Spectacle Correction Research Articles

Visual performance with simultaneous vision multifocal contact lenses

Purpose: The aim was to assess visual performance after PureVision high addition multifocal contact lens (PM) fitting through contrast sensitivity measured under different illumination levels for both distance and near.Methods: In a cross‐over study, 20 presbyopic patients were randomly assigned to PM or spectacles. Near contrast sensitivity was measured with the Vistech VCTS 6500 system. Distance contrast sensitivity and distance visual acuity (VA) were measured with the Functional Vision Analyser under photopic (85-cd/m2) and mesopic (3.0-cd/m2) conditions, the latter also under two levels of induced glare: 1.0 lux and 28 lux. Near VA was measured by logMAR charts under approximately 80-cd/m2 luminance settings.Results: Average monocular spectacle corrected and PM VA were ‐0.02 ± 0.05 and 0.03 ± 0.05 logMAR for distance photopic, 0.16 ± 0.10 and 0.23 ± 0.07 logMAR for distance mesopic and ‐0.03 ± 0.05 and 0.05 ± 0.06 logMAR for near photopic, respectively. Average binocular spectacle corrected and PM VA were ‐0.05 ± 0.07 and ‐0.01 ± 0.03 logMAR for distance photopic, 0.10 ± 0.06 and 0.18 ± 0.05 logMAR for distance mesopic and ‐0.08 ± 0.06 and 0.02 ± 0.05 logMAR for near photopic, respectively. Statistically significant differences were found between the contrast sensitivity with the two types of correction for both distance and near, with spectacle correction being better in all cases.Conclusion: PureVision multifocal contact lenses preserve good VA and good visual performance under real‐life conditions.

Benefit of Adaptive Optics Aberration Correction at Preferred Retinal Locus

To investigate the effect of eccentric refractive correction and full aberration correction on both high- and low-contrast grating resolution at the preferred retinal locus (PRL) of a single low-vision subject with a long-standing central scotoma. The subject was a 68-year-old women with bilateral absolute central scotoma due to Stargardt disease. She developed a single PRL located 25° nasally of the damaged macula in her left eye, this being the better of the two eyes. High- (100%) and low-contrast (25 and 10%) grating resolution acuity was evaluated using four different correction conditions. The first two corrections were solely refractive error corrections, namely, habitual spectacle correction and full spherocylindrical correction. The latter two corrections were two versions of adaptive optics corrections of all aberrations, namely, habitual spectacle correction with aberration correction and full spherocylindrical refractive correction with aberration correction. The mean high-contrast (100%) resolution acuity with her habitual correction was 1.06 logMAR, which improved to 1.00 logMAR with full spherocylindrical correction. Under the same conditions, low-contrast (25%) acuity improved from 1.30 to 1.14 logMAR. With adaptive optics aberration correction, the high-contrast resolution acuities improved to 0.89/0.92 logMAR and the low-contrast acuities improved to 1.04/1.06 logMAR under both correction modalities. The low-contrast (10%) resolution acuity was 1.34 logMAR with adaptive optics aberration correction; however, with purely refractive error corrections, she was unable to identify the orientation of the gratings. Correction of all aberrations using adaptive optics improves both high- and low-contrast resolution acuity at the PRL of a single low-vision subject with long-standing absolute central scotoma.

Contact lens visual rehabilitation in keratoconus and corneal keratoplasty.

Keratoconus is the most common corneal distrophy. It's a noninflammatory progressive thinning process that leads to conical ectasia of the cornea, causing high myopia and astigmatism. Many treatment choices include spectacle correction and contact lens wear, collagen cross linking, intracorneal ring segments implantation and finally keratoplasty. Contact lenses are commonly used to reduce astigmatism and increase vision. There are various types of lenses are available. We reviewed soft contact lenses, rigid gas permeable contact lenses, piggyback contact lenses, hybrid contact lenses and scleral-semiscleral contact lenses in keratoconus management. The surgical option is keratoplasty, but even after sutur removal, high astigmatism may stil exists. Therefore, contact lens is an adequate treatment option to correct astigmatism after keratoplasty.

Importance of vision screening in children regardless of socioeconomic status

Sir, Vision screening is important to achieve the full academic potential of children. Preschool and school vision screening is part of government health programmes in many countries but referral criteria may somewhat vary.1, 2, 3, 4 In this report vision screening was carried out on a selected sample of children from socioeconomically secure families with a high level of parental education at a private school in Rome (Ambrit International). Medical forms were completed by parents and a pediatric assessment of children was performed every year. The ophthalmologist SA carried out screening on children at age 6 and 8. The examination included visual acuity assessment with a standard illuminated decimal chart, cover/uncover testing, the Lang test, and indirect ophthalmoscopy. A total of 380 children were tested from 2001–2011. Higher education was recorded for both parents in 334 families (87.9%) and for one parent in 30 families (7.9%). Any child who did not pass screening with visual acuity ≤0.8 was referred to complete ophthalmological examination under cycloplegia. Refractive errors were considered significant with hyperopia >3 diopters or myopia >0.5 diopters. The salient result was that a total of 14.5% of children had significant refractive errors but only 6.3% had already received a spectacle correction notwithstanding the high socioeconomic status of the families. Furthermore, 18 of these children with no significant defects at age 6 had visual acuities of ≤0.8 at age 8 and received spectacle corrections. At follow up all except three children (one with myopia and two with hyperopia and amblyopia) who had been prescribed glasses presented visual acuities of 1.0 (Table 1). Analysis of the refractive errors showed that while ocular conditions manifesting strabismus and those giving astenopeic symptoms had been cared for, systematic preventive vision examinations were lacking and ‘silent' ametropia had gone unnoticed. It can be concluded that government health programmes for vision screening are essential for all children regardless of socioeconomic status. Furthermore, regular screening during the school years is advisable as vision defects may arise at various stages in childhood and a satisfactory or borderline test should not lead to complacency about the need for further testing.5 Table 1 Screening and complete testing results of children at age 6 and 8

Changes in binocular function in anisometropic nonstrabismic children with optical correction and occlusion therapy

To identify factors that influence binocular function in anisometropic, nonstrabismic children before and after optical correction and amblyopia therapy. This was a prospective observational study of consecutive patients with nonstrabismic anisometropia. Visual acuity and responses to the 4(Δ) base-out prism test, the Worth 4-dot test, and the TNO test were recorded after spectacle correction and every 3 months for 1 year. Factors affecting visual acuity and binocular function were analyzed using univariate and multiple stepwise regression analysis. A total of 118 subjects were enrolled. At the end of the first year, the mean improvement in visual acuity was 2.6 ± 2.3 lines. The percentage of patients showing a positive response to the 4(Δ) base-out prism test increased from 47% to 79%; fusion in the Worth 4-dot test, from 37% to 66%; and measurable stereopsis on TNO testing, from 59% to 80%. Better initial visual acuity and better final visual acuity were associated with better binocular function. Interocular refractive error difference was a predictor of poor binocular function in multiple regression analysis if the difference in spherical error exceeded 4 D. Patients with amblyopia showed significantly worse binocular function compared to those with no amblyopia. Binocular function of anisometropic children can be improved with refractive correction and amblyopia therapy.

Ocular manifestations as key features for diagnosing mucopolysaccharidoses

Diagnosis of mucopolysaccharidosis (MPS) requires awareness of the multisystem disease manifestations and their diverse presentation in terms of time of onset and severity. Many patients with MPS remain undiagnosed for years and progressively develop irreversible pathologies, which ultimately lead to premature death. To foster timely treatment and ensure a better outcome, it is of utmost importance to recognize and evaluate the typical ocular features that present fairly early in the course of the disease in many children with MPS. These include corneal clouding, ocular hypertension/glaucoma, retinal degeneration, optic disc swelling and optic nerve atrophy. Other associations include pseudo-exophthalmos, amblyopia, strabismus and large refractive errors requiring spectacle correction. While some ocular manifestations require specialized equipment for detecting abnormalities, light sensitivity, pseudo-exophthalmos and strabismus are often apparent on a routine physical examination. In addition, patients may be symptomatic from vision impairment, photosensitivity, night blindness and visual field constriction. Combined with the skeletal/joint complications and other manifestations, these ocular features are key in the differential diagnosis of children with joint abnormalities. Rheumatologists should have a high index of suspicion for MPS to facilitate early diagnosis. Referral to a geneticist, a metabolic specialist or physician who specializes in MPS can confirm the diagnosis and provide disease management. Consultation with an ophthalmologist who has expertise in MPS is also needed for thorough examination of the eyes and regular follow-up care.

Accommodation in young adults wearing aspheric multifocal soft contact lenses

The aim of the present project was to investigate accommodative behavior in young adults and adolescents fitted with an aspheric multifocal (center distance) contact lens with focus on evaluating whether these lenses can be an alternative treatment for subjects in which a reduced level of blur and thereby accommodation in near vision is aimed at. Twenty normal subjects aged between 21 and 35 years participated in the study. Aberrometry was perfomed using a Zywave™ aberrometer, first on the uncorrected eyes of all subjects, and again while the subjects wore a multifocal contact lens with a +1.00 add. A Shin-Nippon N Vision-K 5001 Autoref-Keratometer was used to measure accommodative response with two different refractive corrections: (1) habitual spectacle correction only, and (2) habitual correction and a aspheric multifocal (center distance) contact lens. Four hours of adaptation to the lens was allowed. The lag when wearing only the habitual spectacles was compared with the lag while wearing both the habitual spectacles and the aspheric multifocal contact lens. The mean lag of accommodation for the subject group was 0.85 D (±0.57 SD) and 0.75 D (±0.52 SD) without and with the multifocal lens, respectively. Statistical analyses showed no difference in lag (t = 0.8479, p = 0.407) with and without the lens. In conclusion, young normal subjects do not relax accommodation when fitted with aspheric multifocal center distance lenses when the addition is +1.00. It is therefore unlikely that subjects with accommodative ability, in whom the treatment purpose is to reduce blur and thereby accommodation, can be effectively treated with such lenses.

An evaluation of a novel instrument for measuring macular pigment optical density: the MPS 9000

Of the antioxidants found in the human retina, only the macular carotenoid quantities can be estimated noninvasively (albeit in a collective fashion), thus facilitating study of their role in that tissue. The aim of this study was to evaluate concordance between macular pigment optical density (MPOD) values recorded on a commercially available instrument, the MPS 9000, with those of an already validated heterochromatic flicker photometry instrument. Also, we assessed and compared test-retest variability for each instrument. Macular pigment optical density at 0.5 retinal eccentricity was measured using two different heterochromatic flicker photometers, the MPS 9000 and the Macular Densitometer(TM), in 39 healthy subjects. Test-retest variability was evaluated separately for each instrument by taking three readings over a 1-week period in 25 subjects. There was a moderate positive correlation for MPOD at 0.5° of retinal eccentricity between the MPS 9000 and the Macular Densitometer described by the linear equation y = 0.763x + 0.172 (r = 0.68, p < 0.001, r(2) = 0.46); however, a paired-samples t-test showed a significant difference in terms of mean values, with a bias of lower MPOD values being yielded by the MPS 9000 (t = -4.103, p < 0.001). Bland-Altman analysis indicated only moderate agreement between the two instruments, reflected in 95% limits of agreement of 0.1 ± 0.27. Inter-sessional repeatability, expressed as a coefficient of repeatability, ranged from 0.18 to 0.21 [mean (±SD): 0.19 (0.02)] for the MPS 9000 and from 0.11 to 0.12 [mean (±SD): 0.12 (0.01)] for the Macular Densitometer. The results demonstrate that the MPS 9000 consistently yields MPOD readings, which are lower than that found with the Macular Densitometer, and exhibits substantial test-retest variability.

Visual Outcome of Cataract Surgery

Purpose: To assess the visu al ou tcome of cataract su rgery in a tertiary hosp ital in Nigeria. Methods: Three hu nd red and seventy eyes (370) that had cataract su rgery in the op hthalmology d ep artment of University of Benin Teaching Hosp ital (UBTH) from July 2007 to December 2008 were includ ed in the stu d y. Case record s were retrieved and d ata from them analysed . The age range was 4 to 95 years (mean age 41.1 years). There were 181 males and 189 females . Senile cataract was the commonest (64.6%) typ e, followed by traumatic cataract (13%). Extracapsu lar cataract extraction with p osterior chamber intraocu lar lens (IOL) imp lant (75.4%) was the commonest p roced u re, followed by ECCE with anterior chamber intraocu lar lens imp lant (11.6%), ECCE withou t IOL (4.1%) and intracapsular cataract extraction with or withou t IOL ( 8.9% ). Results: Preoperative visu al acu ity was less than 3/ 60 in 73.8% and 6/ 18 &ndash; 6/ 60 in 4% of the eyes. The best corrected p ostop erative visu al acu ity at 6 weeks was 6/ 6 &ndash; 6/ 18 (good ou tcome) in 161 (43.5%) eyes, bord erline in 107(28.9%) and p oor in 73 (19.7%). The best corrected visu al ou tcome at 6 m onths w as good in 221 (59.7%), bord erline in 59 (15.9%) and p oor in 34 (9.3%) eyes. The visu al ou tcome was u nknown in 56 (15.1%) eyes. Conclusion: The visu al ou tcome after cataract extraction in this centre is still less than the WHO recommend ation of 90% for best corrected visual acu ity of 6/ 6-6/ 18 vision. There is the need for biometry, good p atient selection, p rop er management of comp lications and sp ectacle correction of refractive errors in ord er to imp rove visual ou tcome after cataract extraction.Key words: visu al ou tcome, cataract extraction, intraocu lar lens imp lant

Changes in Exodeviation Following Hyperopic Correction in Patients With Intermittent Exotropia

To evaluate changes in the angle of deviation after spectacle correction in patients who had hyperopia and intermittent exotropia (X(T)) and to determine whether the changes and surgical outcomes differ when compared with those of myopic and emmetropic X(T). One hundred fourteen patients with X(T) were recruited and allocated into three groups: X(T) with hyperopia (group I; 38 patients), X(T) with emmetropia (group II; 35 patients), and X(T) with myopia (group III; 41 patients). After at least 6 months wearing spectacles, changes in exodeviation were compared. The results of surgery based on the spectacle-corrected distance angle and the ratios of accommodative convergence over accommodation (AC/A) were also assessed. With spectacle correction, the mean exodeviation increased significantly in group I, but did not change in groups II or III. Thirteen patients in group I (34%) showed a more than 10 prism diopters (PD) exotropic shift after wearing spectacles. The mean AC/A ratio in group I was 2.63 (PD/D), whereas in groups II and III the ratios were 4.03 and 4.06, respectively. There was no difference in surgical results among the three groups. Although hyperopic correction in patients with X(T) resulted in a limited increase in exodeviation with a subnormal AC/A ratio, one-third of the patients experienced a significant increase in exodeviation. A spectacle correction trial should be considered before surgery in patients with hyperopia and X(T).

Two‐year follow‐up of a randomized trial of spectacles alone or combined with Bangerter filters for treating anisometropic amblyopia

To compare spectacle correction alone to spectacle correction with Bangerter filters as treatments for anisometropic amblyopia in children 1 year after completion of a 1-year randomized trial. In a randomized clinical trial, 80 children (mean age, 4.4 years) with anisometropic amblyopia and a best median visual acuity (VA) in the amblyopic eye of 0.4 logarithm of the minimum angle of resolution (logMAR) were assigned to treatment with either spectacles or spectacles in combination with a Bangerter filter for 1 year. After 1 year, treatment with spectacles continued. If the VA differed by ≥ 2 lines, treatment with Bangerter filters was continued if originally prescribed. The main outcome measure was the median change in VA of the amblyopic eye after 2 years. The median change in VA of the amblyopic eye did not differ significantly between the groups (0.4 log unit for both groups) at the 2-year visit. At that time, the VA in the amblyopic eyes and the fellow eyes was 0.0 median logMAR in both groups. Between years 1 and 2, the median VA improved in the amblyopic eyes; in the spectacles group (p = 0.0181) and in the Bangerter filter group (p = 0.0342). The median anisometropia decreased in both groups (p < 0.0001 for both comparisons). We found stability in the VA improvement in both groups. The magnitude of the VA change 2 years after treatment with spectacles alone did not differ significantly from that after treatment with spectacles and a Bangerter filter for anisometropic amblyopia.

Berechnung phaker Intraokularlinsen

A high corneal astigmatism is a major limitation for the attainable visual acuity with spectacle or contact lens correction. In addition, people with higher ametropia may feel discomfort while wearing contact lenses or spectacles which leads to the desire for a permanent correction. Phakic intraocular lenses provide correction possibilities of higher spherocylindrical ametropies beyond those of corneal refractive surgery. For the calculation of toric phakic lenses the matrix formalism for calculation of toric pseudophakic implants is applied. The methods are presented and explained using clinically relevant data examples. A Java-based program JPhakicIOL was used for calculation of the examples and is provided online for teaching and experimental purposes. Phakic IOLs can be calculated using a matrix scheme similar to the one used for toric pseudophakic implants. With the Java programme JPhakicIOL we provide a software tool to assist ophthalmologists in understanding and performing the phakic IOL calculation.

Corneal Autograft and Allograft in a 10-Month-Old Premature Boy With Acquired Bilateral Corneal Opacities

To report a case in which corneal autograft and allograft were performed in a 10.5-month-old, ex 24-week, premature boy with bilateral corneal opacities from infectious keratitis. Case report based upon chart review. At 3 years, the corneal autograft is clear without vascular ingrowth. After transplantation, the clarity of the autograft improved markedly and unexpectedly from its pretransplantation appearance. The child fixes and follows and has central steady maintained fixation at near with a spectacle correction of +11.00 diopters. The allografted cornea is opaque with 360 degrees of vascular ingrowth. This eye is phthisical with no response to light. In circumstances in which a viable cornea is available from the patient's worse prognosis eye, a corneal autograft is a potential treatment option.

P2-413 Assessment of refractive errors and colour vision by vision screening among school children in Shimla district of North India

IntroductionWHO introduced the global initiative for the elimination of avoidable blindness by the year 2020 known as “Vision 2020”. Refractive errors, is one of the priority areas for vision 2020...

Safety and Efficacy of Temporal Manual Small Incision Cataract Surgery in India

To assess safety and efficacy of temporal manual small incision cataract surgery (SICS) in context to visual outcome, astigmatism, and complications. This involved sclerocorneal tunnel, capsulotomy, and hydrodissection. The incision was made with number 11 disposable surgical blade (costing Indian Rs. 2.50, $0.05). Nucleus extraction was done by phaco-sandwich method with the help of vectis and dialer. Posterior chamber intraocular lens implantation was done according to biometric findings. A record of intraoperative and postoperative complications was made. The final postoperative assessment of astigmatism was done with spectacle correction on the 45th day as per the refraction findings. Two thousand eyes were operated by temporal, manual small incision sutureless technique. Uncorrected visual acuity was >6/18 in 1636 (81.7%) patients on the first postoperative day, in 1652 (82.6%) patients at 2 weeks, and in 1732 (88.6%) patients at 6 weeks. Best-corrected visual acuity (BCVA) >6/18 was achieved in 1868 (93.4%) patients at 6 weeks, with 46 (2.3%) having BCVA <6/60, 24 (1.2%) of whom had preexisting retinal pathology. At 6 weeks, 1876 (93.8%) eyes had with-the-rule and 134 (6.2%) against-the-rule astigmatism (mean 0.7±1.25 D). Iris prolapse was noted in 3 (0.15%), wound leak in 3 (0.15%), and transient corneal edema in 136 (6.8%) eyes. Average surgery time was 6 minutes. Temporal SICS with number 11 disposable surgical blade and nucleus delivery by phaco-sandwich method gave excellent outcome with minimal astigmatism and low complication rate at economic cost.

Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles

To evaluate a method for treating uncorrected refractive error in adults in the developing world. Prospective, cross-sectional study in outpatient community health centres. Eight hundred and forty subjects aged 18 and older from rural villages in Haiti and Belize. Undilated refractive error screening exams were conducted over a 5-day period in rural Haiti and Belize using portable autorefractors. Isometropic, spherical, ready-made spectacles were provided to patients with bilateral refractive error, astigmatism ≤ 1 dioptre in each eye and visual acuity worse than 6/9 in each eye. Visual acuity was measured with and without corrective spectacles. The mean visual improvement and median final visual acuity after treatment with ready-made glasses. Eight hundred and forty patients aged 18 and older were screened with autorefractors. One hundred and eighty-nine subjects (22.5%) were found to have visually significant bilateral refractive error. Fifty-eight per cent (110/189) of these patients met criteria for treatment with ready-made spectacles. Visual acuity improved an average of 4.2 lines in the better eye and 4.1 lines in the worse eye with corrective glasses. The median visual acuity in the better eye was 6/6 after treatment. Autorefractors and ready-made spectacles allow for effective treatment of uncorrected refractive error in adults in the developing world.

Effects on Vision With Glare After Correction of Monochromatic Wavefront Aberrations

To investigate effects of optical aberration correction on vision with glare. Correction of aberrations up to the 6th Zernike order (closed-loop correction) was compared with conventional spectacle correction in 42 healthy eyes. To create these corrections, an adaptive optics system including a thin-film transistor (TFT) monitor for displaying optotypes with additional glare sources was used. Employing both corrections, visual acuity and contrast sensitivity (CS) were tested alternately with and without glare. Disability glare was computed as the difference between log CS without and with glare. Individuals were also asked to rate subjectively the quality of three images displayed on the TFT monitor. Significant improvements of CS without and with glare were found with the closed-loop correction (0.147 and 0.198 log CS, respectively), whereas no significant difference in visual acuity was found in either correction. Correlations were determined between reduction of total root-mean-square error and increase of CS with glare (Pearson correlation coefficient r=0.42) and decrease of disability glare (r=-0.33). Visual acuity was correlated with the visual Strehl ratio based on the optical transfer function (r=0.46). Subjective comparison of the images showed improvements more clearly. Depending on the image, in 57% to 78% of the eyes, closed-loop correction was rated better than spectacle correction. The subjective glare effect was reduced as well. Investigation of vision with glare seems to be a reasonable additional test to evaluate the visual outcome of a customized correction.

Presbyopia and Near-Vision Impairment in Rural Northern China

Presbyopia limits activities of daily living, but population-based data from rural China are scarce. A population-based, cross-sectional study was conducted in 2009 among all persons aged 40+ years in a rural area near Shenyang, China. Distance and near VA were measured using logMAR E charts. Individuals with pinhole-corrected distance vision ≥20/63 underwent detailed eye examination and near refraction. A total of 1008 (91.5%) respondents were examined (mean age, 58.4 ± 10.7 years for men, 56.8 ± 9.89 years for women). Women and older subjects were more likely to participate. The prevalence of functional presbyopia (near vision <20/50 [N8] improved by ≥1 line with correction) was 67.3% (95% confidence interval [CI], 64.30%-70.09%), increasing from 27.6% at 40 to 49 years of age to 81.8% at 60 to 69 years. Multivariate analysis showed that older age (P < 0.001), but not gender or education, was significantly associated with a higher risk of presbyopia. Self-reported presbyopic spectacle correction coverage was 51.5%. In multivariate logistic regression models, worse presenting near vision (P = 0.013) and higher required spherical equivalent power (P < 0.001) were associated with having correction, while age, gender, education, and distance vision were unassociated. Major barriers reported by persons without near correction included poor quality of available glasses (33.1%) and lack of awareness of the condition and its treatment (28.8%). Presbyopia is highly prevalent in rural China, and nearly half of affected persons have no access to correction. Interventions should focus on education and improvement in the quality of refractive services.

Influence of Overnight Orthokeratology on Axial Elongation in Childhood Myopia

This prospective study was conducted to assess the influence of overnight orthokeratology (OK) on axial elongation in children, with those wearing spectacles as controls. One hundred five subjects (210 eyes) were enrolled in the study. The OK group comprised 45 patients (90 eyes, age 12.1 ± 2.5 years, mean ± SD; OK group) who matched the inclusion criteria for OK. The control group comprised 60 patients (120 eyes, 11.9 ± 2.0 years) who also matched the inclusion criteria for OK but preferred spectacles for myopia correction. Axial length was measured at baseline and after 2 years using ocular biometry, and the changes were evaluated and compared between the groups. Ninety-two subjects (42 and 50 in the OK and control groups, respectively) completed the 2-year follow-up examinations. At baseline, the spherical equivalent refractive error was -2.55 ± 1.82 and -2.59 ± 1.66 D, and the axial length was 24.66 ± 1.11 and 24.79 ± 0.80 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 2-year study period was 0.39 ± 0.27 and 0.61 ± 0.24 mm, respectively, and the difference was significant (P < 0.0001, unpaired t-test). OK suppressed axial elongation in myopic children, suggesting that this treatment can slow the progression of myopia to a certain extent.

Should Unilateral Congenital Corneal Opacities in Peters’ Anomaly be Grafted?

To evaluate the surgical outcomes and visual results after penetrating keratoplasty for congenital unilateral corneal opacities in Peters anomaly. This was a retrospective study of 14 children who underwent keratoplasty for a unilateral Peters anomaly between 1999 and 2009. All patients received a topical treatment of cyclosporine and corticosteroids. Suture ablation was performed between the first and second postoperative month and all patients had spectacle correction and amblyopia treatment. Age at time of surgery, posterior segment status evaluated by ultrasonography, axial length, preoperative intraocular pressure, fellow eye status, mean follow-up time, early and late complications, final graft outcome, refraction, and visual acuity upon the last visit were noted. Mean age at the time of surgery was 9 months. Posterior segment was normal in all cases. Mean axial length was 18 mm and mean intraocular pressure was 11 mmHg. Mean follow-up was 30 months. Four children had graft rejection episodes, 2 of which responded to medication. Four underwent cataract surgery, one developed pupil deformation requiring a pupilloplasty, and 2 cases were complicated by surgical glaucoma. A total of 11 eyes (78.6%) had clear grafts at the end of the follow-up. Mean spherical equivalent was -1.5 D. Visual acuity was measurable in 3 cases and was 20/50 in one case, 20/63 in the second, and 20/2000 in the third. Concerning preverbal children, central, steady, and maintained fixation was found in 8 cases. Operating on a unilateral congenital corneal opacity is a challenging decision and should be taken after explaining the need for long-term follow-up to the parents. Useful vision can be achieved and maintained after strict amblyopia therapy. A multidisciplinary ophthalmologic follow-up is necessary.