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Corneal anesthesia in childhood
e20 alignment outcomes. We additionally evaluated binocularity by considering stereoacuity. Methods: This is a retrospective review of consecutive patients over twenty years who underwent bilateral medial rectus recession by one surgeon (n 5 695), with a diagnosis of accommodative esotropia and hypermetropia greater than or equal to +2.25 D (n 5 93). Data extracted at the preoperative, 6-week, 1-year, and final postoperative visits included visual acuity, stereoacuity, cycloplegic retinoscopy, and esodeviation at distance and near. Alignment was subdivided into group A (within 8D of orthophoria), group B (residual esotropia greater than 8D), or group C (consecutive exotropia . 8D). Stereoacuity was measured as fine (40-100 arcsec) or gross (101-3600 arcsec). Results: At six weeks, 61% were in group A while 39% patients were in group B. At the final postoperative visit, 42.3% were in group A while 57.7% were in group B. 18.7% of patients maintained stereoacuity despite increased misalignment. Better binocularity was associated with a mean older age at time of surgery (4.75 years-old with stereoacuity versus 3.38 years-old without stereoacuity). Those with fine stereoacuity were the oldest (5.13 years old). Discussion: Better alignment outcomes correlated with better stereoacuity. Children who underwent surgery at an older age were also found to have better stereoacuity. Conclusions: A favorable alignment correlates with good binocularity, which can persist in patients who have a residual esotropia greater than 8D (group B). 069 Long-term cumulative incidence of glaucoma after congenital cataract surgery. Scott R. Lambert, Amitabh Purohit, Hillary M. Superak, Micheal J. Lynn, Allen D. Beck Introduction: Glaucoma is one of the greatest threats to vision following congenital cataract surgery. The odds of developing glaucoma have been reported to be directly related to the age of surgery after short-term follow-up. We report the long-term cumulative incidence of glaucoma in a consecutive series of children undergoing congenital cataract surgery. Methods: We reviewed the medical record of a consecutive series of children who underwent congenital cataract surgery at one institution. Inclusion criteria included cataract surgery \7 months of age and a minimum follow-up of 12 months. Glaucoma was defined as IOP .21 mm Hg consistent with glaucomatous optic neuropathy or pressure-induced ocular enlargement. Kaplan-Meier curves were used to calculate the cumulative incidence of glaucoma and comparisons were analyzed with a Log-Rank test. Results: At total of 67 eyes in 42 children underwent congenital cataract surgery at a median age of 2.0 months. The median age of follow-up was 5.8 years (range, 1.3-26 years). Twenty eyes developed glaucoma at a median age of 13.3 years. The cumulative incidence of glaucoma was projected to be 18.5% at 5 years, 49.9% at 10 years and 66.6% at 20 years. There was a trend for glaucoma to develop more often in children undergoing cataract surgery \2 months of age (P 5 0.12). Discussion: Most studies evaluating the incidence of glaucoma after congenital cataract surgery have had relatively short follow-up intervals and often included children who underwent cataract surgery after infancy. Our study illustrates the importance of carefully monitoring children for glaucoma after congenital cataract surgery on a long-term basis. Conclusions: We projected the cumulative incidence of glaucoma to be nearly 67% 20 years after congenital cataract surgery.
Volume 17 Number 1 / February 2013 070 Corneal anesthesia in childhood. Rosemary G. Lambley, Naira Pereyra, Asim Ali, Kamiar Mireskandari Introduction: Corneal anesthesia (CA) in childhood carries a poor prognosis and there is little literature on its management. We present the largest reported series of children with this rare disorder. Methods: We performed a retrospective chart review of children with congenital or acquired CA presenting to our institution over the last 15 years. Patients with concurrent facial nerve or other cranial nerve palsies were included. Results: 21 eyes of 16 children were identified with CA caused by posterior fossa tumours (5), cerebellar hypoplasia (3), severe head trauma (3), familial dysautonomia (2) and isolated CA (3). The range of follow-up was 1-244 months, median 47.5 months. Six eyes in four children had visual acuities (VA) of 20/40 or better. All eyes with VA 20/200 or worse at last follow-up had associated facial nerve palsy (CNVIIP) or isolated CA. Complications included corneal scarring (81%), infectious keratitis (48%), corneal neovascularization (48%) and perforation secondary to keratitis (5%). Four children underwent corneal grafting for perforation or scarring. All grafts became hazy or opaque, with VAs of 20/800 or worse. The commonest surgical procedure was tarsorrhaphy (ten eyes). Seven were done on eyes with VA already 20/200 or worse. The three eyes undergoing tarsorrhaphy with VA better than 20/200 maintained vision of at least 20/200. Discussion: Isolated CA, and CA with CNVIIP, are associated with visual outcomes below 20/200. Earlier tarsorrhaphy may help preserve vision in these high-risk eyes. Conclusions: We recommend that ophthalmologists suspect and test for CA in children with painless epithelial defects and consider early tarsorrhaphy. 071 Anti-TNF therapy for childhood and adolescent uveitis. Janet D. Leath Breno, Rocha Lima, Nida Sen, Mohamad S. Jaafar Introduction: Childhood uveitis is the third most common cause of blindness in the pediatric population (1). Numerous side effects of chronic corticosteroid use have prompted a quest for a viable steroid-sparing treatment. Our purpose is to describe the corticosteroid-sparing effect of anti-TNF therapy in chronic childhood and adolescent uveitis. Methods: Retrospective longitudinal case series of patients started on anti-TNF therapy for chronic uveitis. Major outcome measures were corticosteroid-sparing success, adverse events, inflammation control, need for and ability to taper concurrent treatments assessed at 1-, 3-, 6-, 12-, 18-, and 24-month intervals. Results: Nineteen eyes of 10 patients who used adalimumab or infliximab and followed for an average of 12 months were identified. Three patients had anterior uveitis and 7 had posterior segment uveitis. All patients with posterior segment inflammation improved significantly with anti-TNF therapy. 84% of eyes with anterior chamber inflammation improved or remained stable. Four patients (40%) required two cycles of therapy due to either relapse or failure. All patients were successfully weaned to systemic steroid dose of less than 7 mg/day without relapse, but 33% required lowdose maintenance steroids. Half of patients required at least one other non-biologic systemic immunosuppressive after 6 months. One serious adverse event (anaphylactic reaction to infliximab) was identified. Discussion: This is the first study of its kind looking at outcomes for both anterior and posterior uveitis after relatively long term treatment with anti-TNF therapy in children. Conclusions: Anti-TNF antibody biologics improve inflammation control and offer a steroid-sparing therapy in pediatric uveitis patients.
Journal of AAPOS
Volume 17 Number 1 / February 2013 070 Corneal anesthesia in childhood. Rosemary G. Lambley, Naira Pereyra, Asim Ali, Kamiar Mireskandari Introduction: Corneal anesthesia (CA) in childhood carries a poor prognosis and there is little literature on its management. We present the largest reported series of children with this rare disorder. Methods: We performed a retrospective chart review of children with congenital or acquired CA presenting to our institution over the last 15 years. Patients with concurrent facial nerve or other cranial nerve palsies were included. Results: 21 eyes of 16 children were identified with CA caused by posterior fossa tumours (5), cerebellar hypoplasia (3), severe head trauma (3), familial dysautonomia (2) and isolated CA (3). The range of follow-up was 1-244 months, median 47.5 months. Six eyes in four children had visual acuities (VA) of 20/40 or better. All eyes with VA 20/200 or worse at last follow-up had associated facial nerve palsy (CNVIIP) or isolated CA. Complications included corneal scarring (81%), infectious keratitis (48%), corneal neovascularization (48%) and perforation secondary to keratitis (5%). Four children underwent corneal grafting for perforation or scarring. All grafts became hazy or opaque, with VAs of 20/800 or worse. The commonest surgical procedure was tarsorrhaphy (ten eyes). Seven were done on eyes with VA already 20/200 or worse. The three eyes undergoing tarsorrhaphy with VA better than 20/200 maintained vision of at least 20/200. Discussion: Isolated CA, and CA with CNVIIP, are associated with visual outcomes below 20/200. Earlier tarsorrhaphy may help preserve vision in these high-risk eyes. Conclusions: We recommend that ophthalmologists suspect and test for CA in children with painless epithelial defects and consider early tarsorrhaphy. 071 Anti-TNF therapy for childhood and adolescent uveitis. Janet D. Leath Breno, Rocha Lima, Nida Sen, Mohamad S. Jaafar Introduction: Childhood uveitis is the third most common cause of blindness in the pediatric population (1). Numerous side effects of chronic corticosteroid use have prompted a quest for a viable steroid-sparing treatment. Our purpose is to describe the corticosteroid-sparing effect of anti-TNF therapy in chronic childhood and adolescent uveitis. Methods: Retrospective longitudinal case series of patients started on anti-TNF therapy for chronic uveitis. Major outcome measures were corticosteroid-sparing success, adverse events, inflammation control, need for and ability to taper concurrent treatments assessed at 1-, 3-, 6-, 12-, 18-, and 24-month intervals. Results: Nineteen eyes of 10 patients who used adalimumab or infliximab and followed for an average of 12 months were identified. Three patients had anterior uveitis and 7 had posterior segment uveitis. All patients with posterior segment inflammation improved significantly with anti-TNF therapy. 84% of eyes with anterior chamber inflammation improved or remained stable. Four patients (40%) required two cycles of therapy due to either relapse or failure. All patients were successfully weaned to systemic steroid dose of less than 7 mg/day without relapse, but 33% required lowdose maintenance steroids. Half of patients required at least one other non-biologic systemic immunosuppressive after 6 months. One serious adverse event (anaphylactic reaction to infliximab) was identified. Discussion: This is the first study of its kind looking at outcomes for both anterior and posterior uveitis after relatively long term treatment with anti-TNF therapy in children. Conclusions: Anti-TNF antibody biologics improve inflammation control and offer a steroid-sparing therapy in pediatric uveitis patients.
Journal of AAPOS