PURPOSE:To evaluate 5-year visual acuity (VA) outcomes by age at surgery and laterality among infants left aphakic at initial lensectomy. DESIGN:Prospective Pediatric Eye Disease Investigator Group cataract registry. PARTICIPANTS:A total of 149 infants (203 eyes; 123 with bilateral surgery) underwent surgery before 12 months of age (median, 1.8; range, 0.6-11.6 months) for nontraumatic cataract without preexisting glaucoma or anterior/posterior segment anomalies who were left aphakic. METHODS:Records were reviewed annually for 5 years after surgery. Children were grouped by age at first surgery (<2 months, 2 to <6 months, and 6 to <12 months). Analyses accounted for nonindependence of eye pairs. MAIN OUTCOME MEASURES:Mean VA and proportion of eyes with VA better than 20/200. RESULTS:Eighty-nine (60%) infants were female, 114 infants (77%) were White, 17 infants (11%) were Black, and 21 infants (14%) were Hispanic or Latino. In unilateral cases (N = 80), surgery before 2 months of age was associated with better mean VA at 5 years than with surgery between 2 and <6 months of age (0.79 vs 1.13 logarithm of the minimum angle of resolution [logMAR], difference = 0.34 [95% CI, 0.08-0.59], P = 0.01). In bilateral cases (N = 123), age at surgery was not associated with 5-year VA outcomes (P = 0.18). A larger proportion of bilaterally operated eyes had VA better than 20/200 compared with undergoing unilateral surgery before 2 months (87% vs 61%; difference = 26% [95% CI, 8%-43%]; P = 0.004) and 2 to <6 months of age (95% vs 23%; difference = 72% [95% CI, 55%-90%]; P < 0.001). CONCLUSIONS:For bilateral surgery in the first year of life, 5-year VA did not differ by age at surgery. However, for unilateral cataract, 5-year VA was better with surgery before 2 months of age compared with 2 to <6 months. These observations may inform surgical decision-making when treating a cataract in the first 2 months of life. Given the increased risk for glaucoma with early cataract surgery, the surgeon may choose a modest delay in the timing of surgery, accepting a decrease in the VA outcome for unilateral cases. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found after the references.

The American Academy of Ophthalmology (AAO) published the Adult Strabismus Preferred Practice Pattern(PPP) in September 2019.The PPP provides an authoritative guidance for the clinical diagnosis and treatment of adult strabismus based on the best clinical evidence.This PPP of version 2019 incorporates recent advances in the field of adult strabismus into the guide, and comprehensively describes and updates the definition, epidemiology, classification, diagnosis and treatment of adult strabismus.This article introduces and interprets the main content of the guide.

Oculomotor nerve schwannomas are rare benign cranial nerve tumors. There are only a limited number of reports on this pathology in the literature, and there are currently no established management guidelines that aid providers in deciding on surgical versus nonsurgical management. We assess the published literature on the topic to identify indications for treatment as well as outcome measures (e.g., local control rates, survival rates, and complication rates) that have been reported as associated with the various treatment modalities. We attempt to develop an algorithm for evaluation and treatment of oculomotor nerve schwannomas in order to establish consensus on how these tumors should be treated.(c) 2021 Elsevier Inc. All rights reserved.

Importance:Cataract is an important cause of visual impairment in children. Outcomes reported from a large clinical disease-specific registry can provide real-world estimates of visual outcomes and rates of adverse events in clinical practice.Objective:To describe visual acuity and refractive error outcomes, as well as rates of amblyopia, glaucoma, and additional eye surgery, during the first year after lensectomy in children.Design, Setting, and Participants:A prospective observational study was conducted from June 18, 2012, to July 8, 2015, at 61 pediatric eye care practices among 880 children younger than 13 years at the time of lensectomy in at least 1 eye with follow-up within 15 months after surgery. Statistical analysis was performed from December 12, 2016, to December 14, 2018.Exposures:Lensectomy with or without implantation of an intraocular lens.Main Outcomes and Measures:Visual acuity as well as rates of amblyopia, glaucoma, suspected glaucoma, and other intraocular surgery.Results:Among the 880 children (432 girls and 448 boys; mean [SD] age at annual follow-up, 4.9 [3.8] years) in the study, lens surgery was bilateral in 362 (41.1%; 95% CI, 37.9%-44.4%) children and unilateral in 518 (58.9%; 95% CI, 55.6%-62.1%). An intraocular lens was implanted in 654 of 1132 eyes (60.2%; 95% CI, 57.0%-63.4% [proportions reported for eye-level outcomes account for the potential correlation induced by enrolling both eyes of some individuals; for participants who received bilateral surgery, these numbers will differ from the quotient of the number of cases divided by the total sample size]). Amblyopia was identified in 449 children (51.0%; 95% CI, 47.7%-54.3%). In children age 3 years or older, mean visual acuity was 0.30 logMAR (about 20/40) in 153 bilateral pseudophakic eyes, 0.49 logMAR (about 20/63) in 141 unilateral pseudophakic eyes, 0.47 logMAR (about 20/63) in 21 bilateral aphakic eyes, and 0.61 logMAR (about 20/80) in 17 unilateral aphakic eyes. Mean visual acuity improved with older age at surgery in eyes with bilateral pseudophakia by 0.2 logMAR line (99% CI, 0.02-0.4; P = .005) and by 0.3 logMAR line (99% CI, 0.04-0.60; P = .004) in eyes with unilateral pseudophakia. A new diagnosis of glaucoma or suspected glaucoma was made in 67 of 1064 eyes that did not have glaucoma prior to lensectomy (5.9%; 95% CI, 4.6%-7.7%); 36 of 273 eyes with bilateral aphakia (13.2%; 95% CI, 9.0%-19.0%), 5 of 308 eyes with bilateral pseudophakia (1.5%; 95% CI, 0.6%-4.2%), 14 of 178 eyes with unilateral aphakia (7.9%; 95% CI, 4.7%-12.8%), and 12 of 305 eyes with unilateral pseudophakia (3.9%; 95% CI, 2.2%-6.8%). Additional intraocular surgery, most commonly vitrectomy or membranectomy to clear the visual axis, was performed in 189 of 1132 eyes (17.0%; 95% CI, 14.8%-19.6%).Conclusions and Relevance:Amblyopia was frequently observed during the first year after lensectomy in this cohort of children younger than 13 years. For children age 2 years or older at surgery visual acuity was typically less than normal for age and was worse with unilateral cataract. Management of visual axis obscuration was the most common complication requiring surgical intervention during the first year after surgery.

Orbital reconstruction following injury can be challenging. Recently the use of 3D printing to model the orbit has aided in understand the extent of the damage and planning repair. However these models can be costly. Low-cost printers are now becoming available and their efficacy is being demonstrated in the adult population. We report our experience using this technology in pediatric orbital rim and floor fractures.

Several dichoptic strategies reveal promising therapeutic results but require expensive equipment. Other low-cost dichoptic therapies do not improve stereoacuity[3]. This study demonstrates rapid recovery of stereoacuity and central fusion in amblyopic children who viewed modified “Clifford the Big Red Dog” cartoons at home for 4 weeks.

Reestablishment of ocular alignment following scleral buckle is fraught with difficulty and limited literature. The primary etiology of the deviation is thought to be secondary to scarring of the extraocular muscles and restrictive in nature. We report our experience in the surgical management of these patients.