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Optic Neuritis Associated with Etanercept Therapy for Juvenile Arthritis
Journal of AAPOS Volume 10 Number 1 February 2006 Strabismus Surgery for Elimination of Bifocals in Accommodative Esotropia Gregg T. Lueder MD; Washington University, St. Louis, MO Introduction: This study reports the outcomes of strabismus surgery to eliminate bifocals in patients with accommodative esotropia with a high accommodative convergence to accommodation (AC:A) ratio. Methods: Sixteen patients who wore bifocals for treatment of accommodative esotropia with a high AC:A ratio underwent strabismus surgery following prism adaptation testing (PAT) for the near angle of esotropia without bifocals. Outcomes were considered successful if patients had microtropias and maintained fusion without bifocals. Results: All patients had successful outcomes following one or two surgeries. Three of 13 (23%) patients with positive PATs required two surgeries. Two of three (67%) patients with negative PATs required two surgeries. Glasses were eliminated entirely in 7 of 16 (44%) patients. Discussion: Strabismus surgery was successful in eliminating the need for bifocals in patients with accommodative esotropia with a high AC:A ratio, and glasses were eliminated entirely in many patients. Preoperative PAT predicted the risk of requiring more than one surgery. Conclusion: Strabismus surgery may be an effective alternative to bifocal glasses for treatment of accommodative esotropia with a high AC:A ratio. Strabismus After Orbital Decompression Dawn N. Maxwell MD, Suqin Guo MD, Rudolph Wagner MD, Anthony Caputo MD; UMDNJ–New Jersey Medical School, Newark, NJ Introduction: Strabismus after orbital decompression for thyroid orbitopathy is common, historically approaching 66% in some series. In an effort to reduce this rate, orbital surgeons have aggressively modified their techniques. Our research compares various surgical approaches and their postoperative diplopia incidence rates. Methods: A retrospective review of articles published between 1995 and 2005 was conducted utilizing the OVID Medline database. Keywords “diplopia,” “orbital decompression,” and “strabismus” were meshed. Incidence rates for postoperative diplopia were recalculated using raw data where available. Results: Overall incidence of new postoperative diplopia is highest after three-wall decompression (21%) and lowest after single-wall decompression (9%). Balanced two-wall decompression carries a lower risk (15%) of postoperative diplopia than standard three-wall decompression (21%). Two-wall decompressions with floor removal have a higher incidence of diplopia (19%) than those with floor preservation (15%). Endoscopic techniques result in more postoperative diplopia (21%) than nonendoscopic approaches (14%). Patients with preexisting motility disturbance and restriction are more likely to experience a worsening of muscle imbalance than those with nonrestrictive disease. Conclusion: Thyroid orbitopathy presentations are extremely variable. While each patient’s orbital surgery must be tailored to meet their specific disease manifestation, certain trends in outcome are apparent. We recommend an individual approach to each patient, utilizing the above points to minimize the risk of postoperative motility problems. References available upon request.
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Aphakic Glaucoma After Congenital Cataract Surgery at Moorfields Eye Hospital (MEH), London, UK Michel Michaelides BSc, MB, BS, MD, MRCOphth, Gillian G.W. Adams BSc, MB, ChB, FRCS(Ed), FRCOphth; Moorfields Eye Hospital, London, UK A retrospective case notes review of all congenital cataract lensectomies with at least 5-year follow-up performed at MEH between 1994 and 2001 was conducted. The following parameters were ascertained: age at surgery, uni- or bilateral cataract, whether a posterior capsulotomy (PC) was performed at surgery, whether an implant (IOL) was inserted, and if aphakic glaucoma (AG) developed. All lensectomies were performed through a limbal incision by a single surgeon. A total of 43 subjects were identified—37 patients with bilateral cataracts and 6 with unilateral cataracts. Of the 37 bilateral cataract patients 71 eyes had lensectomies. Based on patient count, the 5-year risk of AG in at least one eye following surgery was 27%. Considering eye count, the 5-year risk was 21%. The average age at surgery of patients who did not develop AG was 27.6 months, with 20% having surgery within the first month of life. In comparison, the average age at surgery of patients who developed AG was 1.4 months, with 60% having surgery within the first month of life. A PC rate of 100% was identified in the eyes that developed AG compared to 60% in eyes that did not develop AG. An IOL was inserted in 0% of eyes with AG, compared to 57% in eyes that did not develop AG. Onset of AG ranged from 1 month postsurgery to 7 years, with an average yearly incidence of 4.3%. Early surgery is associated with a marked increase in risk of AG. Our data suggest that an intact posterior capsule and an IOL may be associated with a lower rate of AG. Optic Neuritis Associated with Etanercept Therapy for Juvenile Arthritis Yair Morad, Joseph Turetz, Isaac Avni, Judith Barash, Tsivia Tauber; Assaf Harofeh Medical Center, Zrifin, Israel Purpose: To describe cases of optic neuritis associated with etanercept therapy. Methods: A retrospective chart review on all patients that developed uveitis or optic neuritis associated with etanercept therapy between January 2003 and January 2005 in two medical centers: Assaf Harofeh Medical Centre and Kaplan Medical Centre, Israel. Results: Four patients (three girls, one boy) treated with etanercept for juvenile rheumatic arthritis (JRA) are presented. Three girls had oligoarticular onset JRA. The boy had HLA-B27 positive juvenile spondyloarthropathy and bilateral uveitis. After a mean follow-up of 10 months (range 2.5 to 18 months), all four patients had reduced visual acuity due to optic neuritis, which was accompanied by vitreitis in two eyes. In three patients discontinuation of etanercept, together with steroid treatment, resulted in resolution of the inflammation. The fourth patient elected to continue etanercept treatment without further deterioration in visual acuity. Conclusion: Optic neuritis is a potentially sight-threatening complication of etanercept therapy. JRA patients that are candidates for therapy should be examined by an ophthalmologist before starting treatment, and regularly thereafter. Ophthalmologists and rheumatologists should be aware of this hazard and be cautious when using etanercept in this patient population.
Abstracts
89
Aphakic Glaucoma After Congenital Cataract Surgery at Moorfields Eye Hospital (MEH), London, UK Michel Michaelides BSc, MB, BS, MD, MRCOphth, Gillian G.W. Adams BSc, MB, ChB, FRCS(Ed), FRCOphth; Moorfields Eye Hospital, London, UK A retrospective case notes review of all congenital cataract lensectomies with at least 5-year follow-up performed at MEH between 1994 and 2001 was conducted. The following parameters were ascertained: age at surgery, uni- or bilateral cataract, whether a posterior capsulotomy (PC) was performed at surgery, whether an implant (IOL) was inserted, and if aphakic glaucoma (AG) developed. All lensectomies were performed through a limbal incision by a single surgeon. A total of 43 subjects were identified—37 patients with bilateral cataracts and 6 with unilateral cataracts. Of the 37 bilateral cataract patients 71 eyes had lensectomies. Based on patient count, the 5-year risk of AG in at least one eye following surgery was 27%. Considering eye count, the 5-year risk was 21%. The average age at surgery of patients who did not develop AG was 27.6 months, with 20% having surgery within the first month of life. In comparison, the average age at surgery of patients who developed AG was 1.4 months, with 60% having surgery within the first month of life. A PC rate of 100% was identified in the eyes that developed AG compared to 60% in eyes that did not develop AG. An IOL was inserted in 0% of eyes with AG, compared to 57% in eyes that did not develop AG. Onset of AG ranged from 1 month postsurgery to 7 years, with an average yearly incidence of 4.3%. Early surgery is associated with a marked increase in risk of AG. Our data suggest that an intact posterior capsule and an IOL may be associated with a lower rate of AG. Optic Neuritis Associated with Etanercept Therapy for Juvenile Arthritis Yair Morad, Joseph Turetz, Isaac Avni, Judith Barash, Tsivia Tauber; Assaf Harofeh Medical Center, Zrifin, Israel Purpose: To describe cases of optic neuritis associated with etanercept therapy. Methods: A retrospective chart review on all patients that developed uveitis or optic neuritis associated with etanercept therapy between January 2003 and January 2005 in two medical centers: Assaf Harofeh Medical Centre and Kaplan Medical Centre, Israel. Results: Four patients (three girls, one boy) treated with etanercept for juvenile rheumatic arthritis (JRA) are presented. Three girls had oligoarticular onset JRA. The boy had HLA-B27 positive juvenile spondyloarthropathy and bilateral uveitis. After a mean follow-up of 10 months (range 2.5 to 18 months), all four patients had reduced visual acuity due to optic neuritis, which was accompanied by vitreitis in two eyes. In three patients discontinuation of etanercept, together with steroid treatment, resulted in resolution of the inflammation. The fourth patient elected to continue etanercept treatment without further deterioration in visual acuity. Conclusion: Optic neuritis is a potentially sight-threatening complication of etanercept therapy. JRA patients that are candidates for therapy should be examined by an ophthalmologist before starting treatment, and regularly thereafter. Ophthalmologists and rheumatologists should be aware of this hazard and be cautious when using etanercept in this patient population.