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PURPOSE: To assess the pattern of visual development in children aged 1-3 years with stage 1-3 retinopathy of prematurity (ROP). METHODS: One hundred forty-four infants weighing <1500 g were divided into three groups according to ROP stage. Randomly chosen preterm infants were the controls. Ophthalmic examinations started 4-7 weeks after birth and were performed until the retina was fully vascularized or until any ROP that had developed resolved. Preferential looking acuity measurements were carried out at 12, 18, 24, and 36 months of age. RESULTS: Infants with stage 1-2 or no ROP showed evidence of improving acuity development after 12 months. Infants with stage 3 ROP had significantly lower acuity scores compared to infants with stage 1-2 or no ROP at the 18- and 24-month follow-up examinations (P<.001). At 36 months, the visual acuity of infants with stage 3 ROP showed evidence of improving development but still lagged behind infants with stage 1-2 or no ROP. CONCLUSION: Although mild ROP does not seem to have a considerable effect on the development of resolution acuity until age 3, severe forms of ROP may be associated with impaired visual development, which strongly suggests the necessity of periodic monitoring of early visual acuity in infants with ROP.

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Disruption of the blood-aqueous barrier (BAB) induced by retinal photocoagulation and cryopexy in pigmented rabbits was evaluated by laser flare photometry. A significant increase in flare values after retinal photocoagulation was measured from the 1st postoperative day, with values returning to baseline levels by day 7. Cryopexy induced consistently high flare values for 14 days. Intravitreal injection of interleukin (IL) 1, IL-6 and prostaglandin (PG) E(2) induced a significant increase in flare values. Following these treatments, introduction of a PG synthetase inhibitor can partially ameliorate BAB disruption. IL-1, IL-6 and PGE(2) may be involved in BAB disruption following retinal photocoagulation and cryopexy.

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A 54-year-old Japanese female developed granuloma annulare twice in herpes zoster scars. Soon after the second event, she developed ulcerative colitis, which was well controlled by sulfonamides and corticosteroid suppository. She had no history of diabetes mellitus. There was no recurrence of granuloma annulare by June of 1999. Granuloma annulare might have contributed to the complications of ulcerative colitis, although this had not been noticed before.

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AIM: To investigate the postoperative eye alignment and binocular visual function after early surgery for infantile esotropia. METHODS: Both the postoperative eye position and stereopsis were reviewed using the Titmus stereo test in nine patients who received uniocular medial rectus recession and lateral rectus resection under general anaesthesia before 8 months of age and were followed up for a minimum of 4 years. RESULTS: Orthophoria was attained in three cases, whereas esotropia was found in four patients. Dissociated vertical deviation was noted in two other cases at the final examination. Static stereoacuity was achieved in five cases. These results also showed that most infants in whom stereopsis was attained had satisfactory eye alignment during the follow up period and at the final examination. Infants who did not achieve stereopsis still had deviation throughout the follow up period. CONCLUSIONS: It was concluded that early surgery in infantile esotropia is beneficial to achieve binocular visual function, but it is necessary to confirm a stable angle of deviation with accurate preoperative evaluation, and to maintain good postoperative eye alignment throughout the follow up period.

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The blood-aqueous barrier (BAB) in experimentally induced anterior segment ischemia (ASI) following strabismus or retinal detachment surgery in pigmented rabbits was evaluated by laser flare photometry. Four simultaneous rectus tenotomies produced a significantly higher flare value on the 1st postoperative day. Obstruction of one or two vortex veins produced significantly high flare values on the 1st and 3rd postoperative days. Scleral buckling with interference of one vortex vein produced a higher flare value than that with buckling alone. Interference of three vortex veins by diathermy and the encircling procedure produced serious ASI. Disruption of BAB in ASI can be detected quantitatively with laser flare photometry. Introduction of prostaglandin synthetase inhibitor resulted in a significant reduction of flare values following surgery. Prostaglandin synthetase inhibitor can partly ameliorate BAB disruption.

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PURPOSE: To evaluate the visual development in infants with stage 1 approximately 3 ROP and compare their visual results with healthy preterm infants. PATIENTS AND METHODS: One hundred forty-four premature infants were recruited and were divided into 3 groups according to the stage of ROP. Randomly selected preterm subjects with no ROP were taken as controls. Ophthalmic examinations started 4 to 7 weeks after birth and were repeated as needed until the retina was fully vascularized or until any ROP that developed had resolved. Grating acuity was measured by acuity cards between 35-45 weeks of corrected age and by PL method at 12, 18 and 24 months of age. RESULTS: Infants with stage 3 ROP had slightly lower visual acuity scores compared to other infants at most of the testing points throughout the 35-45 week period, which did not show statistical significance at any week. Infants with stage 2 and 3 ROP had similar visual acuity values but slightly lower acuity scores than infants with stage I or no ROP at the 12 month follow-up. The differences were not statistically significant. Stage 3 ROP infants had significantly lower acuity scores compared to infants with stage 1-2 or no ROP at the 18 and 24 month follow-up visits (p<0.0001). CONCLUSION: We stress periodic monitoring of early visual acuity in infants with ROP because of the possibility of impaired visual development.

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To evaluate the results of congenital cataract extraction and postoperative visual function, we retrospectively reviewed the records of 95 patients who underwent pars plana (plicata) lensectomy or aspiration surgery. Forty-nine percent of the patients with bilateral aphakia and 25% with bilateral pseudophakia had a Landolt visual acuity of 0.5 or above at the final visit. The figures were 31% and 66% for patients with unilateral aphakia and pseudophakia, respectively. Eight patients (16.3%) with bilateral and 2 patients (5.8%) with unilateral cataract for whom contact lenses were prescribed after surgery attained fine stereopsis. Five of 8 patients (62.5%) with unilateral cataract who had intraocular lens implantation ended up with gross or fine stereopsis. We stress that very early surgery and optical correction in the sensitive period of binocular visual development should be instituted, especially in the presence of dense opacities. A good postoperative visual outcome can be achieved in patients undergoing late surgery if the opacities are light or partial in nature. We also reemphasize the importance of aggressive and diligent visual rehabilitation and occlusion therapy against amblyopia.

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Forty-two eyes of 31 proliferative diabetic retinopathy patients with laser flare intensity > or = 20 photon counts/ms underwent fluorescein iris angiography to evaluate any changes in the blood-iris barrier and iris biomicroscopy to detect rubeosis iridis. Fluorescein iris angiography revealed abnormal dye leakage in all eyes. Laser flare intensity significantly correlated with the degree of dye leakage. Eyes with dye leakage from only the pupillary border had no rubeosis. In 11 out of 18 (61%) eyes with moderate dye leakage, proliferative diabetic iridopathy with early rubeosis was present in 8 and advanced iridopathy in 3 eyes. In all eyes with excessive leakage, rubeosis iridis was detected under slitlamp examination. High laser flare intensity has a close relationship with advanced blood-ocular barrier disruption. High flare intensity may be a helpful indicator in detecting incipient rubeosis or advanced diabetic iridopathy.

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The laser flare intensity in diabetics, measured with the scattering of a light beam, was evaluated and compared with actual aqueous protein concentration obtained during surgery. Measurement of the laser flare intensity in 120 diabetics and 108 normal subjects was performed with the laser flare cell meter (FC1000 Kowa, Tokyo). Aqueous protein concentration in 26 diabetics and six controls who underwent intraocular surgery was measured by the method of Bradford. No significant difference in the laser flare intensity was found between normal subjects and diabetics without retinopathy. A significant increase in the laser flare intensity was observed after six decades in diabetics with background retinopathy and all with proliferative retinopathy. The laser flare intensity correlated with the duration of diabetes mellitus. There was a significant linear relation between the laser flare intensity and actual aqueous protein concentration. The linear regression formula was X = Y1.39 x 1.02 (X = protein concentration, mg/dl; Y = flare intensity, photon counts/ms). The precise value of the laser flare intensity provides a new indicator to evaluate the diabetic change in the function of the ocular barrier.

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