Because of their varied spectrum of clinical presentation and difficulty in management, pediatric uveitis remains a challenge to the ophthalmologist. Variations in clinical presentation, difficulties in eye examination, extended burden of the inflammation over quality of life, limited treatment modalities, risk of amblyopia are the main challenges in the management of pediatric uveitis. Pediatric uveitis is a cause of significant ocular morbidity and severe vision loss is found in 25-33% of such cases. This article summarizes the common causes of uveitis in children with special approach to the evaluation and diagnosis of each clinical entity.

Angle kappa is the difference between the pupillary and visual axis. This measurement is of paramount consideration in refractive surgery, as proper centration is required for optimal results. Angle kappa may contribute to MFIOL decentration and its resultant photic phenomena. Adjusting placement of MFIOLs for angle kappa is not supported by the literature but is likely to help reduce glare and haloes. Centering LASIK in angle kappa patients over the corneal light reflex is safe, efficacious, and recommended. Centering in-between the corneal reflex and the entrance pupil is also safe and efficacious. The literature regarding PRK in patients with an angle kappa is sparse but centering on the corneal reflex is assumed to be similar to centering LASIK on the corneal reflex. Thus, centration of MFIOLs, LASIK, and PRK should be focused on the corneal reflex for patients with a large angle kappa. More research is needed to guide surgeons' approach to angle kappa.

Iris tumors are broadly classified into cystic or solid lesions. The cystic lesions arise from iris pigment epithelium (IPE) or iris stroma. IPE cysts classically remain stable without need for intervention. Iris stromal cyst, especially those in newborns, usually requires therapy of aspiration, possibly with alcohol-induced sclerosis, or surgical resection. The solid tumors included melanocytic and nonmelanocytic lesions. The melanocytic iris tumors include freckle, nevus (including melanocytoma), Lisch nodule, and melanoma. Information from a tertiary referral center revealed that transformation of suspicious iris nevus to melanoma occurred in 4% by 10 years and 11% by 20 years. Risk factors for transformation of iris nevus to melanoma can be remembered using the ABCDEF guide as follows: A=age young (<40 years), B=blood (hyphema) in anterior chamber, C=clock hour of mass inferiorly, D=diffuse configuration, E=ectropion, F=feathery margins. The most powerful factors are diffuse growth pattern and hyphema. Tumor seeding into the anterior chamber angle and onto the iris stroma are also important. The nonmelanocytic iris tumors are relatively uncommon and included categories of choristomatous, vascular, fibrous, neural, myogenic, epithelial, xanthomatous, metastatic, lymphoid, leukemic, secondary, and non-neoplastic simulators. Overall, the most common diagnoses in a clinical series include nevus, IPE cyst, and melanoma. In summary, iris tumors comprise a wide spectrum including mostly iris nevus, IPE cyst, and iris melanoma. Risk factors estimating transformation of iris nevus to melanoma can be remembered by the ABCDEF guide.

Purpose: To evaluate a simplified method for correction of ocular deviation in patients of infantile and acquired basic esotropia. Materials and Methods: Thirty-six consecutive patients of infantile and acquired basic esotropia were selected for this study. Patients underwent unilateral recession-resection surgery as per the new norm gram. Patients underwent 3.5-7 mm recession of medial rectus (MR) in one eye depending on the pre-operative deviation and patient's age. Together they also underwent 6 or 7 mm resection of the lateral rectus (LR) in the same eye depending on patient's age (6 mm for 3 years and below and 7 mm for older age). In patients 3 years and below, a correction of 6, 7, or 8 PD/mm of recession of MR was expected when the pre-operative deviation was lesser than 30 PD, between 30 and 60 PD, or above 60 PD, respectively. Similarly, these values were 5, 6, and 7 PD/mm of MR recession in patients above 3 years. A ratio between achieved and expected correction was calculated and the calculation was deemed successful for a patient if this ratio fell between 0.9 and 1.1. Results: The calculation procedure was successful in 33 out of 36 patients (91%). The two-tailed probability on paired Wilcoxon test was 0.187. Conclusions: This simplified method of surgical dosage calculation using MR recession as basis is predictable in patients of infantile and basic Esotropia. It may serve as a useful tool for minimizing variability of surgical results.

Purpose: To evaluate the impact of low vision rehabilitation on functional vision of children with visual impairment. Materials and Methods: The LV Prasad-Functional Vision Questionnaire, designed specifically to measure functional performance of visually impaired children of developing countries, was used to assess the level of difficulty in performing various tasks pre and post visual rehabilitation in children with documented visual impairment. Chi-square test was used to assess the impact of rehabilitation intervention on functional vision performance; a P < 0.05 was considered significant. Results: LogMAR visual acuity prior to the introduction of low vision devices (LVDs) was 0.90 ± 0.05 for distance and for near it was 0.61 ± 0.05. After the intervention, the acuities improved significantly for distance (0.2 ± 0.27; P < 0.0001) and near (0.42 ± 0.17; P = 0.001). The most common reported difficulties were related to their academic activities like copying from the blackboard (80%), reading textbook at arm's length (77.2%), and writing along a straight line (77.2%). Absolute raw score of disability pre-LVD was 15.05 which improved to 7.58 post-LVD. An improvement in functional vision post visual rehabilitation was especially found in those activities related to their studying lifestyle like copying from the blackboard (P < 0.0001), reading textbook at arm's length (P < 0.0001), and writing along a straight line (P = 0.003). Conclusions: In our study group, there was a significant improvement in functional vision post visual rehabilitation, especially with those activities which are related to their academic output. It is important for these children to have an early visual rehabilitation to decrease the impairment associated with these decreased visual output and to enhance their learning abilities.

Purpose: The purpose of this study is to assess the magnitude and determinants of refractive error among school children of Lalitpur and Bhaktapur districts in Kathmandu Valley of Nepal. Materials and Methods: A descriptive study was carried out in 2003 in four schools; two in each district. A detailed ocular examination was conducted of all children attending these schools and that included visual acuity testing, slit lamp examination, fundus evaluation, retinoscopy, cycloplegic refraction and subjective refraction. Myopia was defined as more than −0.5 D and hypermetropia was defined as error of more than +1 D. Results: A total of 2000 students of 5-16 years of age were examined. The prevalence of refractive error was 8.60% (95% confidence interval [CI] 7.37-9.83). The prevalence of myopia was 6.85% (95% CI 5.74-7.96). The best-corrected visual acuity was 6/9 or less in the eye of 12.8% children with refractive error. Conclusions: Refractive error is of public health magnitude among school children of 14-16 years of age. School screening program in countries like Nepal for early detection of treatable disease is useful to detect and correct refractive error in older students.

Aim: To study the outcome of repair of rhegmatogenous retinal detachment (RRD) in a tertiary center. Design: Retrospective study. Materials and Methods: Review of electronic medical records within a period of 29 months of consecutive patients who underwent surgical repair for RRD in Sultan Qaboos University Hospital (SQUH). Results: We included 33 consecutive patients (36 eyes). Males constituted 70% of them. The average age was 47 years. Seven eyes out of the 36 had macula-on RRD at presentation. The primary success rate with a single procedure was 86%. However, redetachment occurred in five eyes (14%). Visual acuity was either same as preoperative or better in 81% of the eyes. Giant retinal tear was found in three eyes (8%). The average follow-up period for all patients was 10.25 months (range: 3-25 months). Conclusion: Rhegmatogenous RD is not uncommon disorder. It occurs more frequently in males. However, it has a good prognosis if an intervention was performed in early stages.

Background: The pathogenesis of development and progression of neurosensory retinal detachment (NSD) in diabetic macular edema (DME) is not yet fully understood. The purpose of this study is to describe the spectral domain optical coherence tomography (SD-OCT) morphological characteristics of NSD associated with DME in the form of outer retinal communications and to assess the correlation between the size of communications and various factors. Materials and Methods: This was an observational retrospective nonconsecutive case series in a tertiary care eye institute. We imaged NSD and outer retinal communications in 17 eyes of 16 patients having NSD associated with DME using SD-OCT. We measured manually the size of the outer openings of these communications and studied its correlation with various factors. Statistical analysis (correlation test) was performed using the Statistical Package for Social Sciences (SPSS) software (version 14.0). The main outcome measures were correlation of the size of communications with dimensions of NSD, presence of subretinal hyper-reflective dots, and best-corrected visual acuity (BCVA). Results: The communications were seen as focal defects of the outer layers of elevated retina. With increasing size of communication, there was increase in height of NSD (r = 0.701, P = 0.002), horizontal diameter of NSD (r = 0.695, P = 0.002), and the number of hyper-reflective dots in the subretinal space (r = 0.729, P = 0.002). The minimum angle of resolution (logMAR) BCVA increased with the increasing size of communications (r = 0.827, P < 0.0001). Conclusions: Outer retinal communications between intra and subretinal space were noted in eyes having NSD associated with DME. The size of communications correlated positively with the size of NSD and subretinal detachment space hyper-reflective dots, and inversely with BCVA.

Background: To determine the incidence and demographic features of idiopathic intracranial hypertension (IIH) in south Sharqiyah, Sultanate of Oman. Materials and Methods: A retrospective review of Omani patients diagnosed as IIH in Sur Regional Hospital from January 2001 to December 2011 was carried out. All patients fulfilled the modified Dandy criteria for IIH. Data collected included age and sex of patients, age of onset of the disease, body mass index (BMI), presence of comorbid conditions, and medication use. Findings of ophthalmic examination, neuroimaging, and neurological assessment were recorded. Total number of new outpatients in the study period and the 2010 south Sharqiyah mid-population statistics were also collected. Results: Forty patients were diagnosed as IIH during a period of 11 years from January 2001 to December 2011 in Sur Regional Hospital. The female to male ratio was 3:1; of the 40 patients; 30 (75%) females and 10 (25%) males. Thirteen patients (32.5%) were children below 15 years. Of females in the child bearing age (15-44 years), 60% were obese. As per 2010 census, the Omani population in south Sharqiyah region was 166,318. The calculated annual incidence per 100,000 persons of general population was 2.18. Annual incidence in women of all ages per 100,000 persons was 3.25 and in women of child bearing age was 4.14. In children below 15 years, the incidence was 1.9 per 100,000 children; it was 2.96 per 100,000 for female children. Conclusion: This study shows that the incidence in south Sharqiyah is comparable to that of other countries. Females and obese patients are at a higher risk of developing IIH. Obesity is not a risk factor in males and children. Nearly 60% of the females in the child bearing age were obese.

Background: Septo-optic dysplasia (SOD), also known as de-Morsier's syndrome, is a rare disorder characterized by any combination of optic nerve hypoplasia (ONH), pituitary gland hypoplasia, and midline abnormalities of the brain including absence of septum pellucidum and corpus callosum dysgenesis. It is typically diagnosed in infancy and has a variable presentation that includes visual, neurologic, and/or hypothalamic-pituitary endocrine deficits. Purpose: To demonstrate the ophthalmic, endocrine, and neurologic spectrum of SOD in five Omani children and address the crucial role of high-resolution neuroimaging for its early and accurate diagnosis. Materials and Methods: A retrospective chart review was performed in 2010 of all children in the pediatric ophthalmology database of Sultan Qaboos University Hospital (SQUH) who were diagnosed to have ONH. All relevant demographic, ophthalmic, neurologic, endocrine, and neuro-radiological manifestations were recorded in a data collection form. All previous neuroimaging results were reviewed by a neuro-radiologist. Results: Five patients (four males, one female) with the diagnosis of ONH were included in the study. They presented during the period 1998-2008. All patients were born at term, with normal birth weights to healthy mothers with insignificant antenatal history. Age at presentation ranged from three months to one year. Manifestations at presentation included severe visual impairment (5/5), neonatal hypoglycemia (3/5), seizure disorder (2/5), and failure to thrive (4/5). ONH was bilateral in 3/5 patients and unilateral in (2/5). Brain and orbit imaging revealed varying anomalies in all patients. These included absent septum pellucidum (3/5), severe corpus callosum agenesis (1/5), ectopic pituitary (5/5), falx cerebri deficiency (1/5), optic nerve hypoplasia (5/5), optic chiasmal hypoplasia (5/5), and olfactory tract hypoplasia (1/5). Endocrine deficits were detected in 4/5 patients (3 with panhypopituitarism, and 1 with growth hormone deficiency) and necessitated replacement therapy. Conclusion: SOD is a clinically heterogeneous disorder with a wide spectrum of ophthalmic, endocrine, and neurologic manifestations. All features might not be present in a single patient. A high consanguinity rate and lack of history of alcohol and drug use were observed in our cohort. Most affected children present first to the pediatrician with failure to thrive. Radiological confirmation of ONH necessitates high-resolution imaging and interpretation by an experienced neuro-radiologist. In our cohort, all patients with ONH had associated optic chiasmal hypoplasia. Early detection and treatment reduces disease-related morbidity, and can be life saving.

Background: Eye screening and refractive services to students are part of a school health initiative in Oman. We evaluated the impact of the compliance of spectacle wear on the vision related quality of life (VFQ) among 12-13 years old and 15-16 years old Omani students with refractive error. Materials and Methods: This historical cohort study was conducted in 2012. Students using spectacles and those not using spectacles after 1 year of prescribing/providing spectacles were interviewed to assess their VFQ. The VQ 20 questionnaire with 5 graded close-ended responses was adopted for this purpose. The responses for the VFQ related to different visual functions of students who were/were not spectacle wear compliant, were compared. Results: Our cohort had 124 students in each group. The overall VFQ was significantly higher among the compliant spectacle wearers (compliant group) compared with the non-complaint wearers (non-compliant group) (relative risk [RR] =4.7% [95% of the confidence interval (CI): 2.8-6.6]). The association of gender and the grade level was not significant (P > 0.05). However, the variation of governorate was significantly associated to the difference of VFQ in both groups (χ² = 16.6, degrees of freedom = 4, P = 0.0003). The VFQ related to the near work (RR = 1.3) and school related activities (RR = 1.3) was better in the compliant group. Conclusion: VFQ was better among those students who were spectacle wear compliant compared with those who were not. VFQ related to near work and school related activities seem to be the most influenced by spectacle wear compliance.

The purpose of this study is to describe transient macular cysts in an infant and correlate their occurrence with normal development events. A newborn Caucasian girl presented with a protruding corneal mass in her left eye at birth. She underwent a complete ophthalmic examination. A keratinized staphylomatous malformation involving the entire cornea and precluding further visualization of the anterior and posterior segment was observed in the left eye. Spectral domain optical coherence tomography (SD-OCT) of the right eye performed when the child was approximately 6-week-old had revealed an unexpected finding of macular cysts involving the inner nuclear and outer retinal layers. Corneal transplant in the left eye was performed a month later. Ocular examination under anesthesia just prior to surgery revealed normal intraocular pressure, anterior segment and retina in the right eye. SD-OCT was normal in both eyes and showed complete resolution of the cysts in the right eye. The patient had not been on any medications at that time. Although clinical retinal examination might be unremarkable, SD-OCT may reveal cystic spaces in the macula. In the absence of conditions known to be associated with macular edema, transient macular cysts may arise due to a developmental incompetence of the blood-retinal barrier or may represent transient spaces created during normal migration of retinal cells. Further study is warranted to delineate the entity of transient macular cysts in infancy.