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Purpose: To evaluate the surgical outcome of a frontalis sling using deep temporal fascia in the treatment of severe congenital ptosis (SCP). Methods: A retrospective, interventional case series was performed. The study involved 25 patients with SCP (>4 mm). All patients underwent frontalis sling surgery with deep temporal fascia between 2004 and 2012 with a follow-up period of 12 months at a minimum. Data regarding eyelid position, eyelid symmetry, cosmetic outcomes, and postoperative complications were evaluated. Results: The mean age at surgery was 7.68 years (range 4-17 years) with an average follow-up of 60 months (range is 12-108 months). The functional success rate was 88% (22/25). Ptosis recurred in 8% (2/25) of patients, overcorrection was present in 4% (1/25) of patients. The patients with ptosis recurrence underwent reoperation. The preoperative margin-to-reflex distance (MRD1) was -0.85±0.87 mm (range, -2.5 to + 0.5 mm), while the postoperative MRD1 was + 2.1 ± 1.05 mm (range, -1.5 to + 4 mm) (p < .0001). Lid symmetry (asymmetry < of 1 mm of MRD1 between the two eyes) was present in all the successful cases. Postoperative complications included transient exposure keratopathy (32%) and inflammatory brow reaction (8%). Conclusions: Frontalis sling operation with deep fascia temporalis is very effective in the treatment of SCP with excellent long-term functional and cosmetic successes.

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PURPOSE: To determine if the use of combined HLA matched limbal stem cells allograft with amniotic membrane transplantation (AMT) is a safe and effective prophylactic surgical procedure to prevent corneal graft after penetrating keratoplasty (PK). METHODS: We report the case of a 17 years old patient with a history of congenital glaucoma, trabeculectomy and multiple corneal graft rejections, presenting total limbal cell deficiency. To reduce the possibility of graft rejection in the left eye after a new PK, a two step procedure was performed. At first the patient underwent a combined HLA matched limbal stem cells allograft (LAT) and AMT and then, 10 months later, a new PK. RESULTS: During 12 months of follow-up, the corneal graft remained stable and smooth, with no sign of graft rejection. CONCLUSIONS: In our patient, the prophylactic use of LAT from HLA-matched donors and AMT before PK, may result in a better prognosis of corneal graft survival.

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PURPOSE: To evaluate the efficacy of diode laser welding to close corneal wounds in penetrating keratoplasty (PKP) and cataract surgery in pediatric patients. SETTING: Ophthalmology Department, Bambino Gesù Children's Hospital, Rome, Italy. DESIGN: Prospective observational study. METHODS: Patients had surgery for congenital cataract (Group 1) or femtosecond laser-assisted PKP (Group 2). The surgery was followed by corneal wound closure using diode laser welding of the stroma. In Group 1, no standard suturing was used. In Group 2, the donor button was sutured onto the recipient using 8 single nylon sutures or a 10-0 nylon running suture (12 passages). Laser welding was then used as an adjunct to the traditional suturing procedure. RESULTS: Group 1 comprised 7 eyes (7 patients; mean age 8.1 years ± 5.3 [SD], range 1 to 15 years) and Group 2, 5 eyes (5 patients; mean age 10.6 ± 3.3 years, range 6 to 15 years). The adhesion of the laser-welded tissues was perfect; there were no collateral effects, and restoration of the treated tissues was optimum. Seidel testing showed no wound leakage during the follow-up. Postoperative astigmatism did not change significantly from the first day after cataract surgery and shifted moderately 3 months after PKP. CONCLUSION: Laser welding of corneal tissue appeared to be safe and effective in children for whom a sutureless surgical procedure is important to reduce the use of anesthesia for suture management, prevent endophthalmitis, and improve the antiamblyopic effect.

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PURPOSE: To evaluate corneal curvature (K(m)) and axial length (AL) of eyes of term-born children aged <3.5 years with uncomplicated congenital cataract and provide age-specific estimates. METHODS: This was a retrospective review of patients undergoing cataract extraction from January 1994 to December 2006. Exclusion criteria were preterm birth, microphthalmia, microcornea, megalocornea, glaucoma, traumatic or complicated cataract, retinal disease. Keratometric readings were taken with an autokeratometer before surgery. Linear regression with the logarithm of the patient's age as an independent variable was used to model the relationship between the patient's age and biometric and keratometric readings. RESULTS: All unilateral cataractous eyes (n = 69) and a randomly selected eye in bilateral cases (n = 111) were included in the analysis, for a total of 180 eyes. Mean age was 15.5 +/- 11.8 months; mean AL, 20.03 +/- 2.25 mm; mean K(m), 45.07 +/- 3.00 D. K(m) was significantly greater and AL shorter in younger children (P < 0.001). No differences according to sex were found. As a group, eyes from unilateral cataract had significantly longer AL than those from bilateral cases (P = 0.029). In a small subgroup of unilateral cataract patients for which readings from the clear lens eye were available (n = 39), K(m) of the affected eye was significantly greater than that of the fellow healthy eye (P = 0.007). CONCLUSIONS: In the first 42 months of age, K(m) and AL are significantly different according to age. These findings have implications for the calculation of intraocular lens power in children.

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