Journal of Pediatric Ophthalmology & Strabismus最新文献

Virtual reality presents an efficient and engaging approach to ophthalmological diagnosis and treatment in children. This systematic review investigates the current state of eye tracking technology integrated into virtual reality for the spectrum of pediatric ophthalmology. The search encompassed the MEDLINE database via PubMed, without imposing any time restrictions. A total of 20 relevant studies that met our inclusion criteria were incorporated and categorized into the following domains: diagnosis, examination, treatment, and rehabilitation use of virtual reality devices within the realm of pediatric ophthalmology. Strabismus examinations and postoperative monitoring, inherited retinal degeneration examination and visual function testing, therapy of amblyopia, glaucoma visual field testing, cerebral visual impairment rehabilitation, and neuro-ophthalmic disease examination were included in the final analysis. Pediatric ophthalmology offers a promising landscape for the integration of eye tracking technology within virtual reality, with accelerated, quantifiable, and objective examination and diagnosis, and precise, real-time measurements that are crucial in children. Virtual reality is an engaging experience, easily applied in a pediatric setting and facilitating compliance during examination and adherence to therapy. Although our systematic review provides insights into the current state of research, it is anticipated that further exploration is required for the widespread utilization of eye tracking in virtual reality within pediatric ophthalmology. [J Pediatr Ophthalmol Strabismus. 2024;61(6):381-390.].

Purpose: To evaluate the reliability of Mendonça strabismus forceps in locating the extraocular rectus muscles in patients undergoing primary strabismus surgery or reoperation. The study also compared the method's efficacy in primary surgeries versus reoperations. The overall goal was to avoid unnecessary surgical exploration, thereby enabling more effective planning and safer surgery.

Methods: The study included 41 patients with strabismus undergoing surgical correction. The reliability of the Mendonça strabismus forceps in locating the extraocular rectus muscles was evaluated by comparing preoperative measurements using Mendonça strabismus forceps and Castroviejo forceps to intraoperative measurements made by direct muscle visualization. Differences of 1 mm or less were deemed acceptable.

Results: In patients without prior surgery, Mendonça strabismus forceps reliably located all muscles, with measurements consistently within the 1-mm limit. All muscles with previous surgeries were successfully grasped by the forceps, except for one medial rectus muscle with multiple interventions. In reoperations with satisfactory muscle grasp, 88.8% showed coincident measurements. Non-coincidence cases were attributed to anomalous scarring. The method demonstrated simplicity, cost-effectiveness, and no complications in this study.

Conclusions: The Mendonça strabismus forceps proved to be a reliable and non-invasive method for locating extraocular rectus muscles insertions without the need for additional imaging. It is a cost-effective, simple, and easily executed method that provides valuable information for surgical decision-making and planning. The method enhances surgical outcomes while reducing risks. [J Pediatr Ophthalmol Strabismus. 2024;61(6):404-409.].

The authors describe surgical occlusion with levator resection and partial tarsorrhaphy as a treatment for nystagmus with oscillopsia refractory to medical or surgical therapies. This was a case of Bardet-Biedl syndrome with high myopia and acquired sensory pendular nystagmus in both eyes, where a well-known technique was applied to a novel indication. Permanent occlusion of the left eye led to significant improvement in visual acuity and reduced oscillopsia, enhancing the psychological and social functioning. This case highlights the complexity of treating refractory nystagmus with oscillopsia and proposes surgical occlusion as a viable option for improving patient outcomes in severe cases. [J Pediatr Ophthalmol Strabismus. 2024;61(6):e63-e65.].

Purpose: To identify pediatric patient and appointment characteristics associated with no-show status at a tertiary care pediatric ophthalmology clinic within a U.S. academic ophthalmology department.

Methods: A cross-sectional retrospective chart review was performed for all pediatric patients with a scheduled ophthalmology appointment at the Penn State Eye Center between April 1, 2022 and March 31, 2023. A multivariate logistic regression analysis assessed associations between appointment nonattendance and patient characteristics.

Results: Of 8,083 scheduled visits, 1,445 (17.9%) were no-shows. Factors associated with no-show status included appointment type (new vs return odds ratio [OR]: 1.43, 95% CI: 1.26 to 1.63, P < .001); lower median household income (< $41,374 vs > $68,957 OR: 1.89, 95% CI: 1.40 to 2.55, P < .001; $41,374 to $68,957 vs > $68,957 OR: 1.27, 95% CI: 1.12 to 1.44, P < .001); non-private insurance (self-pay vs private: OR: 5.65, 95% CI: 3.87 to 8.24, P < .001, Medicaid vs private: OR: 2.17, 95% CI: 2.32 to 3.16, P < .001); commute distance 10 to 30 miles vs < 5 miles (OR: 1.49, 95% CI: 1.11 to 1.99, P = .008); race: unavailable vs White (OR: 2.18, 95% CI: 1.66 to 2.85, P < .001), Black vs White (OR: 1.86, 95% CI:1.53 to 2.27, P < .001), Other vs White (OR: 1.47, 95% CI: 1.27 to 1.70, P < .001); ethnicity: Hispanic vs non-Hispanic (OR: 1.92, 95% CI: 1.62 to 2.27, P < .001); and language preference: Spanish vs English (OR: 1.86, 95% CI: 1.49 to 2.32, P < .001), Nepali vs English (OR: 1.60, 95% CI: 1.06 to 2.43, P = .027), other vs English (OR: 1.83, 95% CI: 1.35 to 2.49, P < .001). Appointment reminders (phone call, P = .013); text message, P < .001; other, P = .013) all resulted in a greater propensity to show, but email communication alone did not (P = .674).

Conclusions: Certain patient and appointment characteristics that are linked to a higher rate of no-show status can inform targeted initiatives to improve health care outcomes, resource utilization, and clinical efficiency in the pediatric ophthalmology community. [J Pediatr Ophthalmol Strabismus. 2024;61(6):442-451.].

The authors report a case of a 66-year-old man with sudden-onset diplopia and redness in the left eye. The examination revealed left hypotropia with exotropia and limited elevation. Contrast-enhanced computed tomography and histopathology suggested inferior rectus myositis with fibrosis. The patient was treated with steroid pulse therapy, followed by slow tapering. Later, the patient underwent surgical strabismus correction. He remained diplopia-free with an excellent cosmetic outcome and minimal elevation deficit 12 months postoperatively. [J Pediatr Ophthalmol Strabismus. 2024;61(6):e59-e62.].

Purpose: To contribute evidence about the effectiveness of dichoptic therapy in patients with mild to moderate amblyopia.

Methods: A retrospective study was conducted in patients enrolled for dichoptic therapy on the Bynocs AmblyGo platform (Kanohi Eye Pvt Ltd) from January to August 2023. Data collected included logarithm of the minimum angle of resolution best corrected visual acuity, anterior and posterior segment examination, fixation pattern, dynamic and cycloplegic refraction, orthoptic evaluation, and number of dichoptic therapy sessions. Visual acuity, binocularity, and stereopsis before and after therapy were analyzed.

Results: Of 59 patients (median age: 11 years, range: 5 to 30 years) enrolled, 34 (57.6%) had anisometropic amblyopia, 12 (20.3%) had ametropic amblyopia, 10 (17.0%) had strabismic amblyopia, and 3 (5.1%) had deprivation amblyopia. All 6 (10.2%) and 15 (22.4%) patients who had no binocular single vision for near and distance before therapy, respectively, attained normal binocular single vision on completion, except one who suppressed at distance. Twenty-one (75.0%) had improved near stereopsis, and 21 (60.0%) had improved distance stereopsis. Of 74 eyes treated, 61 (82.4%) had improved visual acuity and 73 (98.6%) improved in at least one tested parameter. A majority of these eyes had residual amblyopia after occlusion therapy.

Conclusions: Dichoptic therapy improves visual acuity, binocularity, and stereoacuity in patients with amblyopia, including those older than 8 years, especially in partial deprivation, ametropic, and anisometropic amblyopia. [J Pediatr Ophthalmol Strabismus. 2024;61(6):416-424.].

Purpose: To compare children's stereometric optic disc parameters and inner retinal thickness measured by optical coherence tomography (OCT) in two different moments in life in the same children and to establish a correlation between the optic nerve head (ONH) area and the difference of these parameters in the two observations.

Methods: In this observational cohort, children were evaluated on two occasions: at 6.7 ± 1.6 and 13.2 ± 0.7 years of age. Cup volume, neuroretinal rim (NRR) area, average cup-to-disc ratio, peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell inner plexiform layer (GCIPL) were measured by the Cirrus HD-OCT (Carl Zeiss Meditec AG).

Results: A total of 175 children were included, 89 boys (50.9%) and 86 girls (49.1%). There was a significant decrease of the NRR area (P < .001) and increase of the cup volume (P < .001) on the second observation. The pRNFL thickness and GCIPL thickness also decreased (P < .001 and P = .002, respectively). There was a positive correlation between the ONH area and the difference of the cup volume (P = .047; r = 0.102) and a negative correlation with the difference of the NRR area (P < .001; r = 0.237).

Conclusions: During childhood, there is an increase of the cup volume, a decrease of the NRR area, and a decrease of inner retinal layer thickness (more significant in the superior and inferior quadrants) measured by OCT. This study demonstrates that in children with large discs the enlargement of the cup and decrease of the NRR is more evident. Considering these changes, the physiological enlargement of the cup in a child with a large disc can be misinterpreted as the development of a glaucomatous lesion. [J Pediatr Ophthalmol Strabismus. 2024;61(6):410-415.].

Purpose: To examine female representation among current chiefs of pediatric ophthalmology services of academic medical centers and children's hospitals, as well as program directors of ophthalmology residency and pediatric ophthalmology fellowship programs in the United States.

Methods: Data collection for this cross-sectional study occurred between December 2023 and February 2024, using publicly available sources to compile a list of academic medical centers and children's hospitals, as well as ophthalmology residency programs and pediatric ophthalmology fellowship programs that participated in the 2023-2024 San Francisco Match. Chi-squared analyses were performed using Excel 2021 software, where a P value less than .05 was considered statistically significant.

Results: Of the dedicated pediatric ophthalmology services across academic medical centers and children's hospitals in the United States, 38.3% (64/167) are led by a female chief. Female representation was greater at children's hospitals (40.0%, 36/90) than at academic medical centers (36.4%, 28/77), although no significant difference was observed (P = .69). Gender distribution was near equivalent at both academic training program levels, with slightly more female directors of fellowship programs (45.7%, 21/46) than ophthalmology residency programs (42.3%, 52/123) (P = .33).

Conclusions: The authors report near equivalent female representation in the leadership of academic training programs at the residency and fellowship level. However, the proportion of female pediatric ophthalmology division chiefs lags behind the actual gender composition of the workforce. Given the increasing prevalence of female pediatric ophthalmologists, promotion of concordant representation in leadership is necessary to reflect the changing sociocultural landscape and to close the gender gap. [J Pediatr Ophthalmol Strabismus. 2024;61(6):391-396.].

Purpose: To introduce the application of novel fixable instruments in strabismus surgery without surgical assistants.

Methods: Patients with strabismus requiring surgical treatment were recruited. Under general anesthesia all patients underwent surgery with the three novel kinds of fixable instruments without assistants. The operation time of each muscle was recorded separately.

Results: A total of 30 patients were enrolled in this study. There were 34 lateral rectus muscles, 22 medial rectus muscles, 2 superior rectus muscles, 2 inferior rectus muscles, and 14 inferior oblique muscles. The amount of recession and resection of the lateral rectus muscle was 6 to 11 and 4 to 6 mm, respectively, and the operation time of each muscle was between 8 and 12 minutes (mean ± standard deviation: 9.88 ± 1.59 minutes). The amount of recession and resection of the medial rectus muscle was 5 to 6.5 and 4 to 6 mm, respectively, and the operation time of each muscle was 7 to 14 minutes (mean ± standard deviation: 10.59 ± 2.38 minutes). Two superior rectus muscles were recessed 7 and 9 mm and the operation time was 8 and 10 minutes, respectively. Two inferior rectus muscles were recessed 4 and 5 mm and the operation time was 7 and 9 minutes, respectively. In addition, the operation time of each oblique muscle was 6 to 10 minutes (mean ± standard deviation: 8.57 ± 1.40 minutes). All patients recovered ocular alignment with no adverse reaction in eyes on the first day after surgery.

Conclusions: With the assistance of the novel fixable instruments, the surgeon can easily perform routine strabismus surgeries even without surgical assistants. [J Pediatr Ophthalmol Strabismus. 2024;61(6):425-433.].