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Predictive value of preoperative central corneal thickness for aphakic glaucoma in congenital cataract patients
Volume 11 Number 1 February 2007
veloped amblyopia had nystagmus. Conclusions: Fixation preference testing appears to overestimate the presence of amblyopia not found on sweep VEP. It may be a more accurate visual assessment in preverbal children with nystagmus. Predictive value of preoperative central corneal thickness for aphakic glaucoma in congenital cataract patients. Shannon R. Cabrera, C. Gail Summers, Erick D. Bothun, Jill S. Anderson, Stephen P. Christiansen Introduction: The purpose of this study was to determine if preoperative central corneal thickness (CCT ) is a predictor of future glaucoma in infants undergoing cataract surgery. Methods: A retrospective chart review was performed for infants who underwent cataract surgery from January 1995 to June 2002. Inclusion required surgery prior to 1 year of age, preoperative CCT measurements, and follow-up of 3 years or longer. We excluded eyes with anterior segment dysgenesis, preoperative glaucoma, and microphthalmia. In patients with bilateral cataracts, one eye was randomly chosen for statistical analysis. Results: In eyes without glaucoma (n ⫽ 35), the mean CCT was 0.559 mm (CI ⫽ 0.542-0.572); mean horizontal corneal diameter was 10.17 mm, and mean age at surgery was 2.8 months. Eyes that developed aphakic glaucoma (n ⫽ 7) had a mean CCT of 0.597 mm (CI ⫽ 0.567-0.628), mean diameter of 10.21 mm, and a mean age at surgery of 1.5 months. Preoperative CCT was significantly greater in eyes that developed aphakic glaucoma compared with those who did not ( p ⫽ 0.029). Neither corneal diameter nor age at the time of surgery was significantly different between the two groups. CCT and corneal diameter were weakly correlated (r ⫽ ⫺0.026, p ⫽ 0.10). Discussion: CCT has become an important factor in glaucoma management. Our data suggest that eyes with congenital cataracts that develop postoperative glaucoma may also have increased CCT preoperatively. Surgeons should consider measuring CCT as part of the routine preoperative cataract evaluation. Conclusions: Thicker preoperative CCT in eyes with congenital cataract may have a predictive value for the development of postoperative aphakic glaucoma. How often does the contralateral inferior oblique muscle need to be weakened after a unilateral inferior oblique muscle weakening procedure? Gad Y. Dotan, John D. Baker, John D. Roarty Introduction: It has been suggested that if surgery is planned to weaken one inferior oblique muscle, in certain cases, consideration should be given for bilateral surgery as the other inferior oblique will often need correction in the future. Purpose: To determine the frequency of contralateral inferior oblique weakening surgery following a unilateral inferior weakening procedure. Methods: A retrospective analysis of the records of 376 patients, who had unilateral inferior oblique muscle surgery between 1984 and 2005. Results: Two hundred six patients had hypertropia alone with a unilateral inferior oblique muscle overaction and 170 patients had an associated horizontal deviation. Seven percent of all patients (n ⫽ 26) required second weakening surgery of the contralateral inferior oblique. The rate for reoperation was higher in patients with esotropia (12.6%) compared with patients with exotropia (5.5%) and only hypertropia (5.3%). The average time interval between the first and second surgeries was 17 months. In six patients (2%) the previously operated muscle had to be reweakened. Discussion: Only 11 of 206
Journal of AAPOS
Abstracts
77
patients with hypertropia that had a weakening procedure of the inferior oblique muscle needed surgery of the contralateral inferior oblique muscle. The need for second surgery was also relatively low in patients with exotropia, and it was slightly higher in patients with esotropia. Conclusions: Single inferior oblique muscle-weakening procedures is effective in the vast majority of patients and the need for weakening the contralateral inferior oblique is low. Rapid improvement in motor development following surgery for infantile esotropia. James R. Drover, David R. Stager Sr., Sarah E. Morale, Joel N. Leffler, Eileen E. Birch Purpose: Infantile esotropia (ET ) influences visual development and thus may delay the achievement of developmental milestones. Fortunately, early muscle surgery can substantially improve visual functioning. Here we address whether surgery can also improve sensorimotor and gross motor development. Methods: Recently, our lab devised the Infant Developmental Skills Survey, a 25-item questionnaire designed to assess 10 sensorimotor and 15 gross motor skills. The questionnaire was completed by the parents of 3- to 10-month-old patients with infantile ET prior to surgery (N ⫽ 145) and the parents of 6to 11-month-old patients a median of 7.3 weeks following surgery (N ⫽ 68). A subset of parents completed the questionnaire for their children (N ⫽ 47) both before and after surgery. Patients with a diagnosis of developmental delay were excluded. The questionnaire was also completed by the parents of infants with normal ocular alignment (N ⫽ 194). Results were analyzed in 1-month age bins. Results: Before surgery, 4-, 5-, 6-, 7-, 9-, and 10-month-old patients showed delayed achievement of sensorimotor milestones ( p ⬍ 0.01) and 5-, 9-, and 10-month-old patients demonstrated delayed attainment of gross motor milestones ( p ⬍ 0.05) compared with normal children. However, following surgery, patients demonstrated a greater rate of sensorimotor development than age-matched normal children ( p ⬍ 0.00001) and caught up with normal children on both sensorimotor and gross motor skills. Conclusions: Prior to surgery, patients with infantile ET were delayed in their achievement of developmental milestones. However, following surgery, these patients showed rapid motor development and possessed motor skills comparable to those of normal children within a few months following months. Utility analysis of screening and laser therapy for retinopathy of prematurity. Jennifer A. Dunbar, Bradley A. Black, Marc Christensen, George R. Beauchamp, Pamela E. Williams Introduction: Retinopathy of prematurity (ROP) is an important cause of lifelong blindness. Utility analysis is used to describe the effect of illness and medical intervention on an individual’s quality of life over the course of a lifetime. Utility analysis has been applied to medical care for ROP in a variety of settings. In this study, utility analysis is used to evaluate the cost effectiveness of both screening and laser treatment for ROP. Methods: Infants screened and treated for ROP between March 2004 and January 2006 were recorded prospectively in a database. Utility analysis was conducted using the model of Brown et al. The cost model was developed using procedures classified by Current Procedural Terminology (CPT ) and the costs paid for by the Health Care Financing Agency for 2006. Results: During the study period, 228 infants received screening and treatment for
veloped amblyopia had nystagmus. Conclusions: Fixation preference testing appears to overestimate the presence of amblyopia not found on sweep VEP. It may be a more accurate visual assessment in preverbal children with nystagmus. Predictive value of preoperative central corneal thickness for aphakic glaucoma in congenital cataract patients. Shannon R. Cabrera, C. Gail Summers, Erick D. Bothun, Jill S. Anderson, Stephen P. Christiansen Introduction: The purpose of this study was to determine if preoperative central corneal thickness (CCT ) is a predictor of future glaucoma in infants undergoing cataract surgery. Methods: A retrospective chart review was performed for infants who underwent cataract surgery from January 1995 to June 2002. Inclusion required surgery prior to 1 year of age, preoperative CCT measurements, and follow-up of 3 years or longer. We excluded eyes with anterior segment dysgenesis, preoperative glaucoma, and microphthalmia. In patients with bilateral cataracts, one eye was randomly chosen for statistical analysis. Results: In eyes without glaucoma (n ⫽ 35), the mean CCT was 0.559 mm (CI ⫽ 0.542-0.572); mean horizontal corneal diameter was 10.17 mm, and mean age at surgery was 2.8 months. Eyes that developed aphakic glaucoma (n ⫽ 7) had a mean CCT of 0.597 mm (CI ⫽ 0.567-0.628), mean diameter of 10.21 mm, and a mean age at surgery of 1.5 months. Preoperative CCT was significantly greater in eyes that developed aphakic glaucoma compared with those who did not ( p ⫽ 0.029). Neither corneal diameter nor age at the time of surgery was significantly different between the two groups. CCT and corneal diameter were weakly correlated (r ⫽ ⫺0.026, p ⫽ 0.10). Discussion: CCT has become an important factor in glaucoma management. Our data suggest that eyes with congenital cataracts that develop postoperative glaucoma may also have increased CCT preoperatively. Surgeons should consider measuring CCT as part of the routine preoperative cataract evaluation. Conclusions: Thicker preoperative CCT in eyes with congenital cataract may have a predictive value for the development of postoperative aphakic glaucoma. How often does the contralateral inferior oblique muscle need to be weakened after a unilateral inferior oblique muscle weakening procedure? Gad Y. Dotan, John D. Baker, John D. Roarty Introduction: It has been suggested that if surgery is planned to weaken one inferior oblique muscle, in certain cases, consideration should be given for bilateral surgery as the other inferior oblique will often need correction in the future. Purpose: To determine the frequency of contralateral inferior oblique weakening surgery following a unilateral inferior weakening procedure. Methods: A retrospective analysis of the records of 376 patients, who had unilateral inferior oblique muscle surgery between 1984 and 2005. Results: Two hundred six patients had hypertropia alone with a unilateral inferior oblique muscle overaction and 170 patients had an associated horizontal deviation. Seven percent of all patients (n ⫽ 26) required second weakening surgery of the contralateral inferior oblique. The rate for reoperation was higher in patients with esotropia (12.6%) compared with patients with exotropia (5.5%) and only hypertropia (5.3%). The average time interval between the first and second surgeries was 17 months. In six patients (2%) the previously operated muscle had to be reweakened. Discussion: Only 11 of 206
Journal of AAPOS
Abstracts
77
patients with hypertropia that had a weakening procedure of the inferior oblique muscle needed surgery of the contralateral inferior oblique muscle. The need for second surgery was also relatively low in patients with exotropia, and it was slightly higher in patients with esotropia. Conclusions: Single inferior oblique muscle-weakening procedures is effective in the vast majority of patients and the need for weakening the contralateral inferior oblique is low. Rapid improvement in motor development following surgery for infantile esotropia. James R. Drover, David R. Stager Sr., Sarah E. Morale, Joel N. Leffler, Eileen E. Birch Purpose: Infantile esotropia (ET ) influences visual development and thus may delay the achievement of developmental milestones. Fortunately, early muscle surgery can substantially improve visual functioning. Here we address whether surgery can also improve sensorimotor and gross motor development. Methods: Recently, our lab devised the Infant Developmental Skills Survey, a 25-item questionnaire designed to assess 10 sensorimotor and 15 gross motor skills. The questionnaire was completed by the parents of 3- to 10-month-old patients with infantile ET prior to surgery (N ⫽ 145) and the parents of 6to 11-month-old patients a median of 7.3 weeks following surgery (N ⫽ 68). A subset of parents completed the questionnaire for their children (N ⫽ 47) both before and after surgery. Patients with a diagnosis of developmental delay were excluded. The questionnaire was also completed by the parents of infants with normal ocular alignment (N ⫽ 194). Results were analyzed in 1-month age bins. Results: Before surgery, 4-, 5-, 6-, 7-, 9-, and 10-month-old patients showed delayed achievement of sensorimotor milestones ( p ⬍ 0.01) and 5-, 9-, and 10-month-old patients demonstrated delayed attainment of gross motor milestones ( p ⬍ 0.05) compared with normal children. However, following surgery, patients demonstrated a greater rate of sensorimotor development than age-matched normal children ( p ⬍ 0.00001) and caught up with normal children on both sensorimotor and gross motor skills. Conclusions: Prior to surgery, patients with infantile ET were delayed in their achievement of developmental milestones. However, following surgery, these patients showed rapid motor development and possessed motor skills comparable to those of normal children within a few months following months. Utility analysis of screening and laser therapy for retinopathy of prematurity. Jennifer A. Dunbar, Bradley A. Black, Marc Christensen, George R. Beauchamp, Pamela E. Williams Introduction: Retinopathy of prematurity (ROP) is an important cause of lifelong blindness. Utility analysis is used to describe the effect of illness and medical intervention on an individual’s quality of life over the course of a lifetime. Utility analysis has been applied to medical care for ROP in a variety of settings. In this study, utility analysis is used to evaluate the cost effectiveness of both screening and laser treatment for ROP. Methods: Infants screened and treated for ROP between March 2004 and January 2006 were recorded prospectively in a database. Utility analysis was conducted using the model of Brown et al. The cost model was developed using procedures classified by Current Procedural Terminology (CPT ) and the costs paid for by the Health Care Financing Agency for 2006. Results: During the study period, 228 infants received screening and treatment for