Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To evaluate the effectiveness and safety of botulinum toxin type A (BTXA) injection with reduced volume without electromyographic guidance for the treatment of acute acquired comitant esotropia (AACE) of 25 prism diopters (PD) or less.

Methods: The authors reviewed the medical records of 60 patients with AACE of 25 PD or less, including 40 patients treated with BTXA injections (BTXA group) and 20 patients treated with Fresnel prism (Fresnel prism group). Patients in the BTXA group were injected with 5 to 6.25 U of BTXA in 0.04 mL of saline into bilateral medial rectus muscles in the absence of electromyography. Patients in the Fresnel prism group wore Fresnel prisms at a minimum amount that could eliminate diplopia. Success was defined with deviations of 10 PD or less at both distance and near fixations and with resolution of diplopia.

Results: In the BTXA group, the success rate of the first injection was 100% after 1 week, but decreased to 57.5% (23/40) after 6 months; the cumulative success rate of two injections was 77.5% (31/40) after 6 months; and one eye (0.93%, 1/108) had complicated mild ptosis. In the Fresnel prism group, the success rate was 5% (1/20) after 6 months of treatment. The difference in cumulative success rate between the two groups was significant (chi-square = 28.158, P < .01).

Conclusions: BTXA injection with reduced volume in the absence of electromyography is a simple, effective, and safe modality for patients with AACE who have a small to moderate deviation. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To determine whether inter-ocular brightness disparity during a self-directed video game on a mobile graphic device can effectively detect unilateral amblyopia.

Methods: Forty-nine children of ages 3 to 17 years participated in this prospective, non-interventional study. A series of sample image pairs were presented on an iPad (Apple, Inc) to illustrate the concept of relative brightness. Participants subsequently wore spectacles with orthogonally polarized lenses to dissociate image pairs between eyes. The video game employed a forced-choice algorithm that varied relative brightness disparity between image pairs in a stepwise manner. Participants chose the brighter of each pair of images until the end point of equal brightness was detected. The game was repeated to assess consistency. Eye examination records with acuities measured in logarithm of the minimum angle of resolution units were subsequently reviewed to compare with the video game results.

Results: The study had a mean game time of 108 seconds. Inter-ocular brightness disparity greater than 0.3 log units indicated a relative afferent brightness sense defect. The video game detected unilateral amblyopia with 88% sensitivity and 95% specificity. The positive predictive value was 78% and the negative predictive value was 98%.

Conclusions: This iPad video game can be played by children at least as young as 3 years of age. Inter-ocular brightness disparity is a sensitive and specific sign of unilateral amblyopia in a general pediatric population. The non-threatening nature and engaging format of this video game make it a promising and accessible method for early amblyopia screening. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To investigate the short-term effect of atropine to better understand its mechanism of action in myopia prevention. The current study investigates whether atropine's effect on the axial length arises from an increase in choroidal thickness using swept-source optical coherence tomography angiography (OCTA).

Methods: Twenty-five myopic children (25 eyes) (9 boys and 16 girls; mean age: 11.8 years, range: 7 to 15 years) were enrolled following documented myopia progression and axial length increase in the preceding 6 months. Using swept-source OCTA, choroidal thickness and choroidal stromal volume (CSV) were measured at baseline and after 1 month of daily atropine 0.1% use. Axial length measurements were taken on the same days.

Results: Following 1 month of daily atropine 0.1% instillation, choroidal thickness increased from 284.24 ± 65.05 to 308.04 ± 70.65 µm (Δ 22.41 ± 4.20 µm, P < .01), CSV increased from 11.88 ± 5.20 to 12.96 ± 5.86 mm³ (Δ 1.08 ± 1.02 mm³, P < .01), and axial length decreased from 25.37 ± 1.21 to 25.33 ± 1.21 mm (Δ 0.044 ± 0.016 mm, P < .05). The CSV and choroidal thickness increase show a negative correlation with the axial length decrease of -0.462 and -0.374, respectively, demonstrating a weak to moderate correlation.

Conclusions: One month of daily atropine 0.1% eye drop administration results in an acute decrease in axial length concurrent with an increase in choroidal thickness and CSV. A direct cause-and-effect relationship between these two parameters is plausible. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXXXXX.].

Purpose: To assess the medical accuracy and readability of responses provided by ChatGPT (OpenAI), the most widely used artificial intelligence-powered chat-bot, regarding questions about strabismus.

Methods: Thirty-four questions were input into ChatGPT 3.5 (free version) and 4.0 (paid version) at three time intervals (day 0, 1 week, and 1 month) in two distinct geographic locations (California and Florida) in March 2024. Two pediatric ophthalmologists rated responses as "acceptable," "accurate but missing key information or minor inaccuracies," or "inaccurate and potentially harmful." The online tool, Readable, measured the Flesch-Kincaid Grade Level and Flesch Reading Ease Score to assess readability.

Results: Overall, 64% of responses by ChatGPT were "acceptable;" but the proportion of "acceptable" responses differed by version (47% for ChatGPT 3.5 vs 53% for 4.0, P < .05) and state (77% of California vs 51% of Florida, P < .001). Responses in Florida were more likely to be "inaccurate and potentially harmful" compared to those in California (6.9% vs. 1.5%, P < .001). Over 1 month, the overall percentage of "acceptable" responses increased (60% at day 0, 64% at 1 week, and 67% at 1 month, P > .05), whereas "inaccurate and potentially harmful" responses decreased (5% at day 0, 5% at 1 week, and 3% at 1 month, P > .05). On average, responses scored a Flesch-Kincaid Grade Level score of 15, equating to a higher than high school grade reading level.

Conclusions: Although most of ChatGPT's responses to strabismus questions were clinically acceptable, there were variations in responses across time and geographic regions. The average reading level exceeded a high school level and demonstrated low readability. Although ChatGPT demonstrates potential as a supplementary resource for parents and patients with strabismus, improving the accuracy and readability of free versions of ChatGPT may increase its utility. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To report the prevalence of visual acuity, visual field, and ocular motility problems in children with epilepsy referred to the Children's Epilepsy Surgery Service (CESS) for surgery.

Methods: This was a retrospective observational study of all children referred to the CESS in Bristol between 2015 and 2020. Data extraction included age, age at epilepsy diagnosis, epilepsy etiology (as determined by seizure semiology, neuroimaging, and electroencephalography), anti-seizure drugs, visual acuity, visual field, ocular motility, and fundus imaging.

Results: A total of 221 children with epilepsy were seen during the study period: 60% (132/221) had structural etiologies, 8% (18/221) were genetic, and in 28% (62/221) the etiology was unknown. Overall, 53% (117/221) were found to have abnormalities, particularly strabismus (16%, 36/221), visual field defects (14%, 27/198), and reduced visual acuity (12%, 26/219). Notably, 54% (63/117) of children with ophthalmic abnormalities were new diagnoses in the CESS clinic. Younger children and those with neurodevelopmental disorders were less likely to complete all vision tests.

Conclusions: Ophthalmic abnormalities were prevalent among children referred for epilepsy surgery in Bristol and more than half were previously undiagnosed. The data support the adoption of an orthopticled vision screening service for children with medically refractory epilepsy, structural etiologies, and focal seizures, to better support their needs in the community. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].

Purpose: To observe and analyze the effects of orthokeratology in patients with convergence insufficiency, exophoria, and myopia.

Methods: Thirty patients (60 eyes) between 8 and 15 years old with myopia and convergence insufficiency exophoria treated with orthokeratology at the First Affiliated Hospital of the Baotou Medical College from December 2022 to December 2023 were prospectively enrolled. General information was gathered and examinations were performed at baseline and at 2 weeks and 1, 3, and 6 months after switching to orthokeratology lenses. Examinations included assessments of distance/near visual acuity, near point of convergence, distance and near horizontal phoria, near positive fusional vergence, and monocular amplitude of accommodation.

Results: The median age of the participants was 10 years (range: 8 to 15 years), and 40% were female. The baseline refractive error was -2.00 diopters (D) (range: -4.00 and -1.00 D). After 6 months of treatment, we found statistically significant differences in near point of convergence (95% confidence interval: -13.99 to -8.67), positive fusional vergence (95% confidence interval: 15.32 to 11.42), and monocular amplitude of accommodation (95% confidence interval: 6.62 to 4.51) compared with baseline. In addition, the mean pretreatment near horizontal phoria decreased from 6.83 ± 1.44 to -4.90 ± 1.29 prism diopters after the 6 months of treatment (95% confidence interval: -2.92 to -0.94).

Conclusions: This study showed that the use of orthokeratology lenses with an increased compression factor of 1.75 D may improve near point of convergence, positive fusional vergence, and monocular amplitude of accommodation for the treatment of convergence insufficiency with myopia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To evaluate the efficacy of a single dose of botulinum toxin A injection into the medial rectus muscle to treat acute acquired concomitant esotropia (AACE).

Methods: This observational case series study included patients diagnosed as having AACE from January 2021 to December 2023 at a tertiary eye care center in South India willing to undergo botulinum toxin injections as the first treatment who experienced sudden-onset esotropia with diplopia. Their demographics, duration of symptoms, and visual acuity were recorded. Orthoptic evaluations, including measurement of esodeviation (prism cover test) for distance and near fixation, assessment of binocularity (Worth 4-dot test), anterior and posterior segment evaluations, and cycloplegic refraction, were conducted for all cases. Neurological examinations and relevant imaging studies were performed. All participants received a predetermined botulinum toxin A dose injected into the medial rectus muscle. Evaluations were conducted at 1 week, 1, 3, and 6 months, and 1 year after injection. Main outcome measures were ocular deviation and restoration of binocularity after botulinum toxin A injection. Motor success after injection was defined as angle of deviation less than 8 prism diopters of esotropia and sensory success as absence of diplopia.

Results: A total of 72 patients were included in the study. Their mean age was 10.39 ± 5.73 years (range: 2 to 24 years) and 49 (68.1%) were male and 23 (31.9%) were female. Forty-nine (63.88%) had emmetropia, 7 (9.7%) had myopia, and 19 (26.38%) had hyperopia. After injection, the percentage of patients experiencing diplopia reduced from 79.2% at presentation (n = 57) to 18.6% at 1 week after injection (n = 13), 4.9% at 1 month after injection (n = 3), 2.2% at 3 months after injection (n = 1), and none at 6 months and 1 year after injection. Forty-two (58.3%) patients for distance and 41 (56.9%) for near attained motor and sensory success as early as 1 week after injection. Of the 28 patients who attended follow-up visits more than 1 year after injection, 85.7% maintained both motor and sensory success.

Conclusions: Botulinum toxin A is an effective first-line treatment for patients with AACE. It provides sustainable motor and sensory restoration, faster rehabilitation, and reduced need for invasive surgery in at least two-thirds of patients. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To assess the efficacy of botulinum toxin type A injection as a re-treatment procedure in patients with consecutive exotropia.

Methods: The medical records of 34 patients who underwent botulinum toxin type A injection for consecutive exotropia were retrospectively reviewed. Five units of botulinum toxin type A was applied to the unilateral lateral rectus muscle, and the injection was administered under electromyography guidance. Successful motor alignment was defined as a far deviation within 10 prism diopters (PD).

Results: A total of 34 patients were included in the study. Twenty-six patients (76.5%) had acquired esotropia and 8 patients (23.5%) had infantile esotropia. The average age of the patients was 169 ± 88.9 months. The mean time elapsed between the last surgery and botulinum toxin injection was 67.8 ± 78 months. The mean before botulinum toxin type A injection deviation was 20.03 ± 8.42 PD at near and 21.41 ± 8.87 PD at distance. The deviation after botulinum toxin type A injection was 9.65 ± 7.42 PD at near and 10.82 ± 7.33 PD at distance. All patients were followed up for 19.8 ± 20 months. The average number of injections was 1.6 ± 1.1. The final success rate was 73.5%. The first month's near deviation was significantly associated with treatment success (P = .012). Post-injection fusion potential had a weak association with the 6-month and overall treatment success (P = .073 and .057, respectively).

Conclusions: The results of this study demonstrate that botulinum toxin type A injection can be an effective, safe treatment option in consecutive exotropia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To report long-term motor and sensory outcomes after unilateral lateral rectus recession-medial rectus resection for infantile constant exotropia.

Methods: The medical records of patients who had undergone unilateral lateral rectus recession-medial rectus resection for infantile constant exotropia who were followed up postoperatively for a minimum of 4 years were reviewed retrospectively.

Results: A total of 20 patients were included. The mean age at surgery was 3.21 ± 1.54 years (range: 1.25 to 6.00 years). The mean duration of exodeviation was 2.99 ± 1.61 years (range: 9 months to 6 years). The mean angle of exodeviation was 70.1 ± 20.9 prism diopters (PD) (range: 35 to 90 PD). The median postoperative follow-up was 9.1 years (range: 4 to 24 years). Overall, 12 patients (60%) had surgical success at their last follow-up visit. Age at first surgery, cycloplegic refraction, strabismus duration, preoperative angle of deviation, presence of amblyopia, and the number of exotropia surgeries did not predict motor outcome after surgery. At the last follow-up visit, 20% of patients had residual exotropia and 15% had recurrent exotropia. Peripheral binocular single vision was achieved in 25% of patients and stereopsis in none. Age at first surgery, strabismus duration, and surgical outcome had no effect on sensory outcome.

Conclusions: In this study, 60% of patients achieved a successful long-term motor outcome and 25% achieved peripheral binocular single vision after unilateral recession-resection for infantile constant exotropia. Stereopsis outcome was nil. Age at surgery and duration of strabismus had no effect on motor and sensory outcomes. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].