This review discusses the potential for strabismic complications after refractive surgery for hyperopia, myopia, anisomyopia, astigmatism and monovision, and how to avoid these complications. Guidelines are given for assessing patients with strabismus seeking refractive surgery. Screening tests are suggested that lead to stratification of refractive surgery patients into different risk groups each warranting a different intensity of evaluation.

Aim:Severe visual loss is the only serious complication of intracranial hypertension secondary to idiopathic intracranial hypertension (IIH) and some cases of cerebral venous thrombosis (CVT). Optic nerve sheath decompression (ONSD) has been shown to improve or stabilize visual function in patients with IIH, while its role in CVT is yet to be established. We report our experience with optic nerve sheath decompression for visual loss in IIH and CVT.Materials and Methods:In this prospective noncomparative, interventional study, 41 eyes of 21 patients with IIH and CVT and visual loss underwent ONSD. The main outcome measures included best-corrected visual acuity (BCVA), visual fields, pupillary light reflex, optic nerve sheath diameter on B-scan and resolution of papilledema which were evaluated preoperatively and at follow-up at four days, two weeks, one month, three months and final follow-up. In 7/41 eyes with absent light perception preoperatively, the functional outcome was analyzed separately.Results:Following ONSD BCVA and visual fields stabilized or improved in 32/34 (94%) eyes. Statistically significant improvement in BCVA, visual fields and pupillary light reflex occurred over the three month follow- up period. Surgical success was indicated by reduction in optic nerve diameter and papilledema resolution occurred in all patients. The outcome in the IIH and CVT groups was comparable. Four eyes with absent light perception showed marginal improvement in visual acuity. Four eyes had transient benign complications.Conclusion:Optic nerve sheath decompression is an effective and safe procedure to improve or stabilize vision in patients with visual loss caused by IIH and CVT.

Purpose: The epidemiology of mechanical eye injuries in children was studied to identify the agents of injury and their contribution to the severity of visual loss and to suggest preventive measures. Methods: The mode, type, and severity of injury were correlated with the visual acuity 6 months after the injury in all children with mechanical eye injuries between January 1 994 to January 1 999. Results: Of the 68 children with mechanical eye injuries, the mode of injury was host (child) related in 1 2 (1 7.65%) patients, agent related in 40 (58.82%) patients, and environment related in 16 (23.53%) patients. Mild injuries were seen in 22 (32.35%) patients, 31 (45.59%) patients had moderate injuries, and 15 (22.06%) patients had severe injuries. None of the patients with host-related injuries had a severe injury. Six (66.67%) patients with host-related injuries had a good visual outcome and none had a poor outcome. Among patients with agentrelated injuries, 1 1 (25%) had a good outcome, 1 4 (40%) patients had a fair outcome, and 10 (22.5%) patients had a poor outcome. Of the patients with environment-related injuries 3 (33.33%) each had good, fair, and poor visual outcomes. Conclusions: Agent and environment-related injuries had a far worse outcome than host-related injuries. This epidemiological classification directly suggests practical preventive measures that can be adopted at home or at schoo) to reduce the incidence and severity of ocular injuries. The other predictors of the final visual outcome were the severity of the injury at presentation and the necessity for a secondary surgical procedure. Journal of Pediatric Ophthalmology and Strabismus 2002;39:5-10.

In orbital infections with atypical presentations, unusual pathogens should be considered as the causative agents.

PHACES syndrome is a neurocutaneous disorder characterized by posterior fossa brain malformations, hemangiomas, cardiac anomalies and coarctation of aorta, eye anomalies ± sternal clefts. All reported cases are sporadic and notably common in females. The underlying cause is unknown. Here is described, one of the twin baby with characteristic features of PHACE syndrome. The presence of large segmental hemangioma, especially on face should prompt the primary care provider to act early, to prevent complications related to facial hemangiomas and other associated anomalies.