Cumulative incidence of converting from clinically unilateral to bilateral exfoliation syndrome

PURPOSE: To obtain long-term cumulative incidence estimates of time to conversion of clinically unilateral to bilateral exfoliation syndrome (ES). METHODS: A retrospective, longitudinal cohort study of 35 patients with clinically unilateral ES from the private office of one author. Diagnosis of ES was made between 1968 and 1998. On return visits a careful search for ES in the nonexfoliative fellow eye was made by the same author in a semidark room using a slit lamp and maximal pupillary dilatation. Cumulative incidence of converting to bilateral ES was calculated, taking death into account as a competing risk. RESULTS: Cumulative incidence of conversion to bilateral ES was 0.11 (95% CI, 0.03-0.25) at 5 years, 0.36 (95% CI, 0.15-0.57) at 10 years, and 0.52 (95% CI, 0.27-0.93) at 15 years when the day of examination was taken to be the day of conversion, and 0.14 (95% CI, 0.04-0.29) at 5 years and 0.52 (95% CI, 0.26-0.73) at 10 years when analysis was based on conversion taking place at the midpoint between the last two visits. The median age at conversion was 72 years (range, 66-86), and the median age of patients remaining clinically unilateral was 77 years (range, 57-90). Factors associated with time to conversion depended on the strategy of the analysis and included higher age at first visit and larger IOP difference between the involved and uninvolved eye. CONCLUSION: A large proportion of patients with clinically unilateral ES will not convert to bilateral involvement in long-term follow-up. Immunohistochemical studies suggest that local factors must either expedite ES or slow it down in one eye to explain the frequently longstanding asymmetric involvement, and a difference in initial aqueous outflow facility might be examined as one candidate.     

Immobilization of the eye. Evaluation of a new method in retinal detachment surgery

Experiments on eye phantoms (closed chambers filled with suspensions of lipoid particles in water) have shown that saccadic rotational movements induce liquid currents flowing back and forth through a hole in a latex membrane mounted inside the chamber. It is postulated that rapid (saccadic) eye movements generate similar motions in the liquid vitreous, capable of moving a detached retina. Sixty-five non-selected eyes with primary rhegmatogenous retinal detachment were immobilized by traction sutures, usually for 2-3 days (range 1-5 days) prior to surgery. An almost complete "spontaneous" reattachment occurred in 45% of the cases, a partial reattachment (i.e. more than half of the detached area) was seen in 37%, but no reattachment took place in 18%. This rate of reattachment is higher than that obtained by bilateral eye patching and complete bed rest. Rapid (saccadic) eye movements are considered to be one crucial factor counteracting retinal reattachment. Eyes, in which preoperative reattachment is achieved, can be cured by simple surgical procedures and have a favourable prognosis.     

Sixth Nerve Palsy in Paediatric Intracranial Hypertension

The purpose of this study was to report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in paediatric patients with intracranial hypertension (IH). A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic intracranial hypertension (IIH), whereas IH with identifiable pathologic aetiology was deemed secondary intracranial hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, aetiology of SIH, ophthalmic examination, lumbar puncture results, neuroimaging results, and response to treatment. Seventy-eight children with intracranial hypertension were included in the study. Nine (11.5%) children (four males, five females; median age 14, range: 3–18) were found to have a unilateral (n = 2) or bilateral (n = 7) CN VI palsy. Five children had IIH; the remaining four had SIH from cerebral venous sinus thrombosis (n = 2) and infection (n = 2). The mean lumbar puncture opening pressure for the nine patients with CN VI palsy was 40 cm H₂O (range: 21–65 cm H₂O). Papilloedema was present in 8/9 (89%) patients. One patient required a lumboperitoneal shunt, and two others required optic nerve sheath fenestrations in addition to medical management. All cases of CN VI palsy resolved with treatment. In our primary service area, the incidence of CN VI palsy is approximately 12% among paediatric IH patients. The majority of cases with CN VI palsy presented with papilloedema and all cases resolved with treatment of intracranial hypertension.     

Acquired oculomotor paralysis: a new therapeutic approach. Apropos of 10 cases

PURPOSE: The aim of this work is to report our rehabilitation scheme and outcome in patients with acquired oculomotor palsy. PATIENTS AND METHODS: We cared for 10 patients with oculomotor palsy between January 1996 and March 1998 at the Casablanca University Hospital. Our orthoptic rehabilitation scheme was based on reinforcing the patient's sensorial potential using a prism dioper and motor capacities by soliciting vergency and version movements. RESULTS: The 10 patients (7 males, 3 females, mean age 39.5 years) had unilateral IV palsy (n =3), bilateral IV palsy (n= 1), unilateral VI palsy (n= 2), bilateral VI palsy (n= 1), partial unilateral III palsy (n= 1) and dissociated bilateral III palsy (n= 2). Mean delay to initiation of rehabilitation was 49 days and mean duration for treatment was 3 months. We achieved total recovery in 50% of the cases and partial recovery in 40%. Intermittent diplopia persisted in 10 per thousand of the cases. These results differ slightly from those in the literature where total regression is reported in about 50% of the patients after therapeutic abstention. CONCLUSION: This small series is insufficient to validate our method. The results obtained do however show that rehabilitation is safe and should be applied more widely in patients with oculomotor palsy.     

Visual results in children treated for macular retinoblastoma

PURPOSE: To evaluate the results of patching treatment in children with macular retinoblastoma in one eye. METHODS: Fifteen children affected by macular retinoblastoma received instructions for patching treatment for amblyopia. Data were collected on age at diagnosis of the tumor, presence of unilateral or bilateral disease, area of posterior pole involvement by the scar of the regressed tumor and its relationship to the fovea; and the onset, duration, and compliance of patching. The visual acuities recorded were expressed in logMAR (logarithm minimum angle of resolution) equivalents. RESULTS: Twelve children (80%) had bilateral retinoblastoma with the macular involved in one eye and three children had unilateral macular tumors. The median age at which patching was initiated was 15 months (range 4-36). Compliance to patching was good in 80% of children, with a median duration of 4 h (range 0.5-8) per day, 7 days per week, with total occlusion of the better eye. The median percentage of posterior pole involvement was 34% (range 11-100%). Eighty percent of children had some improvement in their visual acuity, and of the children in whom final logMAR acuity was recorded, 73% had an acuity of 1.0 logMAR or better and 53% an acuity of 0.5 logMAR or better after patching. There was no evidence of association between age of patient, sex, duration of patching, or percentage of posterior pole involvement and the improvement in visual acuity. CONCLUSIONS: In spite of the macular involvement of eyes with retinoblastoma, some visual recovery was achieved in 80% of children. Hence a trial of patching therapy is recommended for all children with involvement of the macula by retinoblastoma.     

Accommodative esotropia following surgical treatment of infantile esotropia: frequency and risk factors

Purpose: We aimed to examine the frequency of and risk factors for the development of accommodative esotropia following surgical treatment for infantile esotropia. Methods: A total of 29 children were recruited. Potential risk factors for the development of accommodative esotropia included: sex; angle of deviation at initial and final visits; cycloplegic refractive error at initial and final visits; increase in hyperopia; amblyopia; amblyopia treatment; age at surgical treatment; pre‐ and postoperative latent nystagmus; dissociated vertical deviation or inferior oblique muscle overaction; additional surgical procedures; unstable alignment, and binocular sensory status. Results: Overall, 14 (48.2%) of 29 children developed accommodative esotropia during the 36‐ to 132‐month postoperative follow‐up period. Twelve (85.7%) of the 14 patients developed refractive accommodative esotropia and two developed non‐refractive accommodative esotropia. The onset of accommodative esotropia occurred at a mean of 8.8 months (range 6–24 months) after the initial surgical alignment. This corresponded to a mean age of onset for accommodative esotropia of 43.2 months. We determined that, among children with infantile esotropia, those who had hyperopia of ≥ 3.0 D and increasing hyperopia after surgery and those who did not develop dissociated vertical deviation during the follow‐up period were more likely to develop accommodative esotropia. Conclusions: Children who have the established risk factors should be followed closely for the development of accommodative esotropia. The treatment of these children with appropriate glasses may prevent the development of adverse effects of accommodative esotropia on sensory and motor functions.     

Danish Rural Eye Study: Epidemiology of Adult Visual Impairment

Purpose: To examine the frequency and causes of visual impairment (VI) in a select population of Danish adults.

Methods: A total of 3843 adults aged 20–94 years from the Danish General Suburban Population Study (GESUS) were included in the population-based, cross-sectional ophthalmological study, Danish Rural Eye Study (DRES). All DRES participants received a comprehensive general health examination preceding their eye examination, including measurement of best-corrected visual acuity (BCVA) for each eye, bilateral 45° retinal fundus photographs and further ophthalmological examination where indicated.

Results: Overall, 3826 of 3843 participants (99.6%) had bilateral visual acuity measurements. The overall frequency of VI (BCVA <20/40 in the better-seeing eye) was 0.4% (95% confidence interval, CI, 0.2–0.7%; n = 15) among all DRES participants, 0.6% (95% CI 0.3–1.0%; n = 15) among participants >50 years and 3.7% (95% CI 2.1–6.5%; n = 11) in participants >80 years. The primary causes of VI in the better-seeing eye were age-related macular degeneration (AMD) in 46.7% (7/15) and cataract in 26.7% (4/15). A total of 43.3% (n = 115) of participants >80 years were pseudophakic in one or both eyes. The frequency of diabetes (HbA_1c ≥48 mmol/mol or self-reported diagnosis) was 5.9% (n = 227), including 1.3% (n = 51) newly diagnosed in the GESUS. Of participants determined to have VI due to exudative AMD, 50% had received anti-vascular endothelial growth factor (VEGF) treatment.

Conclusion: We report a relatively low frequency of VI among Danish adults over 59 years of age compared with that observed 10–15 years ago, which is both consistent with other recent Scandinavian studies and reflective of our relatively healthy and mobile population sample.     

Cataract surgery in the first year of life: aphakic glaucoma and visual outcomes

Objective: To report the incidence of aphakic glaucoma following lensectomy in infants in their first year of life and examine the impact of this diagnosis on visual outcome.Design: Retrospective cohort study.Participants: All patients who had lensectomy for congenital cataract during the first year of life at British Columbia Children’s Hospital between 1995 and 2006. Methods: Retrospective review of medical records.Results: Seventy-five eyes of 46 patients (29 bilateral, 17 unilateral) were included. The mean age at lensectomy was 93 days (range, 2–364 days) with a mean follow-up of 77.5 months (range, 36–166 months). Patients with bilateral cataracts had a better visual outcome than those with unilateral cataracts (p = 0.032). Of the patients with measurable visual acuity (VA), 34 of 45 eyes (75.6%) with bilateral cataracts and only 3 of 16 eyes (18.8%) with unilateral cataract achieved a VA of 20/40 or better. Eighteen of 75 eyes (24%) developed aphakic glaucoma at a mean of 30 months following lensectomy. Nine patients (50%) achieved final vision of 20/40 or better. The development of aphakic glaucoma was not associated with worse visual outcomes (p = 0.315). The mean intraocular pressure (IOP) at diagnosis was 28.6 ± 5.9 mm Hg and mean final IOP was 14.1 ± 3.0 mm Hg, a significant reduction (p > 0.0001). Fifteen of 18 eyes with aphakic glaucoma (83.3%) required surgical intervention to achieve IOP control.Conclusions: Children with aphakic glaucoma may have good visual outcomes if it is recognized early and managed appropriately. A significant proportion of patients required surgical intervention to control IOP.     

Visual impairment and associated risk factors in patients with diabetes mellitus in Tavush and Armavir provinces of Armenia

International Ophthalmology - Visual impairment (VI) and blindness remain serious public health problems among patients with diabetes. This study assessed the prevalence of VI and its associated...