Refractive Rehabilitation - Chapter 69

Refractive rehabilitation is a critical aspect of visual rehabilitation following ophthalmic surgery. This is especially important in pediatric patients, as appropriate refractive correction is an essential aspect of optimal visual development. The standard of care to assess refractive errors in children is cycloplegic refraction. Depending on the refractive error present and status of ocular anatomy following ocular surgery, different techniques and options are available to provide appropriate refractive correction and optimize visual acuity and development

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

Optic nerve head elevation may be the only clinical sign of a vision- and/or life-threatening condition, particularly in children who are asymptomatic or fail to report symptoms. The purpose of this study is to identify epidemiologic trends, clinical characteristics, and diagnostic outcomes of pediatric patients presenting to an ophthalmology emergency department (ED) with suspected optic nerve head elevation. This retrospective study identified pediatric patients (≤18 years) presenting to an ophthalmology ED over a five- year period with suspected optic nerve head elevation to describe demographic trends, clinical characteristics, and diagnostic outcomes. Of the 213 patients, the majority were female (73.2%) and tended to be older than males (14.3 vs 11.2 years, p12 years old were more likely to have an abnormal MRI than males and children ≤ 12 (OR=1.56 and 1.22, respectively). Patient demographics such as age and sex in conjunction with concurrent symptoms are important factors in determining the urgency of neuroimaging in children with suspected optic nerve head elevation

Combination of anterior segment optical coherence tomography modalities to improve accuracy of rectus muscle insertion location

Anterior segment optical coherence tomography (AS-OCT) is useful for locating the extraocular muscle insertion prior to strabismus surgeryhowever, its accuracy decreases in reoperations. This masked retrospective study investigated whether a combination of AS-OCT modalities improves accuracy. The distance between the corneoscleral limbus and extraocular muscle insertion was measured with AS-OCT, first using the standard grayscale modality alone and then refined with the color modality. The AS-OCT measurement was considered accurate when within 1.00 mm of the intraoperative caliper measurement. A total of 139 AS-OCT images were analyzed from 74 patients (mean age, 52 years), including 60 medial rectus (19 reoperations), 61 lateral rectus (11 reoperations), 10 superior rectus, and 8 inferior rectus muscles. Compared to grayscale alone, the combination grayscale/color modalities improved AS-OCT accuracy from 77% to 87% (P = 0.03), reflecting an increase from 83% to 94% (P = 0.01) in primary surgeries and from 53% to 60% (P = 0.60) in reoperations.Univ Miami, Miller Sch Med, Bascom Palmer Eye Inst, Dept Ophthalmol, Miami, FL 33136 USAUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilWeb of Scienc

Characteristics of diplopia in a pediatric population

To evaluate the characteristics of diplopia in children at a single tertiary eye care center. The medical records of patients with diplopia onset at age 18 years or younger presenting during the period 2015-2018 were reviewed retrospectively. Demographic information, clinical characteristics, diagnoses, treatment, and outcome data were collected. The exact χ test was used to compare groups and select post hoc analyses were performed using the Fisher exact or exact χ tests. A total of 244 patients (average age, 12.2 years at presentation) were included. The most common clinical diagnoses were nonparalytic strabismus (49.2%), trauma (9.4%), and cranial nerve palsies (9%). There was no statistically significant difference in median age of diplopia onset in those with nonparalytic strabismus, cranial nerve palsies, and vision- or life-threatening conditions. There was a statistically significant difference in timing of onset of diplopia at presentation in vision- or life-threatening conditions compared to nonparalytic strabismus (P < 0.0001) and cranial nerve palsies (P = 0.01) and for neurologic symptoms in vision- or life- threatening conditions compared to nonparalytic strabismus (P = 0.032) and cranial nerve palsies (P = 0.0051). In patients with more than one neurologic symptom, the majority (58.3%) had a vision- or life-threatening condition. Initial interventions included observation (28.7%), prisms (18.4%), updating refractive correction (14.3%), and strabismus surgery (11.1%). In patients with follow-up data, 5.3% had resolution of diplopia prior to their clinic visit, and 46.6% had resolution after initial intervention. In our study cohort, most children who presented with diplopia had nonemergent conditions. In those with life-threatening conditions, diplopia tended to have an acute onset and associated neurologic signs and visual symptoms

Oral acetazolamide as a medical adjuvant to retinal surgery in optic disc pit maculopathy in a pediatric patient

To describe a novel combination of surgical and medical management for the treatment of optic disc pit maculopathy. A 12-year-old obese girl with bilateral optic disc pits presented with decreased vision in the left eye (20/400). On dilated fundus examination, she was found to have a macula-involving serous retinal detachment. Pars plana vitrectomy, posterior hyaloid peel, internal limiting membrane peel, fluid-air exchange, temporal juxtapapillary endolaser, and C F tamponade were performed. Postoperatively, there was persistence of subretinal fluid, so oral acetazolamide and a weight loss regimen were started. After 3 months of medical treatment, the subretinal fluid decreased significantly and visual acuity improved to 20/60. Currently, the mechanisms leading to optic disc pit maculopathy remain a topic of debate. As optic disc pits may provide a conduit between the subarachnoid and subretinal spaces, the reduction of intracranial pressure with the use of systemic carbonic anhydrase inhibitors may play a role in decreasing the subretinal fluid associated with select cases of optic disc pit maculopathy