Volume 15 Number 1 / February 2011 e21

Purpose: To examine whether bimatoprost induces choroidal effu-sion and exudative retinal detachment in patients with port winemark, diffuse choroidal haemangioma and receiving pulsed dye lasertreatment.Methods: Retrospective case note review.Results: Twenty-three patients with port wine mark were identifiedfrom records held of all patients on bimatoprost. Of those, 13 patientshad port wine mark, choroidal haemangioma and had been undergo-ing pulsed dye laser treatment. Four of these 13 patients had devel-oped exudative retinal detachments. Cessation of bimatoprost led toself-resolution of the detachment in one of these cases. In somecases, patients had been changed from latanoprost to bimatoprost.Choroidal thickening was heralded by a hypermetropic shift priorto detachment.Discussion:We believe this is the first series of its kind to report ex-udative retinal detachment in patients who are on bimatoprost andreceiving pulsed dye laser treatment for port wine mark along withconfirmed choroidal haemangioma.Conclusions: While the role of pulsed dye laser is unclear, bimato-prost should be used with caution in patients having pulsed dye lasertreatment for port wine mark in the presence of choroidal haeman-gioma.

076 Assessing control in intermittent exotropia. Sarah R. Hatt,Laura Liebermann, David A. Leske, Brian G. Mohney, Jonathan M.HolmesPurpose: Severity of intermittent exotropia (IXT) is often judged byassessing a patient's control of their deviation. A previous study re-ported marked variability of single measures of control throughoutthe day. We therefore evaluated 2 and 3 assessments of controlduring an examination.Methods: Twelve children with IXTwere evaluated during 4 sessionsover the course of a day (2 hours apart) on 2 separate days (8 ses-sions per child). The control score (0 to 5) consists of a 30-secondobservation period and 3 standardized 10-second covers, notingtime to recovery. Control was quantified 3 times during each exami-nation (median 21 minutes). Overall control for a day was calculatedas the mean of all 12 measures. The mean of 3 (triple), mean of2 (double), and single measures were compared to the day mean,calculating proportion that differed by 1 or more levels.Results: For distance control, only 5 (5%, 95% CI, 2% to 12%) of 95 triplemeasures differed by 1 or more levels from the day mean, whereas 24(8%, 95CI, 5% to 12%)of 286 doublemeasures and 49 (17%, 95%CI, 13%to 22%) of 287 single measures differed. Day 1 and Day 2 means werehighly correlated (ICC5 0.88, 95% CI 0.64 to 0.96).Discussion: Single assessments of distance control inadequatelyrepresent control over the day.Conclusions: The mean of 2 assessments, during a clinic visit is morerepresentative of distance control over the day, while the mean of 3assessments may be preferable.

077 A clinical classification system for paravenous pigmentarychorioretinal atrophy (PPCRA) in childhood. G€oran DariusHildebrand, David Taylor, Dorothy Thompson, Isabelle Russell-EggittPurpose: First review of pediatric PPCRA and proposal of a clinicalclassification system.Methods: Review of all known cases of PPCRA under the age of 18years reported in the world literature.Results:We identified 30 cases of paediatric PPCRA, including 3 owncases (mean age 9.3 years, range 4 months to 17 years, 59%male). In-formation regarding the presenting featureswas available in 27 cases.

Journal of AAPOS

Two distinctive patterns of presentation were found: Primary PPCRA(22/27, 81%) presenting with the characteristic fundal changes ofPPCRA associated with either an insidious onset or no symptoms, fa-milial clustering (12/22, 55%) and noclear triggering event. By contrast,children with secondary PPCRA (5/27, 19%) presented with suddenprofound visual loss due to bilateral retinitis/neuroretinitis (4/5) or is-chemic maculopathy (1/5). In these secondary cases, the phenotypeof PPCRAwas not initially seen during the acute phase, but developedsubsequently following the resolution of the acute episode. Unlike inprimary PPCRA, secondary PPCRA was non-familial and associatedwith measles-related neuroretinitis (2 cases), post-vaccination neuro-retinitis and retinitis (one case each).Discussion: We report a simple clinical classification system withtwo distinct patterns of presentation of PPCRA in childhood andfound a strong association between secondary PPCRA and measlesand vaccinations.Conclusions: Secondary PPCRA may be the longterm phenotypicoutcome of neuroretinitis and acute maculopathies in childhood.Further research should be directed at understanding the exactmolecular mechanism by which the secondary retinal dystrophy isinitiated and how this may be prevented or reversed.

078 Defining outcomes in strabismus surgery. Jonathan M.Holmes, Sarah R. Hatt, David A. LeskeIntroduction: We studied the effect of applying motor, diplopia, andhealth-related quality of life (HRQOL) criteria on defining successin adult strabismus surgery.Methods: 94 adult patients underwent strabismus surgery overa one-year period (98 surgeries). We assessed alignment, symptomsof diplopia, and HRQOL (using the AS-20) pre-operatively and6-weeks post-operatively. Success was defined as\10D deviationat distance and near, no diplopia at distance straight ahead andreading, and improvement by more than 95% limits of agreement,respectively. Complete data were available for 84 surgeries.Results: Applying success criteria to each case revealed that diplo-pia criteria could not be applied uniformly; 3 pre-op categories wereneeded: 1, Pre-op diplopia with fusion potential (where elimination ofdiplopia is a goal) 2, No pre-op diplopia (where preservation of nodiplopia is a goal) 3, Pre-op diplopia and no evidence of fusion poten-tial (where elimination of diplopia is often not possible). Applying cri-teria sequentially, motor criteria yielded a success rate of 92% (95%CI 84% to 97%), adding diplopia criteria (specific to each pre-op cat-egory) reduced success to 82% (95% CI, 72% to 90%) and adding AS-20 HRQOL criteria reduced success to 50% (95% CI, 39% to 61%).Conclusions: Although, at a cohort level, HRQOL scores improve af-ter strabismus surgery, at an individual patient level, properties ofcurrent HRQOL instruments may result in potentially unrealisticthresholds. Classifying outcome in strabismus surgery is currentlybest achieved categorizing strabismus by type, and applying motorcriteria combined with category-specific diplopia criteria.

079 Efficacy of hang-back recessions in comparison toconventional recessions. Magdalene D. Israel, Ranojit Basu,Mitalee ChoudhuryPurpose: Hang-back technique was introduced by Repka and Guytonin 1987 to circumvent various problems encountered with conven-tional scleral suturing. The aim of our study was to compare the ef-ficacy of hang-back recessions and conventional recessions incommitant horizontal strabismus.Methods: The surgical outcome in 35 patients who had undergoneconventional recession was compared with 35 patients who had