Severe amblyopia, characterized by a significant reduction in visual acuity through the affected eye, is highly resistant to reversal in adulthood. We have previously shown that synaptic plasticity can be reactivated in the adult rat visual cortex by dark exposure, and the reactivated plasticity can be harnessed to promote the recovery from severe amblyopia. Here we show that deprived-eye visually evoked responses are rapidly strengthened in dark-exposed amblyopes by passive viewing of repetitive visual stimuli. Surprisingly, passive visual stimulation rapidly enhanced visually evoked responses to novel stimuli and enhanced the recovery from severe amblyopia driven by performance of active visual discriminations. Thus a series of simple, noninvasive manipulations of visual experience can be used in combination to significantly guide the recovery of visual response strength, selectivity, and spatial acuity in adult amblyopes.

AIM:

To compare efficacy of 'split hours part-time patching' and 'continuous hours part-time patching' for the treatment of anisometropic amblyopia.

METHODS:

We designed a prospective, interventional, non-randomised, comparative pilot study involving children between 4 and 11 years of age with anisometropic amblyopia who were treated with either continuous wear (Group A) or split hours part-time patching (Group B) as per parents wish, after appropriate discussion with the parents. Children were followed-up for the improvement in visual acuity and the compliance at each follow-up visit.

RESULTS:

44 and 24 children were recruited in Group A and Group B, respectively (mean±SD baseline BCVA of the amblyopic eye: 0.99±0.32 and 0.95±0.23 logMAR, respectively). BCVA (adjusted for baseline BCVA and age) at 3 months in Group A (0.59±0.24) was comparable (p=0.08) with that in Group B (0.71±0.24). This was same even at 6 months (0.51±0.25 in Group A and 0.59±0.25 in Group B, p=0.25). The improvement in BCVA at 3 months was also comparable (p=0.06) in Group A (0.39±0.23) and Group B (0.26±0.23). The improvement in BCVA at 6 months was also comparable (p=0.14) in Group A (0.47±0.26) and Group B (0.37±0.26).

CONCLUSIONS:

Both patching regimens lead to significant and comparable improvement in BCVA in anisometropic amblyopia up to 6 months of follow-up.

A 3-year-old child sustained severe ocular surface burns in her left eye after accidental lime injury. Despite appropriate management in the acute stage, she developed limbal stem cell deficiency (LSCD) in that eye. This was initially treated with autologous ex vivo cultivated limbal epithelial transplantation (CLET), which unfortunately failed after 6 months resulting in recurrence of LSCD. One year following CLET, she underwent simple limbal epithelial transplantation (SLET) using autologous donor tissue from the healthy fellow eye. Successful restoration of the ocular surface following SLET combined with amblyopia therapy led to significant cosmetic and functional improvement. One year following SLET her vision in the left eye was 20/80 and she continues to maintain a stable, avascular and completely epithelised corneal surface. This case illustrates that SLET is effective in treating LSCD even in cases that are conventionally considered to be at high risk for failure of limbal stem cell transplantation.

PURPOSE OF REVIEW:

To summarize the articles published in 2012 pertaining to the clinical presentation, diagnosis, and treatment of herpetic keratitis, with specific attention to pediatric population.

RECENT FINDINGS:

Liu et al. confirm prior literature that herpetic keratitis has higher recurrence rate in children than adults. Recurrences are more likely to occur as stromal disease. Vision loss in children is from corneal scarring leading to deprivation and/or refractive amblyopia. Acyclovir is safe and well tolerated as a treatment in pediatric population, and preferable to difficult and toxic eye-drop regimens.Immunochromatographic assay is an effective diagnostic tool to confirm diagnosis of herpes simplex virus-1 (HSV) in corneal scrapings with high specificity but poorer sensitivity.Real time PCR can be employed to follow changes in HSV viral load in patients where resistance is suspected.

SUMMARY:

Delays in treatment related to misdiagnosis, as well as resistance to current antiviral therapeutics, can lead to visually devastating corneal opacification. In the pediatric population, already at risk for amblyopia, this can be especially damaging. Children are unique with regards to the way in which they manifest herpetic keratitis, making rapid diagnosis and treatment even more challenging.

BACKGROUND:

It has been reported that a single session of 1 Hz or 10 Hz repetitive transcranial magnetic stimulation (rTMS) of the visual cortex can temporarily improve contrast sensitivity in adults with amblyopia. More recently, continuous theta burst stimulation (cTBS) of the visual cortex has been found to improve contrast sensitivity in observers with normal vision.

OBJECTIVE

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HYPOTHESIS:

The aims of this study were to assess whether cTBS of the visual cortex could improve contrast sensitivity in adults with amblyopia and whether repeated sessions of cTBS would lead to more pronounced and/or longer lasting effects.

METHODS:

cTBS was delivered to the visual cortex while patients viewed a high contrast stimulus with their non-amblyopic eye. This manipulation was designed to bias the effects of cTBS toward inputs from the amblyopic eye. Contrast sensitivity was measured before and after stimulation. The effects of one cTBS session were measured in five patients and the effects of five consecutive daily sessions were measured in four patients. Three patients were available for follow-up at varying intervals after the final session.

RESULTS:

cTBS improved amblyopic eye contrast sensitivity to high spatial frequencies (P < 0.05) and there was a cumulative improvement across sessions with asymptotic improvement occurring after 2 daily sessions of stimulation. The contrast sensitivity improvements were stable over a period of up to 78 days.

CONCLUSIONS:

These initial results in a small number of patients indicate the cTBS may allow for enduring visual function improvements in adults with amblyopia.

Purpose:

To study functional and anatomic characteristics of eyes of Russian children with fetal alcohol syndrome (FAS).


Methods:

One hundred children aged 10-16 years from Russian orphanages (St. Petersburg) were examined: 50 with verified diagnosis of FAS and 50 healthy children. All children were tested for distance visual acuity (VA) with subjective optimal correction (Sivtsev chart), skiascopy, visual inspection for FAS external ocular features, biomicroscopy, eye alignment using cover test, and indirect ophthalmoscopy.


Results:

All analyzed parameters were worse in children with FAS compared with controls. Children with FAS showed a higher incidence of amblyopia, hyperopia, astigmatism, and anisometropia. In children with FAS, the incidence of blepharophimosis was 34% (8% in controls), epicanthus 14% (2% in controls), telecanthus 32% (compared to 4% in controls), eyelid ptosis 9% (none in controls), and strabismus 26% (10% in controls). Ophthalmoscopy revealed a tilted optic disc in 5 children with FAS (7%) compared with none in controls.


Conclusion:

Russian children with FAS have a higher incidence of vision problems and eye pathology that needs to be taken into account and requires ophthalmologist monitoring.

While conducting medical aid in Mozambique, a 41 year old African male presented to our eye clinic complaining of visual impairment. The male was found to have Peters' anomaly type 2, a rare congenital ocular malformation leading to sensory amblyopia and glaucoma.

BACKGROUND:

The aim was to develop and validate an instrument called the 'Children's Vision for Living Scale' (CVLS) for the assessment of vision-related quality of life in Saudi Arabian children with and without amblyopia.

METHODS:

A 43-item child self-report questionnaire was initially developed based on interviews with children with amblyopia, their parents and eye-care professionals, and a literature review. Following a process that involved the removal of redundant items, 28 items remained and were piloted on children aged five to 12 years with and without amblyopia (n = 48 amblyopic, n = 53 non-amblyopic) living in Saudi Arabia. Rasch analysis was applied to determine whether the 28-item questionnaire fitted the Rasch model. Rasch analysis was used to assess the validity and reliability of the questionnaire. Principal components analysis (PCA) was used to check dimensionality. A 21-item questionnaire resulting from this process was administered in children with (n = 81) and without (n = 82) amblyopia in Saudi Arabia for further validation.

RESULTS:

The final 21-item questionnaire had good validity and reliability as demonstrated by person separation of 2.02, person reliability of 0.80 (mean square and standard deviation: infit = 1.01 ± 0.39; outfit = 1.01 ± 0.40) and item reliability of 0.93 (item infit range = 1.33 to 0.78; item outfit range = 0.78 to 1.30). The mean difference between person and item scores of 0.33 ± 0.53 logits (scale range, 2 to -2) indicates that the items are well targeted to the populations. The PCA (dimensionality measures) shows the percentage of variance explained by measures equal to 26.4 per cent (modelled 26.9 per cent) and an eigenvalue of the first contrast of 2.5, which demonstrated good stability.

CONCLUSION:

The 21-item CVLS is a valid uni-dimensional child self-report instrument for the assessment of the impact of amblyopia on vision-related quality of life in children with and without amblyopia living in Saudi Arabia.

PURPOSE:

To evaluate the possible risk factors in patients with consecutive exotropia following esotropia surgery.

METHODS:

Medical records of patients who had comitant esotropia surgery between June 1999 and April 2011 were reviewed. Those who developed consecutive exotropia composed the exotropia group; patients matched for age and duration of follow-up who did not develop consecutive exotropia composed the no exotropia group. The charts of the patients were reviewed and possible risk factors for development of consecutive exotropia were investigated.

RESULTS:

The average ages of 47 patients in the exotropia group and 54 patients in the no exotropia group were 10.8 ± 8.7 years (range: 1 to 41 years) and 8.5 ± 6.3 years (range: 1 to 30 years), respectively (P = .292). Amblyopia was detected in 31 (66%) and 12 (22.2%) patients in the exotropia and no exotropia groups, respectively (P = .004). Anisometropia was observed in 20 patients (42.6%) in the exotropia group and 5 patients (9.3%) in the no exotropia group (P = .003). Preoperative average esodeviation values were 42.5 ± 8.3 prism diopters (PD) (range: 25 to 60 PD) in the exotropia group and 42 ± 9.4 PD (range: 20 to 65 PD) in the no exotropia group (P = .673). Postoperative deviations were 32.8 ± 23 PD exotropia (range: 10 to 90 PD exotropia) in the exotropia group and 4.4 ± 4.2 PD esotropia (range: 0 to 10 PD esotropia) in the no exotropia group (P = .000). Asymmetric surgery had been performed in 61.7% of the exotropia group (n = 29) and 9.3% of the no exotropia group (n = 5) (P = .000). Limitation of adduction was detected in 14 patients (29.8%) in the exotropia group; none was noted in the no exotropia group (P = .000). The mean interval between the initial surgery and the onset of consecutive exotropia was 11.1 ± 15.1 months (range: 0 to 126 months).

CONCLUSIONS:

Anisometropia, amblyopia, asymmetric surgery, and postoperative adduction deficit were associated with the development of consecutive exotropia. Long-term follow-up should be considered because consecutive exotropia can develop after months or years.[J Pediatr Ophthalmol Strabismus 20XX;XX(X):XX-XX.].

PURPOSE:

: To present a case in which bilateral microkeratome-assisted contralateral anterior lamellar corneal autografting was used in the treatment of a patient with a stromal scar in one eye and dense amblyopia in the fellow eye.

METHODS::

Case report based on chart review.

RESULTS::

Anterior lamellar flaps were created in both eyes with a microkeratome. Six weeks later, central trephination through both flaps was performed, and the resulting corneal discs were switched. Visual acuity improved to 20/30 in the nonamblyopic eye 1 year after the surgery.

CONCLUSIONS::

Microkeratome-assisted contralateral lamellar autokeratoplasty can be useful in the treatment of an anterior stromal scar when the fellow eye has a clear cornea and poor vision limited by untreatable noncorneal pathology.