Assessment of torsion after superior rectus transposition with or without medial rectus recession for Duane syndrome and abducens nerve palsy
BACKGROUND:Superior rectus transposition with or without medial rectus recession has been advocated for the treatment of abducens nerve palsy and esotropic Duane syndrome. Early reports have focused mainly on postoperative ocular alignment, but there is concern that superior rectus transposition may induce torsional misalignment. The purpose of this study was to evaluate torsional outcomes after superior rectus transposition surgery using prospective preoperative and postoperative torsional assessments. METHODS:Prospective measurements were performed on all patients undergoing superior rectus transposition. Preverbal infants were assessed using fundus torsion evaluating the position of the fovea relative to the optic nerve; older children/adults underwent double Maddox rod (DMR) assessment of torsion. RESULTS:A total of 11 subjects met the study inclusion criteria. The etiology of strabismus was an abducens nerve palsy (n = 7) or Duane syndrome (n = 4). For the subjects evaluated by fundus torsion (n = 4), there was no significant change in torsion for 3 (75%). For those subjects undergoing DMR (n = 7), there was a significant change in subjective torsion (4.7 Â± 3.8Â°excyclotorsion vs 0.0Â° Â± 5.0Â° excyclotorsion; P = 0.004). Esotropic deviation improved significantly for all subjects (39(Î”) Â± 23(Î”) vs 6.5(Î”) Â± 13(Î”); P = 0.001) and no significant mean vertical deviation postoperatively, although 1 patient had a clinically significant postoperative hypertropia measuring 14(Î”). Abduction also improved significantly (-4.2 Â± 0.9 vs -2.8 Â± 1, P = 0.0001). CONCLUSIONS:In this patient series, superior rectus transposition with medial rectus recession did not have clinically significant induction of torsional diplopia as a result of the procedure.
Visual Outcomes in Pediatric Open Globe Trauma with Early Amblyopia Therapy
Bilateral traumatic expulsive aniridia after phacoemulsification [Case Report]
We report a case of bilateral traumatic expulsive aniridia after uneventful phacoemulsification through small clear corneal incisions. Phacoemulsification was performed 8 and 13 months prior to the trauma in the left and right eyes, respectively. In both eyes, the intraocular lens and capsular bag were undisturbed after trauma. After resolution of hyphema, transient elevated intraocular pressure, and anterior chamber inflammation, best corrected visual acuity returned to 20/25 in each eye 6 months later. Self-sealing clear corneal wounds likely serve as a decompression valve during blunt trauma, thus preventing devastating intraocular damage and globe rupture. The intraocular lens may absorb the external force, therefore preventing damage to the capsular bag and zonules as well as preventing prolapse of posterior structures. A review of previously reported cases of traumatic aniridia is also presented.
Impact of resident participation in cataract surgery on operative time and cost
OBJECTIVE:To investigate the impact of resident participation in cataract surgery on operative time and cost. DESIGN/METHODS:Retrospective chart review. PARTICIPANTS/METHODS:All patients who underwent phacoemulsification cataract surgery by an attending or resident surgeon of the Penn State Hershey Eye Center between July 1, 2004, and June 30, 2007. METHODS:Operating room records of all phacoemulsification surgeries performed at a single academic center between July 1, 2004, and June 30, 2007, were reviewed. MAIN OUTCOME MEASURES/METHODS:Operative case length in minutes and cost of operating room time. RESULTS:The primary surgeon was an attending physician in 474 cases and a senior resident physician in 473 cases. Phacoemulsification surgeries took an average of 12 minutes 41 seconds longer per eye when performed by a senior resident compared with an attending surgeon (95% confidence interval [CI], 1 minute 48 seconds to 23 minutes 35 seconds; P = 0.027). Resident cases averaged 63 minutes in July, and decreased to an average of 27 minutes in June. Every month from July through December of the academic year, the monthly mean operative case length for resident cases was significantly longer than the mean operative case length for attending cases (P<0.05), except November, when the difference was borderline significant (95% CI, -23 seconds to 23 minutes 9 seconds; P = 0.057). From January through June, there was no difference. Using the nonsupply cost of running the operating room at our institution ($8.30 per operating minute), resident participation added $105.40 to the average phacoemulsification case. This cost totaled $8293.23 per resident per year. CONCLUSIONS:Resident participation is associated with significantly increased phacoemulsification operative times and costs during the first half, but not the second half, of the academic year. The time and cost per resident may be important to consider when allocating resources for preclinical training. FINANCIAL DISCLOSURE(S)/BACKGROUND:The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Chronic anterior uveitis in common variable immunodeficiency [Letter]
PURPOSE/OBJECTIVE:To describe patients with uveitis and common variable immunodeficiency (CVID). DESIGN/METHODS:Retrospective observational case series. METHODS:Retrospective review of patients with uveitis and CVID, specifically focusing on clinical presentation and treatment. RESULTS:Three patients with CVID and uveitis were identified. All patients had chronic anterior uveitis. Two required systemic immunosuppression to control uveitis, with one of these patients relapsing after discontinuation of immunoglobulin therapy. One improved on topical steroid therapy; however, follow-up on this patient did not extend beyond 4 months. CONCLUSIONS:CVID can be associated with chronic anterior uveitis. Patients presenting with uveitis should be questioned about frequent infections and autoimmune disorders as part of the uveitis evaluation.
Chronic Granulomatous Uveitis in Common Variable Immunodeficiency