There should be no doubt in any physician's mind that governmental regulation, on the state and federal level, has a tremendous impact on how physicians practice and on the care that patients receive.

Purpose: To discuss major issues in the management of pediatric cataracts. Objectives and Synopsis: Pediatric cataract surgery continues to evolve. However, major issues persist: best method of optical correction, management of posterior capsule opacification (PCO), and aphakic glaucoma. Issues regarding myopic shift and unilateral cataract management will be presented with a balanced approach. Difficult patient cases with solutions developed by the panel will be presented.

T he following have served as reviewers. The Journal acknowledges their dedication and hard work. Thank you … Cynthia W. Avilla, CO Brian N. Bachynski, MD Neal P. Barney, MD J. Bronwyn Bateman, MD George R. Beauchamp, MD Nancy M. Benegas, MD Albert W. Biglan, MD Eileen E. Birch, PhD Don L. Bremer, MD Sandra M. Brown, MD Edward G. Buckley, MD J. Raymond Buncic, MD Werner Cadera, MD Hilda Capo, MD Melvin R. Carlson, MD Kenneth P. Cheng, MD Earl R. Crouch, Jr., MD Oscar A. Cruz, MD John S. Davis, MD Monte A. Del Monte, MD James Egbert, MD Forrest J. Ellis, MD FrederickJ. Elsas, MD John T. Flynn, MD Howard L. Freedman, MD Debby Giaschi, PhD Wilfiam V. Good, MD David L. Guyton, MD Dianne Heatley, MD Elise Heon, MD Richard W. Hertle, MD Creig S. Hoyt, MD David G. Hunter, MD, PhD Pascal Imesch, MD Christopher M. Inglese … Elbert H. Magoon, MD Lois J …

Patients with cranial base tumors often have impairment in visual function, either due to the pathologic process itself or as a result of surgical treatment of the lesion. We conducted a pilot study in which we performed ophthalmologic evaluations on patients before and after cranial base surgery. The results of the study were used to develop a protocol and reporting form for longitudinal assessment of visual function in these patients. Use of the protocol and reporting form for the past 2(1/2) years has shown that they are easy for physicians to use and that the results provide a representative evaluation of the patient's ability to function visually in everyday life. The authors propose implementation of the protocol and reporting form as a means of collecting data for further research into visual function in patients with cranial base tumors.

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21 % of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage. Ophthalmology 1991; 98:1744-1751

Two hundred and thirty-eight children, all but one with unilateral traumatic cataracts, were treated by our paediatric ophthalmology group between 1974 and 1988. One hundred and seventeen patients received IOLs, 86 received contact lenses, three received glasses, 14 had epikeratoplasties and 18 patients received no correction because of the marked reduction in vision following the initial trauma. Three designs of IOLs were implanted: 79 iris suture IOLs between 1974 and 1981, followed by 28 anterior chamber and 20 posterior chamber IOLs implemented between 1981 and 1988. The incidence of preoperative complications was 59%. Secondary operations were somewhat more frequent for IOL-containing eyes at 51%, but less than epikeratoplasty eyes at 79% and more than contact lens or glasses rehabilitated eyes at 41 and 33% respectively. Iris-supported IOLs required more secondary surgery, but these were often related to the occurrence of secondary membranes which were routinely opened at a second operation. The visual results were equal for patients receiving contact lens and IOLs even with a skewed case selection. Patients receiving primary IOLs had a better visual result than those patients receiving secondary IOLs because of time lost before the IOL was implanted and before amblyopia therapy was begun. Children over 8 years at the time of injury also achieved far better visual results because of the presence of visual maturity.