The autogenous dermis-fat orbital implant in children.

PURPOSE: The autogenous dermis-fat graft orbital implant is one alternative for volume augmentation in the adult anophthalmic socket. We have reviewed our experience with dermis-fat grafts after primary enucleation in the pediatric population. METHODS: We reviewed the clinic charts of all patients under 8 years of age who underwent primary enucleation combined with dermis-fat graft implantation. We assessed subsequent orbital growth by measuring lid and fissure symmetry, superficial soft tissue socket volume, prosthetic fit, and periorbital symmetry. All measurements were obtained by 2 of the authors. RESULTS: Eight children had primary enucleations combined with a dermis-fat implant (Table 1). Age at the time of surgery ranged from 1 week to 8 years. Indications for enucleation were retinoblastoma (4), malignant teratoid medulloepithelioma (1), blind, painful eye secondary to trauma (2), or phthisis secondary to end-stage retinopathy of prematurity (1). Two patients were lost to follow up at 3 months and 6 months post enucleation. The remaining 6 patients had between 1 year and 6 years of follow up. All implants maintained appropriate volume allowing proper prosthetic fit and facial symmetry. Two children experienced excessive growth of their implants, managed by surgical debulking. Two children developed a central graft ulcer, managed by superficial revision and reclosure. CONCLUSIONS: We have observed that dermis-fat grafts in pediatric primary enucleations demonstrate good maintenance of orbital soft tissue volume and periorbital symmetry. The complications of excessive dermis-fat growth or central ulceration were easily corrected. We feel this is a promising implant for the pediatric anophthalmic socket.

Magnetic resonance imaging in ophthalmoplegic migraine of children.

PURPOSE: To present 2 children with ophthalmoplegic migraine and characteristic magnetic resonance imaging (MRI) findings post enhancement with gadopentetate dimeglumine diethylenetriamine pentaacetic acid (Gd-DTPA). METHODS: Two patients, ages 3 years and 7 years, underwent MRI during the acute phases of a recurring oculomotor palsy. MRI was repeated several weeks later as symptoms resolved. RESULTS: In both cases, enhancement and thickening of the cisternal segment of the oculomotor nerve were present at initial presentation. Ophthalmoplegia resolved spontaneously in 1 child and after steroid treatment in the other. Both postresolution MRIs demonstrated decrease in enhancement and thickening of the third nerve. CONCLUSIONS: The enhancing, thickened lesion identified on MRI in our patients may represent an inflammatory process similar to Tolosa-Hunt syndrome occurring in the interpeduncular segment of the oculomotor nerve. Patients with ophthalmoplegic migraine may, therefore, benefit from the use of steroids. MRI of the brain post enhancement is a useful adjunct in the diagnosis and treatment of ophthalmoplegic migraine and should be considered as part of a workup of ophthalmoplegic migraine in children.

A comparison of prophylactic ondansetron hydrochloride and droperidol for strabismus repair in adults.

BACKGROUND: Prophylactic administration of an antiemetic is a common procedure for patients undergoing strabismus surgery. Droperidol and ondansetron hydrochloride are commonly used antiemetics. This study compared the rates of postoperative nausea and vomiting (PONV) in adult patients undergoing strabismus surgery with prophylactically administered Droperidol or ondansetron hydrochloride. METHODS: A double-masked, randomized, prospective study was conducted comparing droperidol with ondansetron hydrochloride when administered prophylactically to adults undergoing strabismus surgery. RESULTS: Forty-five patients entered the study with a mean age of 30 years. Twenty percent of patients had nausea immediately postoperatively and 37% had nausea before discharge with no significant differences between groups. Overall rate of emesis, time in the recovery room, and time to discharge was not significantly different between the droperidol and ondansetron hydrochloride group. CONCLUSION: No real differences in the ability to prevent PONV between the two medications were found in this study.

Posterior chamber intraocular lens use in children.

PURPOSE: The authors report on the efficacy of intraocular lens implantation during pediatric cataract surgery and the results of a consecutive series of intraocular lens implantation in children. METHODS: Twenty-one children underwent implantation of intraocular lenses in 23 eyes. Twenty-one surgeries were primary implantation immediately following anterior lensectomy. Two surgeries were secondary implantations. Primary posterior capsulectomy was performed in 18 of 21 primary implantations. All but two eyes underwent a primary anterior vitrectomy. Topical prednisolone acetate was administered in all cases. Oral prednisone was administered in 17 of 23 cases. Pre- and postoperative visual acuity, cycloplegic refraction, and postoperative complications related to inflammation such as intraocular lens (IOL) capture, IOL decentration, and posterior capsule opacification were examined. RESULTS: Eighteen of 23 eyes have achieved a visual acuity of 20/40 or better. None of the cases in which oral prednisone was used developed complications related to postoperative inflammation. One of the six cases (17%) in which oral prednisone was not used developed such complications. CONCLUSION: Intracular lens implantation accompanied by primary posterior capsulectomy, anterior vitrectomy, and management of postoperative inflammation appears to provide appropriate and safe optical rehabilitation in children.

Migraine in a pediatric ophthalmology practice.

PURPOSE: A prospective study of children between the ages of 2 and 15 years was conducted to investigate the prevalence and characteristics of migraine in children seeking ophthalmic care. METHODS: A questionnaire, based on established criteria for the diagnosis of migraine, was administered to 1479 consecutive children presenting to a single pediatric ophthalmologist (H.P.K.). Over 25% of all respondents reported headaches that met the criteria for migraine. In general, these individuals were older than non-migraine sufferers (mean age of 8.3 years vs. 6.6 years). There were no significant sex differences. RESULTS: Headache was the chief complaint for 8.9% of all patients seeking ophthalmic care in this study population. Eighty percent of this subpopulation described headaches that met the diagnostic criteria for migraine. This study found childhood migraine symptoms to be present in a significant proportion of the patient population of a pediatric ophthalmologist. CONCLUSION: Ophthalmologists must be aware of the high prevalence of migraine in children seeking ophthalmic care with a chief complaint of headache. Such knowledge will aid the ophthalmologist in the timely diagnosis, treatment, and appropriate referral of patients with symptoms of migraine.

Ophthalmia neonatorum.

Ophthalmia neonatorum is the most common infection in the first month of life and can have serious systemic as well as ophthalmic morbidity. This article discusses the differential diagnosis and treatment of conjunctivitis in the neonate. Controversies in method of prophylaxis are reviewed.

Isolated anterior uveitis in a child with acquired immunodeficiency syndrome.

A ten-year-old boy with a four-year history of symptomatic human immunodeficiency virus infection had granulomatous iridocyclitis that subsequently resolved with topical corticosteroid and cycloplegic therapy. This is the first report, to our knowledge, of isolated anterior uveitis in a child with acquired immunodeficiency syndrome.

Surgical correction of excess esotropia at near.

A retrospective study of the surgical treatment of patients with excess esotropia at near was conducted. Thirty-one patients conformed to the following criteria: equal vision in each eye, esotropia at near exceeding distant deviation by 15 or more prism diopters, and no prior surgery. Hyperopes greater than or equal to +1.50 spherical equivalent were measured in their full spectacle correction. All patients had an otherwise normal ocular examination and no overt neurological disease. At distance fixation, approximately half of the population had an esotropia greater than 10 delta and the remainder were orthophoric. All demonstrated a near deviation measuring at least 25 delta. Patient age at time of surgery ranged from 18 months to 36 years. All but two patients underwent bilateral medial rectus recessions of 4.5 mm to 7 mm, based on the near deviation. The remaining two patients underwent right medial rectus recessions of 6 mm each. Minimum postoperative follow-up was 4 months. The majority of patients were able to achieve satisfactory alignment. Many could maintain this alignment without spectacles. Two patients developed consecutive exotropia. One of these patients required bilateral lateral rectus recessions to achieve alignment.

Retinal toxicity of intravitreal cefoperazone.

Cefoperazone is a broad spectrum, third-generation cephalosporin with potential usefulness in treating endophthalmitis because of its in vitro activity against Gram-negative organisms. Retinal toxicity was evaluated via serial indirect ophthalmoscopy, electrophysiologic testing and histopathologic examination of 43 Dutch-belted rabbit eyes injected intravitreally with 2, 4, 8, 16 or 32 mg of cefoperazone in a volume of 0.1 cc each. They were compared with seven eyes injected with sterile saline. Results show electroretinographic and histological evidence of retinal toxicity at concentrations of 16 mg or greater, while a single intravitreal dose of 8 mg or less of cefoperazone produced no evidence of retinal toxicity.