Complicated strabismus frequently requires multiple surgeries to improve ocular alignment, double vision and anomalous face posture.

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.

The authors will investigate the literature for articles of interest to the sub-specialty of pediatric ophthalmology and strabismus for the time period March 2014-February 2015. Ophthalmic journals are stressed but journals from other specialties such as pediatrics, neurology, and comprehensive medicine will be included. The authors will summarize the key findings in the major topics including, but not limited to, vision screening, amblyopia, neuro-ophthalmology, retinopathy of prematurity, strabismus, cataract, glaucoma, genetics, retina, orbit, uveitis and practice management. The presentations in these topic areas will summarize and emphasize second-order analyses of the material.

This Workshop consists of a set of didactic presentations from members of the AAPOS Research Committee. The goal is to help attendees identify key issues related to the selection of a research topic and design of a research study.

BACKGROUND:Very little is known about the prevalence, antecedents, and correlates of impaired visual fixation in former very preterm newborns.METHODS:In the multicenter ELGAN study sample of 1057 infants born before the twenty-eighth week of gestation who had a developmental assessment at 2 years corrected age, we identified 73 who were unable to follow an object across the midline. We compared them to the 984 infants who could follow an object across the midline.RESULTS:In this sample of very preterm newborns, those who had impaired visual fixation were much more likely than those without impaired visual fixation to have been born after the shortest of gestations (odds ratio, 3.2; 99% confidence interval, 1.4-7.5) and exposed to maternal aspirin (odds ratio, 5.2; 99% confidence interval, 2.2-12). They were also more likely than their peers to have had prethreshold retinopathy of prematurity (odds ratio, 4.1; 99% confidence interval, 1.8-9.0). At age 2 years, the children with impaired fixation were more likely than others to be unable to walk (even with assistance) (odds ratio, 7.5; 99% confidence interval, 2.2-26) and have a Mental Development Index more than three standard deviations below the mean of a normative sample (odds ratio, 3.6; 99% confidence interval, 1.4-8.2).CONCLUSION:Risk factors for brain and retinal damages, such as very low gestational age, appear to be risk factors for impaired visual fixation. This inference is further supported by the co-occurrence at age 2 years of impaired visual fixation, inability to walk, and a very low Mental Development Index.

PURPOSE:To explain why very preterm newborns who develop retinopathy of prematurity (ROP) appear to be at increased risk of abnormalities of both brain structure and function.METHODS:A total of 1,085 children born at <28 weeks' gestation had clinically indicated retinal examinations and had a developmental assessment at 2 years corrected age. Relationships between ROP categories and brain abnormalities were explored using logistic regression models with adjustment for potential confounders.RESULTS:The 173 children who had severe ROP, defined as prethreshold ROP (n = 146) or worse (n = 27) were somewhat more likely than their peers without ROP to have brain ultrasound lesions or cerebral palsy. They were approximately twice as likely to have very low Bayley Scales scores. After adjusting for risk factors common to both ROP and brain disorders, infants who developed severe ROP were at increased risk of low Bayley Scales only. Among children with prethreshold ROP, exposure to anesthesia was not associated with low Bayley Scales.CONCLUSIONS:Some but not all of the association of ROP with brain disorders can be explained by common risk factors. Most of the increased risks of very low Bayley Scales associated with ROP are probably not a consequence of exposure to anesthetic agents.

The authors will survey the oOphthalmic literature for articles of interest to the subspecialty of Pediatric Ophthalmology and Strabismus. The authors will summarize the key findings in the major topics, including, but not limited to, amblyopia, neuro-ophthalmology, rop, strabismus and surgery, cataracts , glaucoma, genetics. retina, orbit and oculoplastics. the presentations on these topics will summarize and emphasize second-order analyses of the material.

margins and preserve healthy tissues; however, owing to the propensity for skip lesions (intraepithelial neoplasia) in sebaceous carcinoma, microscopic intraepithelial neoplasia may be present even with negative margins and may lead to local recurrences.It is interesting that our patient developed a late regional nodal metastasis without any evidence of local recurrence.One plausible explanation is that the primary sebaceous carcinoma in the caruncle was a very low-grade, slow-growing carcinoma that gained access to the lymphatic channels at the time of original diagnosis and before surgical removal of the ocular tumor and, because of its slow-growing nature, it took 11 years for the nodal metastasis to reach a size to be detectable on palpation by the patient.Typical follow-up for a patient with periocular sebaceous carcinoma includes serial examination of the ocular surgical site, palpation of the regional lymph nodes, and imaging (eg, ultrasonography or computed tomography) of the regional lymph nodes for 5 years after resection of the primary tumor.Although it is unrealistic, on the basis of this single case, to recommend surveillance of patients with periocular sebaceous carcinoma beyond 5 years, it is important for clinicians and patients to be aware of the potential for late nodal metastasis of sebaceous carcinoma beyond the initial 5 years after diagnosis and treatment of the ocular tumor.Patients with ocular and periocular sebaceous carcinoma should be educated regarding the possible but rare incidence of late relapse in the regional lymph nodes and the location of lymph nodes at risk in the parotid and submandibular regions.

PURPOSE:To describe the surgical technique for a novel poly-HEMA (2-hydroxyethyl methacralate)[PHEMA] implant (Alphasphere, Addition Technology, Des Plaines, IL) in primary enucleation and placement of secondary orbital implant.METHODS:Retrospective chart review of all patients receiving an Alphasphere implant for primary enucleation or secondary implant exchange from October 2009 to 2011. Interval follow-up was performed again on January 2013. Patient demographics, indications for surgery, and post-operative complications were reviewed.RESULTS:Twelve patients received an Alphasphere implant for primary enucleation (n = 10) or secondary exchange (n = 2), with follow-up that ranged from 2 weeks to 14 months. The study included 9 adult and 3 pediatric patients with a mean age of 40 years, range 8-82 years. The indication for enucleation included: painful blind eye (n = 9), enophthalmos with difficult prosthesis fit in cases of secondary implant exchange (n = 2), and prophylaxis for sympathetic ophthalmia (n = 1). Only one patient required removal of the implant, due to a sinus infection with subsequent extrusion of the implant. Otherwise, the only other complication experienced was slight implant migration (n = 1).CONCLUSION:This initial report indicates that Alphasphere can be successfully used in the management of an anophthalmic socket. The advantages of the Alphasphere implant include: it does not require tissue wrapping, extraocular muscles can be directly sutured to the implant, it maintains a smooth surface to limit risk of exposure due to conjunctival breakdown, and undergoes anterior orbital fibrovascular ingrowth which optimizes prosthesis location and socket motility.

We report a patient with clinical anophthalmia, partial eyelid fusion and a hypoplastic socket on the right. The left eye has microphthalmia involving the anterior and posterior segments, microcornea, iris coloboma, chorioretinal dysgenesis, macular dysplasia, absence of retinal vessels, and optic nerve aplasia. Systemic abnormalities include microcephaly, bilateral hearing loss, and duodenal atresia. Electrophysiologic testing showed no response from either eye. Cytogenetic testing revealed a de novo interstitial deletion of chromosome 14q22.3q23.1. The literature of similar interstitial deletions and ongoing candidate gene studies are reviewed.

This Workshop consists of a series of didactic presentations from members of the AAPOS Research Committee and is designed to provide attendees with tools to improve ability for assessing evidence presented in clinical reports.

Good practice management skills are necessary to maintain an efficient practice and provide long-standing and quality patient care. This symposium will cover the following practice management topics: 1.An overview of basic practice financials for the pediatric ophthalmology practice 2.Reducing denied claims and write-offs 3.Optical dispensing for the pediatric practice 4.ROP contracting 5.Managing optometrists as physician extenders in your practice 6.Electronic medical records within the pediatric ophthalmology office 7.Insurance contract negotiations 8.Reducing no-show rates

Introduction: Conjunctival neoplasms in children are rare. Methods: A 13-year-old white female presented with a benign-appearing neoplasm of the medial conjuctiva of the left eye. A 3-week course of topical steroid resulted in no clinical improvement. The child was scheduled for conjunctival excision and biopsy. Results: Conjunctival biopsy revealed the presence of malignant melanoma with minimal pigmentation. Further treatment included wide excision with cryotherapy and sentinel node biopsy. Two-year follow-up has revealed no occurrence. Discussion: Benign-appearing lesions may not be benign. Conclusions: Conjunctival lesions that do not respond to anti-inflammatory treatment should be considered for wide excision biopsy. Malignant conjunctival lesions should be treated with cryotherapy and sentinel node biopsy to rule out metastatic disease.

We report on a patient with ocular-ectodermal syndrome who was previously described in 1993 [Am J Med Genet (1993) 45:764-766]. This boy has now developed additional manifestations, including giant cell granulomas and non-ossifying fibromas. This adds to the list of phenotypic manifestations of this condition.

Background: Spontaneous resolution of traumatic sixth nerve palsy or paresis has been reported to range between 12% and 54%. However, previous studies have been based in tertiary referral centers, have been retrospective in nature, have included a heterogeneous group of patients, and have included patients with long-standing palsies. To provide a more accurate estimate of the true recovery rate, we performed a prospective natural history study. Methods: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis between March 1996–February 1997. Recovery at 6 months after injury was defined as absence of diplopia in primary position and less than or equal to 10 PD distance esotropia in primary position. Patients who had been treated with botulinum toxin (n = 8) within 6 months after injury and patients with <6 months of follow-up (n = 3) were excluded. Results: Thirty-three eligible patients were enrolled by 27 investigators. Twenty-five (76%) of the palsies were unilateral and 8 (24%) were bilateral. The overall spontaneous recovery rate was higher than previously reported (73%, 95% Cl 54%–87%). Spontaneous recovery was more frequent in unilateral cases (84%, 95% Cl 64%–95%) than in bilateral cases (38%, Cl 9%–76%; P = .02). Conclusions: In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, the overall spontaneous recovery rate, particularly in unilateral cases, was much higher than previously reported. Our results have important sample size implications for the planning of any randomized treatment trial and may help guide early treatment decisions.

We describe an apparently new syndrome in 2 unrelated boys with aplasia cutis congenita, epibulbar dermoids, postnatally appearing areas of truncal hyperpigmentation, and macrocephaly. © 1993 Wiley-Liss, Inc.