Intrastromal corneal ring segments for bilateral keratoconus in an 11-year-old boy

We present the case of an 11-year-old boy who had bilateral implantation of intrastromal corneal ring segments for progressive keratoconus and poor vision. No intraoperative or postoperative complications were seen, and 1 year postoperatively, the patient maintained good spectacle-corrected vision. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.     

Periocular corticosteroid injection in the management of uveitis in children

Acta Ophthalmol. 2010: 88: e299–e304

Abstract.

Purpose: To report the outcome of orbital floor corticosteroid injection (OFCI) in the management of uveitis in children. Methods: A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (19 eyes) with various forms of uveitis treated with OFCI of 40 mg/ml methylprednisolone acetate or a combination of 20 mg/0.5 ml Triamcinolone and 2 mg/0.5 ml dexamethasone were reviewed. Data were collected 6 months postinjection and included details of uveitis, best corrected visual acuity (BCVA), ocular inflammation, systemic therapy required and potential complications of OFCI. Results: The mean BCVA improvement was 0.18 logarithm of the minimum angle of resolution (p < 0.001), at a mean of 6 weeks (range, 4–20). Fourteen eyes (74%) had significant improvement in inflammation, 4–7 weeks post‐OFCI, with a median of 4 weeks. Anterior uveitis was treated effectively in all eyes, vitritis resolved in all but one case and resolution of cystoid macular oedema was achieved in six eyes (55%). Uveitis relapsed in seven eyes (50%) after a median time of 4 months (range, 2–5 months). Four eyes (21%) underwent more than one injection. The dosage of immunosuppressive systemic therapy was reduced or able to be stopped in three patients (50%). Steroid‐induced cataract was observed in four eyes (21%), 5 months post‐OFCI. One patient developed cushingoid features 6 weeks post his second OFCI. Conclusion: Corticosteroid orbital floor injections resulted in control of active uveitis and visual acuity improvement in most children. However, the effect might be transient and induce cataract formation.     

Vogt-Koyanagi-Harada syndrome in an 11-year-old Boy

An 11-year-old boy complained of headache, slight fever and decreased visual acuity. Intracameral cells and serous retinal detachment were found in both eyes. Pleocytosis was seen in the cerebrospinal fluid. Bilateral uveitis diminished rapidly in response to corticosteroid treatment. Depigmentation of the fundi developed several months later. We believe that Vogt-Koyanagi-Harada syndrome in a child, as demonstrated in our patient, may be uncommon.     

Iris melanoma in 12-year-old boy

A 12-year-old boy presented with an incidental finding of an iris lesion after blunt injury. Ocular examination revealed a large atypical brown vascular nodule in the nasal iris, extending to the pupillary margin. There were smaller scattered nodules scattered within the iris and anterior chamber. Ultrasound biomicroscopy examination revealed no tumour behind the iris. Fundal examination findings were normal. Sector iridectomy revealed mixed spindle and epitheliod melanoma. The eye was enucleated. Histopathologic examination confirmed malignant melanoma confined to the iridocorneal angle, iris, ciliary body and inner layer of the anterior sclera. Iris melanomas are very rare in the prepubertal age group.     

Periocular necrotizing fasciitis in an infant

Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy.     

Primary orbital ganglioneuroma in a 2-year-old healthy boy

A 2-year-old healthy child presented with progressive unilateral proptosis.Complete work up including: general examination, detailed ophthalmic evaluation and radiological imaging were done. He underwent orbital exploration via anterior orbitotomy incision and debulking of the tumor was done.The histopathological examination confirmed the diagnosis of orbital ganglioneuroma.Ganglioneuroma is an unusual benign tumor of neuroplastic origin with extremely rare orbital involvement with only one prior reported case in a youth. The tumor is slow growing and non-metastasizing. Biopsy is necessary to differentiate it from the malignant neuroblastoma and excision is usually curative.     

Systemic toxicity of topical and periocular corticosteroid therapy in an 11-year-old male with posterior uveitis

PURPOSE: To report a case of systemic corticosteroid toxicity resulting from topical and periocular therapy. METHODS: Treatment and follow-up of an 11-year-old male with uveitis are illustrated. Initial presentation of the patient was bilateral iridocyclitis, for which he was treated with prednisolone acetate 1% every 2 hours for 6 months. Subsequently, posterior uveitis developed, necessitating posterior subtenon injections. RESULTS: After initial topical corticosteroid therapy, the patient developed a cushingoid habitus accompanied by increased lanugo hair, acanthosis nigricans, posterior subcapsular lens opacities, and increased intraocular pressure. Cushingoid stigmata worsened after administration of posterior subtenon injection of corticosteroids. The patient's truncal obesity worsened, and his linear growth stopped. CONCLUSIONS: Systemic toxic effects may develop as a result of topical and local use of ophthalmic corticosteroid preparations in susceptible patients.     

Current Australian practice in the prevention and management of corneal allograft rejection

Purpose : To determine current practices in the prevention and management of corneal allograft rejection in Australia. Methods : A questionnaire was circulated to attendees at the 1998 Eye Bank Meeting in Adelaide. Twenty‐four responses were received and analysed. Results : All respondents used topical corticosteroids for routine prophylaxis and to treat established rejection episodes. Prednisolone acetate was the most frequently prescribed topical corticosteroid. Systemic non‐steroidal immunosuppression was prescribed almost exclusively for high‐risk grafts. Seventy‐five per cent of surgeons used systemic antiviral agents for the treatment of graft rejection in patients with Herpes simplex keratitis. Conclusion : There was a wide variation amongst surgeons in the choice of therapy for routine prophylactic immunosuppression as well as for the treatment of established corneal allograft rejection.     

Epibulbar schwannoma in a 12-year-old boy: A case report and review of literature

Schwannomas are benign, encapsulated, primary neurilemmal tumors composed of proliferating Schwann cells. Schwannomas are commonly seen in the orbit, but are rare on the epibulbar surface. Herein, we report a case of a 12-year-old boy who presented to us with a slow-growing painless subconjunctival mass in the left eye. There was no intraocular extension of the mass and intra-operatively, the mass could be clearly delineated and was excised off the underlying sclera. Histopathological examination of the mass showed typical features of schwannoma and immunohistochemistry helped to confirm the diagnosis. There was no recurrence of the lesion observed at follow-up 26 months after surgery. Here, we describe this uncommon tumor and review the available literature. Although rare, an epibulbar schwannoma should be considered in the differential diagnosis of an amelanotic, painless subconjunctival nodular mass. Excision of the lesion is the recommended treatment.     

Choroidal neovascularisation secondary to Best’s disease in a 13-year-old boy treated by intravitreal bevacizumab

Background To describe the effect of intravitreal bevacizumab for the treatment of choroidal neovascularisation secondary to vitelliform dystrophy of the macula (Best’s disease). Methods A 13-year-old boy with confirmed Best’s disease presented with visual acuity (VA) loss due to secondary choroidal neovascularisation (CNV). He was treated with a single injection of 1-mg bevacizumab. Results Best corrected VA (Snellen) fully recovered from 20/40 preoperatively to 20/20 over a period of 6 months. Optical coherence tomography (OCT) and angiography demonstrated regression of the CNV and resolution of the macular edema. Conclusions A single intravitreal injection of bevacizumab may be effective to induce morphologic and functional improvement in a juvenile suffering from CNV secondary to Best’s disease. Proprietary interest: none for all authors