Homologous scleral graft for corneal perforation in a child.

PURPOSE: To show the emergency use of preserved homologous sclera for the repair of a perforated cornea in a young child. METHODS: Our case was a 3.5-year-old boy who presented with an acute corneal ulcer and endophthalmitis, which was complicated by a developing corneal melting and perforation of 2.5-mm diameter during pars plana vitrectomy. Because no donor cornea was available, a full-thickness preserved donor sclera was used to close the corneal defect. RESULTS: During the next 8 months, scar tissue formed underneath the scleral graft. The graft was removed, revealing mild opacification at the site of corneal perforation. Three years after surgery, best-corrected visual acuity was 20/60. CONCLUSIONS: In the absence of a corneal button for grafting, preserved homologous sclera may be used for closing a corneal defect.

Ocular axial length changes in pseudophakic children after traumatic and congenital cataract surgery.

BACKGROUND: Pseudophakic children tend to develop a large myopic shift. This may be in part due to accelerated growth in axial length. The purpose of this study was to evaluate and compare the postoperative change in axial length (DeltaAL) in pseudophakic eyes, after extraction of traumatic or congenital cataract. METHODS: Included in this retrospective study were 20 children who had undergone surgery for traumatic, unilateral congenital, or bilateral congenital cataracts. All patients were under 10 years old at the time of operation. Axial length was measured perioperatively as well as 1 year or more postoperatively. The three groups were subdivided according to patients' ages (below or above 5 years). The DeltaAL in the operated eyes was compared with DeltaAL of the fellow nonoperated eyes. The difference in DeltaAL between operated and fellow nonoperated eyes was compared among the groups. RESULTS: DeltaAL was greater for operated eyes than for fellow nonoperated eyes (traumatic cataract: p=0.06; unilateral congenital cataract, p=0.055). Axial elongation was significantly greater in children under 5 years old at operation than in those older than 5 (p=0.025). The difference in rate of DeltaAL between operated and fellow nonoperated eyes, per 1 year of follow-up, was similar for traumatic and unilateral congenital cataract groups. CONCLUSIONS: This study demonstrated a tendency toward greater axial lengthening in pseudophakic eyes of children, when compared with their nonoperated eyes. No significant difference was found in the tendency for increased axial lengthening between eyes operated on for traumatic cataracts and those operated on for congenital cataracts.

Multiple branch retinal arteriolar occlusions associated with smallpox vaccination.

We describe a rare combination of multiple multiple branch retinal arteriolar occlusions (BRAO) and encephalopathy, which developed in an adult male 10 days after smallpox vaccination. A 53-year-old physician presented with sudden temporal visual field loss in the left eye. Ten days earlier he had received a smallpox vaccination. Hyperbaric oxygen was administered because of suspected BRAO. Examination on day 3 revealed a decrease in visual acuity and loss of visual field. Fundoscopy of the left eye disclosed a retinal infarct in the inferior macula and multiple cotton wool spots over the entire posterior pole. Fluorescein angiography showed delayed arterial filling and multiple non-perfused areas. Magnetic resonance imaging of the brain disclosed white matter focal lesions. Neurological examination was normal. Audiological examination revealed mild hearing loss caused by an old phonic trauma. A combination of intravenous methylprednisolone and immunoglobulins, recommended for the treatment of Susac syndrome, was administered. At the follow-up visit 3 months later, visual acuity in the left eye improved, fundoscopy showed resolution of the cotton wool spots and temporal disc pallor, and the visual field was substantially restored.

Results of a multicenter clinical trial to evaluate the preferential hyperacuity perimeter for detection of age-related macular degeneration.

PURPOSE: To compare the preferential hyperacuity perimeter (PHP) with an Amsler grid in detection of age-related macular degeneration (AMD). METHODS: Patients underwent refraction, visual acuity examination, PHP, Amsler grid examination, and macular photography. RESULTS: One hundred fifty patients participated in the trial. Of 19 eyes with neovascular AMD, 19 (100%) were positive on the PHP, and 10 (53%), on the Amsler grid. Of 27 eyes with geographic atrophy, 26 (96%) were positive on the PHP, and 12 (44%), on the Amsler grid. Of 20 eyes with intermediate AMD, 14 (70%) were positive on the PHP, and 4 (20%), on the Amsler grid. Of 51 eyes with early AMD, 21 (41%) were positive on the PHP, and 4 (8%), on the Amsler grid. Of 33 eyes with no AMD, 6 (18%) were positive on the PHP, and none, on the Amsler grid. Thus, 80 (68%) of 117 patients with AMD had a positive PHP, while 30 (26%) had positive results of Amsler grid examination (P < 0.001, McNemar test). CONCLUSION: The PHP had greater sensitivity, although with a relatively high rate of false-positive results for healthy individuals, than the Amsler grid in detecting AMD-related lesions.