Journal of Pediatric Ophthalmology & Strabismus最新文献

Social media is a popular, poorly vetted health care information source. Vision therapy is a controversial topic that some claim can benefit patients with visual processing disorders, despite no supporting evidence. The authors assessed quality of Instagram (Meta Platforms) posts tagged with #visiontherapy, finding few high-quality posts and no correlation between engagement and quality. [J Pediatr Ophthalmol Strabismus. 2025;62(1):e8-e13.].

A 64-year-old woman suffered a traumatic rupture of the inferior rectus muscle, with the distal segment unrecoverable. An inferior oblique muscle transposition, augmented with a posterior fixation suture, was performed. This modification may have contributed to the surgical outcome. [J Pediatr Ophthalmol Strabismus. 2025;62(1):e14-e17.].

Purpose: To study the clinical profile of patients with orbital myositis and their management modalities and predictive factors for recurrence.

Methods: The records of all consecutive patients diagnosed as having orbital myositis from 2010 to 2022 were reviewed. Patient demographics, presenting complaints, visual function, primary gaze deviation, and extraocular muscle involved were studied in the clinical profile. The radiological modalities and their management along with the recovery status and need for surgical intervention were documented.

Results: Fifty-two patients (55 eyes) (69% women) were diagnosed as having orbital myositis with a mean age of 36 ± 16 years presenting with periocular pain (55%) followed by diplopia (49%). Disease was unilateral in 94%. Sixty percent had ocular misalignment in primary gaze. The medial rectus was the most involved muscle (58%), with abduction limitation in 73%. Computed tomography (42%), magnetic resonance imaging (42%), and combined imaging (16%) were used in localizing the disease. Muscle biopsy was done in 38% of patients. Systemic immunomodulators were required in 16%. Strabismus surgery was planned in 15% of patients and done in 11%. Recurrence was noted in 43%. Abrupt cessation of steroids was a significant risk factor in recurrence of the disease (P = .046). Recovery was partial in 44% of patients and complete in 47%.

Conclusions: Systemic steroids with slow taper has satisfactory outcomes in orbital myositis. Patients refractory to treatment ideally should undergo biopsy and begin taking steroid-sparing agents. Once the disease is in remission, residual disease can be surgically treated for better functional outcome. [J Pediatr Ophthalmol Strabismus. 2025;62(1):57-66.].

Purpose: To investigate the quality and reliability of YouTube videos about retinopathy of prematurity (ROP) to direct parents of infants with the disease to access more accurate content.

Methods: The term "retinopathy of prematurity" has been searched on YouTube containing all of the videos between January 2 and February 2, 2024. The first 200 videos were evaluated by two ophthalmologists. Duplicated-split videos, videos shorter than 60 seconds, videos presented in languages other than English or with an incomprehensible accent, and videos unrelated to ROP were excluded. Video uploaders, types, continental origins, durations, and viewer interactions were noted. DISCERN, The Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS) scoring systems were used to evaluate the quality of the videos.

Results: The mean quality of all videos was poor in all scoring systems. Academic societies and medical institutes scored highest in video uploaders, followed by physicians; patient experience videos had the lowest quality. Of the video types, the medical education seminars were of the highest quality. Although a strong positive correlation was detected between video duration and video quality, this same strong correlation was not observed between viewer interactions and video quality. There was no significant difference between video origins in terms of video quality.

Conclusions: It would be wiser to direct the parents of patients with ROP to watch longer videos uploaded by the academic community, medical institute, or physicians, and to watch the medical training seminars. Also, it might be important to warn them not to take user interactions too seriously. [J Pediatr Ophthalmol Strabismus. 2025;62(1):42-49.].

This report describes the longest case of a retained metallic intraorbital foreign body with no complications and development of delayed sensory exotropia following traumatic sclopetaria in childhood. A 9-year-old girl suffered a BB gun injury to the left eye, leading to chorioretinitis sclopetaria and loss of vision. The visual acuity was 20/800 with a relative afferent pupillary defect and choroidal rupture with subretinal hemorrhage that evolved to sclopetaria over time. Computed tomography of the orbit demonstrated the BB foreign body. A sensory exotropia of 30 prism diopters developed over time. Sclopetaria is an uncommon sequela of tangential but high velocity, non-penetrating, projectile injury to the globe. The force is sufficient to rupture the retina and choroid but not enough to rupture the globe. Most of the literature has focused on the initial management and visual outcomes for sclopetaria, not on the late sequelae, including ocular motility and alignment. Clinicians should take additional precautions in the surgical management of delayed sensory exotropia. [J Pediatr Ophthalmol Strabismus. 2025;62(1):e4-e7.].

Purpose: To explore the current state of diagnosis and management of neonatal conjunctivitis.

Methods: Cosmos, an EHR-based, de-identified data set including more than 200 million patients, was used for this study. Neonates born between January 1, 2016 and December 31, 2022, discharged from the hospital by day 3 of life, and with an ambulatory visit within the first 4 weeks of life associated with a new diagnosis of neonatal conjunctivitis (SNOMED) or conjunctivitis (ICD-10 H10.*) were included. Cosmos slicer/dicer software was used to extract demographic, diagnostic, etiologic, and therapeutic data.

Results: A total of 1,870 of 7,325,276 (0.0255%) neonates with a hospital stay of 3 days or less met criteria for inclusion: 96.5% were from the United States, 16.2% were admitted to the hospital, and bacterial cultures were obtained from 21.3%. Congenital lacrimal duct stenosis was causative in 2.7% of patients. Important infectious agents included staphylococcal, streptococcal, or enterococcal species (2.5%), Neisseria gonorrhoeae (1.6%), and Chlamydia trachomatis (0.6%). No herpesviral or Pseudomonas infections were identified. Antimicrobial agents were prescribed to 93.7% of patients and given ophthalmically (79.5%), orally (11.4%), and parenterally (7.7%).

Conclusions: The evaluation and management of neonatal conjunctivitis within United States ambulatory settings are highly variable. Diagnostic studies are underused, resulting in limited etiologic data and a lack of susceptibility-guided treatment. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To identify social determinants of health (SDOH) associated with follow-up attendance of pre-term infants with retinopathy of prematurity (ROP) after neonatal intensive care unit (NICU) discharge.

Methods: This retrospective cohort study, conducted at a single academic tertiary care center, included preterm infants screened for ROP from July 2018 to December 2022. Sociodemographic and clinical data were collected from a preexisting NICU database. Residential ZIP code was used to derive community-level SDOH indices. Multivariable logistic regression was used to determine factors associated with ophthalmology follow-up attendance within 8 weeks to 1 year after NICU discharge.

Results: Forty-two percent (303 of 723) of patients attended follow-up in the designated interval. Infants with private insurance (odds ratio [OR]: 4.47, 95% CI: 1.98 to 10.1, P < .001), maternal non-Hispanic White identity (OR: 1.80, 95% CI: 1.15 to 2.81, P = .01), ROP treatment history (OR: 3.67, 95% CI: 2.05 to 6.57, P < .001), and longer NICU stay (weeks) (OR: 1.06, 95% CI: 1.03 to 1.08, P < .001) had higher odds of attending follow-up. In an interaction effect, privately insured patients had lower odds of follow-up with each higher quartile of Social Vulnerability Index Racial and Ethnic Minority Status (OR: 0.61, 95% CI: 0.44 to 0.84, P = .002).

Conclusions: Social determinants of health, including individual and community-level factors, significantly impact access to ROP follow-up. The identified disparities and overall inadequate follow-up rate suggest a need for targeted interventions to improve vision health equity and follow-up adherence. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To investigate whether wide-angle fluorescein angiography (FA) was useful for detecting familial exudative retinopathy (FEVR) in patients with neurodevelopmental disorder with spastic diplegia and visual defects (NEDSDV).

Methods: This was a retrospective chart review from 2013 to 2023 of all consecutive patients with NEDSDV and pathogenic or likely pathogenic CTNNB1 variants.

Results: Seven patients (four females, three males) were seen in the ophthalmology clinic (median age: 14 months). One patient presented with a retinal fold in one eye, was observed without FA, and later developed a tractional retinal detachment involving the macula in the contralateral eye. Another patient observed without FA lost vision due to vitreous hemorrhage. Five patients who lacked signs of FEVR in clinic underwent FA under anesthesia; three showed retinal neovascularization or leakage requiring treatment, one showed mild avascularity, and one was normal.

Conclusions: Despite reassuring eye examinations in the clinic, two patients with NEDSDV experienced vi- sion loss from FEVR, and three patients were found by FA to require treatment. FA aided in the detection of FEVR in these patients. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To explore how serum diabetes autoantibodies are related to the development of early diabetic retinopathy in children with type 1 diabetes mellitus.

Methods: In this prospective and observational study, 62 patients with type 1 diabetes mellitus who had not yet developed clinical diabetic retinopathy were followed up for at least 5 years. Healthy volunteers aged 10 to 20 years were also included. Insulin, pancreatic islet cells, and glutamic acid decarboxylase (GAD) autoantibodies were measured with an RIA kit at the time of type 1 diabetes mellitus diagnosis. Optical coherence tomography angiography (OCTA) was used to evaluate the foveal avascular zone (FAZ) and parafoveal vascular density (PVD) for the development of early diabetic retinopathy among the groups. Patients' OCTA findings were compared with those of healthy volunteers. The obtained data were analyzed via IBM SPSS Statistics for Windows, version 27.0. Spearman's rank correlation test and regression analysis were performed to determine independent predictors of OCTA and type 1 diabetes mellitus parameters.

Results: Eighteen boys and 44 girls with type 1 diabetes mellitus with a median age of 15.6 years (range: 10.08 to 20.88 years) were evaluated. Healthy control participants with a median age of 15.3 years (range: 14.2 to 18.2 years) were also included. The mean FAZ was greater in the type 1 diabetes mellitus group than in the healthy control group (P = .013 and .119, respectively). The mean PVD was significantly lower in the type 1 diabetes mellitus group than in the healthy control group. There was no significant correlation between serum diabetes autoantibodies (GAD and insulin autoantibodies) and FAZ or PVD (FAZ and GAD; r = 0.138, P = .286, FAZ and anti-insulin; r = 0.100, P = .441, PVD and GAD; r = -0.151, P = .24, PVD and anti-insulin; r = -0.087, P = .499).

Conclusions: Type 1 diabetes mellitus in children without clinically detectable diabetic retinopathy is associated with impaired retinal microcirculation and irregularities at the FAZ margin. Impaired retinal microcirculation and irregularities were associated with glycated hemoglobin levels in the study group. Thus, studies with larger patient series are needed. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].