11/19. The loss of fusion in adults with intractable diplopia (central fusion disruption).People over the age of 10 years can lose their fusion ability. This acquired disruption of fusion gives rise to intractable diplopia without suppression. An involuntary vertical bobbing movement of the non-fixing eye, present only with both eyes open, occurs at or near the angle of superimposition. This appears to be a unique and characteristic sign of acquired disruption of fusion and was present in all cases. Other causes of diplopia are mentioned and differentiated. Acquired central fusion disruption usually results from serious head injury. Partial recovery may occur but is unlikely. sensory deprivation of at least 3 1/2 years' duration due to poor vision in one eye resulting from a traumatic cataract and sometimes subsequent uncorrected unilateral aphakia caused loss of fusion in 15 patients. The practical implications with regard to intraocular lenses and unilateral aphakia is discussed. Less commonly, vascular, neoplastic and presumed inflammatory lesions in the mid-brain area cause central fusion disruption.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
12/19. The correction of aphakia in infants with hydrogel extended-wear contact lenses. Corneal studies.Although hydrogel extended-wear contact lenses (EWCLs) have been used extensively in the correction of aphakia in neonates, little is known about the effects of these lenses on infant corneas. Recent studies have demonstrated that long-term contact lenses can induce endothelial morphometric changes, including an increased coefficient of variation (CV) of mean endothelial cell area. Using wide-field specular microscopy, the authors studied 11 eyes of 10 patients, 1 to 3 years of age who, after lensectomy for congenital cataracts, wore EWCLs for the correction of aphakia. Except for two corneas in which increased pachometric readings and CV developed after repeated episodes of lens loss and inflammation, the EWCL were well tolerated and associated with few complications in this study.- - - - - - - - - - ranking = 3keywords = aphakia (Clic here for more details about this article) |
13/19. Extended-wear contact lenses for the treatment of pediatric aphakia.The practicality of extended-wear contact lenses in the refractive correction of pediatric aphakia was assessed with 240 eyes in 184 patients. Patient ages at the time of contact lens fitting ranged from 18 days to 9.8 years. One hundred forty-one eyes were fit from 1 day to 55 months postoperatively and then followed for 6 months to 5.7 years (average, 29 months). Only five patients lost more than five lenses. The overall loss rate was less than one lens per year of follow-up. No patient had contact lens-related complications with permanent visual sequelae. Only 14% of patients had contact lens problems or factors related to parental inability to care for the lens which resulted in discontinuation of contact lens therapy. The authors were unable to identify any subset of patients who should be considered for primary surgical optical correction of their aphakia.- - - - - - - - - - ranking = 3keywords = aphakia (Clic here for more details about this article) |
14/19. Fusion ability lost and regained in visual adults.The case reports are given of two adult patients who lost all fusion ability and had the signs and symptoms of central fusion disruption and intractable diplopia. Both patients suffered binocular sensory deprivation for several years caused by a combination of a traumatic cataract and uncorrected unilateral aphakia. One patient had a posterior chamber intraocular lens inserted to correct the aphakia and the other patient had a contact lens. aniseikonia was not appreciated by either patient and did not appear to contribute to the fusion problem. Adjustable strabismus surgery, in both patients, and prism glasses, in one, enabled approximate superimposition of the visual axes. After several months, both patients began to develop some fusion with small amplitudes and the vertical bobbing typical of central fusion disruption disappeared.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
15/19. epikeratophakia in children with traumatic cataracts.epikeratophakia provides a permanent optical correction for aphakia in children with congenital or traumatic cataracts; suturing the epikeratophakia graft onto the cornea eliminates the problems of contact lens or spectacle non-compliance in these young and generally uncooperative patients and provides tectonic support to scarred and irregular corneas. Eighteen children under the age of six years underwent epikeratophakia for the correction of aphakia after the removal of trauma-induced cataracts. Graft success rate was 88%; the average change in keratometry in the patients with successful grafts was 14.82 /- 2.0 diopters. In the 13 patients eligible for visual acuity tabulation, preoperative acuities ranged from light perception to 20/200, and postoperative acuities ranged from hand motions to 20/30. Ten (77%) had acuities of 20/80 or better. Poor results in three patients with less than 20/200 acuities were likely the results of non-compliance with amblyopia therapy. Present work indicates that in cases of traumatic cataract, the epikeratophakia procedure facilitates amblyopia therapy and decreases the astigmatism in scarred and irregular corneas.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
16/19. Secondary surgical procedures after epikeratophakia.Five patients required secondary surgical procedures after receiving epikeratophakia grafts. A neonate underwent epikeratophakia in combination with extracapsular cataract extraction, followed one week later by peripheral iridectomy and nine months later by strabismus surgery. A 53-year-old male had surgery to correct retinal detachment 4-1/2 months after epikeratophakia surgery for the correction of aphakia. A five-year-old male had epikeratophakia after removal of a traumatic cataract; five weeks later, retinal detachment necessitated vitrectomy, 360 degrees buckle, and cyclocryotherapy. A 4-1/2-year-old female had epikeratophakia for aphakia, followed nine months later by strabismus surgery. A 38-year-old female with keratoconus received a plano epikeratophakia graft, in combination with an extracapsular cataract extraction and anterior vitrectomy, followed two weeks later by an Ocutome vitrectomy. In all cases, the epikeratophakia grafts and interfaces remained clear, and in four of the five patients in whom secondary procedures were successful, vision continued to improve with time.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
17/19. Cataract following radial keratotomy.An intumescent cataract developed 16 weeks after radial keratotomy in a 31-year-old man. corneal perforation was documented at the time of surgery, but no direct injury was noted to the lens capsule. visual acuity decreased to hand motions during a four-month course. Successful extracapsular cataract extraction occurred seven months following the original radial keratotomy. Soft contact lens correction of aphakia recovered a visual acuity of 6/6.- - - - - - - - - - ranking = 0.5keywords = aphakia (Clic here for more details about this article) |
18/19. A histopathologic study of bilateral aphakia with a unilateral intraocular lens in a child.A 7-year-old boy who had had electrically induced cataracts since he was 6 months old underwent a lens extraction by phacoemulsification in his right eye. He later refused to wear a contact lens. When the boy was 10 year old, the lens of his left eye was removed by phacoemulsification and an intraocular lens was implanted. The intraocular lens functioned well and was tolerated by the boy until he died in an automobile accident at the age of 16 years. A histopathologic study of the eyes, which were obtained post mortem, showed a decreased corneal endothelial cell population, mild focal atrophy of iris structures, and mild lymphocytic infiltration in the implanted eye. Vitreous liquefaction and epiretinal membrane formation occurred in both eyes.- - - - - - - - - - ranking = 2keywords = aphakia (Clic here for more details about this article) |
19/19. Correcting low vision in aphakic children.There are many children who have subnormal vision in spite of successful cataract surgery and aphakic spectacle lenses. There are children who have lens opacities for whom the state of aphakia would not be an improvement. Careful evaluation of functional vision, careful refraction, and the prescription of high adds or other optical devices are part of complete ophthalmological care for every one of these children. The dioptric strength of the reading add is determined by the functional reading vision and the calculation of the reciprocal of the visual acuity. It is also important to realize that many children who have lens opacities do not require special aids; functional vision is adequate until their accommodative reserve wanes with age. Continuous-wear contact lenses may eventually replace spectacle corrections for the aphakic child.- - - - - - - - - - ranking = 0.5keywords = aphakia (Clic here for more details about this article) |
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