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	New Approaches to Ocular Surface Disease Treatment
	Author(s)/Faculty: Eric D. Donnenfeld, MD; David R. Hardten, MD; William B. Trattler, MD; Y. Ralph Chu, MD more Eric D. Donnenfeld, MD; David R. Hardten, MD; William B. Trattler, MD; Y. Ralph Chu, MD
	Source: OSN SuperSite	Type: Multimedia	Number of Articles: 1
	Release Date: August 2010	Expiration Date: August 16, 2011	Cost: $0.00 / $0.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW Dry eye significantly affects outcomes following refractive and cataract surgery, making careful preoperative screening imperative in achieving postoperative patient satisfaction and the best visual outcomes. Leading clinicians will outline the rationale for implementing rigorous dry eye screening as part of the preoperative work-up, discuss their screening criteria and describe treatment options to resolve dry eye and optimize the ocular surface before surgery.


	Complications and Visual Prognosis in Children With Aniridia
	Author(s)/Faculty: Helena Lee, MB; Katrina Meyers, MRCOphth; Bernadette Lanigan, MBA and Michael O’Keefe, more FRCOphth
	Source: JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS 47:4	Type: Journal	Number of Articles: 1
	Release Date: July 2010	Expiration Date: July 15, 2011	Cost: $0.00 / $20.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW PURPOSE To characterize the ophthalmological findings, assess surgical outcomes, and review visual outcomes in aniridia. METHODS A retrospective case review was performed and data were collected, including patient demographics, incidence of aniridia-associated keratopathy, glaucoma, cataract, retinal breaks or detachments, optic nerve hypoplasia, macular hypoplasia, poor vision, and nystagmus. All outcomes from surgery, including penetrating keratoplasty, trabeculectomy, Ahmed valve insertion, and cataract extraction, were recorded. RESULTS Six children (12 eyes) had corneal abnormalities, 4 had optic nerve hypoplasia, 9 had nystagmus, and 2 had retinal detachments. Four patients (7 eyes) required penetrating keratoplasty. Five patients (9 eyes) developed glaucoma and only 1 of the 4 trabeculectomies performed succeeded. Of the 6 Ahmed valve procedures performed, all succeeded in maintaining a satisfactory intraocular pressure but some required needling and 5-fluorouracil. Eight patients developed cataract and 7 required surgery. Visual outcomes were poor despite treatment. Nine patients had Snellen acuity of 6/60 or less and required low visual aids to function. CONCLUSION Aniridia is a disorder that requires multiple surgeries. It has a poor visual prognosis despite early diagnosis and aggressive management. Newer techniques such as Ahmed valves and Boston keratoprostheses offer hope, but its proliferative nature makes treatment difficult.


	Interventions in Ocular Surgery: Reducing Postoperative Infection and Inflammation
	Author(s)/Faculty: Richard L. Lindstrom, MD; Edward J. Holland, MD; Jay S. Pepose, MD, PhD; Kerry D. more Solomon, MD
	Source: OCULAR SURGERY NEWS U.S. EDITION	Type: Monograph	Number of Articles: 5
	Release Date: May 2010	Expiration Date: May 25, 2011	Cost: $0.00 / $0.00
	Credit Type: CME	Number of Credit(s): 1.25	Provider:
	OVERVIEW Achievement of optimal visual outcomes following cataract surgery requires a variety of measures. Examining the ocular surface and treating any existing disease prior to surgery is critical. Prevention of postoperative infection and inflammation is also vital. This monograph will review the prevalence of postoperative blepharitis, dry eye, and cystoid macular edema along with risk factors for these conditions. Advice on the preoperative examination and surgical technique will be given. Treatment regimens for prophylaxis of postoperative infection and inflammation will be discussed.


	Conformance With Preferred Practice Patterns in Caring for Children With Esotropia
	Author(s)/Faculty: Preeya K. Gupta, MD; Sharon F. Freedman, MD and Paul P. Lee, MD, JD more Preeya K. Gupta, MD; Sharon F. Freedman, MD and Paul P. Lee, MD, JD
	Source: JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS 47:3	Type: Journal	Number of Articles: 1
	Release Date: May 2010	Expiration Date: May 4, 2014	Cost: $0.00 / $20.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW PURPOSE To evaluate documentation of the initial evaluation in patients with esotropia, with respect to history, physical examination, care management, and patient education, for the presence of key elements as defined in the American Academy of Ophthalmology’s Summary Benchmarks for Preferred Practice Patterns. METHODS Two hundred charts of patients seen at the Pediatrics Service at the Duke Eye Center for an initial diagnosis of esotropia were reviewed relative to both the 2002 (all patients) and 2007 (for those seen in 2007) Preferred Practice Patterns benchmarks for esotropia. Documentation of key elements as defined in the Preferred Practice Patterns was recorded. RESULTS The average total score was 85.8% for all evaluations. On average, 63.6% of the initial history key elements, 99.6% of the initial physical examination key elements, and 94.2% of the care management and patient education key elements were documented. For evaluations performed in 2007 and scored according to the 2007 Preferred Practice Patterns, scores were similar, except that the physical examination subset score average decreased to 90.3% and the family history documentation score increased to 45.5%. CONCLUSION In an academic practice, the process quality of care for strabismus often conforms well to professional practice patterns. However, there are opportunities for improvement in the documentation of key history elements. Additional data are needed from other practice settings and for other conditions to assess the quality of eye care for children.


	Confluent Laser Photocoagulation for the Treatment of Retinopathy of Prematurity
	Author(s)/Faculty: Victor H. Gonzalez, MD; Gian P. Giuliari, MD; Rodolfo M. Banda, MD; David A. Guell, BA; more Michael Wingard, OD
	Source: JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS 47:2	Type: Journal	Number of Articles: 1
	Release Date: March 2010	Expiration Date: March 15, 2011	Cost: $0.00 / $20.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW PURPOSE To describe the efficacy, outcomes, and complications of confluent laser technique in a cohort of premature infants with threshold retinopathy of prematurity. Laser photocoagulation has a good treatment outcome in the management of retinopathy of prematurity; however, the number and density of laser spots remains debatable. Laser treatment can be done in a scattered pattern, a near-confluent pattern, or a confluent treatment pattern. METHODS A retrospective chart review of patients with threshold retinopathy of prematurity treated between 2003 and 2006 was conducted. Confluent laser treatment was applied anterior to the ridge extending to the ora serrata 360. Rate of progression, frequency of retreatment, postoperative complications, structural outcomes, and refractive error were evaluated. RESULTS A total of 100 eyes from 51 patients were included. Mean gestational age was 28 weeks (range: 23 to 32 weeks) and mean birth weight was 1,065 g (range: 477 to 1,905 g). Patients had a mean follow-up of 13 months (range: 6 to 50 months). Progression to stage 4 or 5 occurred only in a total of 6 eyes (6%). Postoperative complications included cataract, vitreous hemorrhage, corneal edema, and macular dragging. Mean spherical equivalent at the last follow-up visit was -3.80 diopters (range: -19.00 to + 4.00 diopters). CONCLUSION Patients treated with confluent laser photocoagulation had a low rate of progression to stage 4 or 5 retinopathy of prematurity. Also, the need for additional laser treatment was small, with rates of complications and structural outcomes comparable to previous reports using a nonconfluent laser pattern.


	Macular Abnormality Observed by Optical Coherence Tomography in Children With Amblyopia Failing to Achieve Normal Visual Acuity After Long-Term Treatment
	Author(s)/Faculty: Hong Liu, MD; Lu Zhong, MD; Xin Zhou, MD; Qing-Zi Jin, MD more Hong Liu, MD; Lu Zhong, MD; Xin Zhou, MD; Qing-Zi Jin, MD
	Source: JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS 47:1	Type: Journal	Number of Articles: 1
	Release Date: January 2010	Expiration Date: January 15, 2011	Cost: $0.00 / $20.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW PURPOSE To investigate why some children with amblyopia fail to achieve normal visual acuity. METHODS Optical coherence tomography (OCT) was performed to observe the morphology of the macular tissue of children with various types of amblyopia who failed to achieve normal visual acuity (< 20/25). Average thickness of the retinal nerve fiber layer (RNFL) of the foveola and fovea (1-mm diameter range) was then assessed by macular retinal tomography map measurement. The data obtained were compared with those considered normal to detect any abnormality. RESULTS Fifteen patients (24 eyes) were examined. Images showed abnormality with thickened RNFL in the macular area in which either the fovea was not observed or the wave lines were flattened or unformed. The average RNFL thickness measured 201.5 ± 17.9 µm for the foveola and 226.9 ± 11.4 µm for the fovea (1-mm diameter range). The differences were highly statistically significant compared with normal values. Five cases were ametropic amblyopia, 5 were anisometropic amblyopia, and 5 were idiopathic amblyopia. Eleven cases showed improvement and 4 cases showed no response to the treatment. Twelve cases were myopic, 1 was mixed astigmatism, and 2 were normal. Nine cases were binocular amblyopia and 6 cases were uniocular amblyopia. CONCLUSION Some children with various types of amblyopia who failed to achieve normal visual acuity after treatment showed macular abnormality on OCT examination.


	Importance of the ‘Third Criterion’ for Retinopathy of Prematurity Screening in Developing Countries
	Author(s)/Faculty: Rajvardhan Azad, MD, FRCS; Parijat Chandra, MD, DNB; Sourabh D. Patwardhan, MD and more Aparna Gupta, MS
	Source: JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS 46:6	Type: Journal	Number of Articles: 1
	Release Date: November 2009	Expiration Date: November 15, 2010	Cost: $0.00 / $20.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW PURPOSE Developing countries often need a modification of the American screening guidelines for retinopathy of prematurity. METHODS A total of 1,302 eyes in 651 infants with retinopathy of prematurity were analyzed by the parameters of gestational age and birth weight suggested by the American guidelines. RESULTS With the use of current gestational age and birth weight guidelines, 86 of 1,302 eyes (6.6%) were missed, and 38 of these eyes (2.9%) had potentially treatable or more severe retinopathy of prematurity and were in need of treatment. CONCLUSION Use of the “third criterion” (ie, neonatologist referral of sick infants who were believed to be at high risk for retinopathy of prematurity), enabled larger infants who were otherwise missed by the American guidelines to be included for screening. Even when the parameters were increased, a relatively small number of infants was still missed. Therefore, in view of the limited resources and manpower in developing countries, the American screening guidelines are appropriate.


	Detailed Magnetic Resonance Imaging Findings of the Ocular Motor Nerves in Duane’s Retraction Syndrome
	Author(s)/Faculty: Jiao Yonghong, MD, PhD; Zhao Kanxing, MD, PhD; Wang Zhenchang, MD, PhD; Wu Xiao, MD; more Qian Xuehan, MD, PhD; Man Fengyuan, MD; Lu Wei, MD; Zhang Fanghua, MD; Nathan H. Schramm, OD
	Source: JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS 46:5	Type: Journal	Number of Articles: 1
	Release Date: September 2009	Expiration Date: September 15, 2010	Cost: $0.00 / $20.00
	Credit Type: CME	Number of Credit(s): 1.00	Provider:
	OVERVIEW PURPOSE To study the neuroanatomic characteristics of patients with Duane’s retraction syndrome with high-resolution magnetic resonance imaging. METHODS The study included 11 consecutive cases, including five patients with type I, one patient with type II, four patients with type III, and one patient with inverse Duane’s retraction syndrome. The patients underwent magnetic resonance imaging of the brain, brain stem, cavernous sinus, and orbits. RESULTS In 10 patients, the abducens nerve (cranial nerve VI) was absent or showed hypoplasia in the brain stem, cavernous sinus, and orbit. However, these findings were not seen in the patient who had inverse Duane’s retraction syndrome. In two children, magnetic resonance imaging showed that the cavernous sinuses were smaller on the affected side. The inferior division of the oculomotor nerve (cranial nerve III) was traced to enter the lateral rectus muscle or had intimate continuity with the lateral rectus muscle in nine patients with type I and type III Duane’s retraction syndrome. In one patient with type III Duane’s retraction syndrome, the oculomotor foramen was significantly larger on the affected side than on the sound side. In the patient with type II Duane’s retraction syndrome, the superior division of cranial nerve III was enlarged and had three branches. In the patient with inverse Duane’s retraction syndrome, the inferior division of cranial nerve III sent two branches to the medial rectus muscle, and the patient had superior oblique muscle hypoplasia. CONCLUSION Neuroimaging findings showed that the absence of cranial nerve VI, hypoplasia in the brain stem, and an extra branch of the inferior division of cranial nerve III to the lateral rectus muscle is the most common presentation of Duane’s retraction syndrome, but not the only one. The aberrant branches likely correspond to the abnormal eye movement seen in patients with this disorder.

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