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Oatts JT, Shen S, Zhu H, Gong Q, Yu Y, Ying GS, Han Y, Liu H. A Prospective Study of the Effects of General Anesthesia on Intraocular Pressure in Healthy Children. Ophthalmol Sci 2024; 4:100455. [PMID: 38313401 PMCID: PMC10837640 DOI: 10.1016/j.xops.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Abstract
Purpose To determine the effect of general anesthesia on intraocular pressure (IOP) in children with no intraocular pathology and determine which postanesthetic time point is most predictive of preinduction IOP. Design Prospective observational study. Participants Children with no intraocular pathology ≤ 18 years scheduled for general anesthesia as part of their routine care followed by a pediatric ophthalmologist at Nanjing Medical University. Methods Participants underwent a standardized general anesthetic protocol using a mask induction with sevoflurane and propofol maintenance. Intraocular pressure was measured at the following 7 time points: preinduction (taken in the preoperative area), postinduction minutes 1, 3, and 5, and postairway placement minutes 1, 3, and 5 for a total time period of 10 minutes after induction. A generalized estimating equation was used to evaluate the effect of anesthesia on IOP and the effect of patient factors (age, gender, vital signs, and airway type) on preanesthetic and postanesthetic IOP. An IOP prediction model was developed using the postanesthesia IOP measurements for predicting preinduction IOP. Main Outcome Measures Intraocular pressure and change in IOP at prespecified time points. Results Eighty-five children were enrolled with a mean ± standard deviation (SD) age of 7.5 ± 2.9 years. Mean ± SD preinduction IOP was 20.1 ± 3.7 mmHg. Overall, IOP was lowest at 3 minutes postinduction, decreased to a mean of 13.4 ± 3.7 mmHg (P < 0.001). After this, IOP rose 5 minutes postinduction to 16.5 ± 4.2 mmHg, which did not reach preinduction IOP levels (P < 0.001). The IOP prediction model showed that combining 1 minute postinduction and 3 minutes postairway was most predictive (R2 = 0.13), whereas 1 minute postairway was least predictive of preinduction IOP (R2 = 0.01). Conclusions After the induction of general anesthesia in children, IOP temporarily decreases with a trough at 3 minutes postinduction before increasing and remaining stable just below preinduction levels. Intraocular pressure measurements taken 1 minute after induction with 3 minutes after airway placement are most predictive of preinduction IOP, though predictive value is relatively low. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Julius T. Oatts
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Shiya Shen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qi Gong
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Larsen AC, Rasmussen MLR. A Patient-Centered Approach to Vernal Keratoconjunctivitis (VKC): A Podcast. Ophthalmol Ther 2024; 13:1061-1069. [PMID: 38436902 DOI: 10.1007/s40123-024-00909-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a rare yet severe form of allergic conjunctivitis predominantly affecting children, mainly boys, with a global prevalence and a higher incidence in certain geographical regions. The disease is characterized by seasonal exacerbations. VKC presents with ocular surface inflammation leading to various distressing symptoms such as itching, redness, mucous discharge, and pain. The disease primarily manifests bilaterally, though it may initially appear unilaterally. If left untreated, VKC can result in corneal complications, including shield ulcers and vision impairment, affecting daily activities and psychosocial well-being, especially in children. The diagnosis of VKC involves identifying key clinical findings on the ocular surface such as Tranta dots, giant papillae, or shield ulcers. Management follows a stepwise approach, including anti-allergic eye drops, steroid eye drops, and topical medications like cyclosporine, which may take up to 3 months to show efficacy. Allergic sensitization, often to inhaled allergens like pollen and house dust mites, is associated with VKC in half of the cases. Understanding and managing these allergies through measures such as avoidance, sensitization control, and co-treatment of associated conditions like asthma and rhinoconjunctivitis are essential in VKC management. Atopic keratoconjunctivitis (AKC), a related condition associated with atopic dermatitis and asthma, shares similarities with VKC but typically affects young adults. However, there is an observed spectrum between the two diseases, indicating similar treatment strategies for both. VKC treatment requires a patient-centered approach, involving informed and supported parents, considering economic factors due to costly eye drops, and ensuring accessibility and practicality of treatment, especially in children. A multidisciplinary team collaboration, including ophthalmologists, pediatricians, and dermatologists, optimizes patient care. The rewarding aspect of VKC treatment lies in witnessing children regain their quality of life, overcome vision challenges, and thrive in their daily activities. In conclusion, understanding VKC, its associated allergies, and employing a comprehensive, patient-centered approach are crucial in managing this challenging condition, particularly in children, to enhance their vision and overall well-being.
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Affiliation(s)
- Ann Cathrine Larsen
- Department of Ophthalmology, Rigshospitalet-Glostrup, University Hospital Rigshospitalet, Valdemar Hansens vej 1-23, 2600, Glostrup, Denmark
| | - Marie Louise Roed Rasmussen
- Department of Ophthalmology, Rigshospitalet-Glostrup, University Hospital Rigshospitalet, Valdemar Hansens vej 1-23, 2600, Glostrup, Denmark.
- Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark.
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Al Hassan S, Bou Ghannam A, S Saade J. An Emerging Ophthalmology Challenge: A Narrative Review of TikTok Trends Impacting Eye Health Among Children and Adolescents. Ophthalmol Ther 2024; 13:895-902. [PMID: 38315349 PMCID: PMC10912387 DOI: 10.1007/s40123-024-00885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
In today's digital age, children and teenagers are deeply entrenched in the world of personal electronic devices including laptops, tablets, and smartphones. These serve as gateways to captivate online content. With children as young as 4 years old having access to these gadgets, the potential benefits of technology coexist with many possible risks. One such risk is the growing global issue of myopia. TikTok, a mobile application that gained immense popularity since its inception in 2016, has garnered 1.7 billion active monthly users in 2023 and is expected to reach two billion in 2024. A significant portion of TikTok's user base consists of adolescents, with approximately 41% falling in the 16-24 age group and a third aged 14 or younger. This social media platform has given rise to the phenomenon of "internet challenges," where users complete and share various tasks through videos. While most of these challenges are harmless, some pose serious risks to teenagers who eagerly seek validation and attention from their peers. This manuscript sheds light on a specific subset of TikTok challenges, namely those related to ophthalmological risks. These challenges include "rubbing castor oil trend," "bleach/bright eye challenge," "mucus fishing challenge," "eggsplosions", "beezin challenge", "Orbeez challenge", "blow-drying eyelashes", "sun gazing," and "popping styes". The manuscript emphasizes the importance of monitoring and regulating potentially dangerous content on social media platforms like TikTok. While these platforms offer educational opportunities, they can also promote life-threatening actions, necessitating efforts to protect vulnerable young users and promote safe online engagement.
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Affiliation(s)
- Sally Al Hassan
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanna S Saade
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
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Girolamo MM, Hadjistilianou T, Lembo A, Salvoldi F, Serafino M, Barchitta M, Menicacci C, De Francesco S, Nucci P. Unusual anterior and posterior segment features of coats disease. Eur J Ophthalmol 2024; 34:419-424. [PMID: 37439027 DOI: 10.1177/11206721231188996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE To report the clinical course and management of unusual anterior and posterior segment features of Coats disease and their relation to the age of the patients to increase the awareness towards these rare clinical features rarely described in the current literature. METHODS A retrospective descriptive review of 45 eyes of 45 patients affected by Coats disease was conducted at the Retinoblastoma Referral Center and Ophthalmology Unit of the University of Siena in Italy analyzing data from 2000 to 2022. Medical records and images were revised to find some cases presenting unusual anterior and posterior segment features in patients affected by Coats disease.We identified therefore 4 unusual clinical conditions: retinal macrocysts, anterior chamber cholesterolosis, fovea-sparing Coats disease and secondary vasoproliferative tumor. RESULTS Two patients presented with retinal macrocyst (2/45 = 4.4%), one with anterior chamber cholesterolosis (1/45 = 2.2%), two with fovea sparing Coats disease (2/45 = 4.4%) and one with vasoproliferative tumor associated (1/45 = 2.2%) for a total of six (6/45 = 13.3%) patients manifesting unusual anterior or posterior segment features in Coats disease. CONCLUSION Unusual anterior and posterior segment features of Coats disease such as retinal macrocyst and anterior chamber cholesterolosis have been more frequently reported in younger children while fovea-sparing and vasoproliferative tumors have been more commonly described in older patients. Age is then a strong prognostic marker which allows to distinguish two different phenotypes of Coats disease: patients younger and older than 3 years old with more aggressive and milder phenotype respectively.
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Affiliation(s)
- Matteo Maria Girolamo
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Theodora Hadjistilianou
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Andrea Lembo
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
| | - Federica Salvoldi
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimiliano Serafino
- Department of Neuroscience, Unit of Ophthalmology, Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo Barchitta
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cristina Menicacci
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sonia De Francesco
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, OcularOncology - Retinoblastoma Referral Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
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Guimaraes S, Vieira MJ, Boas JMV. Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener. Int Ophthalmol 2024; 44:84. [PMID: 38363427 PMCID: PMC10873442 DOI: 10.1007/s10792-024-02954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With high increase in myopia prevalence, we aimed to assess whether Plusoptix_A09 can be used in myopic children over spectacles to predict visual acuity (VA) and myopic refraction changes. METHODS Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. RESULTS In total, 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p < 0.001) and refraction changes (p < 0.001). Values of SP < - 0.06D or SE < - 0.22D indicated a VA decrease (AUC > 0.9, p < 0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p > 0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4-9-year-old patients (p < 0.001 versus p = 0.628) and in 10-18-year-old children (OR < = 0.066 versus OR = 0.190). A decrease in SP and SE of - 0.10D in Plusoptix_A09 predicted a myopia progression of - 0.04D and - 0.05D, respectively. CONCLUSION/RELEVANCE This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of - 0.10D in Plusoptix, a myopia progression of -0.05D is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice.
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Affiliation(s)
- Sandra Guimaraes
- FP-I3ID (Instituto de Investigação, Inovação e Desenvolvimento da Universidade Fernando Pessoa), Porto, Portugal.
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal.
- FCS-UFP (Faculdade de Ciências da Saúde da da Universidade Fernando Pessoa), Porto, Portugal.
| | - Maria João Vieira
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal
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Donahue SP, Chandler DL, Wu R, Marsh JD, Law C, Areaux RG, Ghasia FF, Li Z, Kraker RT, Cotter SA, Holmes JM. Eight-Year Outcomes of Bilateral Lateral Rectus Recessions versus Unilateral Recession-Resection in Childhood Basic-Type Intermittent Exotropia. Ophthalmology 2024; 131:98-106. [PMID: 37696452 PMCID: PMC10841051 DOI: 10.1016/j.ophtha.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE To report 8-year outcomes from a randomized controlled trial (RCT) comparing bilateral lateral rectus muscle recession (BLRc) with unilateral recession-resection (R&R) for childhood intermittent exotropia (IXT). DESIGN Eight-year follow-up of RCT cohort. PARTICIPANTS Of 197 randomized participants, 123 agreed to continue follow-up after the 3-year outcome visit (baseline age, 3-< 11 years; basic-type IXT, 15-40 prism diopters [Δ] by prism and alternate cover test [PACT]; baseline stereoacuity, ≤ 400 arcsec; no prior surgery). METHODS After the RCT primary outcome at 3 years, annual follow-up from 4 through 8 years with treatment at investigator discretion. MAIN OUTCOME MEASURES Suboptimal surgical outcome by 8 years after randomization, defined as any of the following at any visit: exotropia of 10 Δ or more by simultaneous prism cover test (SPCT) at distance or near, constant esotropia (ET) of 6 Δ or more by SPCT at distance or near, loss of near stereoacuity by 0.6 log arcsec or more from baseline, or reoperation. Secondary outcomes included (1) reoperation by 8 years and (2) complete or near-complete resolution at 8 years, defined as exodeviation of less than 10 Δ by SPCT and PACT at distance and near and 10 Δ or more reduction from baseline by PACT at distance and near, ET of less than 6 Δ at distance and near, no decrease in stereoacuity by 0.6 log arcsec or more from baseline, and no reoperation or nonsurgical treatment for IXT. RESULTS The Kaplan-Meier cumulative probability of suboptimal surgical outcome through 8 years was 68% (55 events among 101 at risk) for BLRc and 53% (42 events among 96 at risk) for R&R (difference, 15%; 95% confidence interval [CI], -2% to 32%; P = 0.08). Complete or near-complete resolution at 8 years occurred in 15% (7/46) for BLRc and 37% (16/43) for R&R (difference, -22%; 95% CI, -44% to -0.1%; P = 0.049). The cumulative probability of reoperation was 30% for BLRc and 11% for R&R (difference, 19%; 95% CI, 2%-36%; P = 0.049). CONCLUSIONS Despite no significant difference for the primary outcome, the 95% CI did not exclude a moderate benefit of R&R, which together with secondary outcomes suggests that unilateral R&R followed by usual care may yield better long-term outcomes than BLRc followed by usual care for basic-type childhood IXT using these surgical doses. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Sean P Donahue
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Rui Wu
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Christine Law
- Departments of Ophthalmology and Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Raymond G Areaux
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | - Jonathan M Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona
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Zhang XJ, Wang YM, Jue Z, Chan HN, Lau YH, Zhang W, Kam KW, Ip P, Young AL, Tham CC, Pang CP, Chen LJ, Yam JC. Interocular Symmetry in Retinal Nerve Fiber Layer Thickness in Children: The Hong Kong Children Eye Study. Ophthalmol Ther 2023; 12:3373-3382. [PMID: 37851163 PMCID: PMC10640485 DOI: 10.1007/s40123-023-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION The aim of this work is to determine the interocular differences in peripapillary retinal nerve fiber layer (p-RNFL) thickness and its associations among school children in Hong Kong. METHODS We conducted a population-based study including 4034 children aged 6-8 years from the Hong Kong Children Eye Study (HKCES). All participants received comprehensive ocular examinations where p-RNFL thickness was measured using spectral-domain optical coherence tomography (SD-OCT). The degree of symmetry between both eyes was analyzed and represented by intraclass correlation coefficient (ICC) values. Multivariable linear regression analysis was used to investigate the associations between ocular and systemic factors with p-RNFL thickness difference. RESULTS The study included 4034 children with a mean age of 7.61 ± 0.98 years. The mean global p-RNFL thickness was 106.60 ± 9.41 μm in right eyes and 105.99 ± 9.30 μm in left eyes. The ICC for global p-RNFL difference was 0.866 (95% CI 0.858-0.873, p < 0.001). The symmetry displayed the largest values in nasal inferior quadrant with the ICC value of 0.736 (95% CI 0.721-0.749); and the smallest degree of symmetry was found to be in the superior temporal quadrant with the ICC value of 0.567 (95% CI 0.546-0.588). Axial length (AL) difference was found to have more pronounced correlation to interocular symmetry in p-RNFL thickness with the coefficient of 0.514 (p < 0.001). CONCLUSIONS Normal variation in interocular symmetry exists in children. Our results can contribute to the establishment of a standard reference for interocular differences in OCT parameters in children. The interocular differences in AL should be considered in the interpretation of RNFL symmetry, in terms of identifying children at risk of developing glaucoma or other ocular disorders.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Tianjin Eye Hospital, Tianjin, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Neurobiology, Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Zhenzhen Jue
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yi Han Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wei Zhang
- Tianjin Eye Hospital, Tianjin, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, SAR, China
- 4/F Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, SAR, China.
- 4/F Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, SAR, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, SAR, China.
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Oke I, Nihalani BR, VanderVeen DK. Axial length and corneal curvature of normal eyes in the first decade of life. Eur J Ophthalmol 2023; 33:2217-2221. [PMID: 37093758 DOI: 10.1177/11206721231167643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND/AIMS To establish normative curves for axial length and corneal curvature in the first decade of life. METHODS This is a cross-sectional study from a single institution in the United States. Children from 0- to 10-years of age with no underlying ocular pathology were prospectively enrolled to obtain ultrasound biometry and hand-held keratometry while under anaesthesia for an unrelated procedure. Older cooperative children had optical biometry obtained in-office. Logarithmic quantile regression models were used to determine the change in axial length and average keratometry as a function of age. RESULTS Single-eye measurements from 100 children were included. 75% of children were White and 49% female. Median axial length ranged from 20.6 mm (IQR, 20.2 to 21.1 mm) at age one year to 23.1 mm (IQR, 22.5 to 23.8 mm) at age ten years. Median average keratometry ranged from 44.1 D (IQR, 42.6 to 45.4 D) at age one year to 43.5 (IQR, 42.2 to 44.0 D) at age ten years. As age increased, there was a significant increase in axial length (0.74 mm per doubling of age; 95% CI, 0.62 to 0.82 mm), and a non-significant trend towards lower average keratometry (-0.21 D per doubling of age; 95% CI, -0.62 to 0.08 D). CONCLUSIONS We provide a set of normative charts for axial length and corneal curvature which may facilitate the identification of eyes outside the normal range and assist in the management of ocular conditions such as glaucoma or cataract.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bharti R Nihalani
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Hakim FE, Riaz K, Farooq A. Pediatric herpes zoster ophthalmicus: a systematic review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2169-2179. [PMID: 36949170 PMCID: PMC10033303 DOI: 10.1007/s00417-023-06033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE While typically affecting older adults and immunocompromised individuals, herpes zoster ophthalmicus (HZO) has been reported with varying manifestations and complications in children. In this review, we evaluate reported cases of pediatric HZO in the literature and discuss the epidemiology, risk factors, clinical presentation, treatment and outcomes. METHODS A literature search on PubMed, Scopus, and Web of Science databases was performed using the terms "pediatric herpes zoster ophthalmicus" and "herpes zoster ophthalmicus children." Publications that were not specific to HZO or pediatric populations were excluded, as were publications that were not available to review or not published in the English language. RESULTS Fifty-seven reports describing 130 cases of HZO or HZO-related complications were reviewed. Major risk factors for pediatric HZO included intrauterine exposure to varicella or primary varicella infection at a young age; HZO also occurred in patients who had received varicella vaccination. Both healthy and immunocompromised children were affected, with the majority of affected children being immunocompetent. The diagnosis of HZO is primarily clinical. Children appear to have good vision recovery and resolution of symptoms if they are treated promptly and if they adhere to treatment regimens, except for irreversible vision loss related to uncommon complications such as optic neuritis. CONCLUSION HZO occurs in both healthy and immunocompromised children. Recognizing this treatable condition is essential for reducing ocular and systemic morbidity. Long-term follow-up and assessments of the impact on health in adulthood are lacking. More systematic study is needed to determine the incidence of HZO in children and appropriate diagnostic and treatment protocols for the care of pediatric patients with HZO.
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Affiliation(s)
- Farida E Hakim
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
| | - Kamran Riaz
- Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Asim Farooq
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, USA
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de Saint Sauveur G, Chapron T, Abdelmassih Y, Chehaibou I, Lecler A, Dureau P, Metge F, Caputo G. Management and outcomes of posterior persistent fetal vasculature. Ophthalmology 2023:S0161-6420(23)00228-2. [PMID: 37044159 DOI: 10.1016/j.ophtha.2023.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE To describe the clinical features, management and outcomes of posterior persistent fetal vasculature (PFV) and suggest a management algorithm. DESIGN Retrospective consecutive case series. PARTICIPANTS All children diagnosed with posterior PFV and treated or followed at the Rothschild Foundation Hospital in France between June 2011 and September 2021. METHODS Retrospective analysis of the clinical characteristics of posterior PFV. We reported at diagnosis: age, gender, presenting symptoms, intraocular pressure (IOP), visual acuity (VA). Patients were divided in four group depending on severity and involvement or not of the anterior segment. We reported the vitreoretinal surgical techniques used. MAIN OUTCOME MEASURES Anatomical results, ocular hypertension, BCVA, presence of post-operative adverse events and additional surgical interventions were recorded at each follow-up visit. RESULTS A total of 96 patients were included. Median age at diagnosis was 8 months (mean 18.9±30.9 months) with a mean follow-up of 27±31.2 months. Although PFV is often an isolated disease, it was associated with a systemic disease in 8% of cases. Posterior PFV was associated with anterior involvement in 62 eyes (64%). Forty-one eyes (42.7%) were microphthalmic and were more frequently associated with severe PFV [53% vs. 25%; (p=0.01)]. Surgery was performed in 85 patients (89%). Of them, 69 (81%) were a total success, 5 (6%) were a partial success due to a persistent limited peripheral retinal detachment (RD), and 11 (13%) were a failure due to persistent total RD after surgery. Twenty-four eyes presented post-operative adverse events including ocular hypertension requiring eye drop medication (6.6%), secondary cell proliferation around the IOL (7.7%), intravitreal hemorrhages (6.6%), persistent tractional RD (9.9%). A second surgery was performed in 15 patients (16%). At last follow-up, VA could be measured in logMAR in 43 children (45%), was light perception in 21 eyes (22%), and no light perception or impossible to assess in 32 eyes (33%). CONCLUSIONS In our case-series, most of patients presenting PFV with posterior involvement received complex vitreoretinal surgery. Goals of the surgery varies, and include retinal flattening, reduction of vitreoretinal traction, freeing of the visual axis and aesthetic concerns. We proposed a surgical and medical management algorithm for PFV.
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Affiliation(s)
- Guy de Saint Sauveur
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
| | - Thibaut Chapron
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France; Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France.
| | - Youssef Abdelmassih
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
| | - Ismael Chehaibou
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
| | - Augustin Lecler
- Neuroradiology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
| | - Pascal Dureau
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
| | - Florence Metge
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
| | - Georges Caputo
- Pediatric ophthalmology department, Rothschild Foundation Hospital 25 rue Manin 75940 Paris-Cedex 19 France
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Kelly JP, Feldman KW, Wright JN, Metz JB, Weiss A. Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages. Doc Ophthalmol 2023. [PMID: 36881212 DOI: 10.1007/s10633-023-09927-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Function and anatomy of the visual system were evaluated in children with abusive head trauma (AHT). The relationships between retinal hemorrhages at presentation were examined with outcome measures. METHODS Retrospective review of data in children with AHT for 1) visual acuity at last follow-up, 2) visual evoked potentials (VEP) after recovery, 3) diffusion metrics of white matter tracts and grey matter within the occipital lobe on diffusion tensor imaging (DTI), and 4) patterns of retinal hemorrhages at presentation. Visual acuity was converted into logarithm of minimum angle of resolution (logMAR) after correction for age. VEPs were also scored by objective signal-to-noise ratio (SNR). RESULTS Of 202 AHT victims reviewed, 45 met inclusion criteria. Median logMAR was reduced to 0.8 (approximately 20/125 Snellen equivalent), with 27% having no measurable vision. Thirty-two percent of subjects had no detectable VEP signal. VEPs were significantly reduced in subjects initially presenting with traumatic retinoschisis or hemorrhages involving the macula (p < 0.01). DTI tract volumes were decreased in AHT subjects compared to controls (p < 0.001). DTI metrics were most affected in AHT victims showing macular abnormalities on follow-up ocular examination. However, DTI metrics were not correlated with visual acuity or VEPS. There was large inter-subject variability within each grouping. DISCUSSION Mechanisms causing traumatic retinoschisis, or traumatic abnormalities of the macula, are associated with significant long-term visual pathway dysfunction. AHT associated abnormalities of the macula, and visual cortical pathways were more fully captured by VEPs than visual acuity or DTI metrics.
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12
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Lueder G, Galli M, Cho JCC, Liegel K. Pediatric Ophthalmology Scope of Practice. J Binocul Vis Ocul Motil 2023; 73:53-54. [PMID: 36811625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE To determine practice patterns of pediatric ophthalmologists with respect to types of medical conditions cared for and age of patients treated due to limited data regarding pediatric ophthalmologists' scope of practice. METHODS A survey was sent to 1408 international and United States members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) membership through the group's internet listserv. Responses were collated and analyzed. RESULTS Ninety members (6.4%) responded. 89% of respondents confine their practices to pediatric ophthalmology and adult strabismus. The percentages of respondents who provide primary surgical and medical treatment of the following conditions include 68% for ptosis and anterior orbital lesions, 49% for cataracts, 38% for uveitis, 25% for retinopathy of prematurity, 19% for glaucoma, and 7% for retinoblastoma. For conditions other than strabismus, 59% restrict their practice to patients less than 21 years of age. CONCLUSION Pediatric ophthalmologists provide primary medical and surgical care for children with a wide variety of ocular conditions, including complex disorders. Awareness of this variety of practice might prove beneficial in encouraging residents to consider careers in pediatric ophthalmology. Consequently, fellowship education in pediatric ophthalmology should include exposure to these areas.
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Affiliation(s)
- Gregg Lueder
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri
| | - Marlo Galli
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri
| | | | - Katharine Liegel
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri
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13
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Roston S, Kulenkamp JE, Ferrieri P, Strul S. Rare Thelazia californiensis infant ocular infestation. Am J Ophthalmol Case Rep 2023; 30:101813. [PMID: 36844613 PMCID: PMC9950434 DOI: 10.1016/j.ajoc.2023.101813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose A rare case of Thelazia californiensis ocular infestation was diagnosed and treated in an 11-month-old patient. Observations The patient presented with a visual acuity of 20/130 OU by Teller cards. Exam demonstrated a white, mobile worm in the inferomedial fornix of the right eye. The remainder of the exam was otherwise normal. The worm was removed under anesthesia and identified as Thelazia californiensis by the Division of Parasitic Diseases and Malaria, at the Centers for Disease Control and Prevention. Conclusions and importance This case demonstrates a rare but important cause of follicular conjunctivitis and mobile foreign bodies, especially in patients with a supportive history of exposure to the intermediate and definitive hosts of Thelazia species.
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Affiliation(s)
| | - J. Erik Kulenkamp
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, USA
| | - Patricia Ferrieri
- Infectious Diseases Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, USA
| | - Sasha Strul
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, USA
- Corresponding author. Department of Ophthalmology and Visual Neurosciences, University of Minnesota, 701 S 25 Ave Third Fl, Minneapolis, MN, 55454, USA.
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14
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Lu JE, Yoon MK. The Role of Steroids for Pediatric Orbital Cellulitis - Review of the Controversy. Semin Ophthalmol 2023:1-4. [PMID: 36683269 DOI: 10.1080/08820538.2023.2168487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Orbital cellulitis in the pediatric population is treated primarily with antibiotic therapy. This leaves the inflammatory component unchecked. Corticosteroid therapy has been used to accelerate recovery and decrease the long-term morbidity in other infectious conditions. Its use has also been proposed for pediatric orbital cellulitis. The aim of this manuscript is to conduct a literature review to summarize existing evidence and understand ongoing controversies. Overall, prior investigations on corticosteroid therapy for pediatric orbital cellulitis are limited by their study design and sample sizes. One of the most discussed potential benefits is that adjuvant steroid therapy for pediatric orbital cellulitis is associated with shorter hospitalization without major infectious complications. However, decreased hospitalization length is an imperfect metric, especially without standardized criteria for hospital discharge. Future studies are warranted to better guide the use of adjuvant steroid therapy and to optimize its potential in the management of pediatric orbital cellulitis.
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Affiliation(s)
- Jonathan E Lu
- Department of Ophthalmology, Division of Oculoplastic Surgery Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Michael K Yoon
- Department of Ophthalmology, Division of Oculoplastic Surgery Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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15
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Ranno S, Fontanel L, Ruggiero E, Nucci P, Radice P, Donati S. Central Serous Chorioretinopathy in a 14-year-old atopic boy: a case report. Ital J Pediatr 2023; 49:1. [PMID: 36597009 DOI: 10.1186/s13052-022-01386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Corticosteroids are widely used in medicine. Few cases of central serous chorioretinopathy (CSC) have been reported following topical corticosteroid administration. We describe the first case of pediatric CSC related to topical corticosteroid administration. CASE PRESENTATION A 14-year-old boy presented with decreased vision, pigment epithelial detachments, and serous retinal detachments in the right eye after starting treatment for atopic dermatitis with Betamethasone Valerate 0.1% topical ointment. His condition resolved 2 weeks after discontinuing the steroid and administering Bromfenac 0.9 mg/ml eyedrops. CONCLUSIONS Although the pathogenesis of CSC is poorly understood, ophthalmologists should be informed about the potential link between CSC and topical corticosteroid treatment, and they should be aware that CSC might, albeit infrequently, affect children.
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Xu TT, Bothun CE, Hendricks TM, Mansukhani SA, Bothun ED, White LJ, Mohney BG. Accuracy of the International Classification of Diseases, 9th Revision for Identifying Infantile Eye Disease. Ophthalmic Epidemiol 2022; 29:649-655. [PMID: 34821545 PMCID: PMC9130338 DOI: 10.1080/09286586.2021.2009520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses. METHODS Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. RESULTS In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p < .001), pseudostrabismus (85.9% vs. 25.0%, p < .001), and physiologic anisocoria (95.5% vs. 33.3%, p = .002). CONCLUSION The predictive value of ICD-9 codes for capturing infantile ocular diagnoses varied widely in this cohort. These findings emphasize the limitations of database research methodologies that solely utilize claims data to identify pediatric eye diseases.Abbreviations/Acronyms PPV: positive predictive value; NPV: negative predictive value; CNLDO: congenital nasolacrimal duct obstruction.
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Affiliation(s)
- Timothy T. Xu
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Cole E. Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Erick D. Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Launia J. White
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Brian G. Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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17
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Freedman SF, Hercinovic A, Wallace DK, Kraker RT, Li Z, Bhatt AR, Boente CS, Crouch ER, Hubbard GB, Rogers DL, VanderVeen D, Yang MB, Cheung NL, Cotter SA, Holmes JM. Low- and Very Low-Dose Bevacizumab for Retinopathy of Prematurity: Reactivations, Additional Treatments, and 12-Month Outcomes. Ophthalmology 2022; 129:1120-1128. [PMID: 35660415 PMCID: PMC9509410 DOI: 10.1016/j.ophtha.2022.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants. DESIGN Masked, multicenter, dose de-escalation study. PARTICIPANTS One hundred twenty prematurely born infants with type 1 ROP. METHODS A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment. MAIN OUTCOME MEASURES Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age. RESULTS Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (-0.31 diopter), and strabismus was present in 29% of infants. CONCLUSIONS Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses.
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Affiliation(s)
- Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
| | | | - David K Wallace
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana
| | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | - Amit R Bhatt
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas
| | - Charline S Boente
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana
| | - Eric R Crouch
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia
| | - G Baker Hubbard
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - David L Rogers
- Pediatric Ophthalmology Associates, Inc., Columbus, Ohio
| | - Deborah VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael B Yang
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nathan L Cheung
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | - Jonathan M Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona
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Pineles SL, Repka MX, Velez FG, Yu F, Perez C, Sim D, Coleman AL. Prevalence of pediatric eye disease in the optumlabs data warehouse. Ophthalmic Epidemiol 2022; 29:537-544. [PMID: 34459319 PMCID: PMC8882702 DOI: 10.1080/09286586.2021.1971261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To define the prevalence of medical eye disease diagnoses among children enrolled in commercial insurance plans in the United States and to evaluate differences among groups based on the US census region, race/ethnicity, and familial net worth. METHODS : Retrospective study of de-identified claims data from the OptumLab® Data Warehouse (OLDW) between 2007 and 2018. All children (<19 years) in the OLDW with coverage were studied and those with a claim for a significant eye disease (strabismus, amblyopia, nystagmus or structural eye disorders) with minimum 6-months follow-up were studied. Baseline characteristics were extracted for the calculation of eye disease prevalence, including age, sex, race/ethnicity, region of residence, and family net worth. The prevalence of each type of eye disease was calculated among all children and by baseline characteristics. RESULTS : 10,759,066 children met the study criteria. The presence of any significant eye diagnosis was 6.7%. Disease was diagnosed more often in whites (6.9%) than blacks (5.6%) and Hispanics (5.9%). The most common eye disease diagnosed was strabismus (3.2%) followed by amblyopia (1.5%). In the North-East region, there was a 10.6% prevalence of any significant eye disease diagnosis, whereas in the Mid-West, it was 7.4% followed by the South and West (5.9% and 5.3%, respectively) (p < .001). There was an increase in eye disease diagnoses with increasing income (5.5% in<$25,000 and 9.4% in >$500,000 household net worth groups, p > .001). CONCLUSION : Diagnosis of significant eye diseases is relatively common in American children. The most common medical eye disease diagnosis is strabismus. Prevalence of eye disease diagnosis from claims data varies between geographical regions and different income groups. This may reflect differences in healthcare utilization rather than true disease prevalence.
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Affiliation(s)
- Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, United States
- OptumLabs Visiting Fellow, Eden Prairie, MN, United States
| | - Michael X Repka
- Department of Ophthalmology, Wilmer Eye Institute, the Johns Hopkins University School of Medicine, United States
| | - Federico G Velez
- Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, United States
- Department of Ophthalmology, Duke University School of Medicine, United States
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, United States
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health
| | - Claudia Perez
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Danielle Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, United States
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, United States
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Vongsachang H, Iftikhar M, Canner JK, Woreta F. Factors Associated with Length of Stay and Cost among Pediatric Hospitalizations with a Primary Ophthalmic Diagnosis. Ophthalmic Epidemiol 2022; 30:1-7. [PMID: 36131540 PMCID: PMC10027614 DOI: 10.1080/09286586.2022.2124278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. METHODS This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively). RESULTS An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p = .03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p < .001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p = .04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p = .04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p = .02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p = .02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p < .001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p < .001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p < .05 for all). CONCLUSIONS Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care.
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Affiliation(s)
- Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph K. Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Nucci P, Lembo A, Caputo R, Dellavalle A, Serafino M, Schiavetti I, Pichi F. Efficacy and safety of intraoperative use of tropicamide 0.02%/phenylephrine0.31%/lidocaine1% intracameral combination during pediatric cataract surgery. Int Ophthalmol 2022; 43:989-995. [PMID: 36053475 DOI: 10.1007/s10792-022-02501-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To demonstrate the safety and efficacy of the intracameral use of tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery, a combination widely used in adult patients but still off-label in children. METHODS Design: two-center, prospective, observational study. SETTING San Giuseppe Hospital, Milan and Meyer Children's Hospital, Florence. STUDY POPULATION children from 0 to 4 years of age undergoing cataract surgery with or without intraocular IOL implantation, in the absence of clinically significant systemic conditions, history of ocular surgery, concurrent ocular medication, hypersensitivity to any of the substances and post-traumatic cataracts. During the surgery, patients received the combination drug after the primary access to the anterior chamber. Efficacy was evaluated by achieving an adequate mydriasis in order to perform capsulorhexis, while safety was assessed by recording vital signs (heart rate, blood pressure, respiratory rate, temperature) pre- and post-administration of the substance. RESULTS This study included 53 surgical procedures of 36 patients: 41 eyes were left aphakic, while 12 eyes received primary IOL implantation. The pupil size was adequate to safely perform capsulorhexis in 52 procedures of 53. The difference in pupil enlargement was significant (6.0 ± 1.14 mm, P = < 0.001). There were no notable changes in vital parameters. CONCLUSIONS The administration of intracameral tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery is effective for obtaining an adequate mydriasis without any vital parameters changes throughout the procedure.
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Affiliation(s)
- Paolo Nucci
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy
| | - Andrea Lembo
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Caputo
- Department of Pediatric Ophthalmology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Dellavalle
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy
| | - Massimiliano Serafino
- Department of Neuroscience, Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
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21
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Zhou TE, Kassis PO, Qian C, Bérubé-Thevenet R, Chappaz A, Hamel P, Chemtob S, Nuyt AM, Luu TM. Reduced Contrast Sensitivity in Young Adults Who Had Retinopathy of Prematurity. Ophthalmol Retina 2022; 6:744-746. [PMID: 35430418 DOI: 10.1016/j.oret.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Tianwei Ellen Zhou
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Cynthia Qian
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | | | - Ariane Chappaz
- Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Patrick Hamel
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Sylvain Chemtob
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Anne-Monique Nuyt
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada.
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22
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Turanzas NJ, von Holstein SL, Wiencke AK, Toft PB, Heegaard S, Kessel L. Epidemiology and clinical characteristics of congenital choristomas in the ocular adnexa of pediatric patients. Graefes Arch Clin Exp Ophthalmol 2022; 260:3069-3074. [PMID: 35445875 DOI: 10.1007/s00417-022-05652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the epidemiology and clinical characteristics of infants presenting with conjunctival, palpebral, or orbital congenital choristomas (dermolipomas, epidermoids, and dermoid cysts) and children undergoing surgery for congenital choristomas in the ocular adnexa. METHODS We reviewed the medical files of congenital choristomas in children seen in The Capital Region of Denmark during a 5-year period (2014-2018). Children (< 18 years) were divided into two groups: those referred < 1 year of age (Group I) and those undergoing surgery to remove the lesion (Group II). Group I was used to calculate a population-based incidence of congenital choristomas by comparing our data to birth statistics from the Danish Medical Birth Registry. RESULTS A total of 97 children were included, 43 in Group I and 70 in Group II (including 16 patients from Group I). The total incidence of congenital choristomas was 1 in 2537 live born children. Most lesions were palpebral choristomas (27/43, 63%) located in the superotemporal region (17/27, 63%), followed by the superonasal region (7/27, 26%). The main reasons for surgical removal of a congenital choristoma were growth (28/70, 40%) or cosmesis (25/70, 36%). CONCLUSION The total incidence of congenital choristomas in the ocular adnexa of infants < 1 year of age, including both conjunctival and palpebral congenital choristomas, is about 1 in 2537 live born children in The Capital Region of Denmark. Hence, congenital choristomas are common masses found in the ocular adnexa.
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Affiliation(s)
- Nathali J Turanzas
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Sarah Linea von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Katrine Wiencke
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Uppuluri S, Uppuluri A, Langer PD, Zarbin MA, Bhagat N. Enucleation in pediatric open globe injuries: demographics and risk factors. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 35294638 DOI: 10.1007/s00417-022-05618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of this study is to report the demographics and risk factors for undergoing primary enucleation in the setting of acute open globe injury (OGI) in the pediatric population in the USA. METHODS This retrospective, cross-sectional study of pediatric patients with OGIs in the USA between 2002 and 2014 was conducted utilizing data from the National Inpatient Sample Database. Descriptive statistics, chi-square testing, and univariate and multivariable analyses were performed. RESULTS In the USA, 8944 cases of pediatric OGI were identified between 2002 and 2014 in the NIS Database, of which 344 underwent primary enucleation. Blacks and Asian/Pacific Islanders made up higher proportions of enucleated cases compared to non-enucleated cases. Older age, male sex, being Black or Asian/Pacific Islander, OGI with an intraocular foreign body, rupture type OGI, and concurrent endophthalmitis were identified as risk factors for undergoing enucleation. There was no significant difference in insurance status among enucleated versus non-enucleated cases. Mean length of hospital stay (in days) was almost 3 times higher in enucleated OGIs. By hospital's geographic location, the Midwest hospitals had a greater proportion of enucleated versus non-enucleated cases compared to other regions. CONCLUSION Significant demographic differences were identified in OGI patients that underwent primary enucleation versus repair with regard to age, sex, race, the geographic location of hospital admission, mean length of hospital stay, type of ocular injury, and other ocular complications. Most pediatric traumatic enucleations between 2002 and 2014 were reported in teenagers (16-20 age group), in males, and in Blacks.
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24
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Dakroub M, El Hadi D, El Moussawi Z, Ibrahim P, Al-Haddad C. Characteristics and long-term surgical outcomes of horizontal strabismus. Int Ophthalmol 2022; 42:1639-1649. [PMID: 34978651 DOI: 10.1007/s10792-021-02159-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Our aim was to report the characteristics and long-term surgical outcomes of three subgroups of horizontal strabismus in a single institution (divided by strabismus subtype) in a developing country and look into pre-operative factors predictive of surgical success. METHODS Two hundred and forty-four complete charts of patients, divided into 152 esotropes (ET) and 92 exotropes (XT) who had undergone horizontal strabismus surgeries, were retrospectively reviewed. Charts of patients with muscle palsy, Duane syndrome and consecutive strabismus were excluded; 172 patients were included divided into partially accommodative ET, congenital ET and intermittent XT. Surgical success was defined as a post-operative angle deviation of 12 prism diopters or less. RESULTS The mean follow-up period of all patients was 31.64 ± 23.12 months. The subgroups were divided into partially accommodative ET (60 patients), congenital ET (60 patients), and intermittent XT (52 patients). Esotropes (both partially accommodative and congenital) presented earlier (p < 0.001). Also, partially accommodative ET had a significantly higher spherical equivalent (SE) compared to congenital ET patients, who had a higher SE than intermittent XT (p < 0.001). Congenital ET patients had a significantly larger angle of deviation (for both far and near) than both partially accommodative ET and intermittent XT patients (p < 0.001). The overall success rate was 72.67% for the whole group with no significant differences among subgroups. Success rate of partially accommodative ET surgery was 78.33% compared to that of congenital ET at 66.67% and intermittent XT at 73.07%. Significant post-operative improvement in sensory fusion was observed mainly for patients with partially accommodative esotropia and intermittent exotropia. CONCLUSION Our results showed that esotropes (both partially accommodative and congenital) presented earlier, with a higher spherical equivalent in the partially accommodative ET subgroup, while the congenital ET subgroup had the largest angle of deviation for both distance and near. The overall surgical success rate for horizontal strabismus surgery was 72.67% with the 3 subgroups having similar success rates. A younger age at presentation and absence of amblyopia were positively correlated with surgical success in the partially accommodative esotropia group.
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Affiliation(s)
- Mohamad Dakroub
- Ophthalmology Department, American University of Beirut Medical Center, PO Box 110236, Beirut, Lebanon
| | - Dalia El Hadi
- Ophthalmology Department, American University of Beirut Medical Center, PO Box 110236, Beirut, Lebanon
| | - Zeinab El Moussawi
- Ophthalmology Department, American University of Beirut Medical Center, PO Box 110236, Beirut, Lebanon
| | - Perla Ibrahim
- Ophthalmology Department, American University of Beirut Medical Center, PO Box 110236, Beirut, Lebanon
| | - Christiane Al-Haddad
- Ophthalmology Department, American University of Beirut Medical Center, PO Box 110236, Beirut, Lebanon.
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25
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Alipour F, Ansari S, Dadman N, Hafezi F. Accelerated Corneal Collagen Cross-Linking in Pediatric Keratoconus. J Curr Ophthalmol 2021; 33:285-290. [PMID: 34765816 PMCID: PMC8579799 DOI: 10.4103/joco.joco_163_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To evaluate the visual, refractive, and topographic outcomes of accelerated corneal collagen cross-linking (CXL) in the pediatric age group. Methods In this retrospective case series study, 89 eyes of 56 patients with progressive keratoconus (KCN) who were under or equal to 18 years old at the time of surgery were included. All patients underwent accelerated corneal CXL. A thorough baseline and follow-up ophthalmic examination including uncorrected distance visual acuity, best corrected visual acuity (BCVA), slit-lamp and fundus examination, and corneal tomography by Scheimpflg camera Pentacam (Oculus, Wetzlar, Germany) were performed. Results The mean age of patients was 16.2 ± 1.8 years. Mean follow-up was 16.46 ± 11.6 months (range, 6-40 months). The mean BCVA improved significantly from 0.26 ± 0.26 to 0.16 ± 0.19 (logMAR) after accelerated CXL (P < 0.001). The mean corneal astigmatism based on refraction decreased from 3.69 ± 2.12 to 3.15 ± 1.86 after the intervention (P = 0.016). The mean maximum keratometry (Kmax) reduced significantly from 53.23 ± 6.07 diopter (D) to 52.23 ± 6.33 D (P = 0.047). The mean flat keratometry (K1) reduced from 46.37 ± 3.69 to 45.95 ± 3.65 after the intervention (P = 0.119). Conclusion Our study shows that accelerated CXL increases visual acuity and stabilizes or improves keratometric indices in pediatric patients with progressive KCN without any serious complication for a mean follow-up time of 16 months.
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Affiliation(s)
- Fateme Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Ansari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Dadman
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hafezi
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.,ELZA Institute, Dietikon, Switzerland.,Department of Ophthalmology, University of Wenzhou, Wenzhou, China
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26
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Chiang MF, Quinn GE, Fielder AR, Ostmo SR, Paul Chan RV, Berrocal A, Binenbaum G, Blair M, Peter Campbell J, Capone A, Chen Y, Dai S, Ells A, Fleck BW, Good WV, Elizabeth Hartnett M, Holmstrom G, Kusaka S, Kychenthal A, Lepore D, Lorenz B, Martinez-Castellanos MA, Özdek Ş, Ademola-Popoola D, Reynolds JD, Shah PK, Shapiro M, Stahl A, Toth C, Vinekar A, Visser L, Wallace DK, Wu WC, Zhao P, Zin A. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology 2021; 128:e51-e68. [PMID: 34247850 PMCID: PMC10979521 DOI: 10.1016/j.ophtha.2021.05.031] [Citation(s) in RCA: 216] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system. DESIGN Review of evidence-based literature, along with expert consensus opinion. PARTICIPANTS International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men. METHODS The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification. MAIN OUTCOME MEASURES Consensus statement. RESULTS The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae. CONCLUSIONS These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.
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Affiliation(s)
- Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | - Graham E Quinn
- Division of Ophthalmology, Children's Hospital of Philadelphia, Scheie Eye Institute, Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alistair R Fielder
- Department of Optometry and Visual Science, University of London, London, United Kingdom
| | - Susan R Ostmo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Audina Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Scheie Eye Institute, Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Blair
- Retina Consultants, Ltd., Des Plaines, Illinois; Department of Ophthalmology, University of Chicago, Chicago, Illinois
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Antonio Capone
- Associated Retinal Consultants, PC, Royal Oak, Michigan, and Department of Ophthalmology, Oakland University, William Beaumont Hospital School of Medicine, Auburn Hills, Michigan
| | - Yi Chen
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Shuan Dai
- Ophthalmology Department, Queensland Children's Hospital, Brisbane, Australia
| | - Anna Ells
- Calgary Retina Consultants, Calgary, Canada
| | - Brian W Fleck
- Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - William V Good
- Smith-Kettlewell Eye Research Institute, San Francisco, California
| | - M Elizabeth Hartnett
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gerd Holmstrom
- Department Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University, Osakasayama, Japan
| | | | - Domenico Lepore
- A. Gemelli Foundation IRCSS, Department of Ageing and Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany; Department of Ophthalmology, Universitaetsklinikum Bonn, Bonn, Germany
| | | | - Şengül Özdek
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey
| | | | - James D Reynolds
- Ross Eye Institute, Department of Ophthalmology, University at Buffalo, Buffalo, New York
| | - Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | | | - Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Cynthia Toth
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Linda Visser
- Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa
| | - David K Wallace
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Andrea Zin
- Clinical Research Unit, Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil
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27
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Zhou R, Pfister T, Liu Y, Chen Q, Donahue SP. Age Does Not Influence the Positive Predictive Value of Vision Screening to Detect Amblyopia Risk Factors. Ophthalmology 2021; 129:230-231. [PMID: 34506847 DOI: 10.1016/j.ophtha.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raymond Zhou
- School of Medicine, Vanderbilt University, Nashville, Tennessee.
| | - Tyler Pfister
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Yuhan Liu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Sean P Donahue
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee
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28
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Tolkovsky A, Bachar Zipori A, Maharshak I, Aviel Gadot E, Spierer O. Surgical success of lateral rectus resection for residual and recurrent esotropia. Int Ophthalmol 2021. [PMID: 34129140 DOI: 10.1007/s10792-021-01916-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the surgical outcomes of reoperations for residual and recurrent esotropia. METHODS A retrospective chart review of all patients who underwent surgery during 2000-2017 at a tertiary referral medical center for recurrent or residual esotropia was conducted. Patients who underwent bilateral medial rectus recession as primary surgery and lateral rectus resection as second surgery were included. The success rate of second surgery and its association to various factors were examined. Success of reoperation was defined as mean deviation of < 10 prism diopters (= PD) at last follow-up. RESULTS Twenty-seven patients with mean post-operative follow-up of 50.4 ± 31.7 months were included. On last follow-up examination, 15 (55.6%) patients had a successful reoperation and 12 (44.4%) patients had unsuccessful reoperation. The two groups were similar in the pre-operative amount of esotropia for distance and near. On last follow-up examination, the amount of mean deviation was 1.9 PD esotropia (8 PD exotropia to 9 PD esotropia) in the success group and 11.2 PD esotropia (22.5 PD exotropia to 35 PD esotropia) in the failure group. In the failure group, 75.0% of patients were under-corrected (esotropia of ≥ 10 PD) on last follow-up examination. CONCLUSION Strabismus reoperation in cases of residual or recurrent esotropia was successful in slightly more than half of the patients. Surgical failure was more commonly associated with undercorrection and less with overcorrection.
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29
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Groot ALW, Lissenberg-Witte BI, van Rijn LJ, Hartong DT. Meta-analysis of ocular axial length in newborns and infants up to 3 years of age. Surv Ophthalmol 2021; 67:342-352. [PMID: 34116120 DOI: 10.1016/j.survophthal.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
In pediatric ophthalmology it is often necessary to obtain axial length in young children. For children older than 3 years, noncontact biometry can be used. For younger children this is usually not an option, and the clinician needs to rely on other imaging modalities. Depicted data curves in textbooks elaborate on few studies and limited number of subjects. The existing literature regarding normal axial length for preterm infants and term newborns is summarized and critically appraised for number of subjects, relevance, measurement method and error, gender and retinopathy of prematurity. We obtained axial length measurements for a total number of 6,575 eyes in 27 papers published from 1964 to 2018 (9 papers with 2,272 eyes for preterm children, 24 papers with 4,303 eyes for term children). Initially, axial length increases rapidly: from a mean 5.1-16.2 mm in week 12 to week 37 gestational age. From 38 weeks, growth rate decreases from 16.2 mm to a mean of 21.8 mm at 3 years old. Male infants have a larger average axial length than females at birth; the difference is 0.24 mm (95%CI: 0.15-0.33, P < 0.001). We present a useful growth curve and formula that may serve as a reference for diagnosing abnormal growth.
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Affiliation(s)
- Annabel L W Groot
- Amsterdam UMC, University of Amsterdam, Department of Ophthalmology, Amsterdam Orbital Center, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Boelelaan 1117, Amsterdam, the Netherlands
| | - Laurentius J van Rijn
- Amsterdam UMC, University of Amsterdam, Department of Ophthalmology, Amsterdam Orbital Center, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dyonne T Hartong
- Amsterdam UMC, University of Amsterdam, Department of Ophthalmology, Amsterdam Orbital Center, Meibergdreef 9, Amsterdam, the Netherlands
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30
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Lo Giudice G, Angelini E, Bini S, Candian T, Crudeli C, Galan A. Outcome of cataract surgery in children affected by malignancies other than retinoblastoma with eye-lens radiation exposure. Eur J Ophthalmol 2021; 32:11206721211009445. [PMID: 33843295 DOI: 10.1177/11206721211009445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe, retrospectively, the visual outcome, feasibility, and safety of cataract surgery in a pediatric population affected by iatrogenic cataract, secondary to systemic oncological treatment for malignancies other than retinoblastoma. METHODS Young patients, affected by radiation-induced cataract, who were referred to the San Paolo Ophthalmic Center in Padova between 2010 and 2017, were included in the study. All patients had previously received radiotherapy and/or chemotherapy treatment for malignancies, between 2004 and 2013. All medical records of infants who underwent cataract surgery were accurately reviewed. RESULTS Eighteen eyes out of 11 patients included in the study underwent cataract surgery. The mean age at surgery was 9.7 ± 3.6 years. The interval between tumor diagnosis and cataract development was around 3 years. Mean follow-up after surgery was 15.4 ± 6.3 months. All eyes underwent posterior chamber intraocular lens implantation, posterior capsulotomy, and anterior vitrectomy in one time surgery. No intraoperative complications were shown. Post-operatively, only one eye received laser capsulotomy due to posterior capsule opacification. At the end of follow up, best-corrected visual acuity was 20/20 (LogMAR 0) in all eyes and significantly improved (p < 0.01) compared to baseline. CONCLUSIONS Iatrogenic-cataract surgery in pediatric oncological patients is a safe and effective way to improve visual acuity. Posterior capsulotomy and anterior vitrectomy at the time of surgery reduce the rate of posterior lens opacification and guarantee an excellent visual acuity in these patients.
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Affiliation(s)
- Giuseppe Lo Giudice
- San Paolo Ophthalmic Center, San Antonio Hospital - University Hospital, Padova, Italy
| | - Edoardo Angelini
- San Paolo Ophthalmic Center, San Antonio Hospital - University Hospital, Padova, Italy
| | - Silvia Bini
- San Paolo Ophthalmic Center, San Antonio Hospital - University Hospital, Padova, Italy
| | - Tommaso Candian
- San Paolo Ophthalmic Center, San Antonio Hospital - University Hospital, Padova, Italy
| | - Clorinda Crudeli
- San Paolo Ophthalmic Center, San Antonio Hospital - University Hospital, Padova, Italy
| | - Alessandro Galan
- San Paolo Ophthalmic Center, San Antonio Hospital - University Hospital, Padova, Italy
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31
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Heichel J, Struck HG, Paulsen F, Javed Ali M, Viestenz A. [Deep periocular trauma with affection of the lacrimal ducts during Caesarean section]. HNO 2021; 70:60-64. [PMID: 33822270 PMCID: PMC8760212 DOI: 10.1007/s00106-021-01039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
Periokuläre Verletzungen im Rahmen einer Kaiserschnittentbindung sind extrem selten. Anhand einer Kasuistik eines 5 h alten Neugeborenen soll das Trauma-Management in Hinblick auf Diagnostik, Therapie und Nachsorge einer tiefen periokulären Weichteilwunde dargestellt werden. Das Verletzungsmuster umfasste durchgreifende Wunden des medialen und lateralen Lidwinkels mit Eröffnung der Bindehautumschlagsfalte, der Tenonkapsel und Durchtrennung des oberen Tränenröhrchens. Der schichtweise Wundverschluss beinhaltete eine autostabile monokanalikulonasale Intubation der ableitenden Tränenwege.
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Affiliation(s)
- Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Hans-Gert Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - Friedrich Paulsen
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L. V. Prasad Eye Institute, 500034, Hyderabad, Indien
| | - Arne Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
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Oke I, VanderVeen D. Machine Learning Applications in Pediatric Ophthalmology. Semin Ophthalmol 2021; 36:210-217. [PMID: 33641598 DOI: 10.1080/08820538.2021.1890151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To describe emerging applications of machine learning (ML) in pediatric ophthalmology with an emphasis on the diagnosis and treatment of disorders affecting visual development. Methods: Literature review of studies applying ML algorithms to problems in pediatric ophthalmology. Results: At present, the ML literature emphasizes applications in retinopathy of prematurity. However, there are increasing efforts to apply ML techniques in the diagnosis of amblyogenic conditions such as pediatric cataracts, strabismus, and high refractive error. Conclusions: A greater understanding of the principles governing ML will enable pediatric eye care providers to apply the methodology to unexplored challenges within the subspecialty.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Deborah VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Abstract
OBJECTIVES The purpose of this study was to examine the aetiology, investigation and management of ophthalmia neonatorum (ON) presenting to a tertiary referral children's hospital over 5 years. METHODS The eye swab data of all neonates presenting to Children's Health Ireland at Temple Street (Dublin, Ireland) between 1st January 2013 and 3rd September 2018 was analysed. The medical records of all patients with positive eye swab results were retrospectively reviewed. RESULTS A total of 157 neonates had positive eye swab results. 54 cases were identified as ON. Chlamydia trachomatis (20.4%) was the most common organism identified, followed by Staphylococcus aureus (18.5%), Haemophilus influenzae (14.8%), Moraxella catarrhalis (7.4%), Streptococcus pneumoniae (5.6%), Escherischia coli (3.7%), Klebsiella pneumoniae (1.9%) and Pseudomonas aeruginosa (1.9%). A bacterial culture swab was tested in all cases (100%), a C. trachomatis/N. gonorrhoeae PCR swab in 70.4% and a viral PCR swab in 35.2%. On subanalysis of the cases that had C. trachomatis/N. gonorrhoeae PCR testing, C. trachomatis was responsible for 28.9% of cases. 50% of cases were hospitalised, intravenous antibiotics were administered in 46.3% and macrolide therapy was prescribed in 38.9%. CONCLUSIONS C. trachomatis was the most common cause of ON in this study and may be responsible for an even higher proportion of cases due to incomplete testing. In keeping with studies in different populations, S. aureus, H. influenzae and S. pneumoniae were also common. As a result, an improved management algorithm for cases of ON has been introduced in this centre.
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Affiliation(s)
- David Gildea
- Department of Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Reinold Goetz
- Department of Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Richard Drew
- Children's Health Ireland at Temple Street, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland.,Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Chamney
- Department of Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Ireland
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Spierer O, Spierer A. Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children. BMC Ophthalmol 2021; 21:10. [PMID: 33407259 PMCID: PMC7788696 DOI: 10.1186/s12886-020-01778-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.
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Affiliation(s)
- Oriel Spierer
- Assuta Hospital, Ramat HaHayal, Tel Aviv, Israel. .,Pediatric Ophthalmology and Adult Strabismus Unit, E. Wolfson Medical Center, Holon, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Pediatric Ophthalmology and Adult Strabismus Unit, Sackler Faculty of Medicine, E. Wolfson Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Abraham Spierer
- Assuta Hospital, Ramat HaHayal, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
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Abstract
INTRODUCTION We describe the case of a child affected by typical symptoms of Alice in Wonderland syndrome (AIWS), related to the methylphenidate treatment he was taking for an attention deficit hyperactivity disorder (ADHD). To our knowledge, this is the first case of methylphenidate-associated AIWS. METHODS Retrospective single center observational case report. CASE DESCRIPTION A 12-year-old boy was complaining of micropsias and macropsias. Except a disruptive ADHD treated by methylphenidate for 2 years, his medical history was banal. His symptoms coincided with a change in his treatment regimen and ceased with methylphenidate discontinuation. Unfortunately, they recurred when the medication was reimplemented by his psychiatrist. The ophthalmological examination was unremarkable. We concluded to an AIWS and prescribed ancillary testing (including blood work, electroencephalogram, and brain MRI) to rule out conditions known to be associated with this syndrome. In the meanwhile, the methylphenidate dosage was readapted, and the symptoms disappeared again. Seen this clear dechallenge and rechallenge effect and the fact that all additional tests returned normal results, we deduced that our patient's symptoms were associated to methylphenidate. CONCLUSION AIWS could be a potential side effect of methylphenidate. Given the frequency of methylphenidate prescription for ADHD and its widespread misuse, it is important to consider this peculiar adverse effect. Every physician should be aware of the condition to offer reassurance and to prescribe the appropriate additional examinations, as life-threatening disorders can cause this syndrome.
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Affiliation(s)
| | - Sina Bidgoli
- Service d'Ophtalmologie, Hôpital Erasme, Brussels, Belgium
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36
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Del-Prado-Sánchez C, Seijas-Leal O, Gili-Manzanaro P, Ferreiro-López J, Yangüela-Rodilla J, Arias-Puente A. Choroidal, macular and ganglion cell layer thickness assessment in Caucasian children measured with spectral domain optical coherence tomography. Eur J Ophthalmol 2020; 31:3372-3378. [PMID: 33092392 DOI: 10.1177/1120672120965486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To study the subfoveal choroidal thickness (SFCT), macular ganglion cell layer (GCL-IPL) and central macular thickness (CMT) in Caucasian children, and to analyze these optical coherence tomography (OCT) parameters depending on the spherical equivalent (SE). METHODS Cross-sectional study of SFCT, GCL-IPL, and CMT in Caucasian children, analyzed with spectral-domain OCT Cirrus 5000 and Enhanced-depth imaging technique. Correlation between these three OCT parameters, age, sex, and spherical equivalent was analyzed. The eyes were classified into three groups: group 1 included eyes with SE < 0, group 2 included eyes with SE between 0 and +2.00, and group 3 eyes with SE > +2.00. RESULTS Hundred ninety-eight eyes of 121 subjects were studied. The mean age was 9.22 years (range 3-16); 61.1% were female. The mean SFCT was 351.04 ± 84.08 µm, being 310.04 ± 82.84µm in group 1 (n = 62), 373.14 ± 83.16 µm in group 2 (n = 71) and 365.18 ± 73.16 µm in group 3 (n = 65); statistically significant differences were found between groups 2 and 3, compared with group 1. GCL-IPL thickness was significantly thinner (p < 0.001) in group 1, compared with group 3. There were no statistically significant differences between the three groups regarding CMT. Correlation with age, and sex was not found. CONCLUSIONS SFCT and GCL-IPL thickness were significantly thinner (p < 0.001) in myopic children when compared with a non-myopic pediatric population. However, it seems that there is not a correlation among the three OCT parameters studied, age and sex, when they are analyzed depending on refractive error.
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Affiliation(s)
| | - Olga Seijas-Leal
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Pablo Gili-Manzanaro
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Juan Ferreiro-López
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Alfonso Arias-Puente
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Janic A, Bowden S, Levy S, Stinson J, Dimaras H. Patient-reported outcome measures for retinoblastoma: a scoping review. J Patient Rep Outcomes 2020; 4:66. [PMID: 32770435 PMCID: PMC7415058 DOI: 10.1186/s41687-020-00232-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Retinoblastoma is a childhood retinal cancer with lifelong consequences such as vision loss and increased risk of second cancer. Patient-reported outcome measures (PROMs) are instruments that measure outcomes related to health directly reported by patients. The purpose of this study was to determine the scope, characteristics and quality of PROMs used in retinoblastoma and related fields of pediatric ophthalmology and pediatric oncology. METHODS Databases MEDLINE and Embase were searched for studies in the English language that reported on PROMs used in retinoblastoma, pediatric oncology, or pediatric ophthalmology; grey literature and studies reporting on developmental PROM phases were excluded. PROMs were grouped by the construct measured and domains assessed, and classified as condition-specific or generic. A subsequent search was then conducted in MEDLINE and Embase for studies assessing measurement properties of the identified PROMs. PROMs with associated studies were assessed for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy. RESULTS Among 110 eligible studies uncovered by the database searches, 143 PROMs were identified: one retinoblastoma-specific, 56 ophthalmology- and 86 oncology-related. The most common construct measured was 'health-related quality of life' and the most common domain assessed was emotional well-being. Of the 143 PROMs, 100 had associated validation studies; the one retinoblastoma-specific PROM was not validated. Quality assessment revealed 34/100 PROMs received a score of sufficient quality in both subcategories of 'overall content validity'; 3/100 received a score of sufficient quality in both subcategories of 'internal structure'; 0/100 received a score of sufficient quality in all three subcategories of 'remaining measurement properties'. The Patient-Reported Outcome Measure Information System (PROMIS) Pediatric Profile-25 was the highest-scoring PROM identified, meeting COSMIN standards for 2/3 measurement property categories (and 5/7 subcategories). Eleven additional PROMs were identified which had sufficient scores in 1/3 measurement property categories (and 5/7 subcategories). CONCLUSION The study identified several PROMs from the pediatric ophthalmology and pediatric oncology literature that could be relevant to the retinoblastoma population, but many have limits to their validation. Future development of a retinoblastoma-specific PROM, performed in partnership with retinoblastoma patients to support optimal content validity, could first focus on the selection and definition of the optimal construct to measure, followed potentially by adaptation and further validation of the relevant PROMs with strong methodologic quality identified in this study.
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Affiliation(s)
- Ana Janic
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
| | - Sylvie Bowden
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
| | - Sarah Levy
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, M5T 1P8, Canada
| | - Helen Dimaras
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada.
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada.
- The Centre for Global Child Health, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada.
- Division of Clinical Public Health, University of Toronto, 150 College Street, Toronto, M5T 3M7, Canada.
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Abstract
OBJECTIVE Creating a model to predict Axial Length (AL) growth in paediatric cataract and evaluating influence factors. MATERIAL AND METHODS Eyes with AL measured at surgery and at least one measurement after a 6-month period, from children with unilateral or bilateral cataract and primary IOL implantation, were evaluated. A "rate of axial length growth" (RALG) was calculated for every single eye using these AL measurements and log10 age. One average RALG was calculated for All Eyes and for the groups of Bilateral and Unilateral, Gender, Age at the Surgery, different Visual Acuity, Bilateral Excluded and Not-excluded eye, and Affected and Not-affected eye in unilateral, for comparisons. RESULTS Average age at surgery from 76 children was 2.83 ± 2.74 (0.11-12.21) years with follow up of 2.84 ± 1.84 (0.52-8.17) years, 29 (37.66%) had unilateral cataract. A total of 357 AL measurements were used, average of 4.70 ± 2.13 (2-10) measurements per eye. The average RALG for all eyes was 4.51 ± 3.06. There were no RALG significant differences comparing Unilateral and Bilateral eyes (p = 0.51), Male and Female (p = 0.26), Age at Surgery <0.5 and >0.5 years old (p = 0.21), both eyes in Bilateral cases (p = 0.70) and Unilateral Affected and Not-affected eyes (p = 0.18). The equation Al = initial AL + slope × Log10 ((age + 0.6)⁄(initial age + 0.6)) estimates ALs in different ages. CONCLUSIONS A model to predict AL growth in paediatric cataract was developed. Different studied factors did not significantly influence AL growth.
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Affiliation(s)
- Antonio Carlos Lottelli
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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Stock RA, Lazzari SLT, Martins IP, Bonamigo EL. Surgical debridement of corneal shield ulcers in pediatric patients: two case reports and a review of the literature. J Med Case Rep 2020; 14:70. [PMID: 32546209 DOI: 10.1186/s13256-020-02407-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ocular allergy is a common disease, especially in the pediatric population, with unpleasant and long-term consequences, including corneal complications and decreased visual acuity. This study reports two cases of corneal shield ulcer due to vernal keratoconjunctivitis, with good results of surgical debridement performed after failure of long-term clinical treatment. Furthermore, this study highlights that this therapeutic approach, although less common, is efficient in treating refractory cases that cause suffering in pediatric patients. Case presentation The first patient was a 7-year-old Caucasian boy with chronic ocular allergy, especially photophobia, who had been treated with eye drops, antihistamine, and corticosteroids for 60 days without success. Biomicroscopy of the right eye showed the presence of gelatinous limbus, giant papillae in the tarsal conjunctiva, and a shield ulcer measuring 6.0 mm vertically and 2.7 mm horizontally. Surgical debridement was performed, and the ulcer did not recur. The second patient was a 4-year-old Caucasian boy with chronic ocular allergy, especially itching and photophobia, who had been treated with eye drops for 1 year without success. Biomicroscopy of the left eye showed a shield ulcer, with a dense central corneal plaque, measuring 8 mm vertically and 3.5 mm horizontally. Surgical debridement of the ulcer was performed immediately because of the chronicity of the case and severity of the lesion, and the treatment was effective. Conclusions The treatment of shield ulcers caused by vernal keratoconjunctivitis in the two reported cases was curative and definitive by surgical debridement in the 7-month follow-up period. Therefore, the early debridement of shield ulcers refractory to drug treatment can considerably reduce the time of disease evolution and the probability of ocular complications caused by clinical treatment or disease chronicity. However, this approach is rarely described in the literature and needs to be included in the ophthalmologist’s therapeutic arsenal.
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Smadar L, Dotan G, Abumanhal M, Achiron A, Spierer O. Demographic, clinical features, and outcomes of pediatric non-penetrating ocular foreign bodies. Graefes Arch Clin Exp Ophthalmol 2020; 258:1469-1474. [PMID: 32296989 DOI: 10.1007/s00417-020-04688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Data regarding ocular foreign body (FB) in the pediatric population is sparse. The purpose of this study is to describe the demographic features and the outcomes of pediatric non-penetrating ocular FB. METHODS The charts of all children with non-penetrating ocular FB who presented at a tertiary medical center between 2011 and 2018 were retrospectively reviewed. Data analyzed included demographics, ocular FB site, the need for general anesthesia, or sedation for FB removal and clinical outcomes. RESULTS Three hundred and fifty-two children (58.8% boys) with a mean age of 7.7 ± 3.7 years were included. Two hundred and fifty-one (71.3%) children presented on the same day of injury. Patients with developmental delay presented more often with restlessness than patients without developmental delay (p < 0.0001). One hundred and forty-six (41.5%) of FBs were found on the conjunctiva, 128 (36.4%) under the eyelid, and 62 (17.6%) on the cornea. In 19 (4.5%) cases, general anesthesia or sedation was required for FB removal. A multivariate analysis identified young age (OR 0.976, 95% CI 0.961-0.992, p = 0.003), corneal FB (OR 50.84, 95% CI 10.08-256.37, p < 0.0001), and developmental delay (OR 18.56, 95% CI 1.22-283.45, p = 0.036), as significant predictors for the need of general anesthesia or sedation. Among patients with corneal FB, in two (3.2%) cases, the corneal FB was complicated by infectious keratitis, resulting in mild corneal scar. CONCLUSION The rate of general anesthesia for non-penetrating ocular FB removal in children is low. Children presenting with non-penetrating ocular FB have good prognosis without long-term complications.
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Affiliation(s)
- Lital Smadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ophthalmology Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Muhammad Abumanhal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Asaf Achiron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Ophthalmology and Adult Strabismus Unit, E. Wolfson Medical Center, Holon, Israel
| | - Oriel Spierer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Pediatric Ophthalmology and Adult Strabismus Unit, E. Wolfson Medical Center, Holon, Israel.
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Kelly JP, Feldman K, Wright J, Ganti S, Metz JB, Weiss A. Retinal and visual function in infants with non-accidental trauma and retinal hemorrhages. Doc Ophthalmol 2020; 141:111-126. [PMID: 32052259 DOI: 10.1007/s10633-020-09756-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT). METHODS This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia. RESULTS Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during long-term follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six subjects had responses in one eye that were near normal (≥ 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (≥ 0.7 age-corrected logMAR); four subjects had mild vision loss (≤ 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up. CONCLUSIONS Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts of retinal hemorrhages and anesthesia could not fully account for multifocal ERG abnormalities. Retinal function can be preserved in areas adjacent to traumatic retinoschisis.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, OA.5.342, Seattle, WA, 98105, USA.
- Department of Ophthalmology, University of Washington, Seattle, USA.
| | - Kenneth Feldman
- Seattle Children's Hospital, Children's Protection Program, Seattle, USA
- Division of General Pediatrics, University of Washington, Seattle, USA
| | - Jason Wright
- Division of Radiology, Seattle Children's Hospital, Seattle, USA
| | - Sheila Ganti
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, USA
| | - James B Metz
- Department of Pediatrics, University of Vermont, Burlington, USA
| | - Avery Weiss
- Department of Ophthalmology, University of Washington, Seattle, USA
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Chan H, Cougnard-Grégoire A, Korobelnik JF, Delyfer MN, Touboul D, Coste V, Sarlangue J, Dutheil C, Paya C. Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period. J Fr Ophtalmol 2018; 41:926-932. [PMID: 30442486 DOI: 10.1016/j.jfo.2018.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/17/2018] [Accepted: 02/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. METHODS A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. RESULTS ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at>31 weeks or with BW>1110g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age≤27 weeks and Apgar score at 5minutes≤7. CONCLUSION In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5minutes as a risk factor for severe ROP requires further studies in order to be confirmed.
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Affiliation(s)
- H Chan
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France.
| | - A Cougnard-Grégoire
- Inserm (institut national de la santé et de la recherche médicale), U897-épidemiologie-biostatistique, Bordeaux, France
| | - J F Korobelnik
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France; Inserm (institut national de la santé et de la recherche médicale), U897-épidemiologie-biostatistique, Bordeaux, France
| | - M N Delyfer
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France; Inserm (institut national de la santé et de la recherche médicale), U897-épidemiologie-biostatistique, Bordeaux, France
| | - D Touboul
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - J Sarlangue
- Service de néonatologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Dutheil
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - C Paya
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Osborne DC, Greenhalgh KM, Evans MJE, Self JE. Atropine Penalization Versus Occlusion Therapies for Unilateral Amblyopia after the Critical Period of Visual Development: A Systematic Review. Ophthalmol Ther 2018; 7:323-332. [PMID: 30328078 PMCID: PMC6258585 DOI: 10.1007/s40123-018-0151-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Amblyopia therapy appears to be most effective in children under the age of 7 years, but results from randomized control trials (RCTs) have shown that occlusion therapy and/or atropine penalization therapy may improve visual acuity in an older age group. Which of these two therapies is the most effective with fewer adverse effects in an older age group has not yet been agreed upon. Methods We systematically searched the literature for RCTs that compared atropine penalization therapy and occlusion therapy in terms of their visual acuity outcomes and adverse events and performed a meta-analysis on the visual acuity data obtained. The adverse effects reported and their implications for clinical practice are discussed. Results Two RCTs were identified, with the authors of both concluding that there was no detectable difference between the two therapies for the age groups they studied. The mean difference between atropine penalization and occlusion therapies was calculated to be − 0.01 logMAR (95% confidence interval − 0.07 to 0.03 logMAR) in favor of occlusion therapy, and no statistical difference between the two groups was detected (P = 0.45). Neither study detected a marked difference in terms of reported adverse effects from the two interventions. Conclusion Based on the results of our meta-analysis we conclude that there is no difference in visual acuity outcomes between atropine penalization therapy and occlusion therapy after 17 to 24 weeks of treatment in children aged 7–12 years. Further evidence to determine the efficacy of amblyopia therapy for an older patient population is required before studies comparing atropine penalization and occlusion therapy in patients older than 12 years can be performed. Atropine penalization therapy may cause more frequent minor adverse effects, such as light sensitivity, but in the clinical setting this needs to be balanced with the potential practical benefits of twice-weekly eye drops versus daily occlusion. Funding The funding for this study was provided by the National Institute for Health Research (NIHR) and Health Education England (HEE). Plain Language Summary A plain language summary is available for this article. Electronic supplementary material The online version of this article (10.1007/s40123-018-0151-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel C Osborne
- Orthoptic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | | | - Megan J E Evans
- Orthoptic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jay E Self
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Han JY, Lee DC, Lee SY. Horizontal Extraocular Muscle and Scleral Anatomy in Children: A Swept-Source Anterior Segment Optical Coherence Tomography Study. Korean J Ophthalmol 2018; 32:83-88. [PMID: 29560615 PMCID: PMC5906406 DOI: 10.3341/kjo.2017.0034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/03/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients. METHODS This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. SS-OCT was used to measure horizontal extraocular muscle thickness, limbus to insertion distance, and scleral thickness. Eyes were classified into subgroups by sex, spherical equivalent of the refractive error (measured with cycloplegic refraction), and fixating/deviating eye. RESULTS One patient initially included in this study was excluded due to poor cooperation. Of the remaining 35 eyes of 20 patients, 19 eyes (54.3%) were from male patients and 16 eyes (45.7%) were from female patients. The mean patient age was 7.86 ± 1.38 years. Lateral scleral thickness was greater in male eyes than in female eyes (p = 0.048). No other differences were noted between male and female children. Additionally, there were no statistically significant differences between fixating and deviating eyes or among spherical equivalent groups for any parameter examined. CONCLUSIONS Anterior segment SS-OCT can successfully and comfortably measure horizontal extraocular muscle and scleral anatomy in children. These measurements may be helpful for treatment and follow-up of pediatric strabismus patients.
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Affiliation(s)
- Jung Yeob Han
- Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Se Youp Lee
- Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea.
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Ram R, Marolf MD, Chévez-Barrios P, Herce HH. Juvenile Xanthogranuloma in a Pediatric Patient with Langerhans Cell Histiocytosis. Ocul Oncol Pathol 2017; 4:141-144. [PMID: 29765943 DOI: 10.1159/000479524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of juvenile xanthogranuloma that simulated a chalazion and to discuss the association between juvenile xanthogranuloma and Langerhans cell histiocytosis. Method Case report and review of literature. Results A 13-year-old boy with a prior history of Langerhans cell histiocytosis was referred to our clinic for a possible chalazion. The patient had undergone treatment for Langerhans cell histiocytosis 10 years prior. The patient underwent an excisional biopsy. Histopathology revealed a proliferation of histiocytes and lymphocytes with Touton giant cells, consistent with a diagnosis of juvenile xanthogranuloma. Conclusions Though the relationship between Langerhans cell histiocytosis and juvenile xanthogranuloma has yet to be fully elucidated, juvenile xanthogranuloma should be included in the differential diagnosis for any former Langerhans cell histiocytosis patient presenting with a new cutaneous lesion.
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Affiliation(s)
- Radha Ram
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Ophthalmology, Texas Children's Hospital, Houston, TX, USA
| | - Marissa D Marolf
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Patricia Chévez-Barrios
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist Hospital, Houston, TX, USA
| | - Honey H Herce
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Ophthalmology, Texas Children's Hospital, Houston, TX, USA
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Heichel J, Struck HG, Fiorentzis M, Hammer T, Bredehorn-Mayr T. A Case Series of Dacryoendoscopy in Childhood: A Diagnostic and Therapeutic Alternative for Complex Congenital Nasolacrimal Duct Obstruction Even in the First Year of Life. Adv Ther 2017; 34:1221-32. [PMID: 28341931 DOI: 10.1007/s12325-017-0517-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in infancy. Spontaneous resolution occurs in the majority of the cases by 1 year of age. Nevertheless, obstruction has a negative impact on the outcome of conservative or surgical therapy, especially in cases of complex CNLDO. When the condition persists beyond several months, early intervention with dacryoendoscopy (DE) around the age of 1 year could yield good results. The objective of the study is to analyze the success rate and effectiveness of early DE for complex CNLDO in the first year of life. METHODS A retrospective, non-comparative case series is presented. DE was performed under general anesthesia in patients between the age of 1 and 12 months with severe recurrent acute or chronic dacryocystitis. The medical histories, intraoperative and postoperative results after 3 months as well as via parents' interviews were analyzed to investigate the success rate. RESULTS A total of 18 consecutive DE in 16 patients between the age of 1 and 12 months (mean 7.3 ± 3.4 months) were studied. Nine lacrimal ducts were diagnosed with persistent chronic dacryocystitis refractory to probing/syringing. The remaining 9 presented recurrent acute dacryocystitis. Diagnostic DE was performed in 18 cases. A therapeutic DE was conducted in 15 lacrimal ducts (83.3%) with simultaneous correction of the associated stenosiswith the tip of the endoscope. A visual controlled opening of the stenosis was impossible in 3 cases due to a too narrow presaccal anatomy (n = 1), an osseous duct stenosis (n = 1), and a bulging membrane of Hasner into the inferior nasal meatus (n = 1). Postoperative findings were classified into four categories: poor, fair, good and excellent. Good results were documented in 16.7% (n = 3) and excellent results in 77.7% (n = 14). The bony obstruction was treated with dacryocystorhinostomy. A minimum follow-up of 3 months was considered for final clinical analysis. Ten patients' parents (12 surgeries) were interviewed by telephone (mean follow-up 24.8 months). No recurrence of stenosis and no further postoperative complications were observed. CONCLUSION DE is a diagnostic and therapeutic option for complex CNLDO in patients before the age of 1 year. The outcome of DE in the 3 months follow-up is highly indicative of positive final results in terms of patency of the lacrimal duct.
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Abstract
BACKGROUND One of the most frequent issues in pediatric ophthalmology concerns congenital nasolacrimal duct obstruction (CNLDO). Typically, irritation of the medial eyelid angle occurs during the first days of life and later increased epiphora appears as tear production is still reduced in young infants. In the case of intrasaccal or postsaccal nasolacrimal duct stenosis, a chronic dacryocystitis develops. METHODS Modern minimally invasive diagnostics and therapy of CNLDO are reviewed by means of a search of the recent literature and reflection of own experiences. RESULTS An early diagnosis of CNLDO is desirable. If conservative therapeutic approaches fail, invasive procedures have to be considered. Probing and high pressure syringing of the nasolacrimal ducts remains the therapy of choice. Further therapy options, such as balloon dacryoplasty and dacryoendoscopy are also available. Additionally, due to improvement of the surgical techniques a minimally invasive approach is possible even for dacryocystorhinostomy; nevertheless, this procedure should be considered only as a last resort. CONCLUSION Precise classification of CNLDO and knowledge about the possible treatment options are important. Lacrimal surgery in childhood is dominated by transcanalicular procedures. Advanced minimally invasive techniques, such as dacryoendoscopy or modern autostable intubation sets have to be emphasized. All therapeutic interventions can be summarized using a staged therapeutic concept, which should be used individually and patient-centered.
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Badawi AE. Accelerated corneal collagen cross-linking in pediatric keratoconus: One year study. Saudi J Ophthalmol 2017; 31:11-18. [PMID: 28337057 PMCID: PMC5352941 DOI: 10.1016/j.sjopt.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/03/2022] Open
Abstract
Purpose To evaluate the safety and effectiveness of accelerated corneal collagen crosslinking (CXL) in pediatric keratoconus. Design Prospective non-randomized observational study. Methods 33 eyes of 25 children with keratoconus were included. The corneal epithelium was mechanically removed. Next, riboflavin/hydroxypropyl methylcellulose solution) was applied for 10 min. Accelerated CXL (10 mW/cm2 for 9 min), was accomplished. Visual acuity, slit lamp examination, refraction, keratometry readings, pachymetry, anterior and posterior elevations, average progression indices, and Q values were recorded. The follow-up visits were scheduled on one day, 3 days, 7 days, one month and then on 3, 6, 12 months after the procedure. Results It was statistically significant improvement of the mean UAVA, AVA, and the mean corneal astigmatism (P < .0001). The mean corneal thickness showed a significant reduction. The preoperative mean K max reading was reduced from 49.12 ± 3.7 D preoperatively to 47.9 ± 3.7 D at 12 months. The mean max anterior elevation, average progression index and Q value showed statistically significant improvement. No significant impact on posterior elevation was recorded. Serious complications were not encountered in this study. Conclusion Accelerated CXL shows a stabilization and beneficial clinical outcomes in pediatric keratoconus. It seems an effective and safe procedure in this age group. Effects of accelerated CXL on the posterior corneal surface will need further evaluation.
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Affiliation(s)
- Amani E Badawi
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Egypt
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Gorham JP, Bruce BB, Hutchinson AK. Comparing distance visual acuity measurement with a novel eye chart and the Landolt C chart in a population of children aged 6-18 years. Int Ophthalmol 2016; 37:1345-1348. [PMID: 27826937 DOI: 10.1007/s10792-016-0384-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The Handy Eye Chart™ is designed to assist in evaluating the visual acuity of patients with non-standard communication styles. The Handy Eye Chart™ has been previously validated against the early treatment diabetic retinopathy study (ETDRS) chart. The aim of this research is to compare visual acuity outcomes with The Handy Eye Chart™ against the international gold standard, the Landolt C chart, in a population of children. METHODS Sixty participants between the ages of 6 and 18 were recruited at the Pediatric Section of the Department of Ophthalmology at the Emory Eye Center. Visual acuity was evaluated using The Handy Eye Chart™ and the Landolt C Chart, altering the order of administration between charts. The visual acuity data were compared using t test, linear regression, and Bland-Altman analysis. RESULTS The mean difference in visual acuity was 0.02 logMAR (CI 0.009-0.04, p = 0.002). The correlation coefficient was 0.98. The Bland-Altman analysis shows the 95% limits of agreement between the charts to be -0.14 to 0.09 logMAR. CONCLUSIONS The Handy Eye Chart™ is a valid measure of visual acuity when compared with the international gold standard, the Landolt C Chart.
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Affiliation(s)
- John P Gorham
- The Department of Ophthalmology, Emory University School of Medicine, 1365 B Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Beau B Bruce
- The Department of Ophthalmology, Emory University School of Medicine, 1365 B Clifton Rd NE, Atlanta, GA, 30322, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Amy K Hutchinson
- The Department of Ophthalmology, Emory University School of Medicine, 1365 B Clifton Rd NE, Atlanta, GA, 30322, USA.
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Ho DK, Levin AV, Anninger WV, Piccoli DA, Eagle RC. Anterior Chamber Pathology in Alagille Syndrome. Ocul Oncol Pathol 2016; 2:270-275. [PMID: 27843908 DOI: 10.1159/000446804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alagille syndrome is an autosomal dominant disorder characterized by neonatal cholestasis, characteristic facies, and cardiac abnormalities. Ocular abnormalities include posterior embryotoxon, mosaic pattern of iris stromal hypoplasia, microcornea, optic disc drusen, and pigmentary retinopathy. We present the second report of ocular pathology in two cases of Alagille syndrome. METHODS Gross and histologic preparations of four eyes of two patients. RESULTS Posterior embryotoxon is seen in both cases, with iris processes extending to the embryotoxon in case 1. Case 1 exhibited distinctly abnormal iris stroma with a prominent cleft separating the anterior and posterior stroma. Lacy vacuolization of the iris pigment epithelium was seen in case 2. CONCLUSIONS Alagille syndrome is primarily a hepatic disorder but presents with several distinct ocular pathologic features, most specifically posterior embryotoxon. This and the unusual iris stroma may be caused by improper migration of neural crest cells due to mutation in the Jagged 1 gene that causes Alagille syndrome. Patients with Alagille syndrome rarely present to ocular autopsy. Pathology findings may help us better understand the pathophysiology of the ocular abnormalities in this disorder.
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Affiliation(s)
- Derek K Ho
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa., USA
| | - Alex V Levin
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa., USA; Wills Eye Hospital, Philadelphia, Pa., USA
| | | | | | - Ralph C Eagle
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa., USA; Wills Eye Hospital, Philadelphia, Pa., USA
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