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To investigate the ocular hypertensive and antiinflammatory response to different dosages of fluorometholone (FML).Prospective clinical trial with randomization of fellow eyes to different postoperative treatment.Thirty-one consecutive children undergoing bilateral symmetrical strabismus operation.Among 31 children who received bilateral squint operations, one eye was randomized to receive topical FML six times daily (group 1), whereas the other eye received topical FML three times daily (group 2), both for 4 weeks. Intraocular pressure (IOP) and antiinflammatory response were measured serially in the postoperative period for 8 weeks.Intraocular pressure was measured on the day before surgery and on postoperative days 1, 3, 6, 13, 20, 27, 41, and 55. The antiinflammatory response was also assessed subjectively and objectively at days 6, 13, 20, and 27 after the operations. Peak IOP, net increase in IOP, and antiinflammatory responses in the two study groups were analyzed.Thirty-one children, age 3 to 9 years, (mean +/- standard deviation [SD], 5.52 +/- 1.81) participated in the study. Intraocular pressure increased significantly in both groups compared with the preoperative values (P0.001). The peak IOP ranged from 12.00 to 31.00 mmHg and 12.30 to 25.00 mmHg in groups 1 and 2, respectively. The mean peak IOP (19.00 +/- 5.06 mmHg vs. 17.13 +/- 3.32 mmHg) was significantly higher in group 1 (P0.001). The net increase in IOP was similar (mean +/- SD, 4.37 +/- 4.79 vs. 2.57 +/- 3.32 mmHg; P = 0.005). Ranges of the net IOP increase were -1.00 to 16.00 mmHg and -2.50 to 10.30 mmHg in groups 1 and 2, respectively. Children in group 1 reached the peak IOP earlier than those in group 2 (median, 6 vs. 13 days; P = 0.033). However, there was no significant difference in antiinflammatory response between the two groups.Ocular hypertension occurs in a dose-dependent manner in children treated with FML. Children in group 1 had a quicker onset and more severe ocular hypertensive response than those in group 2. It would be desirable to monitor the IOP regularly when FML is used with a high frequency and for a long duration in children.

Objective To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children. Design Prospective, randomized clinical trial. Participants Thirty-one consecutive children undergoing bilateral strabismus surgery. Intervention Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and another received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for 4 weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more. Main outcome measures Intraocular pressure was measured on the day before the surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP more than 20 mmHg in the two study groups were analyzed. Results A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 ± 2.0 years (range, 2–10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 ± 6.8 mmHg vs. 14.3 ± 2.4 mmHg, P P P P P Conclusions In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children.

Objective To investigate the ocular complications in pediatric bone marrow transplantation (BMT) patients. Design Cross-sectional study. Participants A total of 29 pediatric BMT patients were studied. Testing Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), Schirmer's test, tear breakup time, and slit-lamp and fundus examinations, was performed. Main outcome measures Tear film instability and its related complications, IOP, cataract, and fundus lesions were measured. Results The mean age of patients was 9.1 years (range, 1.5–15 years). The mean post-BMT duration was 20.2 months (range, 3–54 months). Fifteen patients (51.7%) had tear abnormalities. Subconjunctival fibrosis was detected in two patients (6.9%). Dry and scaly skin of the eyelids was seen in one patient (3.4%). Lens opacities were found in 2 (33.3%) of 6 irradiated patients and 2 (8.7%) of 23 nonirradiated patients. Two patients (6.9%) had fundus changes, one with unilateral epiretinal membrane and the other with bilateral multiple discrete chorioretinal hypopigmented lesions in the middle to peripheral part of the retina. The overall complication rates for the anterior and posterior segments were 75.8% and 6.9%, respectively. Conclusion Ocular manifestations of BMT in children are not uncommon. The most common anterior segment problem is tear dysfunction. Posterior segment complications are less common but do exist. High rate of cataract formation is reported, and this probably is the most important long-term "amblyogenic" problem in these immature eyes. Awareness and management of these problems with routine eye examination and early intervention are recommended.

Objective: The purpose of the study is to investigate the rate and degree of ocularhypertensive response to topical steroids in Chinese children. Design: The study design was an institutional, randomized, clinical trial. Participants: A total of 19 consecutive patients were studied. Intervention: Topical steroids were administered to Chinese children younger than 10 years of age who underwent bilateral strabismus surgery. One eye was randomized to receive topical 0.1% dexamethasone (DMS), whereas the fellow eye received 0.1% fluorometholone (FML) six times per day for up to 4 weeks. Intraocular pressure (lOP) was measured on the day before operation and at postoperative days 1, 3, 6, 10, 13, and 27, then every 2 weeks thereafter until the lOP fell to preoperative levels. Topical steroids would be stopped if lOP was 30.00 mmHg or greater. Main Outcome Measures: Peak lOP and maximal change of lOP from baseline were measured and categorized into low, intermediate, and high levels. Time to peak lOP also was studied. Results: A total of 16 patients were included. The peak lOP for DMS-treated eyes was 30.66 ± 8.35 mmHg (range, 13.00–48.00 mmHg), whereas that in FML-treated eyes was significantly lower at 20.66 ± 6.03 mmHg (range, 11.30–36.30 mmHg) ( P = 0.001). The maximal change in lOP ranged from −2.60 to +31.00 mmHg in OMS-treated eyes (mean, 15.48 ± 8.71 mmHg), almost double that of FML-treated eyes (range, +1.00 to +17.00 mmHg; mean, 5.83 ± 4.96 mmHg) ( P = 0.001). When the ocular-hypertensive responses of both DMS and FML groups were categorized into three levels of severity, significant differences were found between the two treatment groups ( P = 0.001). In the OMS group, nine patients (56.25%) were high responders and six patients (37.5%) were intermediate responders. In the FML group, only one patient (6.25%) was a high responder. Conclusions: The ocular-hypertensive response to topical OMS in children occurs more frequently, more severely, and more rapidly than that reported in adults. A total of 56% of the studied children, all younger than 10 years of age, were high responders to topical OMS. Of these, 89% attained their peak lOP within 8 days. Its use in children should best be avoided if possible. It would be desirable to monitor the lOP when it is being used. Conversely, FML produced a much less ocular-hypertensive effect and therefore poses an acceptable risk of clinically significant pressure elevation.