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AAPOS 45TH ANNUAL MEETING ABSTRACT BOOK 27–31 HILTON BAYFRONT Table of Contents Lectures Costenbader page 3 Helveston page 4 Papers page 5 Posters page 44 Session 1 page 45 Session 2 page 145 Workshops page 245 The Costenbader Lecture Making the Superior Oblique Great Again David A. Plager, MD Purpose/Relevance: To review the history and bring up to date clinically relevant knowledge about the anatomy and physiology of the superior oblique Target Audience: Strabismus surgeons Current Practice: Varies widely among strabismologists according to their training and personal experience Best Practice: Evaluation and treatment algorithms based on the author’s 30 years of learning from others, personal experience and mistakes. There will be emphasis on the importance of relative tendon laxity, how it is easily evaluated and how it can be applied to surgical decision making. When torsion should be specifically addressed or perhaps can be willfully ignored will be discussed. Expected Outcomes: Audience will have an appreciation of the history of strabismologist attitudes toward operating on the superior oblique, the evolution of knowledge about its structure and function, and the author’s approach toward formulating individual surgical plans based on a combination of clinical and intraoperative findings. Format: Lecture supplemented with illustrations and videos Summary: The superior oblique is by far the most complicated extraocular muscle and the source of more angst and controversy when learning how best to approach its dysfunction than all the other EOMs combined. However, by applying a few basic principles and avoiding a few common pitfalls, surgeons can have many grateful patients whose annoying or even debilitating symptoms they have relieved. The Helveston Lecture Cataract Surgery in Children from Birth to Less than 13 Years of Age in the PEDIG Registry: Status Three Years Following Surgery Michael X. Repka, MD, MBA for the Pediatric Eye Disease Investigator Group Jaeb Center for Health Research, Tampa, Florida Introduction: To describe visual outcome and complications three years following lensectomy in children. Methods: Prospective observational study in children <13 years of age at time of lensectomy with follow-up between 30 and 42 months after surgery. Review of registry data for 789 eyes of 611 children for visual acuity, rates of amblyopia, change in refractive error, glaucoma and glaucoma suspect, and other intraocular surgery. Results: Lens surgery was bilateral in 274 (45%; 95% confidence interval (CI)=41% to 49%) children and unilateral in 337 (55%; 95% CI=51% to 59%). An intraocular lens (IOL) had been implanted in 414 (56%; 95% CI=52% to 59%) eyes. Amblyopia was identified in 390 (64%; 95% CI=60% to 68%) children. In 488 children 3 years of age and older at follow up, the mean VA was 0.53 (about 20/63) in bilateral aphakic eyes, 0.28 (about 20/40) in bilateral pseudophakic eyes, 0.90 (20/160) in unilateral aphakic eyes, and 0.54 (about 20/63) in unilateral pseudophakic eyes. Age-normal visual acuity was reported for 117 (32%; 95% CI=27% to 37%) pseudophakic eyes and 45 (27%; 95% CI=20% to 35%) aphakic eyes. A myopic shift in refractive error was found with a mean change of -6.87D (95% CI= -8.45 to -5.28) in bilateral aphakia, - 1.28D (95% CI= -1.57 to -0.98) in bilateral pseudophakia, -10.66D (95% CI= -13.43 to -7.90) in unilateral aphakia, and - 1.41D (95% CI= -1.75 to -1.06) in unilateral pseudophakia. A new diagnosis of glaucoma or glaucoma suspect was made in 97 (13%; 95% CI=10% to 15%) eyes. Additional intraocular surgery was performed in 259 (33%; 95% CI=30% to 37%) eyes, most commonly vitrectomy or membranectomy to clear the visual axis. Discussion: About one-third of the eyes with IOLs achieved normal VA for age by 3 years post-lensectomy. Management of visual axis obscuration was the most common surgical intervention, also affecting one-third of eyes. Conclusion: Myopic shift was minimal with the placement of an IOL, about 0.50D per year. This finding will affect the ultimate refractive outcomes and may require adjustment of guidelines for IOL power selection. repka lecture abstract Page 1 of 1 Papers Paper #1 Thursday, 8:50 am – 8:57 am Are Piggyback IOLs Recommendable for Children? M. Edward Wilson, MD; Rupal H. Trivedi, MD, MSCR Storm Eye Institute Medical University of South Carolina Introduction: The selective use of piggyback IOLs for young children has been reported since the mid-1990s but only in small numbers and without longer term follow-up. Surgeons currently have insufficient information about whether these techniques are recommendable. Methods: An IRB-approved retrospective chart review was conducted of consecutive cases of piggyback IOL implantation in children at one institution. Results: 51 eyes of 40 children received piggyback IOL implantation, 42 eyes at the time of cataract surgery and 9 eyes as a later secondary procedure. Median age at cataract surgery and piggyback IOL placement were 0.51 and 0.73 years respectively. 4/51 (8%) eyes underwent unplanned piggyback IOL removal (1 each for IOL tilt, pupillary capture, pupillary block, and pupillary membrane). 44 eyes had >5 years of follow-up (median 12.42 years of follow-up). 35/44 eyes had the piggyback IOL explanted in a planned manner at a median 3.24 years after implantation. 9 eyes have still not had the piggyback IOL explanted after a median 11.6 years of follow-up. 9 eyes have needed IOP-lowering topical medications, and 1 eye has been operated for glaucoma. Discussion: Planned sulcus IOL explantation was uncomplicated in our series. While early-unplanned complications required IOL removal in 4 eyes, late complications were not noted and glaucoma developed at predictable rates for this population. Conclusion: Piggyback IOL placement in young children (1 in the bag and 1 in the sulcus) appears to have an acceptable safety profile. It allows the surgeon to aim for emmetropia at surgery and manage increasing myopia over time rather than decreasing hyperopia. References: Wilson ME, Peterseim MW, Englert JA, et al. Pseudophakia and polypseudophakia in the first year of life. J AAPOS 2001; 5:238-245. Paper #2 Thursday, 8:57 am – 9:04 am Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Concurrent with the Infant Aphakia Treatment Study Erick D. Bothun, MD; Deborah K. Vanderveen, MD; David A. Plager, MD; Sharon Freedman, MD; Rupal H. Trivedi, MD, MSCR; Nancy N. Diehl, BS; M. Edward Wilson, MD; Elias I. Traboulsi, MD, Med; Jill S. Anderson, MD; Nancy C. Weil, MD; Allison R. Loh, MD; David Morrison, MD; Kimberly G. Yen, MD; Scott Lambert, MD Mayo Clinic Rochester, Minnesota Introduction: This study evaluates outcomes of bilateral cataract surgery in infants ages 1 to 7 months performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and compares them to IATS outcomes of unilateral cases. Methods: Retrospective clinical study at 10 IATS sites Results: 178 eyes (89 children) were identified with median age of 1.8 months (range 1-7) at cataract surgery. 51 (29%) eyes of 26 patients received primary intraocular lens (IOL) implantation. Of the 60 children followed between 4-6 years of age with optotype visual acuity (VA) testing, corrected visual acuity was excellent (<20/40) in 45% of better seeing eyes and 20% of worse-seeing eyes. 2% had poor acuity (>20/200) in the better eye and 10% in the worse eye. Median best eye visual acuity was 20/50 (logMAR 0.40) (p=0.84)) in both aphakic and pseudophakic children. Unplanned reoperation occurred in 29% of right eyes (including glaucoma surgery in 9%). Discussion: Good visual outcomes were obtained in both eyes following bilateral infantile cataract surgery. With or without the inclusion of children who tested poorly due to associated neurologic disease, the VA of the worse seeing eye in these bilateral cases is better than VA in unilateral cases included in the IATS. The rates of reoperation and glaucoma are consistent with the published IATS data. Aphakia management did not affect visual acuity outcomes. Conclusion: Visual acuity after bilateral cataract surgery in infants younger than 7 months is better than VA following unilateral cataract surgery, but adverse events were similar. References: 1. The Infant Aphakia Treatment Study Group. Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy A Randomized Clinical Trial of HOTV Optotype Acuity. JAMA Ophthalmol. 2014;132(6):676-682. 2. Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR; Infant Aphakia Treatment Study Group. Complications in the first 5 years following cataract surgery in infants with and without intraocular lens implantation in the Infant Aphakia Treatment Study. Am J Ophthalmol. 2014 Nov;158(5):892-8. Paper #3 Thursday, 9:04 am – 9:11 am Outcomes and Complications of Simultaneous Bilateral Cataract Surgery (SBCS) in Children - A 10-Year Review Vishaal Bhambhwani; Sina Khalili; Maram Isaac; Asim Ali; Nasrin Tehrani; Kamiar Mireskandari The Hospital For Sick Children (SickKids), Toronto, Canada Toronto, Canada Introduction: SBCS has been viewed with caution by the ophthalmology community due to risk of devastating complications in both eyes. There is paucity of literature in children, for whom significant benefits can be derived by operating both eyes under the same anesthesia. Methods: Retrospective analysis of children who underwent SBCS from 2008-2018 was performed. Procedures were consented to by parents following detailed discussion about risks/benefits of surgery in two sessions versus one. Data on outcomes and complications (ophthalmological, anesthesia-related) upto 8 weeks post-op is presented. Results: 37 patients (74 eyes) (mean-age 4.4 months) (21F:16M) underwent bilateral lens aspiration with anterior vitrectomy (6 with, 68 without IOL).
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