低龄儿童不同类型斜视手术远期疗效

目的 分析早期手术治疗儿童斜视的远期疗效,探讨低龄儿童不同类型斜视的手术时机和设计.方法 手术治疗397例3岁以下斜视患儿,手术后随访6～144个月,观察术后眼位、双眼单视功能及二次手术情况.结果 (1)外斜视组、垂直分离性斜视(DVD)组远期正位率分别为78.1%、68.4%,低于术后正位率,P＜0.05;内斜视组、上斜肌麻痹(SOP)、A-V综合征及特殊类型斜视远期正位率与术后正位率无差异,P＞0.05.(2)各组远期立体视＜800"的比率均高于术前,P＜0.05.(3)发病年龄早、伴有垂直斜视及术后一周欠矫或过矫是影响内、外斜视术后远期效果的主要因素,P＜0.05;手术年龄在24个月内与25～36个月远期眼位无差别,P＞0.05.结论 (1)内斜视,SOP及A-V综合征,3岁前手术远期眼位较满意并有利于立体视功能.(2)内、外斜视近期应适度欠矫和过矫,以+10△之内为宜.垂直斜视诊断明确者尽量一次手术,特殊类型斜视宜选分次手术.

Abstract：

Objective To analyze the long-term outcome of early surgical treatment,to review the operation design and timing of different types of strabismus in young children.Methods A total of 397 strabismus cases received operation under 3 years old,postoperative follow-up 6 to144 months,position of eye,binocular vision and second operation were reviewed.Results (1)The long term orthophoria rate ofexotropia and DVD was 78.1%,68.4%,lower than postoperative,P ＜0.05; The orthophoria rate of esotropia,SOP,A-V syndrome and special strabismus had no significant difference at long-term follow-up,P ＞0.05.(2)The ratio of ＜800 " of binocular vision of different group were higher than the preoperative at long-term follow-up,P ＜0.05.(3)The occurrence age early,accompanied by vertical strabismus and postoperative position of eye more or less proper was primary factor for position of eye at long-term follow-up,P ＜0.05.Conclusions (1)For esotropia,SOP and A-V syndrome,operation under 3 years old contribute to orthophoria and binocular vision at long-term follow-up.(2)The operation design of esotropia and exotropia should be moderate more or less proper +10 △.The vertical strabismus should design for once as possible,specific strabismus choose divide into two period operations.     

Treatment of bilateral refractive amblyopia in children three to less than 10 years of age

PURPOSE: To determine the amount and time course of binocular visual acuity improvement during treatment of bilateral refractive amblyopia in children three to less than 10 years of age. DESIGN: Prospective, multicenter, noncomparative intervention. METHODS: One hundred and thirteen children (mean age, 5.1 years) with previously untreated bilateral refractive amblyopia were enrolled at 27 community- and university-based sites and were provided with optimal spectacle correction. Bilateral refractive amblyopia was defined as 20/40 to 20/400 best-corrected binocular visual acuity in the presence of 4.00 diopters (D) or more of hypermetropia by spherical equivalent, 2.00 D or more of astigmatism, or both in each eye. Best-corrected binocular and monocular visual acuities were measured at baseline and at five, 13, 26, and 52 weeks. The primary study outcome was binocular acuity at one year. RESULTS: Mean binocular visual acuity improved from 0.50 logarithm of the minimum angle of resolution (logMAR) units (20/63) at baseline to 0.11 logMAR units (20/25) at one year (mean improvement, 3.9 lines; 95% confidence interval [CI], 3.5 to 4.2). Mean improvement at one year for the 84 children with baseline binocular acuity of 20/40 to 20/80 was 3.4 lines (95% CI, 3.2 to 3.7) and for the 16 children with baseline binocular acuity of 20/100 to 20/320 was 6.3 lines (95% CI, 5.1 to 7.5). The cumulative probability of binocular visual acuity of 20/25 or better was 21% at five weeks, 46% at 13 weeks, 59% at 26 weeks, and 74% at 52 weeks. CONCLUSIONS: Treatment of bilateral refractive amblyopia with spectacle correction improves binocular visual acuity in children three to less than 10 years of age, with most improving to 20/25 or better within one year.     

Corneal laceration by sharp objects in children seven years of age and younger

PURPOSE: Young children are prone to develop amblyopia after penetrating injury. We sought to evaluate the management of penetrating corneal injury without intraocular foreign body (IOFB) in children 18 months. Data retrieved included all details from the initial examination, surgical procedures, amblyopia prevention measures, and final visual acuity. RESULTS: Twenty children eligible for the study were identified. The mean age was 4.3 years, and mean follow-up time was 58 months. The corneal wound size range was 1-10 mm, with 8 eyes having wounds >or=6 mm. All patients required primary surgical management. Traumatic cataract extraction was performed at the primary operation in 6 eyes, with intraocular lens (IOL) implantation in 4 eyes. Additional surgical procedures were performed in 12 eyes. Yttrium-Aluminum-Garnet (YAG) capsulotomy was performed in 3 eyes with secondary cataract. Twelve patients required spectacle or contact lens correction, and 11 patients had patching for amblyopia prevention. At the end of follow-up, visual acuity was 20/40 or better in 14 eyes, 20/50 to 20/100 in 4 eyes, no light perception (NLP) in 1 eye, and unknown in 1 eye. CONCLUSIONS: Proper management of penetrating corneal injury in young children can result in excellent visual rehabilitation. Major measures include prompt traumatic cataract extraction with either primary or secondary IOL implantation, opening of posterior capsular opacification with YAG laser, correction of refractive errors, and patching for amblyopia prevention.     

Compliance and results of treatment for amblyopia in children more than 8 years old

Our prospective study of 350 amblyopic children divided them into three age groups: 2 to 5 1/2 years, 5 1/2 to 8 years, and 8 years and older. Treatment consisted of occlusion of the good eye. Compliance with treatment was analyzed by age group for the whole study population, but visual acuity results were evaluated only in children who complied fully with treatment and who cooperated at the initial visual acuity test with a Snellen chart. Younger children were significantly more compliant than older ones. This was probably the primary reason for the high incidence of treatment failure in older children. Children older than 8 years who complied with treatment showed a marked improvement in visual acuity--one almost as good as that in the younger children. A better initial visual acuity can be taken as a good prognostic sign, especially for this age group. In each group, most of the improvement occurred during the first three months of treatment. Improvement after this period was marginal.     

Part-time occlusion therapy for anisometropic amblyopia detected in children eight years of age and older

PURPOSE: To determine the outcome of part-time occlusion therapy in children with anisometropic amblyopia detected after they were 8 years of age. METHODS: We analyzed 29 eyes with anisometropic amblyopia in children 8 years of age and older. The mean age was 8.79 +/- 0.98 (range 8-12) years old. The subjects whose best-corrected visual acuity (BCVA) did not improve by two lines or better within 2 weeks of wearing glasses full-time were prescribed occlusion therapy for 6 hours a day outside of school hours, along with the instruction to wear glasses full-time. Subjects who complied with occlusion for more than 3 hours a day were considered to comply well. RESULTS: The major component of the anisometropia was hyperopia in 51.7% of the subjects, and hyperopia plus astigmatism was found in 24.1%. The mean pretreatment BCVA score was 0.51 0.23 (LogMAR). Compliance was 89.66%. The mean posttreatment BCVA was 0.03 +/- 0.01 (LogMAR), and the success rate, based on a posttreatment BCVA of 0.1 (LogMAR) and better, was 96.43%. It took an average of 4.79 +/- 3.35 months to reach the desired posttreatment BCVA. The mean posttreatment stereopsis was 79.78 +/- 37.61 seconds of arc. The recurrence rate was 8%. The visual improvement was related to the degree of compliance (p = 0.000). The time taken to reach the posttreatment BCVA was shorter in subjects with a better pretreatment BCVA (p = 0.019), but it did not relate to the compliance (p = 0.366). CONCLUSIONS: The most common component of anisometropia detected after 8 years of age was hyperopia. The part-time occlusion therapy, which had been carried out after school hours, was successful in most cases.     

Prospective evaluation of phacoemulsification in adults younger than 50 years

PURPOSE: To evaluate intraoperative performance and long-term outcome of phacoemulsification in patients younger than 50 years. SETTING: Iladevi cataract and IOL Research Centre, Ahmedabad, India. METHODS: A prospective observational study was conducted comprising 54 patients (35 men and 19 women) under age 50 who had phacoemulsification. Preoperative evaluation included specular microscopy. Phacoemulsification with implantation of an AcrySof MA30BA intraocular lens (IOL) was performed. Intraoperatively, peripheral extension of capsulorhexis, intraoperative posterior capsule opacification (PCO; plaque), and serious complications (eg, posterior capsule rupture, vitreous loss) were noted. Postoperatively, endothelial cell loss, postoperative PCO, neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, and best corrected visual acuity (BCVA) were assessed for 3 years. Patients with intraoperative PCO were analyzed separately. RESULTS: Mean patient age was 42.7 years +/- 5.2 SD (men) and 43.1 +/- 3.25 years (women). Continuous curvilinear capsulorhexis was achieved in 49 patients (90.7%). Intraoperative PCO was present in 14 (25.92%) patients. An Nd:YAG laser posterior capsulotomy was performed in 4 patients (28.5%). Posterior capsule rupture leading to vitreous loss occurred in 1 patient (1.85%). At 3-year follow-up, endothelial cell loss was 5.9%. Postoperative PCO developed in 8 patients (22.2%), and Nd:YAG laser posterior capsulotomy was performed in 5 patients (13.8%). The BCVA was > or = 20/40 in 47 patients (94%). CONCLUSION: Young patients pose a challenge in creating a capsulorhexis and display significant incidence of intraoperative and postoperative PCO.     

Clinical outcomes after Descemet’s stripping endothelial keratoplasty using donor corneas from children younger than 3 years

Importance

There is limited literature on paediatric donors in endothelial keratoplasty.

Background

This study investigated the efficacy of and appropriate paediatric donor age for Descemet’s stripping endothelial keratoplasty (DSEK).

Design

Retrospective and observational case series.

Participants

Thirty‐eight consecutive patients underwent DSEK with paediatric donor corneas.

Methods

The age of the donors ranged from 32 weeks gestation (premature neonate) to 3 years old. All donor consents were obtained from the parents. The causes of donor death included traffic accident, congenital heart disease and neonatal respiratory distress syndrome.

Main Outcome Measures

The outcome measures included best‐corrected visual acuity, endothelial cell loss and complications.

Results

Best‐corrected visual acuity at last follow‐up was >20/40 in 28 of 38 eyes (73.7%). The mean preoperative endothelial cell density of donor corneas was 4682 ± 520 cells/mm². The mean endothelial cell density of grafts was 3977 ± 556 cells/mm² at 18 months postoperatively. Three lenticules from premature neonate donors exhibited severe contraction postoperatively. The edge of six lenticules from donors <1‐year‐old exhibited contraction in the early postoperative period and gradually flattened spontaneously. Graft detachment occurred in one patient.

Conclusions and Relevance

DSEK with paediatric donor corneas can achieve good clinical outcomes. The corneal lenticules from 1‐ to 3‐year‐ old donors are suitable for DSEK while those from donors <1‐year‐old are less suitable due to the possibility of severe postoperative graft contraction.     

Anterior ischemic optic neuropathy in patients younger than 50 years

PURPOSE: To characterize anterior ischemic optic neuropathy (AION) in patients younger than 50 years. DESIGN: Retrospective study. METHODS: Records of all AION patients seen between 1989 and 2006 were reviewed. Patients younger than 50 years when initial visual loss occurred were included. RESULTS: Of 727 consecutive patients with AION, 169 (23%) were younger than 50 years (median, 43 years; range, 13 to 49 years; 58% men; 93% White). Involvement was unilateral in 59% of patients and bilateral in 41%. At least one cardiovascular risk factor was found in 74% of patients. Hypercoagulable states and vasculitis were found in 8%. An underlying small or anomalous optic disk was found in 92% of eyes (210/230). Isolated disk anomalies (without systemic risk factors) were present in 26% of eyes. Final visual acuities were 20/40 or better in 64% of eyes and 20/200 or worse in 22%. Among patients with bilateral involvement, final visual acuity was similar in the two eyes in 70% of patients. Anemia and type I diabetes were associated significantly with fellow eye involvement. Recurrent AION in the same eye occurred in 6% of patients. CONCLUSIONS: AION in younger patients is not uncommon and represents 23% of AION patients in a tertiary neuro-ophthalmic service. Except for giant cell arteritis, ocular and systemic risk factors and associated disorders are similar to those described in older AION patients. Younger AION patients have better visual acuity outcomes but a higher risk of fellow eye involvement than older AION patients.