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Conservative management of lower lid epiblepharon in children
Volume 20 Number 4 / August 2016 involvement treated with AMT. Time from the symptom onset to surgery, number of AMT surgeries, type of AMT surgery, and adverse outcomes were recorded. Data were analyzed using univariate analysis. Results: 68% of eyes had no ocular sequelae following AMT for acute SJS. In the 16 (32%) eyes with an adverse outcome, median time between symptom onset to surgery was 6 days (range, 3-10). In those eyes with an adverse outcome, 9% had decreased visual acuity (#20/30), 8% had symblepharon, 6% had lid malposition, 4% had moderate conjunctival scarring, 4% had moderate dry eye, 8% had photophobia and 8% had distichiasis or trichiasis. There was a trend between increased incidence of adverse outcomes and number of surgeries (OR 5 9.6, P 5 0.07). Discussion: In the pediatric population, the incidence of adverse outcomes is similar to those previously reported in adults. The majority of eyes had no adverse outcomes following AMT for acute SJS. Conclusions: AMT continues to be a promising ocular treatment for acute SJS in children. Further research of this population may be able to define an optimal timeframe for AMT to prevent chronic ocular sequelae. 090 Conservative management of lower lid epiblepharon in children. Kathryn H. Williams, John W. Simon, Jitka L. Zobal-Ratner, Gerard P. Barry Introduction: Although much literature has focused on various techniques to repair epiblepharon, no study has addressed how frequently surgical intervention is required. Methods:We tabulated data from all patients seen with epiblepharon over the past 15 years. Results: Eighty-nine patients were included, 61 (69%) with tearing, discharge, conjunctival injection, or eye rubbing. Trichiasis was present in 15 cases (17%), 6 (7%) with corneal staining. In all cases, our initial treatment was conservative, with antibiotic ointment or tear substitutes in 73 cases with trichiasis, symptoms of irritation, or corneal changes and observation in the remaining 16. Three children (3%) were referred for eyelid surgery because of persistent symptoms. No patient had corneal scarring or long-term complications. Discussion: Although vision-threatening complications can result, a trial of topical antibiotic ointment and/or ocular lubricants was effective in nearly all our patients. Most resolved with minimal symptoms. The few eventually requiring eyelid surgery suffered no long-term complications. Conclusions: We recommend a trial of conservative treatment before eyelid surgery is undertaken. 091 Structural changes following early childhood lensectomy and the risk for secondary glaucoma. Helen H. Yeung, Sachin Kalarn, Osamah Saeedi, Mohamad S. Jaafar, Bethany Karwoski, Namratha Turlapati, Samuel C. Faith, William P. Madigan, Janet Leath Alexander Introduction: The purpose of this study is to describe baseline characteristic changes of the anterior segment structures after childhood lensectomy. We hypothesize that structural variants may be predictors of aphakic or pseudophakic glaucoma. Methods: For this prospective, nonrandomized study, 28 eyes in 23 children age 3 weeks to 5 years were enrolled. UBM images were collected on patients pre- and post-lensectomy. The fellow eye in most patients was used as controls and postoperative aphakic and
Journal of AAPOS
e25 pseudophakics were grouped together. Children with congenital or early childhood cataracts were included. Exclusion criteria included preexisting glaucoma, trauma, or any other anterior or posterior segment anomalies. UBM analyzed the cornea, anterior chamber, angle, iris, lens, and ciliary body structures. A total of 47 parameters were measured. Results: Preliminary analysis on 5 of the 47 parameters in the preoperative versus postoperative eyes demonstrate: anterior chamber depth (mm) 2.16 .79 versus 3.61 .36; trabeculo-Iris angle (degree) 35.88 13.06 vs 52.68 11.06; ciliary body area (mm2) 1.14 .26 vs 1.51 0.36; maximum iris thickness (mm) 498.90 111.04 vs 564.17 88.32; and sulcus angle (degree) 26.65 8.73 vs 27.47 14.07. Based on this preliminary data, none of the structural anatomic changes measured thus far before and after lensectomy reached statistical significance. Discussion: This is an ongoing study of structural predictors of aphakic and pseudophakic glaucoma. Completed data analysis of the remaining 42 parameters may demonstrate structural changes related to the development of secondary glaucoma. Conclusions: Anterior segment anatomic changes can be demonstrated by UBM. Future studies will evaluate whether these changescan predict the risk for aphakic and pseudophakic glaucoma. 092 Strabismus due to isolated schwannoma involving extraocular muscles. Fatma Yulek, Joseph L. Demer Introduction: Progressive acquired strabismus initially considered idiopathic may be caused by isolated cranial nerve schwannoma of motor nerves to the extraocular muscles detectable only by carefully directed imaging. Schwannomas have pathognomonic appearance on magnetic resonance imaging (MRI). We reviewed clinical experience of an imaging referral practice specializing in complex strabismus. Methods: We reviewed 647 cases imaged for strabismus to identify presumed cranial nerve schwannomas, identified by gadodiamideenhanced, high resolution surface coil orbital MRI, and thin section cranial MRI. Clinical features and management were correlated with MRI. Results: Presumed schwannomas involving cranial nerves were identified as fusiform intraneural enlargements in 8 cases: One affecting superior oblique, two abducens and 5 oculomotor nerves. Involved muscles were atrophic. Both abducens, superior oblique but only one oculomotor schwannomas were subarachnoid; The others were intraorbital. Associated strabismus was progressive for 3-17 years. Abducens schwannoma caused esotropia. Intracranial oculomotor schwannoma caused mydriasis and exotropia. Intraorbital schwannomas caused exotropia with or without hypertropia. Since lesion diameters were 3–9 mm, 6 had been previously missed on routine MRI. Discussion: Cranial nerve schwannomas underlie 1% of strabismus cases. The oculomotor is more often involved than the abducens nerve. Most lesions are intraorbital, and typically missed by routine imaging, so that strabismus is typically regarded as idiopathic. Conclusions: Progressive, acquired strabismus may be caused by isolated schwannomas of cranial nerves. Since most of these schwannomas are small and deep in the orbit, they should be suspected when extraocular muscles are atrophic and are identifiable only using high resolution MRI technique targeted to identify them.
Journal of AAPOS
e25 pseudophakics were grouped together. Children with congenital or early childhood cataracts were included. Exclusion criteria included preexisting glaucoma, trauma, or any other anterior or posterior segment anomalies. UBM analyzed the cornea, anterior chamber, angle, iris, lens, and ciliary body structures. A total of 47 parameters were measured. Results: Preliminary analysis on 5 of the 47 parameters in the preoperative versus postoperative eyes demonstrate: anterior chamber depth (mm) 2.16 .79 versus 3.61 .36; trabeculo-Iris angle (degree) 35.88 13.06 vs 52.68 11.06; ciliary body area (mm2) 1.14 .26 vs 1.51 0.36; maximum iris thickness (mm) 498.90 111.04 vs 564.17 88.32; and sulcus angle (degree) 26.65 8.73 vs 27.47 14.07. Based on this preliminary data, none of the structural anatomic changes measured thus far before and after lensectomy reached statistical significance. Discussion: This is an ongoing study of structural predictors of aphakic and pseudophakic glaucoma. Completed data analysis of the remaining 42 parameters may demonstrate structural changes related to the development of secondary glaucoma. Conclusions: Anterior segment anatomic changes can be demonstrated by UBM. Future studies will evaluate whether these changescan predict the risk for aphakic and pseudophakic glaucoma. 092 Strabismus due to isolated schwannoma involving extraocular muscles. Fatma Yulek, Joseph L. Demer Introduction: Progressive acquired strabismus initially considered idiopathic may be caused by isolated cranial nerve schwannoma of motor nerves to the extraocular muscles detectable only by carefully directed imaging. Schwannomas have pathognomonic appearance on magnetic resonance imaging (MRI). We reviewed clinical experience of an imaging referral practice specializing in complex strabismus. Methods: We reviewed 647 cases imaged for strabismus to identify presumed cranial nerve schwannomas, identified by gadodiamideenhanced, high resolution surface coil orbital MRI, and thin section cranial MRI. Clinical features and management were correlated with MRI. Results: Presumed schwannomas involving cranial nerves were identified as fusiform intraneural enlargements in 8 cases: One affecting superior oblique, two abducens and 5 oculomotor nerves. Involved muscles were atrophic. Both abducens, superior oblique but only one oculomotor schwannomas were subarachnoid; The others were intraorbital. Associated strabismus was progressive for 3-17 years. Abducens schwannoma caused esotropia. Intracranial oculomotor schwannoma caused mydriasis and exotropia. Intraorbital schwannomas caused exotropia with or without hypertropia. Since lesion diameters were 3–9 mm, 6 had been previously missed on routine MRI. Discussion: Cranial nerve schwannomas underlie 1% of strabismus cases. The oculomotor is more often involved than the abducens nerve. Most lesions are intraorbital, and typically missed by routine imaging, so that strabismus is typically regarded as idiopathic. Conclusions: Progressive, acquired strabismus may be caused by isolated schwannomas of cranial nerves. Since most of these schwannomas are small and deep in the orbit, they should be suspected when extraocular muscles are atrophic and are identifiable only using high resolution MRI technique targeted to identify them.