e.g., Tono-Pen® (Reichert, Depew, NY). A dilated fundus examination is required to exclude the presence of ocular comorbidities such as optic nerve, macular, and retinal pathology. If precluded by the opacity, a B scan ultrasound may be useful to ensure retinal attachment. A cycloplegic refraction should also be performed if possible. An EUA is usually required to thoroughly assess the infants’ ocular pathology.

The presence of significant comorbidities may preclude surgery and referral to a pediatrician may occasionally be necessary.

Summary for the Clinician

•A comprehensive history and clinical examination often gives clues to the underlying etiology and visual prognosis.

•An examination under anesthetic is often required for a thorough assessment.

Ancillary Testing

Ultrasound biomicroscopy (UBM) is a very useful tool as it allows for detailed visualization of the underlying anterior segment structures (Fig. 7.1) [29, 33]. It greatly assists in preoperative diagnosis and surgical planning in eyes with severe corneal opacity. An additional benefit is that the images obtained are often helpful in explaining to parents the infants’ condition. In addition, a B-scan ultrasound may be performed to exclude posterior segment pathology and an A-scan can be performed to measure axial length (e.g., microphthalmia, buphthalmos). In some cases, electrophysiological testing with electroretinogram and/or visual evoked potential may be performed to determine the visual potential of the eye.

Fig. 7.1 UBM images taken parallel to the limbus shows extensive peripheral anterior synechiae. The image taken radially shows lenticulocorneal touch