Biomedical subjects
Publications and source records attributed to D J Apple.
A six-year-old Bantu child presented with a mass in the right orbital region, proptosis, and moderate pallor of the optic disk. Orbital exploration revealed an unsuspected hydatid cyst. The characteristic histopathologic features of the organism Echinococcus granulosus are emphasized.
This report describes a young girl with ocular and dermatologic manifestations of incontinentia pigmenti. Fortunately, she has thus far been spared the more severe systemic problems, as well as any vision-threatening complications. However, a unique finding of sector stromal hypoplasia of the iris in her left eye was noted. It is interesting to speculate that this iris pigmentary disturbance may in some way relate to the underlying pigmentary disturbance seen in the skin and in the retinal pigment epithelium.
We present our ocular clinicopathologic findings of a child who suffered bilateral perforation of the globe during medial rectus recession bilaterally for congenital esotropia. The right eye progressed to a painful phthisis bulbi and subsequently required enucleation. Penetration or perforation of the sclera during extraocular muscle surgery is not rare; however, serious sequelae such as visual loss or loss of the eye are unusual. Such complications can be avoided if the surgeon is aware of the causes, as well as the dangers, of such perforation, and, in particular, if modern spatula-type needles are used.
As surgeons gain more experience with the implantation of posterior chamber intraocular lenses (IOLs) into the capsular bag in children, the minimum age for which implantation is advised may continue to be lowered. Accurate sizing of an IOL intended for in-the-bag fixation may depend on knowledge of the size of the capsular bag. In order to develop a growth curve for the normal crystalline lens and hence the capsular bag, 50 pediatric autopsy eyes ranging in age from 1 day to 16 years were obtained postmortem and measured within 24 hours after enucleation. Mean crystalline lens diameter was 6.00 mm at birth, 6.80 mm at 2 months, 7.1 mm at 3 months, 7.66 mm at 6 to 9 months, 8.4 mm at 21 months, 8.5 mm at 2 to 5 years, and 9.3 mm at 16 years. The post-lensectomy capsular bag size at each respective age is 1 mm larger. While age was a predictor of crystalline lens size, corneal diameter and globe axial length were better predictors of crystalline lens size. These data and accompanying linear regressions may be helpful in designing appropriate IOLs for pediatric patients.
BACKGROUND: Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, it is more difficult to perform in very young eyes because the capsular bag is more elastic. Our mechanized anterior capsulectomy technique has compared favorably with manual capsulorhexis in the laboratory using autopsy eyes. We now report the results of circular mechanized anterior capsulectomy in consecutive pediatric patients receiving a posterior chamber intraocular lens (IOL) after cataract extraction. METHODS: Twenty eyes of 17 consecutive patients between 6 months and 13 years of age underwent a mechanized anterior capsulectomy followed by IOL implantation into the capsular bag. The integrity of the anterior capsular edge was evaluated at the completion of capsulectomy, prior to IOL insertion, and at the end of surgery. RESULTS: A single radial tear developed in three eyes (15%) of two patients (12%). In the remaining 17 eyes (85%), an intact circular capsulectomy edge was verified at the completion of the mechanized capsulectomy, at the end of IOL insertion, and at the completion of surgery. Complete in-the-bag capsular fixation of the IOL was accomplished in all 20 eyes. Both patients who sustained radial tears were older children (age 11 years). All IOLs remain well centered behind a smooth circular anterior capsular edge after a minimum follow up of 6 months. CONCLUSION: A mechanized anterior capsulectomy technique can produce a circular capsular opening that resists tearing during lens aspiration and IOL insertion. The vitrector-cut capsulectomy performed well even in the youngest patients in whom manual capsulorhexis would have been difficult to control.
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