Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To compare structural and visual outcomes of anterior versus retropupillary iris-claw intraocular lens (IOL) implantation in aphakic children with inadequate capsular support.

Methods: Thirty-two pediatric aphakic eyes with inadequate capsular support were prospectively randomized to anterior or retropupillary fixation. Outcome measures were evaluated at 1, 6, and 12 months. Visual acuity, refraction, central endothelial cell density (CECD), central corneal thickness (CCT), IOL tilt, and centration of both groups were compared.

Results: In the 32 eyes (18 children), mean age at implantation was 6.5 years. Mean best corrected visual acuity improved to 0.23 ± 0.24 and 0.18 ± 0.21 logarithm of the minimum angle of resolution at 12 months in the anterior and retropupillary groups, respectively (P = .32). There was a decrease in CECD that was significant in the anterior fixation group (P = .006), but not in the retropupillary fixation group (P = .154). The lower CECD in the anterior fixation group was statistically significant at 12 months (P = .018). Mean endothelial cell loss at 12 months was 17.4% and 5.6% in the anterior fixation group and the retropupillary fixation group, respectively. Haptic dis-enclavation occurred in 1 eye per group (6%). Pupillary block occurred in 1 eye (6%) and a significant anterior chamber (AC) reaction occurred in 2 eyes (12%) in the anterior fixation group. At 1 year of follow-up, differences in CCT and angle width between both groups were insignificant. IOL tilt and decentration were less than 4 degrees and less than 0.6 mm, respectively, in both groups. AC was significantly shallower (P < .001) in the anterior fixation group.

Conclusions: Anterior fixation of iris-claw IOLs displayed higher endothelial cell loss than retropupillary fixation at 1 year of follow-up, higher incidence of inflammatory reaction, pupillary block, and shallower AC.

Incontinentia pigmenti is an X-linked dominant multisystemic disorder caused by pathogenic variants in the inhibitor of nuclear factor kappa B kinase regulatory subunit gamma (IKBKG) gene. Mutations in the IKBKG gene, encoding the NF-kappa-B essential modulator protein, underlie its pathogenesis, leading to inflammation-driven vascular ischemia and significant ocular manifestations. The authors report a case of an Asian-Indian infant diagnosed as having stage 3 incontinentia pigmenti in both eyes treated with anti-vascular endothelial growth factor and laser photocoagulation where standard whole exome sequencing failed to reveal pathogenic variants. This case emphasizes the need for a multi-disciplinary approach to early diagnosis and intervention, and the challenges in genetic testing when dealing with rare diseases in resource-limited settings.

Purpose: To provide an improved accounting of the economic burden of chalazion removal for patients.

Methods: A retrospective study approved by the institutional review board of patients who underwent surgical incision and drainage of a chalazion at a tertiary academic center from January 2011 to December 2020 was conducted. Patients were younger than 18 years with a diagnosis of chalazion requiring excision. Out-of-pocket expenses were defined as sum of procedure cost, facility fees, and anesthesia. Center for Medicare and Medicaid Services (CMS) physician fee schedule data and the study hospital's cost estimator were used. Out-of-pocket expenses were calculated and adjusted to 2020 dollars. The cumulative cost was calculated by factoring in the average rate of surgical re-intervention for a chalazion recurrence. Cost trends were tabulated and visualized.

Results: The unadjusted, average total incision and drainage cost for chalazion from 2011 to 2020 was $543.42, increasing from $513.89 to $563.48 (+9.7%). Using costs adjusted to 2020 dollars, cost declines from $591.27 (2011) to $563.48 (2020, -4.93%) were uncovered. Using an averaged recurrence rate of 24.3%, the cumulative adjusted total cost of incision and drainage decreased from $734.95 (2011) to $700.41 (2020, -4.70%).

Conclusions: Chalazion treatment costs declined from 2011 to 2020, suggesting potentially greater affordability for families. However, families should be counseled up front on potential future expenses with surgical intervention for a recurring chalazion. Understanding total costs for recurring chalazion by accounting for potential surgical re-intervention will help pediatric ophthalmologists provide more informed counseling regarding the total cost of treatment with an appreciation for potential future costs if surgical re-intervention is required.

Purpose: To categorize the demographics, clinical profile, and medical work-up findings in adult-onset comitant esotropia (AOCET).

Methods: The authors conducted a retrospective study of adult patients with AOCET and without a history of childhood strabismus, prior strabismus surgery, ocular trauma, recent concussion, other neurologic symptoms excluding diplopia, duction deficit, or evidence of sixth cranial nerve palsy. Patients were analyzed by age of onset and refractive error.

Results: Two hundred sixty-eight patients were included, for which the mean age was 53.7 ± 19.3 years. There were more women (62.7%) than men (37.3%) overall and in every age decade. The mean refractive error was -3.22 ± 3.84 diopters, with myopia being prevalent in the younger decades, whereas the proportion of hypermetropia increased as age of onset increased. The overall mean distance esotropia was 17.2 ± 13.1 prism diopters, and was seen in an inverse relationship pattern with higher mean esotropia in the younger cohorts and lower mean esotropia in older patients. An etiology for esotropia was identified in 18 of 268 (6.7%) but only revealed new diagnoses for 6 patients: 4 thyroid eye disease, 1 myasthenia gravis, and 1 multiple sclerosis.

Conclusions: The study revealed a predominantly female, White, and myopic cohort. Testing for thyroid eye disease, myasthenia gravis, and neuroimaging rarely found an underlying medical cause for AOCET.

Purpose: To describe the findings and outcomes in pediatric endogenous endophthalmitis cases over a 5-year period in Vietnam.

Methods: All cases of pediatric endogenous endophthalmitis seen at Vietnam National Eye Hospital from 2016 to 2020 (n = 157) were retrospectively studied. Data on epidemiology, microbiology, clinical manifestations, ultrasound findings, and outcomes were collected and analyzed. Success was defined as visual acuity of counting fingers at 1 meter or better if visual acuity testing could be done, and a fully attached retina, controlled intraocular pressure, and no phthisis bulbi.

Results: The mean patient age was 6.0 ± 3.8 years. Gram-positive cocci were the most common causative agents (45.2%), followed by Gram-negative bacilli (10.8%). Among 31 cases in which both vitreous and aqueous specimens were collected, 17 (54.8%) showed discordant microbiological results. The overall treatment success rate was 38.2%. An initial visual acuity better than light perception was associated with a higher success rate (45.8% vs 16.7%, P < .05). Children presenting with ultrasound grade 3 vitreous opacity had a lower success rate compared to those with grades 1 and 2 combined (38.1% vs 69.6%, P < .05).

Conclusions: Gram-positive cocci were the most frequently identified pathogens in children with endogenous endophthalmitis in Vietnam. The low agreement between smear stain and culture results indicates that using both methods could enhance diagnostic accuracy. Initial visual acuity at admission and the degree of vitreous opacity were recognized as important prognostic factors for treatment outcomes.

Giant-cell tumors of bone (GCTBs) are benign, expansile lesions usually found in the long bones of young adults. The authors report a pediatric skull base GCTB causing cranial nerve deficits and vision loss. The patient presented with blurry vision, left eye misalignment, headaches, nausea, and vomiting. Imaging revealed a large heterogenous mass invading the anterior cranial fossa floor. Initial histopathology suggested an aneurysmal bone cyst (ABC), and the mass was surgically resected. Four months later, recurrence led to genetic testing, which identified a p.G35W H3F3A mutation, confirming GCTB with secondary ABC of the pituitary fossa causing right compressive optic neuropathy and left orbital apex syndrome. Management included repeat resection and denosumab therapy, achieving radiographic stability with preservation of vision in the right eye, although the optic nerve of the left eye remained atrophic. Given the diagnostic overlap between GCTB and ABC, the authors emphasize the importance of genetic testing for accurate and early diagnosis to enable timely treatment and reduce the risk of recurrence.

Purpose: To evaluate the efficacy of large language models (LLMs) in generating patient education materials (PEMs) on retinopathy of prematurity (ROP).

Methods: ChatGPT-3.5 (OpenAI), ChatGPT-4 (OpenAI), and Gemini (Google AI) were compared on three separate prompts. Prompt A requested that each LLM generate a novel PEM on ROP. Prompt B requested generated PEMs at the 6th-grade reading level using the validated Simple Measure of Gobbledygook (SMOG) readability formula. Prompt C requested LLMs improve the readability of existing, human-written PEMs to a 6th-grade reading level. PEMs inserted into Prompt C were sourced through a Google search of "retinopathy of prematurity." Each PEM was analyzed for readability (SMOG, Flesch-Kincaid Grade Level [FKGL]), quality (Patient Education Materials Assessment Tool [PEMAT], DISCERN), and accuracy (Likert Misinformation Scale).

Results: LLM-generated PEMs were of high quality (median DISCERN = 4), understandable (PEMAT-U ≥ 70%), and accurate (Likert = 1). Prompt B generated more readable PEMs than Prompt A (P < .001). ChatGPT-4 and Gemini rewrote PEMs (Prompt C) from a baseline readability level (FKGL: 8.8 ± 1.9, SMOG: 8.6 ± 1.5) to the targeted 6th-grade reading level. Only ChatGPT-4 rewrites maintained high quality and reliability (median DISCERN = 4).

Conclusions: LLMs, particularly ChatGPT-4, can serve as strong supplementary tools to automate the process of generating readable and high-quality PEMs for parents on ROP.