Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To compare the results of botulinum toxin A injection and bridge Faden operation performed with bimedial rectus recession in the treatment of large-angle esotropia.

Methods: The medical charts of patients with large-angle esotropia who underwent bimedial rectus recession combined with the Faden operation or botulinum toxin A injection between January 2018 and March 2022 were retrospectively screened. The degree of deviations measured before surgery and at 1, 3, 6, and 12 months after surgery were compared between the two groups.

Results: The sample consisted of 26 patients, of whom 15 (57.7%) were male and 11 (42.3%) were female. In the botulinum toxin A group (n = 11), the mean age was 42.1 ± 22.6 months at admission and 65.3 ± 17.1 months at surgery, and the mean preoperative near and far distance deviations were 49.8 ± 8.4 and 44.3 ± 9.4 PD, respectively. In the Faden group (n = 15), the mean age was 54.9 ± 21.7 months at admission and 71.3 ± 12.6 months at surgery, and the mean preoperative deviations at near and far distances were 49.3 ± 11.2 and 44.3 ± 9.2 PD, respectively. The complete success rates of the botulinum toxin A and Faden groups evaluated 12 months after treatment were 63.6% and 66.7%, respectively, for the near distance deviation and 72.7% and 73.3%, respectively, for the far distance deviation. After the botulinum toxin A injection, 2 patients developed transient ptosis and 1 developed consecutive exotropia.

Conclusions: As an alternative to multi-muscle surgery in large-angle esotropia, botulinum toxin A injection and Faden procedures, performed with bilateral medial rectus recession, provide successful results. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To compare changes of vertical palpebral fissure height after bilateral lateral rectus (BLR) recessions versus unilateral lateral rectus (LR) recession and medial rectus (MR) muscle scleral plication, for treatment of intermittent exotropia.

Methods: This prospective, comparative, randomized study included 40 patients with intermittent exotropia who were divided into two groups: 20 patients who underwent BLR recessions (BLR recession group) and 20 patients who underwent unilateral LR recession and MR muscle scleral plication (recession-plication group). Eyelid evaluation included measurement of margin reflex distance 1 (MRD1) and margin reflex distance 2 (MRD2) at 1 week, 6 weeks, and 3 months postoperatively. Angle of deviation and any incomitance were also recorded at each visit.

Results: There was no significant statistical difference in eyelid measurements after the surgery between both groups (P = 1.00). There was no significant statistical difference in ocular alignment after the surgery between both groups (P = 1.00). Also, there was no significant statistical difference in lateral incomitance after the surgery between both groups (P = 1.00).

Conclusions: Both the unilateral recession and plication of horizontal rectus muscles technique and bilateral recession provide comparable surgical results for correction of exotropia without significant palpebral fissures changes or lateral incomitance. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To review the current literature, to provide a foundation of knowledge on strabismus surgery in patients with developmental delay, and to present results from the authors' personal experience.

Methods: The following terms were searched on PubMed: strabismus surgery, mental delay, developmental delay, Down syndrome, Angelman syndrome, cerebral palsy, hydrocephalus, Williams syndrome, fragile X syndrome, and fetal alcohol syndrome. Surgical outcomes were analyzed and discussed; only English articles were included. Medical records of 183 patients with developmental delay who underwent strabismus correction surgery from 2001 to 2020 were examined and discussed.

Results: Articles were reviewed and analyzed, categorized based on the disease. The authors' experience included 183 patients with various diseases or syndromes: 44 Down syndrome, 40 fetal alcohol syndrome, 36 Williams syndrome, 9 fragile X syndrome, 12 Angel-man syndrome, 11 Cohen syndrome, and 31 cerebral palsy. Surgical results at 3 and 18 months of follow-up were analyzed. Regarding esotropia surgery, 83.9% had a deviation of less than 8 prism diopters at 3 months and 53.8% at 18 months of follow-up. Hypocorrection was seen in 7.7% and 3.5% and hypercorrection was observed in 8.4% and 52.7% at 3 and 18 months, respectively. For exotropia, 60% had a deviation of less than 8 prism diopters at 3 months and 22.5% at 18 months. Hypocorrection occurred in 35% and 75%, whereas hypercorrection was found in 5% and 2.5%, respectively.

Conclusions: A higher prevalence of strabismus was found in these patients and the surgical outcomes were more difficult to predict. Patients with esotropia were more hypercorrected, whereas those with exotropia were more hyporcorrected. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To evaluate the quality and reliability of patient-targeted videos about childhood glaucoma on the YouTube platform.

Methods: On March 1, 2024, a search was performed on YouTube (www.youtube.com) using the keywords "Infantile glaucoma," "childhood glaucoma," "paediatric glaucoma," "congenital glaucoma," "juvenile glaucoma," "buphthalmos," and "pediatric glaucoma." For each video, the time since the upload date (days), duration of the videos (minutes), number of likes, dislikes, and comments, the view ratio (number of views/time since the upload date), like ratio (likes × 100) / (likes+dislikes), view power index ([like ratio × view ratio] / 100), and upload source (whether it was uploaded by medical organization versus uploaded by patients or commercial organization) were recorded. Two independent reviewers blindly evaluated the patient-targeted videos using DISCERN, the Journal of American Medical Association (JAMA), and the Global Quality Score (GQS) criteria.

Results: Twenty-five videos were analyzed, and 19 (64%) of them were uploaded by physicians or medical organizations. The overall median (interquartile range) scores for DISCERN, JAMA, and GQS criteria were 2.5 (1.8 to 3.0), 2.5 (2.0 to 2.5), and 3.5 (2.5 to 4.0), respectively. No significant differences in scoring were noted between the two reviewers. The duration of the videos was significantly correlated with the GQS; however, no other video parameters were correlated to the quality scorings.

Conclusions: YouTube videos of patient education about childhood glaucoma were of moderate quality and reliability. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Purpose: To evaluate ocular treatment adherence and its impact on clinical outcomes in patients with cystinosis in southwestern Ontario, where the disease incidence is higher due to a founder effect in the Old Order Amish population.

Methods: This was a retrospective case series of patients with ocular cystinosis seen at Victoria Hospital and the Ivey Eye Institute at St Joseph's Health Care in London, Ontario, Canada, from 2008 to 2023. The authors investigated the demographics, ocular manifestations, and visual outcomes and characteristics in pediatric patients with ocular cystinosis. They also conducted qualitative analysis to characterize medication compliance and identify treatment barriers to compliance.

Results: This study included 14 patients with ocular cystinosis. In southwestern Ontario, the incidence of cystinosis is approximately 1 in 4,700 live births. Most patients were Old Order Amish, with a family history of cystinosis and consanguineous parents. During treatment, patients were typically asymptomatic, but photophobia was the most reported symptom. Slit-lamp examination revealed cystine crystals in the cornea of all patients; however, best corrected visual acuity and intraocular pressure were unremarkable in every case. A Fisher's exact test revealed a trend toward lower compliance in Amish patients compared to non-Amish patients (odds ratio: 0.067, P = .103). Significant treatment barriers for patients with ocular cystinosis were identified, including compliance issues with frequent eye drop regimens, educational and financial burdens, and geographical and cultural challenges, all impacting patient care and follow-up.

Conclusions: This study highlights the need for improved strategies to improve treatment compliance and overcome barriers to care for patients with ocular cystinosis, particularly within the Old Order Amish population in southwestern Ontario, to ensure better clinical outcomes and quality of life. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].

Purpose: To evaluate the ability of the monocular QuickSee Free (QSF) portable autorefractor (PlenOptika) to detect and measure refractive error relative to gold standard cycloplegic retinoscopy in a population of school-aged children in a low-resource setting in The Gambia.

Methods: A total of 101 children, aged between 3 and 17 years (10.2 ± 3.45 years) underwent visual acuity screening, autorefraction by the QSF, and complete ophthalmic examination including cycloplegic retinoscopy. The agreement of the results was evaluated by Bland-Altman plots. The sensitivity and specificity of detecting myopia, anisometropia, and astigmatism were calculated based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2021 guidelines. The overall accuracy of detecting refractive error was analyzed with receiver operating characteristic curves.

Results: Spherical equivalent (SE), sphere, and cylinder of the QSF all displayed moderate interclass correlation with cycloplegic retinoscopy with cylinder correlating the highest with physician measurements followed by SE, then sphere. The average bias for the QSF was slightly negative for sphere and spherical equivalents, indicating that on average the QSF tended to underestimate these measures relative to physicians. Based on AAPOS 2021 guidelines, the sensitivity and specificity (in respective order) were 62% and 93% for detecting myopia, 57% and 86% for detecting anisometropia, and 78% and 95% for detecting astigmatism. The area under the receiver operating characteristic curve was greater than 0.75 for all three conditions, suggesting the QSF has good predictive ability to detect myopia, anisometropia, and astigmatism.

Conclusions: The QSF displayed moderate agreement with physician reported refractions and it also tended to underestimate spherical equivalents and sphere. The device exhibited high predictability in detecting refractive error in the low-resource setting. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].

The authors present the case of a 5-year-old boy who developed a unilateral internuclear ophthalmoplegia (INO) following mild head trauma with supporting magnetic resonance imaging (MRI) findings of damage to the medial longitudinal fasciculus. At 2 months of follow-up, the patient had resolution of diplopia and only minimal residual nystagmus. Although rare in the children, INO can develop following head trauma. Management should include work-up to exclude etiologies beyond trauma (specifically with MRI, which is superior to computed tomography imaging in evaluating INO) followed by observation and, if needed, comanagement of any amblyogenic potential from ocular misalignment. [J Pediatr Ophthalmol Strabismus. 2024;61(6):e75-e77.].

Purpose: To evaluate the structural and microvascular changes in the retina and choroid after strabismus surgery.

Methods: The study included 44 eyes from 44 patients who underwent strabismus surgery between August 2020 and December 2021. Among these patients, 9 (20%) underwent horizontal one-muscle surgery, 27 (61%) underwent horizontal two-muscle surgery, and 8 (18%) underwent inferior oblique muscle anteriorization surgery. Optical coherence tomography angiography scans were conducted preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively.

Results: The outer retinal blood flow showed a significant increase at 1 day postoperatively in horizontal two-muscle and inferior oblique muscle anteriorization surgery, whereas no significant difference was observed between periods in horizontal one-muscle surgery (P = .007). Choriocapillaris blood flow exhibited a significant increase at 1 day and 1 month postoperatively compared to the preoperative period (P < .001). Whole image superficial capillary plexus vascular density was significantly lower at 1 day postoperatively than preoperatively and 1 and 3 months postoperatively (P < .001). Whole image deep capillary plexus vascular density was significantly lower at 1 day than at 1 month postoperatively (P = .002).

Conclusions: Following strabismus surgery, temporary changes in the hemodynamic microcirculation in the retina and choroid are observed. A transient decrease in retinal artery blood supply may be noticed, possibly attributed to the reduced anterior segment blood supply. [J Pediatr Ophthalmol Strabismus. 2024;61(6):397-403.].