Silicone-eyelid closure to improve vision in deeply amblyopic eyes.

BACKGROUND

Deep amblyopia is a recognized cause of monocular visual deficit in children with a high rate of poor compliance with conventional occlusion therapy. This study evaluates a new occlusion technique that can be used for children with failed amblyopia treatment.

METHODS

In a prospective study, surgical silicone-eyelid closure was done for 15 children (age: 4 to 6 years; median age: 5.2 years) with a history of deep amblyopia and poor compliance with occlusion methods. In this technique, the good eye was closed by passing one limb of a double armed 5-0 polypropylene suture from one eyelid margin through a silicone sleeve and through the corresponding eyelid margin. The other polypropylene limb was passed behind the silicone sleeve and then through the opposite eyelid margin to form a barrier between the sleeve and the cornea. After 2 to 4 weeks, the suture was cut and the silicone sleeve was removed.

RESULTS

Preoperative visual acuity ranged between counting fingers at 1 meter and counting fingers at 4 meters. Following eyelid closure, visual acuity was improved to between 20/40 and 20/200 for 12 patients, whereas three patients did not improve. Complications were seen in 8 patients: marginal eyelid irritation and erythema in 6 and suture break in 2.

CONCLUSION

Silicone-eyelid closure can be used safely and effectively for management of deep amblyopia. This technique affords a good option to restore vision in a deeply amblyopic eye and grants the child a lifetime of useful vision.