Pediatric Ophthalmology Service Research Articles

Assessing The Relationship Between Demand And Accessibility For Pediatric Ophthalmology Services By State In The United States.

To investigate the relationship between public demand for pediatric ophthalmology services and the accessibility of such services on a statewide basis in the United States, focusing on strabismus care. Using Google Trends data, search volumes for "strabismus" were analyzed from January 2014 to December 2023. Pediatric ophthalmologist availability was assessed via the American Academy of Ophthalmology directory, normalized for state population size to create a relative demand index. Additional metrics from the United States Census Bureau and Centers for Disease Control and Prevention provided socioeconomic and health data. Correlation coefficients were used to explore relationships between search volumes, specialist availability, vision screening, socioeconomics, and demographic factors. The data revealed variability in public interest in pediatric ophthalmology across states, with Alaska showing the highest relative search volume for strabismus. The data also indicated notable disparities in pediatric ophthalmologist density, with North Dakota, Vermont, and Wyoming having no pediatric ophthalmologists. A significant correlation was identified between pediatric ophthalmologist availability and vision screening (R = 0.486, p < 0.001). Negative correlations were observed between the relative demand index and urbanization (R = -0.388, p = 0.007), as well as the strabismus prevalence (R = -0.455, p = 0.001), indicating that urbanization and specialist distribution influence eyecare demand and access. The findings highlight disparities in accessibility and demand for pediatric ophthalmology services across the US, influenced by urbanization and distribution of healthcare professionals. The study underscores the need for targeted interventions to improve access to care and bridge gaps in pediatric ophthalmology service provision.

Uveitis in children assessed in the paediatric rheumatology clinic, a multicentre study

IntroductionUveitis is inflammation of the middle layer of the uveal tract. The paediatric population is at risk of chronic evolution and permanent visual loss. ObjectivesTo characterize children diagnosed with uveitis in 5 institutions in Bogotá city, evaluated by the paediatric rheumatology and ophthalmology service. Materials and methodsA retrospective cohort study in children with a previous uveitis diagnosis between January 2015 and January 2018 in 5 Institutions of Bogotá. A univariate and bivariate analysis of the demographic, clinical characteristics, complications, treatment, and evolution of the disease was performed. Results91 patient histories were analysed. Of the patients, 51.65% were male. The average age was 8.44 years (SD 3.66 years). Bilateral presentation (63.74%), intermediate location (35.16%), and uveitis (25.27%) were more frequent. Idiopathic and infectious aetiology predominated in intermediate uveitis. Bilateral presentation was greater in intermediate uveitis and unilateral in anterior uveitis. Unilateral involvement was more frequent in idiopathic aetiology (42.1%) and bilateral in autoimmune aetiology (60%) (p=0.005). Uveitis associated with juvenile idiopathic arthritis, corresponded to 45.2% of those secondary to autoimmunity. Infectious aetiology was more frequent in boys, while autoimmune aetiology was more frequent in girls. The most frequent infectious cause was tuberculosis in 44%. Of the children, 25.7% arrived with some complications on admission: 69.5% synechiae, 30.5% retinal detachment, and 26% glaucoma. ConclusionsPaediatric uveitis is an important disease in children, in our study the most frequent cause was idiopathic followed by an autoimmune disorder and infection. Almost half the patients had associated complications with a major impact on the children’s lives.

Combined trabeculotomy-trabeculectomy for glaucoma after congenital cataract surgery: long-term results

ObjectifNotre étude présente les résultats à long terme (> 5 ans) de la chirurgie du glaucome faisant suite à une chirurgie de la cataracte congénitale. NatureÉtude rétrospective. MéthodesIl s'agit d'une revue de synthèse des dossiers médicaux de tous les enfants qui ont fait l'objet, entre 2005 et 2014, d'une intervention en raison d'un glaucome après avoir subi une chirurgie de la cataracte congénitale au service d'ophtalmologie pédiatrique du département d'ophtalmologie de l'Alexandria Main University Hospital (Alexandrie, Égypte) et pour lesquels on dispose d'un suivi à 5 ans. Les données démographiques, cliniques et chirurgicales ont été tirées des dossiers médicaux. La réussite reposait sur la stabilité et/ou le rétablissement de l'excavation du nerf optique comparativement à ce qui a été observé lors de la visite initiale et, en l'absence de cette donnée, sur une pression intraoculaire (PIO) inférieure à la PIO initiale et une PIO inférieure à 16 mm Hg avec (réussite mitigée) ou sans (réussite complète) collyre antiglaucomateux. RésultatsLes dossiers médicaux de 48 enfants ont été passés en revue. On disposait des données de suivi pendant au moins 5 ans pour 32 yeux de 24 enfants, qui ont donc été inclus dans l’étude. L’âge moyen (± é.-t.) des enfants de l’étude était de 11,6 ± 11,3 mois (fourchette : 3,2–52,0 mois) lors de l'examen initial, et la durée moyenne du suivi (± é.-t.) était de 105,5 ± 31,4 mois (fourchette : 60–156 mois). Sur le total des 47 chirurgies du glaucome, une technique reposant à la fois sur une chirurgie de l'angle et une chirurgie filtrante avec antimétabolite était l'intervention le plus souvent réalisée (n = 30; 63,8 %). Les pourcentages annuels de réussite de la cinquième à la treizième année après l'intervention se chiffraient respectivement comme suit : 69,6 %; 68,8 %; 77,8 %; 50,0 %; 71,4 %; 60,0 %; 50,0 %; 83,3 % et 50,0 %. ConclusionsLa chirurgie du glaucome réalisée après une chirurgie de la cataracte congénitale demeure sûre, et son efficacité s'est maintenue pendant les 13 années suivantes.

Missed appointments in a tertiary academic pediatric ophthalmology and adult strabismus service: cross-sectional study and literature review

To investigate the rate of missed appointments in a Canadian academic hospital-based pediatric ophthalmology and adult strabismus practice and the demographic and clinical factors associated with missed appointments. This cross-sectional study included all consecutive patients seen from June 1, 2018, to May 31, 2019. Multivariable logistic regression model assessed associations between clinical and demographic variables with no-show status. A literature review on evidence-based interventions to reduce no-show appointments in ophthalmology was performed. Of 3,922 visits, 718 (18.3%) were no-shows. Characteristics associated with no-shows included new patient (OR = 1.4; 95% CI, 1.1-1.7 [P = 0.001]), age 4-12 years (OR=1.6; 95% CI, 1.1-2.3 [P = 0.011]) or age 13-18 years (OR = 1.8; 95% CI, 1.2-2.7 [P = 0.007]) compared with age 19+ years, history of previous no-shows (OR = 2.2; 95% CI, 1.8-2.7 [P = 0.001]), referrals from nurse practitioners (OR = 1.8; 95% CI, 1.0-3.2 [P = 0.037]), nonsurgical diagnoses such as retinopathy of prematurity (OR = 3.2; 95% CI, 1.8-5.6 [P< 0.001]), and winter season (OR = 1.4; 95% CI, 1.2-1.7 [P < 0.001]). Missed appointments in our pediatric ophthalmology and strabismus academic center are more likely new patient referrals, prior no-shows, referrals from nurse practitioners, and nonsurgical diagnoses. These findings may facilitate targeted strategies to help improve utilization of healthcare resources.

Impact of COVID 19 pandemic lockdown in pediatric ophthalmology service in Kedia eye hospital, Nepal

Purpose: The Objective of the study is to know and record the effect of lockdown in the outpatient and emergency services of pediatric ophthalmology department of Kedia Eye Hospital.Method: Comparison of the children attending the Pediatric Eye Department of Kedia Eye Hospital during and before lockdown. Data of February 16 2021 to April 15 2021 was compared with April 16 2021 to June 15 2021. Collection of data was done from the Kedia Eye Hospital Outpatients and Emergency Eye Register.Results: Children below 15 years of age were enrolled in this study. Number of patients recorded from February 16 to April 15 2021 were 2030 and from April 16 to June 15 2021 were 318. Male patients attending hospital before lockdown was 51.62% and 55.47% during lockdown. Before lockdown female patient in the hospital was 55.47% and during lockdown was 44.02%. Total surgeries performed before lockdown was 94 and during lockdown was 11. Before lockdown Refractive error (43.15%) was the most common problem followed by Dry eye (16.55), vernal keratoconjunctivitis (15.41%). During lockdown Refractive Error (32.38%) was common followed by viral conjunctivitis (17.92%), Nasolacrimal duct obstruction (13.83%) and Trauma (11.63%).Conclusion: COVID -19 Lockdown reduced the number of patients and surgeries in the hospital. Trauma related eye disease, ocular infections and nasolacrimal duct obstruction increased in children during the lockdown.

Letter to the Editor: Accuracy of Referrals to Canadian Pediatric Ophthalmology Services.

Letter to the Editor: Accuracy of Referrals to Canadian Pediatric Ophthalmology Services.

Ocular toxoplasmosis in infants 0 to 12 months of age with congenital toxoplasmosis

Ocular toxoplasmosis (OT) is a retinochoroiditis that evolves with several episodes of inflammation and can occur both in the congenital or acquired form of the disease, Aim: To describe the frequency and clinical characteristics of OT in infants aged 0 to 12 months, children of mothers with positive serology for toxoplasmosis in the perinatal period. Cross-sectional descriptive, ambispective study. Infants from 0 to 12 months of age, whose mothers had positive serology for toxoplasmosis in the perinatal period, referred to the pediatric ophthalmology service for evaluation, were admitted. Demographic variables, maternal and infant serology and the results of the ophthalmological examination were collected. Data were analyzed in SPSS v21 Results: 46.4% of 125 infants had OT, of them 67.2% were female, (p = 0.04) the median age was 6 months, 41% had IgG and IgM positive. The lesions were bilateral in 82.8%, central in 86.2%, and inactive in 81%. Retinochoroiditis was accompanied by strabismus in 41%. The frequency of OT in this population of infants with congenital toxoplasmosis was high. more than 80% of the eye lesions were inactive, centrally located and bilaterally involved.

Caracterización de pacientes con diagnóstico de uveítis en la consulta de reumatología pediátrica, estudio multicéntrico

IntroductionUveitis is inflammation of the middle layer of the uveal tract. The paediatric population is at risk of chronic evolution and permanent visual loss. ObjectivesTo characterize children diagnosed with uveitis in 5 institutions in Bogotá city, evaluated by the paediatric rheumatology and ophthalmology service. Materials and methodsA retrospective cohort study in children with a previous uveitis diagnosis between January 2015 and January 2018 in 5 Institutions of Bogotá. A univariate and bivariate analysis of the demographic, clinical characteristics, complications, treatment, and evolution of the disease was performed. Results91 patient histories were analysed. Of the patients, 51.65% were male. The average age was 8.44 years (SD 3.66 years). Bilateral presentation (63.74%), intermediate location (35.16%), and uveitis (25.27%) were more frequent. Idiopathic and infectious aetiology predominated in intermediate uveitis. Bilateral presentation was greater in intermediate uveitis and unilateral in anterior uveitis. Unilateral involvement was more frequent in idiopathic aetiology (42.1%) and bilateral in autoimmune aetiology (60%) (p=.005). Uveitis associated with juvenile idiopathic arthritis, corresponded to 45.2% of those secondary to autoimmunity. Infectious aetiology was more frequent in boys, while autoimmune aetiology was more frequent in girls. The most frequent infectious cause was tuberculosis in 44%. Of the children, 25.7% arrived with some complications on admission: 69.5% synechiae, 30.5% retinal detachment, and 26% glaucoma. ConclusionsPaediatric uveitis is an important disease in children, in our study the most frequent cause was idiopathic followed by an autoimmune disorder and infection. Almost half the patients had associated complications with a major impact on the children's lives.

Novel web application for self-assessment of distance visual acuity to support remote consultation: a real-world validation study in children

ObjectiveThe difficulty in accurately assessing distance visual acuity (VA) at home limits the usefulness of remote consultation in ophthalmology. A novel web application, DigiVis, enables automated VA self-assessment using standard...

Missed appointments in a Canadian tertiary care, academic centre pediatric ophthalmology and adult strabismus service: rates and financial impact

Missed appointments are barriers to health care delivery that result in loss of revenue and disruption of physician-patient relationship. There is a paucity of data describing the rate and impact of missed appointments in Pediatric Ophthalmology.

The Impact of the First Peak of the COVID-19 Pandemic on a Paediatric Ophthalmology Service in the United Kingdom: Experience from Alder Hey Children's Hospital.

Objective:The COVID-19 pandemic has led to significant service loss across the NHS, and ophthalmology is one of the greatest affected specialties. We attempt to quantify the impact of the first peak of the COVID-19 pandemic on a paediatric ophthalmology unit in a children’s hospital in the United Kingdom (UK) and report lessons learnt to aid in the recovery of the service.Methods and Analysis:Two eight-week periods of clinical activity were compared; one during the first UK peak of the COVID-19 pandemic and the other during a similar period the previous year. Four areas of clinical activity were included in the study: outpatient clinic appointments, theatre activity, outpatient referrals to ophthalmology and ward reviews. Appointment data was collected from departmental databases.Results:During the first peak of the pandemic, outpatient clinic appointments were reduced by 87.2%, ophthalmic surgery by 90.9%, outpatient referrals to ophthalmology by 50.2% and ward reviews by 50%. The number of actual cancelled appointments was 1377, of which 6.8% were triaged as suitable for teleophthalmology.Conclusion:The COVID-19 pandemic has dramatically restricted clinical activity in the ophthalmology service. Paediatric ophthalmology is vulnerable to capacity issues and the consequences of delayed or cancelled appointments. Departments must adapt quickly and maximise capacity to help reduce the backlog and treat patients effectively and safely. Solutions such as teleophthalmology have potential although can be difficult in the paediatric population.

Referral outcomes from a vision screening program for school-aged children

ObjectiveTo assess ocular diagnoses and follow-up patterns of children referred for a comprehensive eye examination after a school-based vision screening program. DesignRetrospective chart review. ParticipantsStudents in grades K–5 from the School District of Philadelphia public schools screened by The Wills Eye Vision Screening Program for Children between January 2014 and June 2015. MethodsChildren with subnormal best-corrected visual acuity or other ocular conditions were referred to the Wills Eye pediatric ophthalmology service. A social worker assisted parents/guardians of referred children in scheduling an appointment and navigating insurance/payment issues. Measured outcomes included demographic information, ocular diagnoses, treatments, and follow-up patterns. ResultsOf 10 726 children screened, 509 (5%) were referred for a follow-up eye examination. Of these 509 children, only 127 (25%) completed a referral eye examination with parental consent. Most children (58%) were diagnosed with more than one eye condition, including refractive error (76%), amblyopia (43%), strabismus (16%), and anisometropia (13%). Other conditions included macular hypoplasia, ptosis, and other congenital anomalies. ConclusionsThis program discovered and addressed potentially vision-threatening conditions in underserved children susceptible to amblyopia by offering social worker services and financial support to enable referred children to complete an eye examination. Contact by the social worker required consent. Obtaining such consent proved to be a barrier to connecting children with the recommended consultation.

Establishing a Pediatric Ophthalmology Service in Malawi: Developments in Childhood Cataract Surgery.

PURPOSE:The purpose of this study is to report on the establishment of a Pediatric Ophthalmology Service for Malawi using childhood cataract surgery as a surrogate measure of its effectiveness.MATERIALS AND METHODS:A retrospective review of pediatric cataract surgery at Lions Sight First Eye Hospital, Blantyre, between 2011 and 2016. The paucity of comprehensive records allowed for the sampling of a maximum of 25 cases/year (n = 150) for comparison. Theatre records and population statistics were used to calculate childhood cataract surgical rates (CCSR).RESULTS:A total of 949 cataract operations were performed during the six years studied – 55.8% of these were boys. The number of operations per year remained generally stable. Of the 150 cases reviewed, the mean age at presentation was 6.01 years, with a trend toward a slightly younger age over the period. Over the years studied, the geographical distribution of referrals became more reflective of the population's distribution. Where the logarithm of the minimum angle of resolution (LogMAR) visions were available, these demonstrated a mean improvement from 2.008 (n = 43) preoperatively to 0.613 (n = 51) postoperatively. The mean follow-up was 106 days (0 days–3.25 years). Complication rates were low. The CCSR was 9.2/million population.CONCLUSIONS:A Pediatric Ophthalmology Service has been established in Malawi delivering safe, effective surgery on a country-wide scale for childhood cataract. Over the period studied, the age at presentation reduced, and there was an improvement in the geographical distribution of patients, likely due to an improvement in referral systems throughout Malawi.

Cerebral visual impairment is a major cause of profound visual impairment in children aged less than 3 years: A study from tertiary eye care center in South India.

Purpose:The purpose of this study was to evaluate causes for profound visual impairment in children ≤3 years of age at a tertiary eye care center in Andhra Pradesh, India.Methods:A retrospective study was conducted for all the children (≤3 years) who attended the pediatric ophthalmology service between January 2012 and February 2017.Results:A total of 428 severely visually impaired children aged ≤3 years were seen during the study period: 264 (62%) of them were boys and I64 (38%) were girls. The average age at presentation was 14.02 months. The causes of visual impairment were cerebral visual impairment (CVI) 142 (33%), a combination of CVI and ocular visual impairment (OVI) 48 (11%), and OVI only 236 (56%), which included congenital cataract 56 (13.1%), retinopathy of prematurity 52 (I2.6%), optic atrophy 17 (4.5%), congenital nystagmus (4.4%), congenital globe anomalies 2I (5.2%), and high refractive errors - 10 (2.8%). Delays in different areas of development were seen in 103 out of 142 children with CVI (72.5%), which included motor delay 53 (51.5%), cognitive delay 15 (14.6%), speech delay in 3 (2.9%), and delay in multiple areas of development (like combination of motor, cognitive, and speech delay) in 32 (31.1%).Conclusion:In children under 3 years of age, CVI is a major cause of profound visual impairment in our area and the majority of them manifest delay in several areas of development.

Retrospective data on causes of childhood vision impairment in Eritrea

BackgroundProper information on causes of childhood vision loss is essential in developing appropriate strategies and programs to address such causes. This study aimed at identifying the causes of vision loss in children attending the national referral eye hospital with the only pediatric ophthalmology service in Eritrea.MethodsA retrospective data review was conducted for all the children (< 16 years of age) who attended Berhan Aiyni National Referral Eye Hospital in five years period from January 2011 to December 2015. Causes of vision loss for children with vision impairment (recorded visual acuity less than 6/18 for distance in the better eye) was classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor.ResultsThe medical record cards of 22,509 children were reviewed, of whom 249 (1.1%) were visually impaired. The mean age of the participants was 7.82 ± 5.43 years (range: one month to 16 years) and male to female ratio was 1:0.65. The leading causes of vision loss were cataract (19.7%), corneal scars (15.7%), refractive error and amblyopia (12.1%), optic atrophy (6.4%), phthisis bulbi (6.4%), aphakia (5.6%) and glaucoma (5.2%). Childhood factors including trauma were the leading causes identified (34.5%) whereas other causes included hereditary factors (4%), intrauterine factors (2.0%) and perinatal factors (4.4%). In 55.0% of the children, the underlying etiology could not be attributed. Over two-thirds (69.9%) of vision loss was potentially avoidable in nature.ConclusionThis study explored the causes of vision loss in Eritrean children using hospital based data. Cataract corneal opacities, refractive error and amblyopia, globe damage due to trauma, infection and nutritional deficiency, retinal disorders, and other congenital abnormalities were the leading causes of childhood vision impairment in children attending the tertiary eye hospital in Eritrea. As majority of the causes of vision loss was due to avoidable causes, we recommended primary level public health strategies to prevent ocular injuries, vitamin A deficiency, perinatal infections and retinopathy of prematurity as well as specialist pediatric eye care facilities for cataract, refractive errors, glaucoma and rehabilitative services to address childhood vision loss in Eritrea.

Retinal haemorrhage in infants with pertussis

AimsIt has been hypothesised that paroxysmal coughing in infantile pertussis (whooping cough) could produce retinal haemorrhages identical to those seen in abusive head trauma. We aimed to test this hypothesis.MethodsThis...

THE SELECTED PAGES OF THE HISTORY OF PEDIATRIC OPHTHALMOLOGY IN SAINT PETERSBURG

The history of pediatric ophthalmology in Saint Petersburg dates back to the opening of the city children’s hospital “in memory of the sacred coronation of their Imperil Majesties” under the patronage of Nikolas II, Emperor of Russia, in 1905. Based at this facility, the Russia’s first department of pediatric ophthalmology was founded in 1935 to be affiliated with Leningrad Pediatric Medical Institute. The department was successively headed by professors V.V. Chirkovsky, L.A. Dymshits, V.I. Grigor’eva, A.I. Gorban’, and E.E. Somov. The present head of the department is professor V.V. Brzheskiy. One more department of pediatric ophthalmology was opened in 1983 based at the Leningrad Institute of Advanced Medical Training. It was successively headed by the associate professor V.V. Kolotov, professors S.S. Saporovsky and R.L. Troyanovsky, E.I. Saidasheva, d-r med. sci. At present, an extensive network of children’s clinics and specialized kindergartens for the children suffering from visual impairment successfully operates in Saint-Petersburg, besides two schools for the blind and visually impaired children, the eye diagnostic centre for the children and adults, and three pediatric ophthalmological hospitals. The city pediatric ophthalmology service is headed by R.V. Ershova. N.N. Sadovnikova is in charge of the Ophthalmological Department of the Clinic of Saint Petersburg State Pediatric Medical University. The Ophthalmological Department of K.A. Raukhfus municipal city hospital No 19 is headed by A.V. Baranov, PhD, and the Department of Eye Microsurgery at the Leningrad regional Children’s Clinical Hospital by O.V. Diskalenko. The present-day clinical, scientific, and educational potential of the Saint-Petersburg pediatric ophthalmological community formed at the base of many-year experience of the preceding generations of physicians continues to further increase which creates conditions for the formulation and successful achievement of the new ambitious goals.

Esotropia in Children with Ventricular-Peritoneal Shunts

ABSTRACTPurpose: Compared with the general population, patients with hydrocephalus are more likely to have strabismus. This study was undertaken to examine characteristics and outcomes of children with esotropia and ventricular-peritoneal shunt placement due to hydrocephalus.Methods: This is a retrospective chart review of all pediatric patients with esotropia and a history of ventricular-peritoneal shunt placement seen by our pediatric ophthalmology service between January 2000 and December 2010.Results: Sixteen patients between the age of 3 months and 5.6 years met study criteria. Nine were premature and all but one of the patients had developmental delay. Although all patients had a ventricular-peritoneal shunt, the diagnosis leading to shunt placement was intraventricular hemorrhage or congenital hydrocephalus in 75% of the patients. In all but 3 patients the hydrocephalus was diagnosed before the esotropia. Ten children had congenital esotropia and 6 had acquired esotropia. Eleven of the 16 children required glasses: 5 had a myopic prescription and 6 had a hyperopic prescription. Treatment of the esotropia resulted in 9 patients (56%) with successful ocular alignment (<10 prism diopters) on their last visit: 7 underwent strabismus surgery and 2 were treated with glasses only. Of the 9 patients who had strabismus surgery, 6 had congenital esotropia and 3 had acquired esotropia. Among patients who underwent strabismus surgery, 78% had successful ocular alignment at their last visit.Conclusions: While acquired accommodative esotropia is more common in the general population, children with ventricular-peritoneal shunts may be more likely to have congenital esotropia. Although developmental delay is very frequent, successful ocular alignment may be possible in this patient population.

Anterior segment OCT imaging in mucopolysaccharidoses type I, II, and VI

To describe the anterior segment optical coherence tomography (AS-OCT) characteristics of patients with ocular manifestations of mucopolysaccharidoses type I (Hurler), II (Hunter), and VI (Maroteaux-Lamy). Prospective, observational study of nine consecutive patients with variants of mucopolysaccharidosis (MPS) attending the Paediatric Ophthalmology service at Manchester Royal Eye Hospital, UK. All patients underwent Visante AS-OCT imaging as part of their ophthalmic assessment. Ocular involvement tended to be symmetrical. Angle-to-angle distance was significantly lower in MPS VI than in MPS I (P=0.04). Anterior chamber depth, angle opening distance, trabecular-iris space area, and scleral spur angle tended to be lower in MPS VI than in MPS I, but did not reach statistical significance. Corneal thickness in the central 0-2 mm zone was greater in MPS VI than in MPS I, approaching but not attaining statistical significance (P=0.07). The 2-5 and 5-7 mm zones were significantly thicker in MPS VI than MPS I (P=0.04, P=0.04). There was no difference in corneal thickness between MPS I and MPS VI in the peripheral 7-10 mm zone (P=0.57). Measurements of the patient with MPS II resembled the mean values of the MPS I group. AS-OCT is valuable in quantifying anterior segment pathology in MPS. It suggests more crowded anterior segments and greater corneal thickness in patients with MPS VI than MPS I. AS-OCT is useful in evaluating the risk and mechanism of glaucoma in MPS patients, and may improve our assessment of the efficacy of systemic treatment.

Results of Surgery for Congenital Esotropia

Congenital esotropia is a convergent deviation of the eyes when fixating on an object. It appears during the first six months of life and affects muscle structure and physiology, as well as the relation of the eyes with the environment, retinal relations and neural integration phenomena. Amblyopia develops in 30-50% of those affected. Timely surgery is effective in most cases. Describe surgical results in congenital esotropia cases treated in the Pediatric Ophthalmology and Strabismus Service of the Ramon Pando Ferrer Ophthalmology Institute in Havana between January 2008 and May 2009. A descriptive, retrospective study was carried out through review of 127 cases (aged 1-18 years, 55 male and 72 female) operated on for congenital esotropia between January 2008 and May [corrected] 2009. Variables used were: age at surgery, degree of preoperative amblyopia, type of fixation, refractive error, associated conditions, type of surgery performed and pre- and postoperative deviation angles. The largest number of congenital esotropia cases were found in children <2 years old (38.6%). Before surgery, 37% of cases studied showed mild amblyopia; 22.8% moderate and 12.6% severe; 27.6% did not cooperate with visual acuity testing. With respect to fixation: 91.3% showed central fixation and 8.7% eccentric. Refractive errors found were: mild hyperopia (65.4%), moderate hyperopia (29.1%), and myopia (5.5%). Associated conditions were: overaction of the inferior oblique muscles (48%), latent nystagmus (16.5%), and dissociated vertical deviation (8.7%); no alterations were found in 26.8% of cases. The most frequently used surgical treatment was bilateral medial rectus muscle recession (92.1%). The most common preoperative deviation angle range was 31–40 prism diopters (PD) in 51.9% of patients; the postoperative deviation angle most commonly found after 12 months was <10 PD in 64.6% (orthotropia). Surgery, most commonly with medial rectus muscle resection, was effective in correcting congenital esotropia.