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Purpose To assess the use of limbal versus fornix conjunctival incisions in primary and repeat horizontal rectus muscle surgeries among pediatric ophthalmologists and adult strabismus surgeons. Methods A 2-page questionnaire was mailed to members of the American Association for Pediatric Ophthalmology and Adult Strabismus. Participants were asked about their use of limbal, fornix, or other incision types in their pediatric and adult strabismus patient population. Results A total of 1,022 questionnaires were circulated. The net overall response rate was 27.8%. For first-time strabismus surgeries in pediatric patients, 40.8% of respondents used limbal incisions in the majority of their cases, 58.1% used fornix incisions, and 1.1% used other incision types. For reoperations, 58.1% used limbal-based incisions, 39.1% used fornix incisions, and 2.1% used other incision types. In the majority of their primary surgeries on adults, 40.1% used limbal incisions, 53.5% preferred fornix incisions, 1.4% used other incision types, and 4.9% answered "not applicable" (available for respondents who operated exclusively on either children or adults). On reoperations, limbal incisions were used by 63.4% of respondents, 29.9% used fornix incisions, 1.4% used other incision types, and 5.3% answered "not applicable." Conclusions Among those surveyed, limbal incisions were preferred for greater intraoperative exposure and better teaching of junior surgeons; fornix incisions were thought to cause less postoperative pain and inflammation and lead to more rapid soft-tissue healing.

Background The effect of adding oral to topical carbonic anhydrase inhibitors in the management of pediatric glaucoma is unknown. Methods We undertook a retrospective analysis of children with a diagnosis of glaucoma before the age of 16 years who initially were treated with topical dorzolamide or dorzolamide–timolol combination and then treated with oral acetazolamide. Children who had uveitic glaucoma or who had ocular surgery within 3 months before or during oral acetazolamide therapy were excluded. Various methods of intraocular pressure (IOP) measurement were used in the study. However, in each case, the IOP was measured using the same technique, once at the last visit before the addition of oral acetazolamide and once at the first examination after the addition of oral acetazolamide. Results Twenty-two patients were included in the study with an age range of 8 months to 15 years. Seventeen children were boys. Oral acetazolamide treatment was via a daily dose (13.3 to 30 mg/kg, mean 22.5 mg/kg), and duration (6 to 31 days, mean 18.1 days). The intraocular pressure (mean ± SD) before acetazolamide (32.2 ± 6.5 mm Hg) was significantly different than after acetazolamide (21.8 ± 6.3 mm Hg) with a mean difference of 10.36 mm Hg (p Conclusions The addition of oral acetazolamide to topical dorzolamide may provide additional reduction in IOP in some children already being treated with topical carbonic anhydrase inhibitors. This possible additive effect has not been observed in adults treated with a combination of topical and systemic carbonic anhydrase inhibitors.