- Email: [email protected]
Contact lens adherence to age of 5 years in the infant aphakia treatment study
Volume 21 Number 4 / August 2017 Discussion: Earlier introduction of biologics was associated with fewer ocular surgeries (P 5 0.006) and reduced dependence on prolonged topical corticosteroids1 (P \ 0.001). Conclusions: Earlier introduction of biologics with methotrexate was associated with fewer ophthalmic surgeries in patients with JIA- and idiopathic uveitis. 014 Contact lens adherence to age of 5 years in the infant aphakia treatment study. Caroline H. Cromelin, Carolyn Drews-Botsch, Buddy Russell, Scott R. Lambert Introduction: While contact lenses (CL) have been used for decades to optically correct children, there has never been a prospective study looking at CL adherence in young children following cataract surgery. Methods:Fifty-seven of the 114 infants in the Infant Aphakia Treatment Study (IATS) were randomized to CL wear; all were followed until age 5 years. A 48-hour recall telephone interview was completed every 3 months to assess CL adherence starting 2 months after surgery. A traveling examiner assessed visual acuity at age 4.5 years. Results: A total of 238 telephone interviews were completed. Mean percentage of waking hours spent wearing contact lenses was 84 21. Although there was some variance in CL adherence at different ages, the differences were not statistically significant. While visual acuity outcomes (20/32 or better, 20/40-20/200, worse than 20/200) were not related to CL adherence (P 5 0.08), there was a trend for better adherence with better visual outcomes. There was no statistically significant effect of gender, private insurance or age at cataract surgery. Discussion: Contact lens use in young children is challenging and requires a consistent effort by caregivers. This study confirms that it is possible to achieve a consistently high level of CL adherence over a 5 year period. Surprisingly, CL adherence was not significantly related to visual outcome, suggesting that lack of adherence to prescribed CL use did not limit visual acuity in most of these children. Conclusions: Excellent CL adherence can be consistently achieved in infants following unilateral cataract surgery to age five years. 015 Are we underestimating superior oblique involvement in restrictive strabismus from thyroid eye disease (TED)? Lana del Porto, Anne-Marie Hinds, Naz Raoof, Christen Barras, Indran Davagnanam, Gillian G. Adams Introduction: Strabismus surgery in TED is challenging. Severe restrictions from tight rectus muscles may mask superior oblique (SO) involvement. Troublesome A-patterns and intorsion may only be evident after rectus muscle surgery and later require SO surgery. Orbital CT scans can measure extraocular muscle size and infer the extent of their involvement in TED. Methods: Institutional audit committee approved retrospective review of 66 TED patients treated for strabismus. The cross-sectional area of the superior oblique was compared to age-matched controls using the Osirix Program. Results: The female:male ratio was 2:1, 50% were smokers, and 26% took statins. The SO cross sectional area in TED patients was 250% larger than normal controls (9.3 mm2 [SD 1.79] vs 23 mm2 [SD 6.52]). 96% of TED patients demonstrated significant SO enlargement (cross sectional area greater than three standard de-
Journal of AAPOS
e7 viations from the mean). The first strabismus surgery in most cases was either vertical muscle surgery alone (41%) or combined vertical and horizontal surgery (42%) with none having SO surgery. At second operation, 15% had SO surgery and at third procedure 60% had SO surgery. Discussion: Superior oblique enlargement in TED was ubiquitous but may not correlate with the severity of orthoptic finding such as Apatterns and intorsion. The frequency of SO surgery increased significantly with increasing surgical procedures. Conclusions: Strabismus surgeons should be aware of the possible involvement of the SO in TED and be prepared to address this surgically. Intorsion and A-patterns should be measured in TED patients, although this may not be possible until after initial rectus muscle surgery. 016 Randomized trial comparing bilateral lateral rectus recession versus unilateral recess-resect for basic-type intermittent exotropia. Sean P. Donahue, Danielle L. Chandler, Jonathan M. Holmes, David K. Wallace, Raymond T. Kraker, Aaron M. Miller, Evelyn A. Paysse, David B. Petersen, Brian W. Arthur, on behalf of the Pediatric Eye Disease Investigator Group (PEDIG) Introduction: There is no consensus on the preferred surgical treatment for intermittent exotropia (IXT) in children. Methods: 197 children, age 3 to \11 years, with basic type IXT, largest deviation by prism and alternate cover test at any distance 15D-40D, and near stereoacuity of at least 400 arcsec, were randomized to bilateral lateral rectus recession (BLRc) or unilateral recessresect (R/R). The primary outcome measure was the proportion of subjects with "suboptimal surgical outcome," defined as: exotropia $10D at distance or near using simultaneous prism and cover test (SPCT), constant esotropia $6D at distance or near using SPCT, or loss of $2 octaves ($0.6 log arcsec) stereoacuity from baseline, at ANY of the masked examinations performed every 6 months between 6 months and 3 years. Reoperation was allowed, at investigator discretion, only after meeting suboptimal surgical outcome criteria; reoperation without meeting criteria was counted as a suboptimal surgical outcome for analysis. Results: The cumulative probability of suboptimal surgical outcome occurring at ANY masked examination up to and including 3 years after surgery was 45.9% (43 of 101) in the BLRc group compared with 37.3% (33 of 96) in the R/R group (treatment group difference 5 8.6%; 95% CI 5 5.8% to 23.0%). Surgeons elected to reoperate by 3 years in 9 (9.8%) subjects in the BLRc group (8 met suboptimal surgical outcome criteria; 1 did not), and in 4 (4.6%) subjects in the R/R group (3 met suboptimal surgical outcome criteria; 1 did not) (treatment group difference 5 5.2%; 95% CI, 2.3% to 12.7%). Among subjects who completed a full 3 years of follow-up, 29.1% (25 of 86) in the BLRc group, and 16.9% (13/77) in the R/R group underwent reoperation or met suboptimal surgical outcome criteria at the 3 year visit (treatment group difference 5 12.8%; 95% CI, 2.8% to 28.0%); this lower rate is primarily because several subjects in each group with suboptimal outcomes at earlier visits did not meet these criteria at 3 years. Discussion: We did not find a statistically significant difference in suboptimal surgical outcomes by 3 years between children treated with BLRc compared with R/R; both treatment groups had a relatively high proportion with such outcomes although few patients underwent reoperation.
Journal of AAPOS
e7 viations from the mean). The first strabismus surgery in most cases was either vertical muscle surgery alone (41%) or combined vertical and horizontal surgery (42%) with none having SO surgery. At second operation, 15% had SO surgery and at third procedure 60% had SO surgery. Discussion: Superior oblique enlargement in TED was ubiquitous but may not correlate with the severity of orthoptic finding such as Apatterns and intorsion. The frequency of SO surgery increased significantly with increasing surgical procedures. Conclusions: Strabismus surgeons should be aware of the possible involvement of the SO in TED and be prepared to address this surgically. Intorsion and A-patterns should be measured in TED patients, although this may not be possible until after initial rectus muscle surgery. 016 Randomized trial comparing bilateral lateral rectus recession versus unilateral recess-resect for basic-type intermittent exotropia. Sean P. Donahue, Danielle L. Chandler, Jonathan M. Holmes, David K. Wallace, Raymond T. Kraker, Aaron M. Miller, Evelyn A. Paysse, David B. Petersen, Brian W. Arthur, on behalf of the Pediatric Eye Disease Investigator Group (PEDIG) Introduction: There is no consensus on the preferred surgical treatment for intermittent exotropia (IXT) in children. Methods: 197 children, age 3 to \11 years, with basic type IXT, largest deviation by prism and alternate cover test at any distance 15D-40D, and near stereoacuity of at least 400 arcsec, were randomized to bilateral lateral rectus recession (BLRc) or unilateral recessresect (R/R). The primary outcome measure was the proportion of subjects with "suboptimal surgical outcome," defined as: exotropia $10D at distance or near using simultaneous prism and cover test (SPCT), constant esotropia $6D at distance or near using SPCT, or loss of $2 octaves ($0.6 log arcsec) stereoacuity from baseline, at ANY of the masked examinations performed every 6 months between 6 months and 3 years. Reoperation was allowed, at investigator discretion, only after meeting suboptimal surgical outcome criteria; reoperation without meeting criteria was counted as a suboptimal surgical outcome for analysis. Results: The cumulative probability of suboptimal surgical outcome occurring at ANY masked examination up to and including 3 years after surgery was 45.9% (43 of 101) in the BLRc group compared with 37.3% (33 of 96) in the R/R group (treatment group difference 5 8.6%; 95% CI 5 5.8% to 23.0%). Surgeons elected to reoperate by 3 years in 9 (9.8%) subjects in the BLRc group (8 met suboptimal surgical outcome criteria; 1 did not), and in 4 (4.6%) subjects in the R/R group (3 met suboptimal surgical outcome criteria; 1 did not) (treatment group difference 5 5.2%; 95% CI, 2.3% to 12.7%). Among subjects who completed a full 3 years of follow-up, 29.1% (25 of 86) in the BLRc group, and 16.9% (13/77) in the R/R group underwent reoperation or met suboptimal surgical outcome criteria at the 3 year visit (treatment group difference 5 12.8%; 95% CI, 2.8% to 28.0%); this lower rate is primarily because several subjects in each group with suboptimal outcomes at earlier visits did not meet these criteria at 3 years. Discussion: We did not find a statistically significant difference in suboptimal surgical outcomes by 3 years between children treated with BLRc compared with R/R; both treatment groups had a relatively high proportion with such outcomes although few patients underwent reoperation.