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Purpose To investigate long-term complications following pediatric cataract surgery with implantation of a heparin-coated PMMA IOL and posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy versus PCCC without anterior vitrectomy with optic capture buttonholing. Setting Department of Ophthalmology, Goethe University, Frankfurt, Germany. Design Prospective randomized clinical trial. Methods Eyes with unilateral or bilateral congenital cataract without further pathologies or former surgeries were randomly assigned in two groups: cataract removal, IOL implantation and PCCC with anterior vitrectomy (AV; group A) or posterior optic buttonholing without anterior vitrectomy (optic capture, OC; group B). The main outcome measures were posterior capsule opacification (PCO), complication rates and refractive development. Results 58 eyes of 41 pediatric cataract surgery patients were included. The mean age at time of operation was 66.05 months (± 29.39). In group A (n=26), two eyes required treatment for posterior capsule opacification, whereas the optic axis remained clear in all eyes in group B (n=30), which was not statistically significant. Additionally, group B had a slightly lower rate of complications. Mean SE after a mean postoperative follow-up of 6.5 years was -0.11 ± 2.51 D (-5.0 to +4.0 D) in group A and -0.08 ± 2.14 D (-5.0 to +4.0 D) in group B, which was not statistically significant either. Conclusion Optic capture with a heparin-coated PMMA IOL proved to be a safe technique in the prevention of secondary cataract formation without a higher rate of complications and the necessity of vitrectomy.

Background: According to the ROTAS study most of the improvement in visual acuity (VA) during amblyopia therapy of children aged 3 to 8 years occurs during the first 6 to 8 weeks 1. Sattler reported a VA gain in 11-year olds even during the second year of treatment 2. So far there are no standards concerning the intensity and duration of the treatment of patients older than 7 years of age. After a report on electronic monitoring of occlusion treatment in patients aged 7 to 16 years for 4 months 3, we now analyse whether this age group benefits from a longer-lasting treatment. Materials and Methods: In this pilot study the progression of VA was analysed in 11 patients (age range 7.18 to 15.76 years; median 11.42 years) during 12 months of occlusion therapy (types of amblyopia: 5 anisometropic, 1 strabismic, 5 combined). The daily occlusion times were recorded using the occlusion dose monitor (ODM) 4. At the beginning of treatment the prescription of the occlusion regime (median) was 6 h/d (range 4 to 7 h/d), the (decimal) VA 0.2 (range 0.02 to 0.63) for single and 0.16 (range 0.02 to 0.8) for crowded optotypes. Results: The recorded occlusion time (median) was 4.4 h/d during the 12 months of treatment, the VA gain (median) was 0.4 log units for single (range 0.2 to 0.7 log units) and 0.3 for crowded optotypes (range 0.1 to 0.6). During the period of 4 to 12 months of treatment (received occlusion 4.12 h/d) the VA gain was 0.1 log units for single and for crowded optotypes. The maximum VA gain during the interval of 4 to 12 months of treatment was 0.2 log units, both single and crowded. The interocular difference for crowded VA (median) decreased from 0.9 to 0.6 log units during treatment, however only one patient achieved an interocular difference of < 0.2 log units. Conclusion: The patients presented here were able to integrate daily occlusion lasting several hours and the electronic monitoring of occlusion treatment into their daily routine over a period of 12 months. During this period the VA of all included types of amblyopia improved significantly, both from a clinical and statistical point of view. Further long-term studies using ODMs with larger groups of patients may identify factors for success of treatment, reveal the long-term stability of the improvement and contribute to a standardised treatment in this age group.

Purpose: To assess the predictability of postoperative refraction using the Holladay II-formula in paediatric patients randomized to undergo 2 different surgical procedures. Methods: Fourty cataractous eyes of 29 patients (age 2.31–11.75 years) were operated with in-the-bag intraocular lens implantation. Randomly, either an anterior vitrectomy (group A, 19 eyes) or posterior optic capture without vitrectomy (group B, 21 eyes) was performed. Randomization was done in 4 separate age groups, in accordance with 4 target refractions (0, 1, 2 and 3 dpt) to compensate for the anticipated myopic shift. Results: The predicted refraction correlated with the achieved postoperative refraction (total group, p = 0.019), closer in group A (p = 0.033) than in group B (p = 0.265); however, the results of groups A and B were not significantly different (p = 0.324). There was a tendency for postoperative targeted hyperopia being underachieved in the youngest patients. Conclusion: The Holladay II formula provides reliable intraocular lens calculation in paediatric cataracts. The tendency to underachieve the target refraction in younger patients needs further investigation.

Electronic Occlusion Dose Monitors (ODMs) are a fairly recent development. As part of the international Electronic Recording of Patching for Amblyopia Group (ERPAG), we are the first center in Germany to apply these devices. The aim of our independent study was a further assessment of their potential, including technical features and the practicability of long-term use under near-clinical conditions. The ODMs, taped to the occlusion patch, measure the temperature difference between the surface of the eye and the surroundings. Investigators and patients' families kept occlusion diaries while using ODMs. Measurements were performed on the eye (patch tight or detached), forehead, arm and in trouser pockets, and while varying the room temperature. Patients' occlusion was monitored for several months together with acuity development. ODM acceptance was assessed by questionnaire. Written and monitored occlusion times corresponded excellently. Proper measurements on the eye could be distinguished more readily from those with the patch detached or in the pocket than from measurements on the arm and forehead. Very high temperatures (33-37 degrees C) prevented reliable measurements. Using ODMs was convenient for parents but time-consuming for researchers. Despite occasional data loss (incomplete diaries, ODM failure), acuity development could be followed as a function of monitored occlusion dose. This study contributes to the specification of the ODM features and their refinement for clinical use.

Approximately one third of all amblyopic eyes do not reach visual acuity of 20/40 in spite of occlusion therapy. One of the reasons is a lack of adherence to therapy, which, however, could not be quantified in the past. Experience with new devices (occlusion dose monitors, ODMs) for electronic recording of occlusion has recently been reported. The aim of the present study was to evaluate the potential of the ODMs developed in The Netherlands. Various features were tested, including the reliability of the ODM recordings compared to diaries, two ODMs used simultaneously on one patch, the influence of the ambient temperature, and the specificity of the recording pattern for measurements on the eye.The ODMs were taped to the outside of the standard occlusion patch and measured the temperature difference between their front and back surfaces. Members of the research group and the families of two patients kept occlusion diaries while using the ODMs. Recorded and written occlusion periods were compared. Measurements were carried out under various conditions: patch with one ODM tightly on the eye or detached (allowing peeping); ODMs taped to various parts of the body; two ODMs simultaneously on one patch; variation of room temperature.There was good correspondence between the occlusion times recorded by the ODMs and those from the diaries, as well as between the recordings of two ODMs used simultaneously on one patch. High ambient temperatures (33 degrees C to 37 degrees C) prevented reliable ODM measurements. Measurements on other parts of the body were misclassified with probabilities between P=0.099 and P=0.325 as measurements with the patch tightly on the eye.In spite of some technical limitations, the ODMs provide a chance for reliable assessment of compliance and therefore objective information on dose-response function for occlusion therapy. This will lead to a more evidence-based treatment for amblyopia.

Besides loss of visual acuity and binocularity, spatial localization deficits (comprising both increased spatial uncertainty and spatial distortions) are an important feature of strabismic amblyopia. Although they have been extensively investigated in adult amblyopes, there are still many open questions concerning their substrate and relationship to clinical parameters. Our aim was to develop a procedure for assessing vertical alignment, which enabled us to find out whether children with strabismic amblyopia had similar spatial localization deficits, and their relation to the children’s clinical condition. Vertical alignment was assessed in children by comparing the visual direction in space of three loci along the vertical meridian, separated by 5 deg of visual angle. We tested alignment in the amblyopic and dominant eyes of 32 strabismic and in both eyes of 35 control children from 4.5 to 10 years, together with a careful orthoptic examination. In the amblyopic eyes, increased uncertainty and systematic distortions outside the normal range occurred. Large angles of deviation and pathological fixation patterns were necessary, but not sufficient conditions for gross spatial deficits to occur. The fellow dominant eyes showed spatial localization similar to normal eyes. Children with strabismic amblyopia exhibited localization deficits and relationship to clinical data similar to those in adult amblyopes. These data are important for further investigations about the substrate, plasticity and the clinical relevance of perceptual distortions.

Congenital fibrosis of the extraocular muscles type 1 (CFEOM1; OMIM #135700) is an autosomal dominant strabismus disorder associated with defects of the oculomotor nerve. We show that individuals with CFEOM1 harbor heterozygous missense mutations in a kinesin motor protein encoded by KIF21A. We identified six different mutations in 44 of 45 probands. The primary mutational hotspots are in the stalk domain, highlighting an important new role for KIF21A and its stalk in the formation of the oculomotor axis.

Objective: To investigate brain areas involved in the initiation and execution of eyelid spasm in patients with benign essential blepharospasm. Methods: The authors used fMRI and correlated the blood oxygenation level-dependent (BOLD) signal with epochs of frequent eyelid spasm in six patients and with epochs of voluntary eye blinks in four healthy subjects. Results: Spasm epochs were accompanied by activation in a subregion of the putamen in all patients, whereas voluntary blinking in healthy subjects was not. Other areas of activation common to patients and healthy subjects included frontal and parietal operculum, supplementary motor area, primary sensorimotor cortex, various visual areas, and the cerebellum. Conclusions: The striatum may be involved in the initiation or execution of eyelid spasm. Future studies, possibly including electromyography (EMG) during fMRI, are needed to detect the sequence and role of other concomitantly activated areas.

BACKGROUND The aim of the study was to evaluate the predictive value of grating acuity as measured by the TAC Test (TACT) at the age of 6 months corrected age and to compare grating and recognition acuities in eyes with and without ROP residua at an age of three to seven years. PATIENTS AND METHODS The development of visual acuity between 6 months and 3 - 7 years (4.5 years median) was evaluated in 87 eyes of 44 premature children born between the 24 th and 36 th week of gestation, with a birthweight ranging from 550 to 2580 g. Thirteen eyes reached threshold: ROP disease and underwent cryocoagulation. Grating acuity was measured with the TACT at 6 months corrected age and every half year up to three to seven years (median 4.5 years). Recognition acuity was measured with the Sheridan-Gardiner Test (SGT) at 4.5 years (median). TACT-results at 6 months corrected age and 3 - 7 years were compared for the group of patients with normal posterior pole and patients with ROP residua. Furthermore, SGT scores and TACT scores were compared at the 4.5 years follow-up. A visual acuity of >/= 0.1 (3 cy/ degrees ) and >/= 0.4 (13 cy/ degrees ) was considered favourable at the age of 6 months corrected age and 3 - 7 years, respectively. RESULTS The TACT scores ranged from < 0.03 to 0.2 (< 1.0 to 6.5 cy/ degrees ) at 6 months and from < 0.05 to 2.0 (< 1.6 to 57 cy/ degrees ) at 3 - 7 years. In 77 % of cases the TACT scores at 6 months had predictive value for the further TACT scores and in 78 % for the optotype acuity. There was no difference between eyes with normal posterior pole and eyes with ROP residua concerning the predictive value of non favourable optotype acuity. CONCLUSIONS Testing grating acuity at 6 months corrected age allows to roughly predict both grating and recognition acuities at the age of 3 - 7 years. No difference between patients with normal posterior pole and patients with ROP residua was found.

Hintergrund: Die Ergebnisse der CRYO-ROP-Gruppe belegen den Nutzen der Kryokoagulation der Netzhaut fur Funktion und Morphologie bei Schwellenwert-Fruhgeborenen-Retinopathie (RPM). Untersucht wird die Sehscharfe im Alter von 2 Jahren korrigierten Gestationsalters aller 48 Augen, die wegen akuter RPM zwischen 1990 und 1994 konsekutiv in unserer Klinik kryokoaguliert wurden.

Purpose: In cases of esotropia combined with a high AC/A ratio, partly accommodative convergence excess or with nonaccommodative convergence excess, two methods of surgical therapy are possible: recession of the medial recti (Parks) and retroequatorial myopexy (Cuppers). Our aim was to answer the question whether retroequatorial myopexy alone and in combination with bimedial recession are appropriate methods of reducing the strabismic angle at near and distant fixation to values under 10 PD and near-distance disparity to less than 10 PD to form the basis for single binocular vision without bifocals.

Background: The aim of the study was to evaluate results of visual acuity and binocularity and complications after cataract surgery with primary capsular bag-fixated IOL implantation in children. Materials and methods: Thirty-three children [mean age (± SEM) 6.9 ± 2.9 years, range 3–12 years] accounting for 43 eyes, were examined before and after surgery (15 traumatic, 19 developmental, and 9 congenital cataracts, of the latter two groups 9 unilateral and 19 bilateral cataracts). Results: All eyes had a best corrected postoperative visual acuity of 0.5 ± 0.05. The postoperative visual acuity of the traumatic cataracts was 0.6 ± 0.07, of the developmental cataracts 0.5 ± 0.07, and of the congenital cataracts 0.2 ± 0.05. Of the 43 eyes, 17 (40 %) showed a best corrected visual acuity of 0.5 or better. There was a positive correlation between morphology (lamellar versus subcapsular opacification) and visual acuity (0.7 ± 0.07 versus 0.5 ± 0.05; P < 0.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (0.7 ± 0.07 versus 0.2 ± 0.05; P < 0.001). Stereopsis was found postoperatively in 62 % of the children. In one eye a capsular bag-fixated IOL implantation was not possible, and so the IOL was inserted in the sulcus. Four children presented with postoperative fibrin formation. Posterior capsule opacification occurred in 19 % of the eyes in which a primary posterior capsulotomy had been performed. Conclusions: The prognosis of visual acuity and the results of stereopsis in children older than 3 years following capsular bag-fixated IOL implantation are very good. Both the intraoperative and postoperative complication rates were low.

Idiopathic congenital nystagmus is characterized by involuntary, periodic, predominantly horizontal oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 singleton cases of idiopathic congenital nystagmus (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina, suggesting a specific role in the control of eye movement and gaze stability. Nat Genet

Dissociated vertical deviation (DVD), a vertical strabismus, is often associated with infantile esotropia, latent nystagmus and excyclo-torsion. DVD usually becomes apparent at about three years of age. The authors wished to determine whether DVD is a manifestation of an abnormal motor vergence system or is part of a visual system disorder. Vertical eye movements of six subjects with DVD, on cover-uncover and alternate cover tests, were studied using the magnetic search eye coil system. Asymmetry between the eyes' saccades were quantified during the DVD upward movement and during a trial of pure vertical saccades. In three subjects the vertical deviation increased to its full amount through a smooth vertical divergence movement, and in the other three patients through a combination of smooth and asymmetrical saccade-like movements. The latencies of the DVD, the peak velocity of the deviation movements, its time constant and the asymmetries in the saccades suggest that DVD represents an abnormal vertical vergence system.

Purpose: The authors compared the preoperative and postoperative binocular visual acuities and eye movement recordings of patients who underwent eye muscle surgery consisting of the Anderson-Kestenbaum procedure or the artificial divergence procedure modeled after Cuppers, or a combination of both procedures, for the treatment of infantile nystagmus with head turn. Methods: Binocular visual acuities and eye movement recordings by electro-ocu-lography (EOG) were compared preoperatively with those done within 3 weeks post-operatively. Shifting and broadening of the minimal intensity zone and foveation time and changing of the waveform were measured. The treatment of 6 of 18 patients was based on the artificial divergence principle; for 7 patients, treatment was in accordance with the Anderson-Kestenbaum principle; and 5 patients had combined procedures. Results: The improvement in binocular visual acuities was two Snellen lines or more in one of six patients in the artificial divergence group and four of five patients in the combined treatment group. The EOG recordings showed shifting of the minimal intensity zone toward the primary position in all three groups. A broadening of the minimal intensity zone occurred mostly in the artificial divergence and combined groups. Increases in foveation time and changes in waveforms from jerk to jerk with foveation were found in three of six patients in the artificial divergence group and in two of five patients in the combined group. Conclusion: With less muscle surgery, the artificial divergence and combined operations gave better vision improvement than the Anderson-Kestenbaum operation.

Up to 25% of the eyes affected with Duane's syndrome show upshoot and/or downshoot in attempted adduction. This is thought to be caused by the tight horizontal muscles both contracting in attempted adduction (leash or bridle effect) due to abnormal firing of the lateral rectus muscle through which the globe slips beneath the muscle. Surgical procedures successful in correcting the very disturbing cosmesis of gaze are posterior fixation, recession of the horizontal rectus muscles or splitting of lateral recti muscles insertion. The authors report on a 27-year-old male with Duane's syndrome type III with extreme upshoot in adduction. After recession of both horizontal muscles the upshoot on attempted adduction was no longer present postoperatively. At one year follow-up a very discrete upshoot in attempted adduction could be documented. The resolving of the upshoot postoperatively could be explained by the bridle mechanism alone. The low grade upshoot in attempted adduction at one year follow-up could have been caused by new adhesions of the check ligaments and Tenon's capsule at the level of the lateral rectus muscle resulting from surgery itself. The possibility of an anomalous cyclovertical innervation playing a role in the vertical anomalous movements as Duane originally hypothetized cannot be excluded.

Eight patients with manifest latent nystagmus, as noted by ocular movement recordings, were examined for nystagmus reduction after surgical or optical treatment. Seven of the patients had strabismus. Five patients underwent strabismus surgery, had no tropia postoperatively, and the manifest latent nystagmus converted to latent nystagmus. Four of these five patients subsequently showed improvement in binocular visual acuity. Three patients received optical treatment; one had accommodative esotropia and, with appropriate spectacle correction, the manifest latent nystagmus was converted to latent nystagmus with improved vision. In the other two patients the manifest latent nystagmus lessened after correction with appropriate spectacles; binocular visual acuity of one of these patients improved. The possibility of converting manifest latent nystagmus to latent nystagmus by strabismus surgery is a reasonable surgical goal. In patients with manifest latent nystagmus and strabismus, surgical or optical alignment of the eyes decreases the nystagmus intensity and may also improve binocular visual acuity.

Four patients with dissociated horizontal deviation (DHD) are described and an explanation of their horizontal comitant deviations is offered. The patients had asymmetric comitant horizontal deviations dependent on the fixing eye. All of them had unequal visual acuity (VA) and asymmetric manifest latent nystagmus (MLN) documented with eye movement recordings. The subjects appear to use convergence to reduce their nystagmus when viewing with the eye having more severe nystagmus and hence poorer vision. When patients viewed with the eye having less nystagmus, little or no convergence was exhibited. We suggest that DHD may be the manifestation of an asymmetric nystagmus blockage syndrome (NBS). The dampening effect of convergence on nystagmus has been well documented in the past and seems to apply here. The patients demonstrate that a true, but asymmetric NBS, can be found with MLN.

To determine scotopic pupil diameter in a normal pediatric population.Scotopic pupil size was measured in 166 eyes of 83 children with a mean age of 6.01+/-4.11 years (range 0.51-14.26 years) using the light and hand-held Colvard infrared pupillometer. Measurements were performed under dim illumination after 2 min of dark adaptation. The Colvard infrared pupillometer utilizes light amplification technology to determine scotopic pupil size.The mean scotopic pupil diameter was 6.06+/-0.95 mm (range 4.0-8.5 mm) in the right eyes (OD) and 6.11+/-1.02 mm (range 4.0-8.5 mm) in the left eyes (OS), and 6.09+/-0.98 mm (range 4.0-8.5 mm) for both eyes (OU). An increase in mean scotopic pupil size with age was detected, with a peak of 7.28+/-0.42 mm at the age of 10-11 years. The correlation coefficient for age and scotopic pupil diameter was 0.51 OU (OD 0.52, OS 0.51), and the correlation coefficient for objective refraction (spherical equivalent) and scotopic pupil diameter was 0.05 OU (OD 0.01, OS 0.08).The scotopic pupil diameter in a pediatric population increases with age until the age of 11 years and then decreases again.

The aim of the study was to evaluate the predictive value of grating acuity as measured by the TAC Test (TACT) at the age of 6 months corrected age and to compare grating and recognition acuities in eyes with and without ROP residua at an age of three to seven years.The development of visual acuity between 6 months and 3 - 7 years (4.5 years median) was evaluated in 87 eyes of 44 premature children born between the 24 th and 36 th week of gestation, with a birthweight ranging from 550 to 2580 g. Thirteen eyes reached threshold: ROP disease and underwent cryocoagulation. Grating acuity was measured with the TACT at 6 months corrected age and every half year up to three to seven years (median 4.5 years). Recognition acuity was measured with the Sheridan-Gardiner Test (SGT) at 4.5 years (median). TACT-results at 6 months corrected age and 3 - 7 years were compared for the group of patients with normal posterior pole and patients with ROP residua. Furthermore, SGT scores and TACT scores were compared at the 4.5 years follow-up. A visual acuity of/= 0.1 (3 cy/ degrees ) and/= 0.4 (13 cy/ degrees ) was considered favourable at the age of 6 months corrected age and 3 - 7 years, respectively.The TACT scores ranged from0.03 to 0.2 (1.0 to 6.5 cy/ degrees ) at 6 months and from0.05 to 2.0 (1.6 to 57 cy/ degrees ) at 3 - 7 years. In 77 % of cases the TACT scores at 6 months had predictive value for the further TACT scores and in 78 % for the optotype acuity. There was no difference between eyes with normal posterior pole and eyes with ROP residua concerning the predictive value of non favourable optotype acuity.Testing grating acuity at 6 months corrected age allows to roughly predict both grating and recognition acuities at the age of 3 - 7 years. No difference between patients with normal posterior pole and patients with ROP residua was found.

Under normal conditions activated protein C is a natural anticoagulant that cleaves 2 activated coagulation factors, factor Va and factor VIIIa, thereby inhibiting the conversion of factor X to factor Xa and of prothrombin to thrombin. Additionally, activated protein C enhances tissue-plasminogen activator-mediated fibrinolysis by inhibition of plasminogen activator inhibitor-1. This results in an increase in circulatory plasminogen activator levels. Protein C deficiency, a genetic or acquired thrombophilic abnormality, has been demonstrated to predispose to episodes of potentially blinding and lethal thromboembolic events. Heterozygous-deficient subjects usually remain asymptomatic until adolescence or adulthood. In homozygous-deficient patients, protein C activity is usually less than 1% (reference range, 70%-140%), resulting in thromboembolism as early as in the neonatal period. The major clinical symptoms in affected newborn infants have been purpura fulminans, vitreous hemorrhage, and central nervous system thrombosis. The age of onset of the first symptoms has ranged from a few hours to 2 weeks after birth, usually after an uncomplicated full-term pregnancy and delivery. In contrast to the genetic form, acquired neonatal protein C deficiency occurs particularly in ill preterm babies. Typical complications of prematurity such as respiratory distress syndrome, necrotizing enterocolitis, and neonatal sepsis may also be present. In the medical literature, there are only a few reports of homozygous protein C deficiency in neonates. We present 2 cases of homozygous protein C deficiency with ocular and extraocular manifestation.

Purpose: To evaluate the efficacy and safety of intracameral recombinant tissueplasminogen activator (rt-PA) application for fibrinolysis of fibrin formation after cataract surgery in children. Setting: Johann Wolfgang Goethe-University, Department of Ophthalmology; Frankfurt am Main, Germany. Methods: This study comprised 11 eyes of 10 patients aged 3 to 13 years (mean7.2 ± 3.68 [SD]) who developed severe fibrin formation after cataract surgery and IOL implantation despite intensive topical steroid therapy. Under general anesthesia, fibrinolysis was performed with 10 μg of rt-PA 7.18 ± 2.04 days after intraocular surgery. Follow-up included slitlamp examination, tonometry, visual acuity testing, and ophthalmoscopy. Anterior chamber flare measurements could be performed in 6 eyes. Results: Complete resolution of fibrin formations occurred in 90% of the patients. Inthese cases, no recurrent fibrinous reaction or adverse effects were noted. In 2 eyes of the same patient with a history of juvenile rheumatoid arthritis and chronic uveitis, fibrin clot dissolution was incomplete. A recurrent fibrinous formation could be observed after 2 and 4 weeks, respectively. A beginning band kenatopathy excluding the central and limbal cornea, was noted after 6 and 8 weeks, respectively. Conclusion: Intraocular application of rt-PA 'appears to be a safe and efficacious therapeutic approach in the management of severe fibrinous reactions after pediatric cataract surgery.

76% of cataract surgeons in German speaking countries use phacoemulsification (phaco) as the procedure of choice for cataract extraction while the other 24% still use the planned extracapsular extraction (ECCE). The opening technique of the anterior capsule is chosen accordingly: for phaco capsulorhexis is preferred, while for ECCE can opener or letter box technique is usually done. The length of the sclerocorneal incision is 3.2 mm in phaco, 6.2 mm for a PMMA posterior chamber lens implantation and 9-13 mm for the ECCE. We prospectively compared both procedures with each group including 100 consecutive patients. The mean irrigation volume was 96.6 +/- 48.8 ml in the phaco group as opposed to 48.1 +/- 26 ml in the ECCE group. The mean duration of irrigation was 130 +/- 67 s in the first versus 129 +/- 76 s in the second group; mean endothelial cell loss was 7.9 versus 7.1%. No correlation was found between endothelial cell loss and duration of irrigation. Mean postoperative astigmatism measured 1.0 +/- 0.49 in the first group as compared to 3.3 +/- 1.7 dpt in the second group. Except for the astigmatism, our study could not detect significant differences regarding the outcome between both procedures. There are advantages to the phacoemulsification procedure, however, such as a smaller incision (e.g. tunnel technique), a closed irrigation-aspiration system, controlled intraocular pressure and the more frequent use of capsulorhexis. Preferred indications are zonulolysis or previously performed fistulating surgery.

Nat. Genet. 38, 1242–1244 (2006); published online 1 October 2006; corrected after print 6 June 2011 In the version of this article initially published, the author Andrew Bastawrous was omitted from the author list. The error has been corrected in the HTML and PDF versions of the article.

Background: Spasmus nutans is defined as asymmetric nystagmus with associated head nodding in childhood. It is not clear whether head nodding is a compensatory mechanism to control the nystagmus or an involuntary movement of pathologic origin. Methods: The authors analyzed the relation between head and eye movements by simultaneous eye and head movement recordings of 35 patients with spasmus nutans. Results: In 21 of these patients, the fine, fast, dissociated nystagmus changed during head nodding to larger and slower symmetric eye movements with both eyes oscillating at the same amplitude in phase and 180° out of phase to the head movements, corresponding to a normal compensatory vestibulo-ocular reflex. Conclusion: These findings indicate that head nodding is compensatory in spasmus nutans.

Clinical findings as well as eye and head movement recordings were analyzed from 23 patients with spasmus nutans without central nervous system (CNS) changes, 10 patients with spasmus nutans-like disease (head nodding, intermittent nystagmus associated with intracranial anomalies or visual pathway disorders), and 25 patients with infantile nystagmus. Ten diagnostic signs were established to differentiate between the patient groups. Although they were helpful in separating patients with infantile nystagmus from those with spasmus nutans, no difference was found between the patients with spasmus nutans with and without CNS lesions. This study indicates that eye and head movement recordings do not allow differentiation between benign spasmus nutans and spasmus nutans-like disease. The differentiation must be made on the basis of neuroimaging.

Previous studies have indicated that visual acuities of normal infants can be estimated with good accuracy using swept spatial frequency visual-evoked-potentials (VECPs). In this report we describe acuity measurements obtained with this technique from 304 examinations performed on 135 children having various visual disorders. When possible, two or more different stimulation frequencies (8, 12, 15 or 24 contrast reversals/sec) were used in each patient, and three to eight sweep VECPs were obtained from each patient under each simulation and recording condition. High correlation coefficients (0.94 - 0.96) between the acuity estimated on each patient from either the single sweep giving the best visual acuity (BSS) or from vector averages (VeA) of the EEG data obtained from several sweeps confirmed previous findings in normal infants. We also found high correlation coefficients among BSS recorded at different temporal frequencies (0.79 - 0.97) and among comparisons of BSS or VeA acuity to optotype visual acuity (0.6 - 0.89). Children with clinically undetectable optokinetic responses showed lower visual acuity estimated by BSS than those who demonstrated optokinetic nystagmus. We conclude that the sweep VECP is a valid method, giving estimates of acuity which correlate well with optotype acuity and correspond well to other clinical findings, and that it can be useful in the clinical management of nonverbal patients.

Only one form of nystagmus, manifest latent nystagmus (MLN), seems at this time to afford us an opportunity to treat the cause of the nystagmus--namely the lack of binocularity. The binocularity impediments needing treatment may include refractive errors, strabismus, and amblyopia. We should be able to diagnose MLN by wave form analysis, treat the obstacle(s) of fusion, and eliminate or reduce the nystagmus. The purpose of this paper is to review the data and eye movement recordings of MLN patients and look at those in which we have seen improvement (or worsening) of the nystagmus with treatment, particularly in regard to their visual disability, their potential for treatment, and their associated findings.