.12-1.50D), compared to a mean change of 0.40D (range 0.25-2.00D) in the non-operated eye. The mean cylindrical change in the operated eyes was 0.38D (range 0.25-1.00D), compared to a mean of 0.21D (range 0.50-1.75D) in the non-operated eye. In conclusion, this study did not show a significant change in refractive error following levator resection surgery for congenital ptosis.

Black-on-clear piggyback technique for a black occlusive intraocular device in intractable diplopia.

Black occlusive intraocular devices have been used successfully for intractable binocular diplopia. We describe a novel technique of implanting both a black occlusive device and a clear poly(methyl methacrylate) intraocular lens (IOL) in the capsular bag during phacoemulsification surgery. If the need should arise at a later date, this approach will allow safer and easier explantation of the black occlusive device, avoiding the need for IOL exchange.