Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To compare the prevalence and severity of dry eye disease among children aged 6 to 12 years with and without a history of ocular infections.

Methods: Children aged 6 to 12 years who came to the pediatric eye clinic were included. A total of 400 children were screened for dry eye over a 6-month study period. Consecutive sampling was used, meaning all eligible children who attended the Pediatric Ophthalmology outpatient department during this period were included based on inclusion and exclusion criteria by using the the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (TBUT), and the Schirmer I test.

Results: Dry eye disease was diagnosed in 37% (n = 148) of the participants overall, and the diagnosed children with dry eye were divided into two groups (history of ocular infection and no history of ocular infection). The history of ocular infection group showed noticeably worse results on two key tests compared to the no history of ocular infection group. Their TBUT was significantly lower at 6.3 seconds (with a margin of ±1.8 seconds), and their Schirmer I test results were also reduced at 9.2 ± 2.4 mm. The no history of ocular infection group had TBUT values of 8.9 ± 2.0 seconds and Schirmer I readings of 13.1 ± 2.7 mm. Both of these differences were statistically significant (P < .001).

Conclusions: Dry eye disease seems to be common among school-aged children, especially those who have had eye infections before. On analyzing previous infections, particularly viral and bacterial conjunctivitis, it appears that there are important factors contributing to problems such as unstable tear films and reduced tear production.

Purpose: To compare conventional and inverse occlusion in the treatment of amblyopia with eccentric fixation.

Methods: This prospective randomized interventional study was conducted at a tertiary care center over a period of 1 year. Sixty patients with amblyopia (refractive or strabismic) with eccentric fixation who were older than 12 years were divided into two groups with systematic randomization: conventional occlusion (occlusion of sound eye for 6 hours/day) and inverse occlusion (occlusion of amblyopic eye for 6 hours/day). Patients with a systemic illness or neurological disorder were excluded. Follow-up data for corrected distance visual acuity (CDVA), stereopsis, and fixation pattern were taken at baseline and 1, 3, and 6 months postoperatively.

Results: At the final follow-up visit, there was significant improvement in CDVA in the amblyopic eye in both the conventional occlusion (P = .007) and inverse occlusion (P < .001) groups. The mean ± standard deviation of CDVA improved from 1.32 ± 0.3 and 1.32 ± 0.32 logMAR at baseline to 1.17 ± 0.15 and 1.10 ± 0.27 logMAR in the conventional occlusion and inverse occlusion groups, respectively. Stereoacuity improved significantly in both groups (P = .013 and .016 in the conventional and inverse occlusion groups, respectively). Improvement in fixation function was statistically significant only in the inverse occlusion group I (P = .002).

Conclusions: Both conventional and inverse occlusion therapy are effective in treating amblyopia with eccentric fixation in terms of improvement of visual acuity and stereopsis. However, for improvement in anomalous fixation pattern, inverse occlusion is preferred with no issues of compliance and functional limitation.

Purpose: To evaluate keratometric measurements of the anterior and posterior corneal surface before and after corneal cross-linking (CXL) surgery for pediatric keratoconus.

Methods: A total of 111 eyes were found eligible for CXL. Anterior and posterior corneal surface keratometry values obtained before and after CXL were analyzed.

Results: The mean anterior keratometry values were 47.99 ± 3.96 and 47.74 ± 3.63 diopters (D) before and after CXL. The mean anterior surface steep keratometry was 50.05 ± 4.70 D before CXL and 49.58 ± 4.01 D at the end of the follow-up. The mean anterior surface flat keratometry was 45.91 ± 3.31 D before CXL and 45.93 ± 3.45 D at the end of the follow-up. The mean astigmatism of the anterior surface was 3.98 ± 2.34 cylinder diopters (Dcyl) before CXL and 3.63 ± 1.86 Dcyl at the end of the follow-up. The mean posterior surface keratometry value was -7.16 ± 0.81 D before CXL and -7.27 ± 0.76 D at the end of the follow-up. The mean posterior surface steep keratometry value was -7.52 ± 0.86 D before CXL and -7.64 ± 0.81 D at the end of the follow-up. The mean posterior surface flat keratometry value was -6.81 ± 0.80 D before CXL and -6.90 ± 0.75 D at the end of the follow-up. The mean posterior surface astigmatism was 0.71 ± 0.33 Dcyl before CXL and 0.73 ± 0.34 Dcyl at the end of the follow-up. The difference was not statistically significant.

Conclusions: CXL is recommended for children with keratoconus. The treatment does not significantly alter anterior and posterior corneal surface keratometry values.

Purpose: To determine the efficacy of five types of myopia control glasses (MCG) among Indian children.

Methods: A retrospective cohort study with 1-year follow-up was done in 397 eyes of 216 children aged 4 to 17 years, with myopia between -0.75 and -10.00 diopters (D), astigmatism of 4.00 D or less, and baseline progression of 0.50 D or greater. Data from children prescribed type I (defocus incorporated multiple segments), type II (highly aspherical lenslet target), type III (cylindrical annular refractive elements), type IV (peripheral defocus reducing lenses), and type V (pediatric progressive addition lenses) MCG were analyzed. Mean change in spherical equivalence of refractive error (SER) and axial length (AL) and percentage efficacy in reducing SER and AL progression to physiological levels were compared. Subgroup analysis was done by age, gender, and amount of myopia.

Results: Mean change in SER and AL at 6 and 12 months with all MCG combined was -0.05 ± 0.23 D, -0.26 ± 0.43 D, 0.07 ± 0.11 mm, and 0.16 ± 0.18 mm, respectively. No statistically significant difference was noted between types I, II, and III. Axial and refractive efficacy at 6 and 12 months of all MCG combined was 42.34%, 43.99%, 90.41%, and 68.91%, respectively. There was no significant difference among boys and girls. The older group showed significantly better axial efficacy (P < .01) at 6 and 12 months. Refractive efficacy was significantly higher at 12 months (P < .01) among children with low myopia.

Conclusions: Types I, II, and III MCG are equally efficacious in controlling myopia progression among Indian children, with better results among older children and those with low myopia.

Purpose: To analyze the origin and quality of health information on one social media platform on the use of vision therapy in treating pediatric visual and learning disorders.

Methods: Nine hashtags were selected, and the 20 most liked videos were independently assessed using the DISCERN and Global Quality Scoring (GQS) systems, totaling 147 videos with 11,194,000 views. Across all hashtags, vision therapy content was predominantly created by behavioral optometrists (32.2%) and vision therapy clinics (21.2%).

Results: This content scored poorly on both the DISCERN and GQS scoring systems, demonstrating widespread misinformation. With the increasing influence of social media on health care decisions, misinformation may lead to misguided treatment choices, potentially delaying evidence-based care. These findings underscore the need for increased engagement from ophthalmologists and other medical professionals to provide accurate, research-backed information and counter the spread of misleading claims of vision therapy in treating pediatric and visual learning disorders.

Conclusions: Future research should explore content across multiple platforms and broaden the scope of analysis to enhance the understanding of online health misinformation.

Purpose: To assess the risk of developing ocular alignment disorders, refractive errors, amblyopia, and nystagmus in patients with Rett syndrome.

Methods: This retrospective cohort study used de-identified patient data from the TriNetX US Collaborative network and compared a Rett syndrome and a control cohort. Propensity score matching was conducted to balance demographics and well-characterized comorbidities. Statistical analysis calculated risk ratios (RRs) and 95% confidence intervals (CIs), with significance defined by excluding CIs between 0.9 and 1.1.

Results: Patients with Rett syndrome had an increased risk of developing strabismus (RR: 3.39; CI: 2.47 to 4.65) and risk for the specific horizontal subtypes of esotropia (RR: 4.06; CI: 2.26 to 7.26) and exotropia (RR: 2.92; CI: 1.83 ro 4.68). Additionally, patients with Rett syndrome had an increased risk of developing amblyopia (RR: 1.90; CI: 1.28 to 2.82) and nystagmus (RR: 1.98; CI: 1.12 to 3.53). No differences in risk were found for astigmatism, myopia, and hyperopia development given Rett syndrome diagnosis.

Conclusions: These findings demonstrate the importance of regularly monitoring ocular health in patients with Rett syndrome and a need for further investigation into the underlying mechanisms linking the disease with these specific ocular pathologies.

Purpose: To report early implantation results of a pediatric modular intraocular lens (IOL).

Methods: This prospective cohort study included 14 consecutive eyes of 11 patients (4 boys, 7 girls) with visually significant congenital cataract who had surgery in the first year of life at a single clinical site. Intervention involved lens aspiration, IOL placement, primary pars plana posterior capsulectomy and anterior vitrectomy. A two-piece hydrophobic acrylic device composed of an 11-mm haptic and a 5.5-mm exchangeable optic disc was injected into the bag in one piece after prior ex vivo assembly.

Results: Mean patient age at the time of surgery was 6.2 ± 3.0 months. On average the patients were followed up for 8.2 ± 7.9 months. Mean targeted initial refraction was 4.11 ± 1.68 diopters. The surgery was uneventful in every case. There were no intraoperative or implant-related postoperative complications. Three eyes (21%) developed retrolenticular visual axis opacification necessitating surgical clearing.

Conclusions: The dedicated pediatric modular implant demonstrated acceptable intraoperative and early postoperative safety profile. Given extraocular assembly of the study IOL, its implantation procedure is technically comparable to that of regular non-adjustable IOLs, whereas its modular design allows for future optical modification to address changing refractive status.

Purpose: To investigate the impact of long-term abnormal head position on internal carotid artery (ICA) and external carotid artery (ECA) flow patterns in patients with unilateral congenital fourth nerve palsy.

Methods: This study was conducted in a tertiary clinic and involved 29 patients with congenital fourth cranial nerve palsy, with a vertical deviation greater than 14 prism diopters. Demographic information, clinical presentations, and ophthalmological findings were reviewed, and carotid Doppler ultrasound measurements were compared.

Results: The mean age of the patients was 21.4 ± 10.9 years, with 16 females and 13 males included in the study. The vertical deviation of the cases ranged from 14 to 35 prism diopters (PD), with a median deviation of 22 PD. ECA and ICA diameters were significantly lower on the non-paralytic side compared to the paralytic side (P = .001 and .008), whereas resistive index values were higher on the non-paralytic side (P = .009 and .011). A strong positive correlation was found between the angle of deviation and age (r = 0.685, P < .001), and a negative correlation was noted between carotid flow velocities and angle of deviation (r = -0.546 to -0.626, P < .001).

Conclusions: In patients with congenital fourth nerve palsy, long-term abnormal head position may alter carotid artery flow, reducing vessel diameter, and increasing resistive index on the non-paralytic side. These changes may contribute to complications, suggesting that timely surgical intervention might help prevent carotid flow alterations, facial asymmetry, and musculoskeletal issues.

Purpose: To provide a comprehensive bibliometric analysis of global research on nystagmus from 1980 to 2024, highlighting key contributors, evolving themes, collaborative patterns, and future directions.

Methods: A total of 2,570 English-language articles and reviews with "nystagmus" in the title were retrieved from the Web of Science Core Collection. Data were analyzed using VOSviewer, CiteSpace, and Microsoft Excel. Trends in publication output, citation impact, keyword evolution, and co-authorship were examined. Mann-Kendall trend tests and linear regression were used to assess changes over time.

Results: Nystagmus research has increased steadily since 1980, with a significant surge after 2010 and peak output in 2021 (τ = 0.3509, P < .001). The United States led in publications (32.18%) and centrality (0.52), followed by Japan and England. Among 1,999 contributing institutions, the U.S. Department of Veterans Affairs and Case Western Reserve University were most productive. Authors such as Louis F. Dell'Osso, Irene Gottlob, and Ji-Soo Kim were prominent. Keyword clustering identified 10 thematic domains, with recent hotspots including infantile nystagmus, FRMD7 mutations, and optical coherence tomography. Citation burst analysis revealed both historic and emerging influential authors and topics.

Conclusions: This is the first study to systematically map the intellectual structure of nystagmus research over four decades. Findings underscore increasing academic attention, but also reveal fragmented collaboration and underrepresentation of low- and middle-income countries. Future efforts should promote global partnerships and integration of artificial intelligence, imaging, and genetics to advance diagnosis and management of nystagmus.

Purpose: To compare surgical outcomes in pediatric patients with superior oblique palsy and exodeviation to those with isolated intermittent exotropia lacking a vertical component, with a focus on the horizontal components in both groups.

Methods: This was a retrospective analysis of patients undergoing strabismus surgery from January 2010 to September 2022 in a single tertiary hospital's pediatric ophthalmology unit. The superior oblique palsy and exodeviation group was matched with the intermittent exotropia control group. All patients included had an exodeviation of 25 prism diopters (PD) or less. Surgical success was defined by residual horizontal strabismus of 10 PD or less or residual vertical deviation of 4 PD or less, and lack of additional surgery for residual or consecutive strabismus.

Results: Among 45 eligible patients, 17 were in the superior oblique palsy and exodeviation group and 28 in the isolated intermittent exotropia group. At follow-up, patients with combined superior oblique palsy and exotropia exhibited significantly lower horizontal measurements at distance (1.8 ± 2.5 vs 6.6 ± 6.6 PD, P = .006) and near (1.9 ± 3.3 vs 7.4 ± 6.8 PD, P = .004). Additional surgery rates were also lower in this group (5.9% vs 21.4%). One patient with superior oblique palsy and exotropia had residual exotropia exceeding 10 PD (5.9%), compared to 21.4% in the intermittent exotropia group. The success rate was higher in the mixed group (88.2% vs 57.1%, P = .045). Multivariate regression analysis demonstrated that the type of strabismus (P = .013) and shorter follow-up (P = .004) emerged as significant predictors of a successful surgical outcome.

Conclusions: Patients with small to moderate superior oblique palsy and exodeviation demonstrated superior surgical outcomes for their exodeviation compared to those with small to moderate isolated intermittent exotropia, emphasizing the distinction between these groups and the potential impact on surgical expectations. These findings highlight the need for extended follow-up in intermittent exotropia cases.