Phakic anterior chamber intraocular lens (Verisyse™) implantation in children for treatment of severe ansiometropia myopia and amblyopia: Six-month pilot clincial trial and review of literature

Amir Pirouzian1,3, Kenneth C Ip2, Henry S O’Halloran31The Permanente Medical Group, Santa Clara, CA, USA; 2The Permanente Medical Group, San Francisco, CA, USA; 3Rady’s Children’s Hospital of San Diego, San Diego, CA, USAPurpose: The current study aims to evaluate both safety and efficacy of Verisyse™ (AMO, Irvine, CA) phakic anterior chamber intraocular lens (IOL) in the reduction of clinically significant (>-8 D) myopic anisometropia in children who are noncompliant to traditional medical treatment including spectacle correction or contact lenses.Design: Retrospective interventional case series.Methods: Six anisometropic myopic pediatric patients in one practice were identified through chart-review. None of the patients were compliant with specatacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity (mean <20/400). All patients underwent Verisyse™ phakic IOL implantation in the more myopic eye by one surgeon (AP). Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible.Results: The age of patients ranged from 5–11 years. The mean post-operative follow-up time was six months from the time of IOL insertion. Improvement in visual acuity >6 lines was achieved in four patients (mean visual acuity of 20/70 at six months). Improvement in stereoacuity was noted in all six patients (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by randot stereoacuity testing). Improvement of >2 lines of visual acuity lines was achieved in the other two patients. No patient lost any lines of visual acuity. Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. No intra/post-operative complications were noted.Discussion: Irreversible or intractable amblyopia secondary to severe anisometropic myopia is a serious medical concern in the pediatric population. Failure of compliance with contact lens therapy consistently leads to visual loss. Anterior chamber phakic IOLs may provide a safe alternative in treatment of noncompliant anisometropic myopic patients who do not accept spectacle wear or contact lens therapy.Conclusion: To reduce or eliminate highly significant anisometropic myopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation may be considered as an alternative modality of treatment. Keywords: amblyopia, anisometropia, myopia, intraocular lens implan

Femtosecond Assisted Deep Lamellar Keratoplasty in a 4½ Year Old Child for Traumatic and Infectious Corneal scar- A Case Report

Purpose: To report a case of central deep corneal scar secondary to trauma and subsequently resolved fungal infection in a 4½ year old and secondary amblyopia treated with femtosecond-assisted deep lamellar keratoplasty (FALK).Methods: A 4½ year old male patient with reduced vision and photophobia as a result of a centrally dense mid-stromal corneal scar in the right eye was referred to Gavin Herbert Eye Institute, University of California, Irvine, by an out of state ophthalmologist for consideration of femtosecondassisted laser lamellar keratoplasty. Following a complete ocular examination, FALK was performed under general anesthesia.Results: The original non-perforating cornea trauma had occurred 10-months previously while the child had accidentally run into a branch of a tree, penetrating the right central cornea and resulting in Aspergillus corneal infection. The penetrating cornea injury was repaired and the ensuing infection was treated with a course of topical antifungal medications. After resolution of the infection, a deep and dense mid-stromal scar, obstructing visual axis, had developed. Irregular astigmatism and secondary amblyopia were present. The zigzag pattern FALK using IntralaseTM laser (AMO, Santa Ana, CA) for both donor and recipient cuts was performed.Conclusions: This is the first case report of traumatic central corneal scar from trauma and infection resulting in amblyopia, which was successfully treated with zigzag-shaped femtosecond assisted laser lamellar keratoplasty in a young child.&nbsp;</p

Retinoblastoma (RB) in Saudi Arabia- Retrospective Comparative Review of a Registry

Purpose: Published data regarding retinoblastoma in Saudi Arabia (KSA) is sparse. The study will present comparison of clinical and pathologic features, and evolving patterns of the treatment during 1983-1997 (Early group=EG) to 1998-2012 (Late group=LG) periods from an RB registry representing all Rb cases in KSA.&nbsp;Methods: This health record review was conducted in 2014. From the RB registry, information about&nbsp; gender, age, clinical features and stage at presentation; laterality, regional distribution, history, co-morbid diseases, pathologic features, surgical treatment modality and treatment outcomes were collected.Results: The EG and LG group had 343 and 430 Rb patients respectively. The incidence of Rb in 1997 and in 2012 was 0.06 and 0.03 per 1,000 live births in Saudi Arabia respectively. The gender distribution was similar. The median age of presentation was 24 (range 11, 39) months in EG vs. 18 (8, 31) months in LG (p &lt;0.001). Incidence of unilateral Rb was 58% [200/343] in EG vs. 56% [278/485] in LG. Positive family history of Rb was &lt;10% in both groups. However, in EG, 120 (35%) parents were first cousins vs. 124 (27%) in the LG (p=0.12). Leukocoria was the most common presentation [71% (n=255) in EG and 66% (n=343) in LG]. Tumor confined to the eye at presentation was more common in the LG group (67% EG vs. 84% LG). Vitreous seeding was more common in LG [62% (n=302) LG vs 45% (n=156) EG; p&lt;0.001]. In the non-surgical group, photocoagulation rate increased in the LG [23.19% (106) LG vs 3.8 %( n=13) EG; p&lt;0.001]. The rate of chemotherapy increased from 4.1% (n= 14) in EG to 14.2% (n=65) in LG (p &lt;0.001). The rate of external beam radiation decreased [37% (n=125) EG vs. 23.4% (n=107) LG]. The rate of extraocular tumor extension was similar in both groups (53.7% EG vs. 51.6% LG; p&lt;0.001). The rate of full thickness choroidal involvement decreased from 13% (n=35) EG to 7.7 % (n=30) LG, (p =0.04). Optic nerve (ON) involvement in LG decreased to 3.4% (n=22) compared to 9.8 %( n=48) in EG (p &lt;0.001).&nbsp;Conclusions: Most clinical parameters of Rb remained unchanged over 30 years except an earlier median age of presentation suggesting earlier tumor detection. However, an increasing total number of Rb cases were seen in the last fifteen years. The pathologic features in LG were less advanced. A significant increase in the non-surgical treatment approaches of Rb was noted in the last 15 years.</p

Clinical findings following Ahmed Glaucoma Valve&amp;trade; implantation in pediatric glaucoma

Amir Pirouzian1, Joseph L Demer21Department of Ophthalmology, San Diego Children&amp;rsquo;s Hospital, San Diego, UCSD, San Diego, CA, USA; 2Department of Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USAPurpose: To describe clinical findings after Ahmed valve drainage implantation in children.Design: All records in one practice were reviewed to identify and describe clinical findings in all children who had undergone Ahmed Glaucoma ValveTM S2 model insertion for uncontrolled primary or secondary glaucoma.Results: A total of 6 patients were identified, ranging in age from 2&amp;ndash;15 years. Mean follow-up time averaged from 2&amp;ndash;5 years from the time of tube insertion. Three patients exhibited pupillary peaking towards the tube of the valve. All patients required additional surgery or additional medications to control intraocular pressure. Lenticular opacification near the tube site developed in one patient. Gradual tube extrusion was also noted in another two patients.Conclusion: Multiple clinical events follow the Ahmed valve insertion in children. Pupillary irregularity is the most commonly noted event in this series. To avoid or reduce the risk of this complication, additional or modification of surgical procedures could be considered. The mechanism of such occurrence will further be discussed.Keywords: Ahmed Glaucoma Valve, children, pediatric glaucom