Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint.

Purpose: Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients' reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management.

Rehabilitation of the Severely Visually Impaired and the Blind in a Developing Country.

Blind individuals whether from birth or after being sighted for different periods of their lives constitute about 1% of the Nigerian population. These are individuals who can meaningfully contribute to the growth and development of society if properly guided. However, the traditional way of thinking within the society they find themselves in contributes to their lack of productivity.

Review of effects of anti-VEGF treatment on refractive error.

To examine the effect of anti-vascular endothelial growth factor (anti-VEGF) agents on refractive error in the setting of retinopathy of prematurity (ROP) through a review of the literature, a PubMed search was performed of appropriate search terms, and the results of all relevant studies were extracted and compiled. Eleven relevant articles were identified in the literature, totaling 466 eyes, treated with varied anti-VEGF agents (bevacizumab, ranibizumab, and aflibercept) with mean spherical equivalent refractions ranging from +0.75 D to -3.

Orbital Infarction due to Sickle Cell Disease without Orbital Pain.

Sickle cell disease is a hemoglobinopathy that results in paroxysmal arteriolar occlusion and tissue infarction that can manifest in a plurality of tissues. Rarely, these infarcted crises manifest in the bony orbit. Orbital infarction usually presents with acute onset of periorbital tenderness, swelling, erythema, and pain.

Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy.

Purpose: To determine incidence, risk factors, risk period, and characteristics of recurrent retinopathy of prematurity (ROP) treated by intravitreal bevacizumab (IVB) monotherapy.

Design: Retrospective case series.

Participants: Premature infants with type 1 ROP (subdivided into stage 3+ ROP and aggressive posterior ROP [APROP]) in zone I or zone II posterior who received IVB monotherapy and were followed up for at least 65 weeks adjusted age (AA).

Risk factors associated with retinal hemorrhage in suspected abusive head trauma.

Purpose: To determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects.

Methods: Records of children aged 0-3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case-control study. Children were classified into case and control groups based on RH presence.

Malaria retinopathy and cerebellitis in a 9-year-old boy in the United States.

Malarial retinopathy is characterized by retinal whitening, vessel change, and hemorrhages usually associated with a white center. We present the case of a 9-year-old boy who presented with a systemic Plasmodium falciparum infection, hemorrhagic cerebellitis and malarial retinopathy characterized by "fire flare" hemorrhages (scleral icterus with subconjunctival hemorrhages), Roth spot-like hemorrhages, and subhyaloid hemorrhage. To our knowledge, this is the first reported case of hemorrhagic cerebellitis secondary to P.

The light-flash-evoked response as a possible indicator of increased intracranial pressure in hydrocephalus.

Surgical treatment of infantile hydrocephalus by shunt implantation may result in suboptimal intracranial pressure. Major neurological impairments and death are usually prevented by shunt treatment, but minor sequelae may persist or develop. The introduction of adjustable shunts has improved the possibilities of optimizing shunt function and minimizing the risk of such impairments.

Binocular field expansion in adults after surgery for esotropia.

Objectives: To determine how frequently adults with long-standing esotropia will experience an expansion of their binocular visual field after surgical correction of their strabismus and to determine if the postoperative expansion of binocular fields in esotropic adults correlates with the type of esotropia (infantile vs acquired), duration of the deviation, visual acuity in the deviating eye, or a history of satisfactory alignment in early childhood.

Design: Preoperative and postoperative binocular visual fields were measured in a consecutive series of 37 adults undergoing surgery for esotropia. The fields were obtained and graded by masked observers.

Factors influencing response to strabismus surgery.

Based on analyses in a series of 116 patients, we found that the response to strabismus surgery (degrees of change of ocular alignment per millimeter of rectus recession) correlated significantly with the preoperative deviation for esotropic and exotropic patients. The prediction of response to strabismus surgery was not improved significantly with the inclusion of axial length, age, and/or preoperative refractive error beyond the prediction provided with use of only the preoperative deviation, even though we have previously suggested that the response to strabismus surgery should be related to axial length. We believed that larger eyes should have a smaller response for the same number of millimeters of surgery than smaller eyes.

'V' esotropia and excyclotropia after surgery for bilateral fourth nerve palsy.

Six patients had residual diplopia at near in the downgaze position after surgery for bilateral fourth nerve palsy. They all showed a large excyclotropia in the downgaze position that was associated with a "V"-pattern esotropia and could not fuse in the reading position because of the size of the excyclotropia. They were treated with bilateral recessions of the inferior recti, which resulted in an expansion of the single binocular field of vision in downgaze, with an elimination of diplopia in the reading position.

Unexpected cyclotropia simulating disruption of fusion.

Fifteen patients with diplopia associated with prior scleral buckling, prior penetrating keratoplasty, severe corneal scarring, monocular aphakia, long-standing strabismus, or prior vertical offsets of the horizontal recti were thought to have disruption of fusion because diplopia could not be eliminated with prisms. They were each found to have a substantial symptomatic cyclotropia unassociated with an obvious dysfunction of an oblique muscle. In 13 patients, diplopia resolved after the cyclotropia was corrected surgically.

A surgical procedure to minimize lower-eyelid retraction with inferior rectus recession.

Advancement of the capsulopalpebral head at the time of inferior rectus recession has been described as a technique to minimize postoperative lower-eyelid retraction. In a prospective randomized masked clinical trial, this technique combined with inferior rectus recession was compared with inferior rectus recession alone, with respect to post-operative lower-eyelid retraction. The mean (+/- SD) postoperative lower-eyelid retraction was 0.

Postoperative binocularity in adults with longstanding strabismus.

The authors tested preoperatively and postoperatively for binocularity with the Bagolini lenses in a series of 359 adults who underwent surgery for long-standing constant strabismus. Eighty-six percent of patients showed a binocular response with the Bagolini lens test almost immediately after surgery. Regardless of the type of deviation present preoperatively, the duration of strabismus, or the depth of amblyopia in the deviating eye (if present), the vast majority of patients developed binocularity.

Pseudo inferior oblique overaction associated with Y and V patterns.

Nine patients with Y or V patterns are presented. All patients had an eye movement pattern that resembled but was distinctly different from bilateral inferior oblique overaction. Despite marked abduction of either eye when it elevated in adduction, no patient had elevation of the adducting eye on direct side gaze, superior oblique underaction, a forced head tilt difference, or torsion.

Errors in the three-step test in the diagnosis of vertical strabismus.

The Parks three-step test is the standard for diagnosing which isolated cyclovertical muscle is palsied. It does not, however, tell the examiner if in fact one is dealing with a palsy of one cyclovertical muscle. Numerous other causes of vertical strabismus may have a positive Bielschowsky head tilt test.

The diagnosis and treatment of bilateral masked superior oblique palsy.

I reviewed retrospectively the records of 147 consecutive patients who had superior oblique palsy. Of the 147 patients, 28 had bilateral superior oblique palsies, and in nine of the 28 the involvement was so asymmetric that the palsy in the lesser affected eye was either completely masked or almost masked preoperatively. Relying on preoperative diagnostic criteria such as the presence of bilateral objective torsion, cover testing in the oblique fields of gaze, size of the subjective cyclotropia, amount of the "V" shift, and subjective symptoms, all nine patients underwent bilateral surgery at the time of their initial operation and obtained satisfactory results.

Low-contrast visual acuity cards in pediatric ophthalmology.

The usual high-contrast visual acuity chart is well known as the best indicator of central visual function. It has the limitation of only testing the high frequency, high-contrast sensitive cells in the visual system. Some conditions demonstrate a normal response on the standard visual acuity test, but abnormal results when testing visual fields or contrast-sensitivity function (CSF).

Successful treatment of functional amblyopia associated with juvenile glaucoma.

Twelve patients with either unilateral or bilateral juvenile glaucoma underwent standard amblyopia management for the treatment of suspected functional amblyopia secondary to their glaucoma. Despite the presence of glaucomatous cupping or corneal changes, the amblyopia therapy was successful in ten patients.

Persistent accommodative spasm nine years after head trauma.

Spasm of the near reflex is most often seen on a functional basis in young adults with underlying emotional problems. In particular, when convergence spasm is associated with miosis on attempted lateral gaze, a functional basis for the disorder should be suspected. Patients who experience spasm of the near reflex following trauma commonly follow a benign course with spontaneous resolution of their ocular complaints within 1-2 years.

Eye testing in children.

Tests that the pediatrician can perform include vision testing, external examination, motility tests, and funduscopic examination; more complete evaluations as described are in the province of the ophthalmologist.