Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To investigate whether using an enhanced monofocal intraocular lens (IOL) in the pediatric age group can improve the visual performance at varying distances in comparison to standard monofocal lenses.

Methods: Forty-five eyes of children aged 6 to 13 years with unilateral or bilateral cataract were prospectively randomized into two groups: the monofocal group (23 eyes) who had a standard monofocal aspheric lens (Tecnis Model ZCB00) implanted and the enhanced mono-focal group (22 eyes) who had an enhanced monofocal lens (Tecnis Eyhance ICB00) implanted (both Johnson & Johnson Vision). Target refraction was emmetropia. Visual acuity was measured at distance, intermediate, and near distance 3 months postoperatively. Defocus curves wearing distance correction were plotted.

Results: Unilateral cataract surgery with Eyhance and Tecnis monofocal implantation was performed in 10 and 9 patients, respectively. Thirteen children underwent bilateral surgery, 4 had an Eyhance IOL implanted in one eye and a Tecnis monofocal IOL in the other eye, 4 had bilateral Eyhance IOL implantation, and 5 had bilateral Tecnis mono-focal IOL implantation. Uncorrected and corrected distance, intermediate, and near visual acuity, and the power of near add were comparable between both groups (P > .05). Mean visual acuity through the defocus range was significantly better (P < .01) in the Eyhance group (0.30 vs 0.41).

Conclusions: Use of an enhanced monofocal IOL improved visual performance at intermediate distances of greater than 1 meter but did not reduce the power of spectacles needed for distances of less than 1 meter.

Purpose: To highlight ophthalmic and imaging features associated with congenital optic nerve aplasia (ONA) in eyes with microcornea/sclerocornea.

Methods: This was a retrospective series of patients with microcornea/sclerocornea with suspected posterior segment pathology who underwent detailed clinical evaluation and imaging with ultrasound B-scan and magnetic resonance imaging (MRI). Evaluation by a low vision clinic for rehabilitation and genetic testing was offered to all infants and they were referred to a pediatrician/endocrinologist.

Results: Eight eyes of 5 infants (3 bilateral and 2 unilateral) presented between 3 months and 4 years of age, with microcornea in 6 of 8 eyes, of which sclerocornea was noted in 5 eyes. B-scan and MRI confirmed ONA and additional features included crumpled or dysplastic retina, total close funnel retinal detachment, or presence of a stalk-like structure (n = 5) or absent lens (n = 2). Three eyes had a view of the posterior segment and showed absent/rudimentary disk, absent retinal vessels, or crumpled retinal tissue with mottled pigmented or tessellated background. Two infants had chiasmal aplasia and 1 infant had a midline lesion in the parieto-occipital region with chiasmal deviation to the right. Balanced reciprocal chromosomal translocation and PITX3 mutation was noted in the patients.

Conclusions: ONA is possibly underdiagnosed due to a focus on other obvious findings, such as microphthalmos/microcornea, poor media clarity obscuring visualization, and lack of imaging to ascertain the optic nerve status. The diagnosis of congenital ONA is significant due to its genetic and systemic implications where the ophthalmologist has the chance to identify it and refer patients for genetic and pediatric assessment, in addition to playing an important role in initiating early visual rehabilitation.

Purpose: To report the results of a survey on the anterior ciliary vessels (ACVs) based on intraoperative and postoperative observation to help surgeons better understand and more easily manipulate the ACVs.

Methods: This was a cross-sectional study. Patients with horizontal strabismus who had bilateral recession on the lateral rectus (LR) or medial rectus (MR) muscle and patients with vertical strabismus were included. Patients with consecutive strabismus who had previous strabismus surgery with ACV preservation were also included. The surgical images of ACVs were recorded and the anatomic and morphological characteristics were observed.

Results: There were 212 patients included in the study. Bilateral ACVs on the LR or MR of most patients were polymorphous and markedly different. Most ACVs of the LR were generally more superficial than those of other three rectus muscles. Moreover, although there was no apparent fascia tissue connected between ACVs on the other three rectus muscles, most ACVs on the LR were fully located within the orbital fascia of the muscle. So the ACVs on the LR could be separated from the surface of the muscle as a whole, whereas the ACVs on other three rectus muscles could be only preserved one by one.

Conclusions: The ACVs have obvious polymorphism. Nevertheless, most ACVs of the LR are positioned within the fascia tissue on the muscle surface; therefore all ACVs of the LR can be easily separated from the muscle as a whole.

Purpose: To retrospectively analyze the efficacy of multi-zone positive optical defocus lenses (DIMS) + fog vision + 0.01% atropine for the treatment of children with preclinical and early stages of myopia.

Methods: The axial length (AL) and refraction were analyzed at baseline and after 12 months of follow-up in 192 eyes treated with combined therapy. The success of treatment was defined as an annual AL growth rate within the physiological growth range and myopia progression of -0.50 diopters (D)/year or greater. Subgroup analysis was performed to investigate the percentage of treatment success in the overall population compared to the subgroups based on baseline AL and age.

Results: Overall, the success rates were 87% and 93% for AL control and myopia control, respectively. Compared to before combined therapy, there was an increase in AL after treatment (boys: P < .001; girls: P < .001). The change in spherical equivalent (SE) was consistent with the change in AL, with both boys and girls showing an increase in SE after treatment, with a statistically significant difference in girls (boys: P = .059; girls: P = .001). There was no statistically significant difference in the percentage of treatment success in either boys or girls based on baseline AL and age subgroups compared to the overall population.

Conclusions: The treatment regimen of DIMS + fog vision + 0.01% atropine demonstrated significant control effects on myopia in preclinical and early stages of myopia in children across different genders, baseline ALs, and ages. Timely intervention is recommended once a tendency toward myopia is observed in children.

Purpose: To report on retinal detachment (RD) in eyes that had surgery for primary congenital glaucoma (PCG).

Methods: This retrospective chart review took place at Alexandra Main University Hospital. The charts of 363 children (507 eyes) presenting with and having surgery for PCG from January 2019 to March 2005 were reviewed. Eyes that developed RD were enrolled as cases and the remaining eyes as controls. Retrieved data included demographic and clinical characteristics and operative and postoperative follow-up data pertaining to glaucoma (and RD) surgery.

Results: The records revealed that 17 eyes of 13 children (cases) developed RD (bilateral in 4 children, 30.7%) (3.35% of eyes, 3.58% of children, rhegmatogenous in 15 eyes, 88.2%). The mean ± standard deviation of age at presentation of cases and controls was 4.3 ± 3.8 and 8.1 ± 11.1 months, respectively (P = .22). There were no statistically significant differences in intraocular pressure (P = .76), corneal diameter (P = .22), axial length (P = .98), and cup/disk ratio (P = .45) between case and control eyes at glaucoma presentation. Case eyes had undergone twice as many glaucoma procedures as control eyes. At RD diagnosis, 5 eyes (29.4 %) had their glaucoma controlled and 8 eyes (47.1%) had inoperable RD. Four eyes underwent conventional retinopexy and 4 eyes underwent pars plana vitrectomy with silicone oil. The mean ± standard deviation of follow-up of case eyes was 63.7 ± 56.9 months before RD diagnosis and 45.9 ± 22.3 months after RD repair. There was a statistically significant difference in axial length at presentation and at the diagnosis of RD (P < .001) in case eyes. At the final follow-up visit, 7 eyes (41.2%) had atrophia.

Conclusions: RD occurred in 3.5% of eyes with PCG that had surgery over 14 years, of which 41% culminated in atrophia bulbi.

Isolated, non-congenital herpes simplex virus type 1 (HSV-1) keratitis in immunocompetent infants is exceedingly rare and may be easily misdiagnosed, leading to delays in appropriate antiviral therapy. This case is unique in that it describes HSV-1 keratitis in a healthy 9-month-old infant presenting without systemic illness, initially treated as bacterial conjunctivitis. The patient presented with unilateral eye pain, redness, and corneal opacification. Subsequent evaluation revealed HSV-1 keratitis, and the patient was treated with intravenous acyclovir in combination with topical moxifloxacin and topical ganciclovir, resulting in complete resolution of symptoms within one week. This case adds to the limited literature on infantile HSV keratitis and highlights the importance of maintaining a high index of suspicion for HSV infection in infants with corneal involvement. Early recognition and prompt antiviral treatment are critical to preventing vision-threatening complications.