- Email: [email protected]
Cortical visual impairment (CVI) in children—an analysis of risk factors, clinical presentation and treatment outcome
e12 images of acceptable quality were submitted for grading, 67.2% when 4 acceptable images were submitted, and 66.7% for 3 or fewer acceptable images (P 5 0.02), with corresponding specificity of 82.2%, 89.0% and 81.7% respectively (P \ 0.0001). Sensitivity was not increased with number of images when images of any quality were evaluated (P 5 0.74). Discussion: The likelihood of detecting RW-ROP by telemedicine screening is decreased when a full set of retinal images is not obtained. Conclusions: Acceptable image quality is needed to improve detection accuracy from retinal images. 042 Incidence and pathophysiology of inferior oblique overaction after surgery for unilateral superior oblique palsy. Alaa S. Bou Ghannam, William P. Madigan, Mohannad Al-Samarraie, Helia Garcia, Julie Conley, Mohamad S. Jaafar Introduction: Masked contralateral superior oblique paresis (MCSOP) occurs in a significant number of patients who had surgery for presumed unilateral superior oblique palsy (PUSOP). Clinical findings and possible etiologies have been identified to help diagnose MCSOP. Methods: We retrospectively reviewed 102 patients with PUSOP, operated over 10 years, to further refine our clinical diagnosis and identify possible etiology of the acquired contralateral inferior oblique muscle overaction (ACIOOA). Results: Postoperatively 72% of patients remained unilateral and 28% developed ACIOOA. The median age of onset was 3.25 and 2 years, respectively. Preoperatively, both groups showed the same percentage of anomalous head posture. However, among those who presented without anomalous head posture preoperatively, more patients developed ACIOOA (21% straight head versus 8% AHP; P 5 0.015). Median hypertropia in primary position was 10D in unilateral cases versus 5D in MCSOP (P 5 0.14). Of the ACIOOA, 14% showed bilateral excyclotorsion versus 3% in those who remained unilateral (P 5 0.003). There was no association between the type of muscle surgery (inferior oblique myectomy or recession) and the development of ACIOOA. The etiology of strabismus (congenital vs traumatic) did not vary between the two groups. Discussion: The percentage of presumed MCSOP is higher in our series (median age at presentation 3 years) than previous studies (age .30 years). Except for straight head posture and bilateral excyclotorsion, preoperatively, our study showed no real predictor of ACIOOA. Conclusions: In spite of critical evaluation in young patients, a high percentage of PUSOP developed ACIOOA. The etiology was suspected to be mechanical in some. 043 Long-term efficacy of endoscopic cyclophotocoagulation in the management of aphakic and pseudophakic glaucoma in children. Adam J. Cantor, Jingyun Wang, Shanshan Li, Daniel Neely, David Plager Introduction: Endoscopic cyclophotocoagulation (ECP) has been effective in the management of a variety of difficult pediatric and adult glaucomas. This study reports long-term efficacy and safety of ECP in pediatric aphakic and pseudophakic glaucoma. Methods: ECP was performed on 40 eyes of 28 patients under 16 years of age with aphakic or pseudophakic glaucoma. Patients were followed for a minimum of 12 months. Treatment failure was defined as postoperative intraocular pressure (IOP) of .24 mm Hg, IOP lowering of less than 15%, or occurrence of visually significant complications.
Volume 20 Number 4 / August 2016 Results: Success rate was 50.0% (20/40), with 62% receiving one treatment only. Pretreatment IOP averaged 34.4 8.2 mm Hg. Average total arc of treatment was 284 . Final IOP after mean follow-up period of 6.6 years was 19.3 8.6 (P \ 0.001). Patients with single ECP demonstrated significant improvement in visual acuity from baseline to most recent follow-up. Discussion: ECP is successful in the majority of patients who receive a single procedure. Risk factors for treatment failure include elevated IOP at first measurement following cataract extraction, at time of diagnosis of glaucoma, and baseline prior to ECP; increased patient age at time of ECP; and increased time between cataract extraction and ECP. Hypotony was not encountered. Conclusions: Analysis of longitudinal IOP and visual acuity data demonstrates that ECP remains a successful tool in the treatment of aphakic and pseudophakic glaucoma, with a low rate of visually significant complications. Unlike previous studies, failure was not increased in pseudophakic patients relative to aphakic patients. 044 Cortical visual impairment (CVI) in children—an analysis of risk factors, clinical presentation and treatment outcome. Sandra Chandramouli Introduction: To gain more insight into causes of cortical visual impairment (CVI) in children and to analyze associated ophthalmic findings and treatment outcomes at a tertiary care referral facility. Methods: The clinical data of 49 consecutive children \5 years of age diagnosed with CVI in our low vision department from January to September 2014 were analyzed for etiology, ocular variables, presenting vision, and treatment outcome. All were advised vision training techniques. Results: Of the study population, 29% was preterm and 76% were males; 50% had birth weight of \2500 g. There were documented MRI findings in 49% of children, of which 20% had hypoxic ischemic encephalopathy, 14% had periventricular leukomalacia, 4% had structural brain anomalies, 6% had neonatal infection, 3% had hydrocephalus and 2% had intraventricular hemorrhage. Associated ophthalmic findings included nystagmus (14%), strabismus (7%), disk pallor (53%), and severe sequelae of ROP (8%). Majority had mild hyperopia/ astigmatism and only 4% were high myopic. All of them showed delay in developmental milestones. On final followup, 55% of children showed an improvement in visual function. Discussion: Cortical visual impairment is emerging as the leading cause of bilateral visual impairment in children. Prevention of diseases that lead to prematurity and hypoxia/ischemia at term would be the ultimate goal in preventing this condition. Conclusions: In our study, the major risk factors for CVI were perinatal hypoxia and premature birth. Most patients had associated serious neurological and ophthalmic abnormalities. 045 The socioeconomic impact of patient no-shows and same-day cancellations on a university-based pediatric ophthalmology practice. Edward W. Cheeseman, Rupel H. Trivedi, Millicent M. Peterseim, Jeffrey Blice, Kelly Unkrich Introduction: Patient no-show and same-day cancellation frequencies are an ongoing problem for many pediatric ophthalmology practices. This study places a dollar value on the economic losses that result from clinic vacancies in a university based practice due to a patient not presenting for a scheduled appointment, or cancelling the day of the appointment. Methods:A retrospective review was completed of all patient scheduled appointments for the pediatric ophthalmology service at the
Journal of AAPOS
Volume 20 Number 4 / August 2016 Results: Success rate was 50.0% (20/40), with 62% receiving one treatment only. Pretreatment IOP averaged 34.4 8.2 mm Hg. Average total arc of treatment was 284 . Final IOP after mean follow-up period of 6.6 years was 19.3 8.6 (P \ 0.001). Patients with single ECP demonstrated significant improvement in visual acuity from baseline to most recent follow-up. Discussion: ECP is successful in the majority of patients who receive a single procedure. Risk factors for treatment failure include elevated IOP at first measurement following cataract extraction, at time of diagnosis of glaucoma, and baseline prior to ECP; increased patient age at time of ECP; and increased time between cataract extraction and ECP. Hypotony was not encountered. Conclusions: Analysis of longitudinal IOP and visual acuity data demonstrates that ECP remains a successful tool in the treatment of aphakic and pseudophakic glaucoma, with a low rate of visually significant complications. Unlike previous studies, failure was not increased in pseudophakic patients relative to aphakic patients. 044 Cortical visual impairment (CVI) in children—an analysis of risk factors, clinical presentation and treatment outcome. Sandra Chandramouli Introduction: To gain more insight into causes of cortical visual impairment (CVI) in children and to analyze associated ophthalmic findings and treatment outcomes at a tertiary care referral facility. Methods: The clinical data of 49 consecutive children \5 years of age diagnosed with CVI in our low vision department from January to September 2014 were analyzed for etiology, ocular variables, presenting vision, and treatment outcome. All were advised vision training techniques. Results: Of the study population, 29% was preterm and 76% were males; 50% had birth weight of \2500 g. There were documented MRI findings in 49% of children, of which 20% had hypoxic ischemic encephalopathy, 14% had periventricular leukomalacia, 4% had structural brain anomalies, 6% had neonatal infection, 3% had hydrocephalus and 2% had intraventricular hemorrhage. Associated ophthalmic findings included nystagmus (14%), strabismus (7%), disk pallor (53%), and severe sequelae of ROP (8%). Majority had mild hyperopia/ astigmatism and only 4% were high myopic. All of them showed delay in developmental milestones. On final followup, 55% of children showed an improvement in visual function. Discussion: Cortical visual impairment is emerging as the leading cause of bilateral visual impairment in children. Prevention of diseases that lead to prematurity and hypoxia/ischemia at term would be the ultimate goal in preventing this condition. Conclusions: In our study, the major risk factors for CVI were perinatal hypoxia and premature birth. Most patients had associated serious neurological and ophthalmic abnormalities. 045 The socioeconomic impact of patient no-shows and same-day cancellations on a university-based pediatric ophthalmology practice. Edward W. Cheeseman, Rupel H. Trivedi, Millicent M. Peterseim, Jeffrey Blice, Kelly Unkrich Introduction: Patient no-show and same-day cancellation frequencies are an ongoing problem for many pediatric ophthalmology practices. This study places a dollar value on the economic losses that result from clinic vacancies in a university based practice due to a patient not presenting for a scheduled appointment, or cancelling the day of the appointment. Methods:A retrospective review was completed of all patient scheduled appointments for the pediatric ophthalmology service at the
Journal of AAPOS