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| PEDIATRIC OPHTHALMOLOGY & STRABISMUS | ||
| The Institute of Ophthalmology and Visual Science houses The Fight For Sight Children’s Eye Center, 1 of only 5 such centers in the United States. The Institute also houses the State’s only Ocular Genetics Unit, which specializes in the evaluation and treatment of pediatric patients referred to the Unit. | ||
| Biostaining-Assisted
Anterior Virectomy for Pediatric and Complicated Adult Cataract Surgery |
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| Suqin Guo, MD; Rudolph S. Wagner, MD | ||
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The goal of this project is to improve visualization of the vitreous during surgery by using various biostains during anterior vitrectomy for congenital and/or complicated adult cataract surgery. Congenital cataract can cause severe visual impairment in young children if not treated properly or promptly. Primary treatment of this condition is a cataract extraction with intraocular lens implantation. However, a major drawback to this procedure is the very high incidence of secondary cataract formation (posterior capsular opacity) postoperatively, reported to be as high as 98.5% and occurring as quickly as a few weeks after surgery. Secondary cataract can cause severe amblyopia and blindness in a very short period of time. A primary anterior vitrectomy is an important surgical step for avoiding secondary cataract in pediatric patients. The transparent vitreous is extremely difficult to visualize in the anterior chamber during cataract surgery, and it is important to ensure that the anterior chamber and surgical wounds are free from vitreous strands. Reducing postoperative complications is challenging but crucial. Common complications due to vitreous traction include chronic uveitis, endophthalmitis (intraocular infection), and retinal detachment. The latter two may lead to blindness. Biostaining of the vitreous will not only enhance visualization of the vitreous to ensure a clean anterior vitrectomy, but also act to preclude potential postoperative complications. The biostains chosen for this animal model study are being tested for 1) lowest concentration required to stain and best visualize the vitreous and 2) toxicity of biostains to ocular tissues, including cornea, uvea, and retina at different concentrations. During a complicated cataract and intraocular lens implantation surgery in adult patients, the posterior lens capsule may be ruptured accidentally, thus requiring anterior vitrectomy as a next necessary step of the surgery. Incarceration of transparent vitreous to the surgical wound is a common complication of anterior vitrectomy due to the poor visualization of the vitreous in the anterior chamber. Vitreous traction may cause sight-threatening complications. Improving visualization of the transparent vitreous with different biostains in the anterior chamber surgery will be helpful for efficient cleaning of vitreous from the surgical wounds and for reducing potential sight-threatening postoperative complications. The ultimate goal of this study is to find the lowest and least toxic concentration of biodyes for enhanced visualization of the vitreous and, thus, to allow the best results of anterior vitrectomy. |
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| Pediatric Intraocular Implants | ||
| Suqin Guo, MD | ||
| Dr. Guo is studying various surgical approaches for intraocular implants in children, since pediatric eyes differ from those of adults (eg, growth rate). Dr. Guo is also comparing the effects of clear corneal incisions and scleral incisions on postoperative astigmatism in pediatric implants. Additionally, she is randomly using different intraocular implants and comparing postoperative ocular reactions. Early optic correction with intraocular implants is an important means of preventing amblyopia. | ||
| Natural History of Retinitis Associated With Children Born Infected With HIV | ||
| Rudolph S. Wagner, MD | ||
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Many children who are HIV-positive at birth develop a chorioretinitis due, presumably, to cytomegalovirus (CMV) and/or Toxoplasma gondii. A prospective study is being undertaken to determine the incidence and course of retinal disease in this pediatric population. Our group has access to the largest such population in the United States and is undertaking this project in conjunction with Dr. James Oleske of the Department of Pediatrics at UMDNJ, who has considerable NIH finding for his studies on children infected with HIV. One of the goals of this investigation is to determine new routes for the delivery of medications to treat retinitis. This is important, since traditional intravenous delivery is associated with numerous systemic complications. In addition, the prophylactic effect of “triple” pharmacologic therapy will be evaluated. |
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| Intraocular Lens Implantation in Children | ||
| Rudolph S. Wagner, MD; Suqin Guo, MD | ||
| Because of the small size of children’s eyes, implantation of intraocular lenses poses special problems. Drs. Wagner and Guo are investigating ideal lens size, surgical technique, and factors to decrease postoperative inflammation. During the past year, Drs. Wagner and Guo have successfully implanted IOLs in children. The use of indocyanine green dye has allowed visualization of the anterior capsule, thus facilitating capsulorrhexis. | ||
| Unexpected Strabismus Following Refractive Surgery | ||
| Rudolph S. Wagner, MD | ||
| Dr. Wagner has been evaluating the factors that predispose to the development of strabismus following LASIK surgery. Patients with histories of strabismus or anisometropia are at particular risk for postsurgical redevelopment of these conditions. Thus far, 7 patients in the series have been identified. Dr. Wagner is currently developing a presurgical predictive protocol for the refractive surgeon to determine which patients are at risk. If these patients can be identified, preventive measures, eg, avoidance of overcorrection from myopia to hyperopia, can be implemented. | ||
| Preschool Vision Screening | ||
| Rudolph S. Wagner, MD; Kathryn S. Pokorny, PhD | ||
| It is estimated that fewer than 60% of children undergo eye screening/eye examination before entering kindergarten. Of the most common visual disorders of childhood (for example, amblyopia and strabismus), many cannot be treated successfully at a more advanced age. It is imperative to diagnose and treat these disorders in children before the age of ~6 years. The negative consequences associated with lack of treatment are far-reaching and include both an educational and societal (monetary) component. Early vision screening can successfully detect not only common visual disorders, but also more serious ocular pathologic conditions, for example, cataract and retinal tumors, which ultimately reduce visual acuity. Because many children do not have access to a pediatrician, ophthalmologist, or to a screening program, Drs. Wagner and Pokorny have devised a simple, inexpensive method to detect common visual disorders, which can be easily implemented by nonmedical personnel. The usefulness of this method was tested with preschool children in daycare centers. Drs. Wagner and Pokorny concluded that more accurate results were obtained when each eye was alternately occluded with paper tape than by using an occluder. Future plans include expansion of this type of program, to include the screening by nonprofessional personnel of adults in residences, such as senior citizens’ homes. | ||
| Prescribing Eyeglasses in Young Children | ||
| Patrick A. DeRespinis, MD; Rudolph S. Wagner, MD; Anthony R. Caputo, MD | ||
| Results from this long-term, ongoing study have once again been presented at the American Academy of Ophthalmology. Prescribing eyeglasses in very young children (birth to age 3) can be problematic, not only because there are no specific guidelines, but also because of other significant variables, eg, age of practitioner, training program, and regional prescribing trends. In this nationwide survey, pediatric ophthalmologists are requested to complete a 22-item questionnaire. The study address the different levels of myopia, hypermetropia, and astigmatism (symmetric and asymmetric); influence of the different varieties of strabismus on prescribing patterns; use of bifocals to treat a variety of conditions; therapeutic use of minus lenses for conditions such as convergence insufficiency; and use of polycarbonate and other types of lenses. Data from this survey will aid in supporting decisions regarding appropriate prescription of eyeglasses for young children. | ||
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