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IMPORTANCE: The transscleral XEN Glaucoma Gel Microstent (XEN-GGM, Allergan Plc., Parsippany, New Jersey) is implanted by a minimally invasive ab interno technique. BACKGROUND: The present study aims to assess the long-term clinical outcomes in patients after XEN-GGM implantation. DESIGN: This prospective, non-randomized, multi-centred study was conducted in three countries (Austria, Canada and Germany). PARTICIPANTS: Sixty-four consecutive eyes of 64 patients with open angle glaucoma received the XEN-GGM (63 µm) without Mitomycin C. Thirty-five (55%) were solo procedures, and 29 (45%) were combined with cataract surgery. METHODS: Visits were planned at baseline, 6 months, 1, 2, 3 and 4 years postoperatively. MAIN OUTCOME MEASURES: The main outcome measures were mean intraocular pressure (IOP), mean number of IOP lowering medication. Secondary outcome parameters were: visual acuity, visual fields and complete surgical failure (defined as presence of a secondary IOP lowering procedure or loss of light perception) at 4 years, postoperatively. RESULTS: Mean best-medicated baseline IOP was 22.5 ± 4.2 mmHg and decreased significantly to 13.4 ± 3.1 mmHg 4 years postoperatively (-40%, n = 34, P < 0.001). Mean number of IOP lowering medication decreased significantly from 2.4 ± 1.3 preoperatively to 1.2 ± 1.3 (-50%, n = 34, P < 0.001) postoperatively. Visual field mean deviation showed no significant change between preoperative and postoperative examinations. Complete surgical failure rate per year was 10%. CONCLUSIONS AND RELEVANCE: The XEN-GGM resulted in lower IOP and a reduction in medications from baseline over 4 years of follow-up. There was no detectable decrease in visual fields over the study. The surgical failure rate is comparable to other filtration surgeries.

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Ocular involvement in hemolytic uremic syndrome is rare and in most cases presents with retinal ischemia, hemorrhages, and neovascularization. The authors describe the progression of retinal involvement as a rare complication of typical hemolytic uremic syndrome in a 2-year-old boy. Progression of retinal findings were demonstrated with serial fundus photographs. All children who develop hemolytic uremic syndrome have an early ocular consultation and regular ophthalmic follow-up. Early and regular ophthalmic examinations will be useful to expand the understanding of this rare ocular complication and to guide treatment options. [J Pediatr Ophthalmol Strabismus. 2018;55:e49-e51.].

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OBJECTIVE: To assess the ophthalmic needs of families with children residing in Toronto shelters. DESIGN: Cross-sectional study. PARTICIPANTS: Forty-nine families, including 86 children (age 0-16 years) and 55 adult and youth family members (AYFM) (age >16 years), randomly selected from 5 family shelters in Toronto, Ont. METHODS: Ten families with at least 1 child aged 16 years or younger were randomly recruited from each shelter. Data on sociodemographics, medical history, ocular history, and access to eye care were collected through a structured interview. Eye examinations were performed in the shelters for all children and AYFM. RESULTS: The mean age for AYFM was 34.9 ± 9.3 years (range, 17-60 years), and the mean age for children was 6.1 ± 4.3 years (range, 1 month-16 years). Thirty-nine percent of parents reported dissatisfaction with their vision, and 6.7% of children had parents who perceived that their child had eye problems. Overall, fewer parents had accessed care for their own eye problems in the last year than for their children (parents 36.4%, children 81.8%). Examination revealed abnormal ocular findings in 47.3% of AYFM and 24.4% of children. The commonest finding in AYFM was refractive error (30.9%); among children, it was refractive errors (16.3.%) and strabismus (3.5%). CONCLUSIONS: We found that a significant percentage of families living in shelters had eye problems that required treatment. We propose a proactive approach to identify these families and their dependent children in order to expedite access to appropriate eye care in a timely fashion for this vulnerable population.

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Congenital cranial dysinnervation disorders, also known as CCDDs, are characterized by aberrant innervation to extraocular and facial muscles resulting in unusual forms of incomitant strabismus. Anomalous innervation to extraocular muscles can result in a wide variety of phenotypes causing various clinical conditions such as Duane syndrome, congenital fibrosis of the extraocular muscles, and Möbius syndrome. We report a case of bilateral dysinnervation disorder causing atypical ocular movements in both eyes as the patient changes fixation from one eye to the other and from right gaze to left gaze that fits with the wider diagnosis of CCDDs.

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AIMS: The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy. METHOD: We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks. RESULTS: Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness. INTERPRETATION: The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.

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