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To assess the intraocular pressure and visual acuity before and after pediatric congenital cataract surgery performed at a relatively older age. A retrospective analysis of all consecutive pediatric patients diagnosed and operated for bilateral congenital cataracts during a seven-year period (2012–2018) in rural southern Ethiopia. Non-ambulatory vision was defined as hand motion or worse. The main outcome measures were intraocular pressure (IOP) and visual acuity. Thirty-two children were included, 17 females (53.1%), with a mean age of 11 years (± 2.83) [range, 7–18]. A total of 59 eyes were operated on. The mean follow-up was 4.8 ± 1.8 years (range, 2–8). VA improved from 20/1400 preoperatively to 20/440 postoperatively OD and 20/540 OS (p 21 mmHg) preoperatively, of which three remained high after surgery. Positive correlations were found between IOP, axial length and cup-to-disc ratio. None of the patients required pressure-lowering procedures. Bilateral congenital cataracts may be associated with ocular hypertension, with possible progression to glaucoma if left untreated. Surgery at a relatively older age often was associated with a significant improvement in intraocular pressure and ambulatory vision.

Gaze understanding—a suggested precursor for understanding others’ intentions—requires recovery of gaze direction from the observed person's head and eye position. This challenging computation is naturally acquired at infancy without explicit external guidance, but can it be learned later if vision is extremely poor throughout early childhood? We addressed this question by studying gaze following in Ethiopian patients with early bilateral congenital cataracts diagnosed and treated by us only at late childhood. This sight restoration provided a unique opportunity to directly address basic issues on the roles of “nature” and “nurture” in development, as it caused a selective perturbation to the natural process, eliminating some gaze-direction cues while leaving others still available. Following surgery, the patients’ visual acuity typically improved substantially, allowing discrimination of pupil position in the eye. Yet, the patients failed to show eye gaze-following effects and fixated less than controls on the eyes—two spontaneous behaviors typically seen in controls. Our model for unsupervised learning of gaze direction explains how head-based gaze following can develop under severe image blur, resembling preoperative conditions. It also suggests why, despite acquiring sufficient resolution to extract eye position, automatic eye gaze following is not established after surgery due to lack of detailed early visual experience. We suggest that visual skills acquired in infancy in an unsupervised manner will be difficult or impossible to acquire when internal guidance is no longer available, even when sufficient image resolution for the task is restored. This creates fundamental barriers to spontaneous vision recovery following prolonged deprivation in early age.

Being able to perform goal-directed actions requires predictive, feed-forward control, including a mapping between the visually estimated target locations and the motor commands reaching for them. When the mapping is perturbed, e.g., due to muscle fatigue or optical distortions, we are quickly able to recalibrate the sensorimotor system to update this mapping. Here we investigated whether early visual and visuomotor experience is essential for developing the ability to recalibrate. To this end, we assessed young individuals deprived from vision due to dense congenital bilateral cataracts, who were surgically treated for sight restoration only years after birth. We compared their recalibration performance to such distortion to that of age-matched sighted controls. Their recalibration performance was impaired right after surgery. This finding cannot be explained by their still lower visual acuity, since blurring vision in controls to a matching degree did not lead to comparable behavior. Nevertheless, the recalibration ability of cataract-treated participants improved with experience, matching controls’ performance after around 2 years from surgery. Thus, the lack of early visual experience affects visuomotor recalibration. However, this ability is not lost but slowly develops after sight restoration, highlighting the importance of sensorimotor experience for brain plasticity late in life.

Purpose: To report normative data on paediatric refractive and ocular indices in kindergarten Israeli children. Methods: Retrospective cross-sectional study of 101,417 Israeli children from 4-5 years old, obtained from 2013-2018. Data was collected using the PlusoptiX S12. We studied the number of referrals made for hyperopia, myopia, astigmatism and anisometropia. Results: Mean sphere value was 0.83D±0.73 for the right eye and 0.85D±0.73 for the left eye. Mean SE was 0.56D±0.66 for the right eye and 0.59D±0.67 for the left eye. Mean cylinder value was -0.53D±0.48 for the right eye and was the same, -0.53D±0.47, for the left eye. Mean axis values for the right and left eyes were 80.85°±55.57 and 80.42°±56.60 respectively. Mean pupil size was 5.83mm±0.87 for the right eye, and 5.82mm±0.88 for the left eye. 13.26% had anisocoria ≥0.4mm; of these, 0.66% had anisocoria >1.0mm. There was no difference in pupil size between sexes or different cities. Mean IPD was 49.58mm±3.50, and mean gaze vector value was 2.64±1.66. According to the Vision Screening Guidelines, 0.8% of children had hyperopia and 0.17% had myopia. 6.22% of children had astigmatism and 10.85% had anisometropia. Conclusion: Amblyopia is the most common cause of unilateral vision loss in childhood. The earlier the diagnosis, the better the outcome, hence the importance of investigating the causative indices leading to amblyopia in kindergarten. After searching the literature, this is the largest study population for this topic to our knowledge.

Summary Visual perception requires massive use of inference because the 3D structure of the world is not directly provided by the sensory input.1 Particularly challenging is anorthoscopic vision—when an object moves behind a narrow slit such that only a tiny fraction of it is visible at any instant. Impressively, human observers correctly recognize objects in slit-viewing conditions by early childhood,2,3 via temporal integration of the contours available in each sliver.4,5 But can this capability be acquired if one has been effectively blind throughout childhood? We studied 23 Ethiopian children which had bilateral early-onset cataracts—resulting in extremely poor vision in infancy—and surgically treated only years later. We tested their anorthoscopic vision, precisely because it requires a cascade of demanding visual inference processes to perceive veridical shape. Failure to perform the task may allow mapping specific bottlenecks for late visual recovery. The patients' visual acuity typically improved substantially within 6 months post-surgery. Still, at this stage many were unable to recover shape under slit-viewing conditions, although they could infer the direction of global motion. However, when retested later, almost all patients could judge shape in slit-conditions necessitating temporal integration. This acquired capability often transferred to novel stimuli, in similar slit-viewing conditions. Thus, learning was not limited to the specific visual features of the original shapes. These results indicate that plasticity of sophisticated visual inference routines is preserved well into adolescence, and vision restoration after prolonged early-onset blindness is feasible to a greater extent than previously thought.

Summary Adult humans make effortless use of multisensory signals and typically integrate them in an optimal fashion. 1 This remarkable ability takes many years for normally sighted children to develop. 2 , 3 Would individuals born blind or with extremely low vision still be able to develop multisensory integration later in life when surgically treated for sight restoration? Late acquisition of such capability would be a vivid example of the brain’s ability to retain high levels of plasticity. We studied the development of multisensory integration in individuals suffering from congenital dense bilateral cataract, surgically treated years after birth. We assessed cataract-treated individuals’ reliance on their restored visual abilities when estimating the size of an object simultaneously explored by touch. Within weeks to months after surgery, when combining information from vision and touch, they developed a multisensory weighting behavior similar to matched typically sighted controls. Next, we tested whether cataract-treated individuals benefited from integrating vision with touch by increasing the precision of size estimates, as it occurs when integrating signals in a statistically optimal fashion. 1 For participants retested multiple times, such a benefit developed within months after surgery to levels of precision indistinguishable from optimal behavior. To summarize, the development of multisensory integration does not merely depend on age, but requires extensive multisensory experience with the world, rendered possible by the improved post-surgical visual acuity. We conclude that early exposure to multisensory signals is not essential for the development of multisensory integration, which can still be acquired even after many years of visual deprivation.

Viewing a hand action performed by another person facilitates a response-compatible action and slows a response-incompatible one, even when the viewed action is irrelevant to the task. This automatic imitation effect is taken as the clearest evidence for a direct mapping between action viewing and motor performance. But there is an ongoing debate whether this effect is innate or experience dependent. We tackled this issue by studying a unique group of newly sighted children who suffered from dense bilateral cataracts from early infancy and were surgically treated only years later. The newly sighted children were less affected by viewing task-irrelevant actions than were control children, even 2 years after the cataract-removal surgery. This strongly suggests that visually guided motor experience is necessary for the development of automatic imitation. At the very least, our results indicate that if imitation is based on innate mechanisms, these are clearly susceptible to long periods of visual deprivation.

We can estimate the veridical size of nearby objects reasonably well irrespective of their viewing distance. This perceptual capability, termed size constancy, is accomplished by combining information about retinal image size together with the viewing distance, or using the relational information available in the scene, via direct perception [1]. A previous study [2] showed that children typically underestimate the size of a distant object. This underestimation is reduced with time, suggesting that years of visual experience may be essential for attaining true size constancy. But what if you have had very limited vision during the early years of life? We studied 23 Ethiopian children suffering from bilateral, early-onset cataract, who were surgically treated only years after birth. Surprisingly, most children were able to estimate object size reasonably well irrespective of distance; in fact, they usually tended to overestimate the far-object size. Closer examination indicated that, although before surgery the patients were diagnosed as having a full, mature bilateral cataract, they nevertheless had some residual form of vision, typically limited to very close range. Gandhi et al.[3] earlier reported immediate susceptibility to geometric visual illusions in a similar group of newly-sighted children, concluding that size constancy was probably innate. We suggest that their immediate ability to judge physical size irrespective of distance is more likely to result from their previous visual experience.

Objective To examine the association of orbital decompression and the characteristics and outcome of subsequent strabismus surgery in patients with thyroid eye disease (TED). Methods Data on patients with TED who underwent orbital decompression at the Goldschleger Eye Institute, Sheba Medical Center, Israel, between January 1990 to December 2011 were extracted. The characteristics of decompression and strabismus surgeries were recorded. The outcomes and association of both surgical procedures were analyzed. Statistical analysis included distribution, Pearson correlation, and matched paired tests. Results 145 eyes underwent orbital decompression, of which 45 eyes (31.0%) underwent strabismus surgery. Esotropia developed in 70% of the patients. Men and smokers underwent strabismus surgeries after decompression procedures more frequently than women and nonsmokers (χ 2 test, p = 0.07, 0.002). Moreover, patients who complained of diplopia before the decompression surgery underwent strabismus surgery more frequently (χ 2 test, p = 0.005). Seventy-seven percent of the patients who underwent medial wall decompression developed esotropia (χ 2 test, p = 0.004). Conclusions To the best of our knowledge, this is the largest series in the literature examining the association between decompression and strabismus surgeries. The patients' characteristics and the orbital walls involved in the decompression procedures are associated with the characteristics of subsequent strabismus that develops thereafter. These findings may have significant implications in planning TED management.

To assess the long-term results of a reduced amount of medial rectus recession in children with esotropia and developmental delay.A retrospective chart analysis of 42 children with developmental delay who had undergone surgery for esotropia during a 20-year period in a large referral center was performed. The pre- and postoperative angle of deviation was calculated for each subject as the mean of distant and near angles measured by a cover test or the Krimsky measurement. Surgical success was categorized as esotropia or exotropia of ≤10 prism diopters (PD). The main outcome measure was a stable surgical result after several years of follow-up.The chart review identified 42 children who met inclusion criteria, with a mean age of 2.9 years (range, 0.8-10 years). The mean angle of esotropia prior to surgery was 44.29 ± 13.9 PD (range 20-80 PD). All patients had bilateral medial rectus muscle recessions, with a mean surgical dosage of 5.04 ± 0.62 mm per muscle, on average 0.66 mm less than the standard amount. The average postoperative follow-up was 4.6 years (median 3.67 years, range 8 months-15 years). Twenty-four children (57%) achieved surgical success, 13 (31%) were undercorrected, and 5 (12%) were overcorrected. Ten of the 18 with an unsuccessful surgical outcome underwent a second procedure. The overall surgical success rate for all patients after all procedures was 71%.The main reason for surgical failure after bilateral medial rectus muscle recession (BMR) in developmentally delayed children remains residual esotropia. However, with time, more patients demonstrated consecutive exotropia. Although it is difficult to achieve a stable long-term ocular alignment in children with developmental delay, satisfactory results may be achieved with additional surgical procedures. The optimal amount of primary recession and whether to perform the surgical schedules according to the Parks tables or to reduce the amount of the recession when operating on children with developmental delay is still debatable.

Purpose To examine the shift in astigmatic error following the use of oral propranolol as first-line treatment for periocular capillary hemangioma. Design Retrospective observational study. Methods study population: Three healthy infants (1 male) clinically diagnosed with periocular capillary hemangioma. Cycloplegic refraction measurements were obtained at presentation. After a comprehensive clinical evaluation, oral propranolol therapy was starting with a loading dose and titrated up to 2 mg/kg/day under monitoring of heart rate, blood pressure, and blood glucose alterations. Clinical follow-up and repeating cycloplegic refraction measurements were undertaken at the 1-week and 1- and 3-month follow-up visits. intervention: Oral propranolol therapy for infants diagnosed with periocular capillary hemangioma. main outcome measures: Astigmatic refractive errors before and after propranolol treatment. Results The infants' mean age at the initiation of propranolol therapy was 6.3 months (range: 3.0–8.0 months). A rapid therapeutic effect was noticed in all cases, including a major change in lesion size and color. No complications were recorded during or following treatment. The mean astigmatic error decreased from 2.83 diopters before propranolol treatment to 1.33 diopters after 1 month of treatment. The drug was well tolerated by all 3 patients and no side effects were noted. Conclusions Infants can benefit from a rapid, meaningful reduction in periocular capillary hemangioma – induced astigmatism following oral propranolol treatment. Propranolol seems to be an effective and safe drug, which can be used as a steroid-sparing first-line treatment modality in this patient population.

Purpose To report the effect of oral propranolol on intraocular pressure (IOP) in infants newly diagnosed with unilateral Sturge-Weber syndrome (SWS) glaucoma receiving no other treatment. Methods This was a prospective, nonrandomized interventional case series. Four infants presenting with unilateral SWS glaucoma with no prior treatment were treated with oral propranolol at a dose of 2 mg/kg and followed thereafter. Results Propranolol had a temporary IOP-lowering effect in 3 of 4 children after 1 week of treatment. This effect diminished thereafter and 3 of 4 children required additional medical or surgical treatment. Conclusions Oral propranolol has a temporary effect on IOP in SWS glaucoma and is not effective as a single treatment in this syndrome, yet can serve to delay surgical treatment for a short period of time. In one case, the glaucoma was well-controlled on this medication.

Purpose To determine the accuracy of postoperative predicted refractive outcomes in surgically aphakic pediatric patients undergoing secondary intraocular lens (IOL) implantation. Comparisons were also made with other variables historically considered important in cataract surgery. Methods Retrospective review of 50 eyes from 35 consecutive pediatric patients (≤18 years of age) undergoing secondary IOL implantation within the ciliary sulcus or posterior capsular bag. All cases were performed by 1 of 2 surgeons and all refractions were performed manually using the retinoscope by an experienced pediatric ophthalmologist. Results The mean patient age at the time of the secondary implantation was 6.5 years of age (range, 0.58-15.04). The mean patient age at the time of the primary cataract extraction was 0.78 years (range, 0.08-5.77). For all patients, mean absolute value of prediction error was 1.64 D (SD 1.58 D). There were no significant associations between mean absolute value of prediction error and any of the variables measured including axial length, corneal mean curvature, bag or sulcus implantation, formula used, or age at primary and secondary surgery (p > 0.05). Conclusions The mean absolute value of prediction error observed in this study is consistent with previous pediatric primary and secondary IOL data in that it shows a considerable difference from that expected in adult populations. Our findings support the argument that methods currently employed to calculate IOL power may fail to accurately account for all the variations in the eyes of pediatric patients.

Intraocular pressure, a major risk factor for glaucoma, is known to vary throughout the day, yet glaucoma continues to progress in some patients despite it being well controlled. It is important to understand how other glaucomatous risk factors are affected by circadian variations. The purpose of this review is to analyze the literature concerning circadian variations in systemic blood pressure, ocular perfusion pressure, and ocular blood flow and to identify consensus findings regarding their impact on glaucoma. This review suggests that nonphysiologic nocturnal blood pressure dipping and wider circadian fluctuations in ocular perfusion pressure are linked with the development and progression of glaucoma. No consensus concerning circadian variations in ocular blood flow exists in the current literature, and future investigations of nocturnal changes in blood flow and glaucoma progression are required.

PurposeSturge-Weber syndrome (SWS) is frequently associated with early onset glaucoma in the eye on the same side as the facial angioma. The exact cause of glaucoma in SWS is poorly understood and difficult to treat. The purpose of this study is to investigate the ocular hemodynamics of children with SWS-associated glaucoma using color Doppler imaging techniques.MethodsThis is a prospective study of 10 pediatric patients with unilateral SWS-associated glaucoma. Color Doppler imaging was used to measure the peak systolic velocity and the end diastolic velocity of both the ophthalmic and central retinal arteries in the glaucomatous eye compared to the fellow healthy eye.ResultsTwenty eyes of 10 children with SWS (6 boys) with unilateral glaucoma were included in the prospective study. The mean age of the 10 participants was 5.5 years. When compared to their contralateral normal eyes, the glaucomatous eyes had greater CDR (pConclusionsVascular pathology has been proposed to play a role in SWS glaucoma etiology. The authors did not find arterial retrobulbar blood flow differences between the glaucomatous and the fellow normal eye. Since the primary vascular anomaly in patients with SWS is in the venous plexus, a bigger prospective trial is warranted in order to better understand and treat children with SWS glaucoma.

Purpose To test the accuracy and reliability of the plusoptiX A12 in detecting amblyogenic risk factors. Methods We prospectively collected data on children undergoing screening with the plusoptiX A12, cycloplegic refraction, and complete ophthalmic examination. American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 guidelines for the detection of amblyogenic risk factors were used for plusoptiX A12 screening and comparison of the results of both examination modes. Results Data on 402 eyes of 201 children (mean age, 7.63 ± 3.41 years) was collected. Mean (with standard deviation) cycloplegic refraction results were as follows: sphere, 0.88 ± 1.5 D; cylinder, −0.61 ± 0.74 D; axis, 71.17 ± 71.04; and spherical equivalent, 0.68 ± 2.63. The plusoptiX A12 measurements were as follows: sphere, 0.58 ± 1.4 D; cylinder, −0.66 ± 0.77 D; axis, 77.3 ± 68.9; and spherical equivalent, 0.25 ± 1.3. We found a strong correlation (Pearson) for sphere ( r = 0.91), cylinder ( r = 0.81), and axis ( r = 0.7). The mean difference of the myopic spherical component between the plusoptiX and cycloplegic refraction was −0.048 ± 0.55 (95% LoA, +1.04 to −1.14 D); for the hyperopic spherical component, 0.37 ± 0.93 (LoA, +2.20 to −1.45 D); and for the cylindrical component, 0.05 ± 0.32 (LoA, +0.68 to −0.57D). The sensitivity, specificity, positive and negative predictive values for myopia were, respectively, 86%, 93%, 82%, and 94%; for astigmatism, 85%, 98%, 88% and 98%; and for hyperopia, 40%, 100%, 100%, and 98%. Conclusions The plusoptiX A12 accuracy is high in all subgroups but better in the myopic, astigmatic, and anisometropic subgroups. Reliability was lower in the hyperopic eyes, possibly resulting in underestimation of hyperopic refractive error.

Purpose To describe trends in the incidence and causes of legal childhood blindness in Israel, one of the few countries worldwide that maintain a national registry of the blind. Methods We performed a historical cohort study of annual reports of the National Registry of the Blind (NRB) between 1999 and 2013. All data regarding demographic information, year of registration and cause of blindness of children 0-18 years of age registered for blind certification were obtained from the annual reports of the NRB. Causes of legal blindness analyzed were optic atrophy, retinitis pigmentosa, retinopathy of prematurity (ROP), albinism, other retinal disorders, cataract, and glaucoma. The main outcome measure was the incidence of new cases of certified legal blindness. Results The incidence of newly registered legally blind children in Israel almost halved from 7.7 per 100,000 in 1999 to 3.1 per 100,000 in 2013. The decline was mainly attributable to a decreased incidence of blindness resulting from retinitis pigmentosa and ROP. The incidence of registered cases due to cerebral visual impairment increased. Conclusions During the past decade the incidence of severe childhood visual impairment and blindness declined in Israel. A continuous decline in consanguineous marriages among the Jewish and Arab populations in Israel may have contributed to the decrease in the rate of vision loss due to retinitis pigmentosa in children.

Purpose To compare the surgical outcome visual acuity and complication rates among pediatric patients undergoing cataract surgery under local or general anesthesia in rural southern Ethiopia Methods This retrospective study included pediatric patients younger than years who underwent cataract surgery in rural southern Ethiopia during July August Local anesthesia was use in patients over the age of years unless they suffered from traumatic or bilateral cataract Clinical indices were collected before and following surgery including uncorrected visual acuity categorized into ambulatory better than hand motion and non ambulatory hand motion or light perception vision intraocular pressure cycloplegic refraction and ocular complications Results Ninety one eyes of consecutive patients male female were included in the study The average age at diagnosis was plusmn years Fifty five operations were performed under general anesthesia GA and using local anesthesia LA The percentage of patients with ambulatory UCVA improved significantly in both the GA vs p lt and LA groups vs lt No significant differences between the groups were noted regarding visual acuity results or complications Conclusions Our results suggest that the outcomes of pediatric cataract surgery performed under either local or general anesthesia were comparable LA should be considered a valid option for older children undergoing cataract surgery especially when medical resources are limited

To report the experience of two tertiary care facilities in southern Ethiopia in the treatment of traumatic pediatric cataract for a period of more than 1 year.The medical records of consecutive traumatic pediatric cataract patients who underwent surgery at the Hawassa University and the Yirgalem University schools of medicine from July 2007 to August 2008 were retrospectively reviewed. All patients with a follow-up of at least 12 months were included.A total of 49 children were included. Mean patient age was 8.6 ± 0.3 years (range, 5-15 years). Of the 49 cases, 32 (65%) were caused by blunt trauma. Average follow-up period was 15 months. Postoperative visual acuity of counting fingers or better was achieved in 43 (88%) eyes compared with 5 (10%) at presentation (P0.0001). Better visual acuity at presentation and blunt trauma were associated with better final visual acuity. Only blunt trauma was found by multivariate analysis to influence final visual acuity (P = 0.0001).Visual acuity of counting fingers or better visual can be achieved in most cases. Blunt trauma is a good independent prognostic factor for visual acuity.

To assess the prevalence of eye disease among malnourished children in a rural Ethiopian health center and evaluate correlations between xerophthalmia and grades of malnutrition. A retrospective, cross-sectional survey. An institution-based cross-sectional prospective study was performed at Bushulo Health Center in rural south Ethiopia and included all children age 6 months to 14 years receiving care for malnourishment from June 1st to July 30th, 2008. Data collection involved a combination of interviews with caretakers, ocular examination by a pediatric ophthalmologist and anthropometric measurements. One hundred and seventy-three children (average age at examination 2.9 ± 0.2 years) were treated for malnutrition (97 female, 76 male). One hundred and forty-nine patients had moderate malnutrition (86.03 %) and 24 had severe malnutrition (13.9 %). The following eye diseases were diagnosed--trachoma (12.1 %), blepharitis (13.3 %) and xerophthalmia (20.8 %). Severely malnourished children were more likely to suffer from xerophthalmia than moderately malnourished children (p < 0.0001). When comparing anthropometric measurements to the diagnosis of xerophthalmia, only weight percentile showed significance (p = 0.008). Xerophthalmia is a common global cause of pediatric blindness and is highly correlated with severe malnutrition. Continued efforts are necessary to improve nutrition and outcomes in these patients.

Primary congenital glaucoma is the most common type of infantile glaucoma, yet it remains a relatively rare disease. Treatment is principally surgical, and management lasts a lifetime. In the developing world, delayed diagnosis, limited treatment, and inadequate follow-up lead to a heavier burden on the patient and community. We highlight the epidemiology and genetics of the disease, its current management and prognosis, and the limitations facing both providers and patients in the developing world. Further efforts are necessary to provide effective, timely screening of children and allocate adequate resources to allow health care workers to reduce the rate of avoidable blindness in developing countries.

Hyperbaric oxygenation (HBO) is a common treatment both for emergency medicine as well as for chronic treatments. One of the most common indications for treatment is a non-healing wound due to diabetes. It is known that prolonged HBO treatments cause a myopic change in refraction. From the literature we know that the myopic shift is usually temporary, reversing back to basic refraction within a few weeks of cessation of the HBO course. There is controversy in the literature regarding the cause of refraction change, but research with animals reinforces the view that the source is the lens nucleus.To measure the refractive change following 30 HBO treatments, and to quantify the rate of change.A prospective study that included 44 eyes of diabetic patients treated with HBO in Rambam and Elisha Hyperbaric Center. Follow-up examinations were carried out every 10 treatments for spherical equivalents, sphere components, cylinder powers and axes (SPHER, SE, CYLINDER and AXIS respectively). The measurement device was an autorefractometer. A single examiner performed all the measurements; the examiner was blinded to the previous results. For each parameter, a regression equation was calculated after plotting the myopic change over time.A positive correlation was found between HBO treatments and a myopic shift in the refraction. The correlation was statistically significant for: SPHER, SE. (0.58D, 0.61D) respectively. The change accrued from the first examination and remained throughout the follow-ups at a steady rate. Both eyes behaved similarly. The authors did not find a correlation between the myopic shift and gender, age or basic refraction. This information is vital both to clinicians, to understand the physiologic changes occurring during chronic HBO treatments, and especially to our patients, who are about to receive HBO treatments.

PURPOSE To determine the interobserver reproducibility of Heidelberg retinal flowmeter (HRF) blood flow measurements using independently selected study areas for pixel-by-pixel analysis. PATIENTS AND METHODS Blood flow measurements were performed on 257 scans from 15 patients, 14 of whom had glaucoma or ocular hypertension. HRF was used to record capillary perfusion in a 2560x640 mum area of the supratemporal peripapillary region and pixel-by-pixel analysis was performed from an area adjacent to the optic disc with a minimum of 1600 pixels. Each observer independently selected the area for analysis. The percentage of pixels with

The concept of retinal oximetry is based on physical properties that have been recognized since the 18th century. Attempts to non-invasively quantify the oxygen saturation of blood within the retinal vasculature date back to the 1950's. There are different techniques in existence for the measurement of retinal oxygenation, the leading ones are: photographic, digital, spectroscopy and the pulse methods. Each method has its advantages and disadvantages. Current data from studies on retinal oximetry is presented, for both the healthy retina and in diseases such as glaucoma, diabetic retinopathy and age-related macular degeneration. It is clear that a thorough understanding of retinal oxygen tension is vital to our understanding of normal retinal physiology and the pathophysiology of degenerative eye diseases.

Primary congenital glaucoma is an uncommon pediatric ocular disease contributing to a disproportionately high percentage of childhood blindness worldwide. This case report describes bilateral primary congenital glaucoma in monozygotic twins who first presented to an ophthalmologist in Ethiopia at 6 years of age. Both had severe, protracted disease, with only moderate improvement after surgical intervention. [J Pediatr Ophthalmol Strabismus 2010;41:124–126.]

Purpose To determine the accuracy of predicted postoperative refractive outcomes in pediatric patients having cataract surgery with intraocular lens (IOL) implantation and to compare them with other variables historically considered important in cataract surgery. Setting Tertiary care referral hospital. Methods This retrospective review comprised 203 eyes of 153 consecutive pediatric patients (≤18 years old) having cataract extraction with primary posterior chamber IOL implantation in the capsular bag. All cases were performed by 1 of 2 surgeons, and all refractions were performed manually by an experienced pediatric ophthalmologist using a retinoscope. Results In all patients, the mean absolute value (MAE) of the prediction error was 1.08 diopters (D) ± 0.93 (SD). Age at time of surgery and corneal (K) mean curvature were significantly correlated with the absolute value of the prediction error (P = .0006 and P = .0088, respectively). A multiple regression model showed that age at time of surgery and K mean curvature were the only 2 variables significantly associated with MAE; axial length, formula, surgeon, and A-scan type were not significantly associated with prediction error. Conclusions Data from 203 consecutive primary pediatric IOL implantations showed the heterogeneous nature of the variables involved in predictions of refractive outcomes in this population. The complexities of this issue support the need for specific methods of measurement and an IOL calculation formula for the pediatric population.

Purpose To evaluate the accuracy of pediatric IOL calculations performed under general anesthesia by using immersion A-scan biometry and to compare the results to those obtained using contact A-scan biometry. Methods A retrospective review of 203 consecutive cases of pediatric cataract extraction with primary IOL implantation within the capsular bag; mean patient age was 5.52 ± 4.19 years (range, 18 days to 18 years). Axial length measurements were performed with the contact A-scan biometry in 138 eyes, whereas immersion technique biometry was used in the remaining consecutive 65 eyes. Preoperative predictive target refraction was compared with the refractive result obtained at the 2-month postoperative visit. Results The mean of the absolute value lens prediction error for all eyes was 1.08 ± 0.93 D from the desired postoperative refractive result. Lens prediction error for the contact A-scan subgroup was 1.11 ± 0.90 D, whereas the immersion A-scan subgroup was less at 1.03 ± 0.98 D. This result was not statistically significant ( p = 0.6442). Statistically significant correlations were found between increased lens prediction error and age at time of surgery or corneal curvature. Conclusions This retrospective, noncomparative pilot study showed no significant difference in IOL prediction error when comparing the postoperative refractive results obtained with immersion versus contact A-scan biometry in pediatric IOL calculations.

Although ocular tonography measures a pulsatile component of the ocular perfusion, the retinal and/or choroidal components of this pulsatile flow remain undefined.To compare ocular tonography with the assessment of flow velocities in arteries supplying the retina, choroid and entire orbit.22 normal eyes from 11 subjects were studied. Pulsatile ocular blood flow (POBF) was measured using the ocular blood flow tonograph, and flow velocities in the ophthalmic, central retinal (CRA) and temporal short posterior ciliary arteries (TSPCA) using colour Doppler imaging. The correlation between POBF and retrobulbar flow velocities was determined.POBF correlated significantly with peak systolic velocity (PSV) of the CRA (r = 0.56, p = 0.007) and the TSPCA (r = 0.48, p = 0.02), and with the resistive index of the TSPCA (r = 0.45, p = 0.04). Additionally, pulse amplitude (PSV-end diastolic velocity) in the CRA and the TSPCA correlated significantly with POBF measurements (each p0.05). However, POBF did not correlate with any flow velocity indices in the ophthalmic artery.POBF is associated with systolic and pulsatile components of blood flow velocities in both the CRA and the TSPCA. This result suggests that POBF determinations are influenced by the pulsatile components of both choroidal and retinal perfusion.

We report a unique pair of monozygotic twins with congenital bilateral Brown syndrome and review previously reported familial cases. Most cases of Brown syndrome are sporadic and unilateral. We believe this to be the first reported occurrence in monozygotic twins.

Purpose To examine whether axial length measurement in awake infants and toddlers is feasible, and whether there is a difference in axial length measurement between an office setting and under general anesthesia. Methods This prospective comparative case study was conducted at the Goldschleger Eye Institute, Sheba Medical Center, Israel. Using the same instruments, axial length measurements were obtained using a standard applanation technique twice: once in an office setting when the infant/toddler was awake and once under general anesthesia in the operating room. A paired t test was used to test for differences between measurements. Results Thirty-three eyes of 19 participants younger than 28 months were examined; 24 (73%) eyes had cataracts and the remainder had clear lenses. One child was excluded from the study due to lack of cooperation during axial length measurement in the office setting and another due to the lengthy gap between measurements. Of the remaining 31 children, the average age was 9 months. Average axial length measurements were shorter by 0.12 mm in the office setting than under general anesthesia (P = .14). No adverse effects were observed after axial length measurements in the office setting. Conclusions Axial length measurement in an office setting is generally reasonable to obtain. The results showed no significant difference in the axial length measured in the two settings.

Abnormal angle kappa simulating strabismus has been described in cases of structural retinal disorders, such as retinopathy of prematurity, familial exudative vitroretinopathy, and retinochoroidal scars. We report a patient with abnormal vertical angle kappa caused by ectopic fovea and in the absence of any other identifiable eye disorder.

Objective To evaluate the etiologies, management, and outcomes of pediatric cataracts in a rural sub-Saharan African setting. Methods A retrospective, consecutive case series of patients presenting to a tertiary referral center in southern Ethiopia during a 13-month period. All patients underwent clinical examination, were diagnosed as having cataract on the basis of standard clinical assessment, and immediately underwent surgical management. Visual acuity results were grossly divided into ambulatory and nonambulatory vision according to patient age and cooperation. Results Ninety-one eyes of 73 consecutive patients (57 boys and 16 girls) were included in the study. The mean (SEM) age at diagnosis was 7.1 (0.5) years (range, 0.5-15 years). Fifty-five patients had unilateral cataract and 18 had bilateral cataract. Cataracts were categorized according to the etiologic cause: congenital (n = 50), traumatic (n = 33), congenital glaucoma-related (n = 3), partially absorbed cataracts (n = 3), and congenital rubella infections (n = 2). At presentation, visual acuity ranged from 6/60 to light perception, with 13 eyes (14%) having ambulatory vision (better than hand motion). The mean postoperative visual acuity was significantly improved, ranging from light perception to 6/9. Seventy-five eyes (82%) achieved ambulatory vision. Of the 61 eyes with an implanted intraocular lens, 56 (92%) reached ambulatory visual acuity following surgery. This was significantly greater than preoperative visual acuity results (P Conclusions The underlying cause and management of pediatric cataracts in the developing world can differ significantly from that commonly reported in the literature. The effects of appropriate intervention on both visual outcome and associated survival statistics may be profound.

Objective To present the anatomic and functional results of surgical treatment for advanced primary congenital glaucoma (PCG) in a rural setting. Design Retrospective, observational case series. Participants Forty eyes of 22 consecutive patients diagnosed with PCG and who underwent surgical treatment. Methods All eyes underwent surgical treatment for PCG. Type of surgery and postoperative complications were noted. We examined anatomic and functional indices before and after the operation. Main Outcome Measures Visual acuity (VA), intraocular pressure (IOP), refractive spherical error, cup-to-disc ratio (CDR), and horizontal corneal diameter (HCD). Results Average age at the time of surgery was 3.3 years (range, 0.4–10) and the mean follow-up was 6 months (range, 1–11). 15% showed marked lens dislocation owing to the severe buphthalmos at presentation. Preoperative IOP was 54±2 mmHg, HCD was 15.1±0.3 mm, and CDR (when visible) was 0.8±0.02. Surgical intervention included 31 trabeculotomies, 6 Ahmed Glaucoma Valve implants, 1 goniotomy, and 2 eviscerations. Serious complications were noted in 4 eyes. Final postoperative IOP was 23±2 mmHg ( P P Conclusions Our surgical outcomes in children with advanced PCG demonstrated moderate overall improvement in IOP and modest improvement of VA. Deep deprivation amblyopia, severe disease manifestation at presentation, opaque corneas, and frequent lens dislocation limited the possible success. These data further signify the need for effective, timely screening of children and prompt recognition by health care workers to reduce the rate of avoidable blindness in developing countries. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Objective: To present the anatomic and functional results of surgical treatment for advanced primary congenital glaucoma (PCG) in a rural setting. Design: Retrospective, observational case series. Participants: Forty eyes of 22 consecutive patients diagnosed with PCG and who underwent surgical treatment. Methods: All eyes underwent surgical treatment for PCG. Type of surgery and postoperative complications were noted. We examined anatomic and functional indices before and after the operation. Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), refractive spherical error, cup-todisc ratio (CDR), and horizontal corneal diameter (HCD). Results: Average age at the time of surgery was 3.3 years (range, 0.4–10) and the mean follow-up was 6 months (range, 1–11). 15% showed marked lens dislocation owing to the severe buphthalmos at presentation. Preoperative IOP was 54 2 mmHg, HCD was 15.1 0.3 mm, and CDR (when visible) was 0.8 0.02. Surgical intervention included 31 trabeculotomies, 6 Ahmed Glaucoma Valve implants, 1 goniotomy, and 2 eviscerations. Serious complications were noted in 4 eyes. Final postoperative IOP was 23 2 mmHg (P 0.0001). Patients were significantly more likely to have ambulatory VA (following objects or better) after operation (18% vs 64%; P 0.0001). Conclusions: Our surgical outcomes in children with advanced PCG demonstrated moderate overall improvement in IOP and modest improvement of VA. Deep deprivation amblyopia, severe disease manifestation at presentation, opaque corneas, and frequent lens dislocation limited the possible success. These data further signify the need for effective, timely screening of children and prompt recognition by health care workers to reduce the rate of avoidable blindness in developing countries. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2011;118:231–235 © 2011 by the American Academy of Ophthalmology.