Journal of Pediatric Ophthalmology & Strabismus最新文献

This is a case report of a female infant with two rare pathogenic chromosomal abnormalities: partial trisomy of chromosome 3 (3q25.2 to 3q29) and partial monosomy of chromosome 4 (4q34.1 to 4q35.2). A comprehensive evaluation and literature review revealed ocular and systemic malformations not previously described in association with either chromosomal aberration. Comparative genomic hybridization was performed to confirm the chromosomal abnormalities. A thorough literature search was conducted to contextualize the findings within existing knowledge of similar chromosomal aberrations. Genetic analysis revealed an unbalanced translocation between the long arms of chromosomes 3 and 4, resulting in partial trisomy of chromosome 3 (3q25.2 to 3q29) and partial monosomy of chromosome 4 (4q34.1 to 4q35.2). Ocular anomalies included nystagmus, epicanthus, lagophthalmos, entropion, megalocornea, corneal clouding, infantile glaucoma, high myopia, and retinal hyperpigmentation. The patient would undergo bilateral lower eyelid rotation and gonioscopy-assisted transluminal trabeculectomy procedures in the management of her congenital malformations. The distinct ophthalmic abnormalities observed represent novel features within the spectrum of partial trisomy three and partial monosomy four at the specified breakpoints. The literature search unveiled the previously documented features associated with genetic translocation and confirmed various novel features specific to our patient's phenotype. Further research will be essential to elucidate the genetic mechanisms underlying these ocular manifestations and their implications for the clinical management of cases. [J Pediatr Ophthalmol Strabismus. 2024;61(6):e66-e74.].

Purpose: To evaluate for an association between systemic hypertension and intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) treatment, due to a 2020 case report of a neonate with ROP developing systemic hypertension and posterior reversible encephalopathy syndrome (PRES) after IVB and limited data on long-term safety of IVB.

Methods: A retrospective cohort study was conducted using vital signs for 90 days, comparing IVB to laser treatment. The primary outcome was short-term hypertension, recorded for at least 3 consecutive days following treatment. As a secondary outcome, infants treated with IVB were also compared to infants with severe ROP who experienced spontaneous regression without treatment. Rates of long-term hypertension, based on chart diagnoses at discharge, were also reviewed. Neuroimaging was re-reviewed to evaluate for vasogenic edema consistent with PRES.

Results: Overall, 137 infants with severe ROP were included, of whom 94 required treatment. There were no baseline differences in neonatal comorbidities comparing laser to IVB. There was no difference on unadjusted or adjusted logistic regression comparing odds of short-term hypertension after IVB to laser (adjusted odds ratio: 0.69, 095% CI: 0.25, 1.87). There was no significant difference in the rate of long-term hypertension diagnoses by treatment group.

Conclusions: The lack of association between IVB and short-term systemic hypertension is reassuring. Further studies are warranted to confirm this. [J Pediatr Ophthalmol Strabismus. 2024;61(6):434-441.].

Purpose: To assess the appropriateness and readability of responses provided by four large language models (LLMs) (ChatGPT-4, Claude 3, Gemini, and Microsoft Co-pilot) to parents' queries pertaining to retinopathy of prematurity (ROP).

Methods: A total of 60 frequently asked questions were collated and categorized into six distinct sections. The responses generated by the LLMs were evaluated by three experienced ROP specialists to determine their appropriateness and comprehensiveness. Additionally, the readability of the responses was assessed using a range of metrics, including the Flesch-Kincaid Grade Level (FKGL), Gunning Fog (GF) Index, Coleman-Liau (CL) Index, Simple Measure of Gobbledygook (SMOG) Index, and Flesch Reading Ease (FRE) score.

Results: ChatGPT-4 demonstrated the highest level of appropriateness (100%) and performed exceptionally well in the Likert analysis, scoring 5 points on 96% of questions. The CL Index and FRE scores identified Gemini as the most readable LLM, whereas the GF Index and SMOG Index rated Microsoft Copilot as the most readable. Nevertheless, ChatGPT-4 exhibited the most intricate text structure, with scores of 18.56 on the GF Index, 18.56 on the CL Index, 17.2 on the SMOG Index, and 9.45 on the FRE score. This suggests that the responses demand a college-level comprehension.

Conclusions: ChatGPT-4 demonstrated higher performance than other LLMs in responding to questions related to ROP; however, its texts were more complex. In terms of readability, Gemini and Microsoft Copilot were found to be more successful. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].

Purpose: To evaluate the demographic profile of premature infants presenting with stage 4B and stage 5 retinopathy of prematurity (ROP) at a tertiary referral center in South India.

Methods: This was a retrospective review including all premature infants with stage 4B and 5 ROP between January 1, 2015 and December 31, 2022. Parameters included the newborns born at the tertiary care nursery of various institutes, gestational age, birth weight, age at presentation to the hospital, risk factors, screening details, neonatal intensive care unit details, reason for consultation, and timing of referral to the center.

Results: Two hundred twenty eyes of 110 premature infants were included. Of 110 infants, 6 were born within the same city and 104 were from other districts or states. Mean birth weight was 1,125 ± 360 g and mean gestational age at birth was 28 ± 2 weeks. Mean age was 42 ± 82 weeks and median age at presentation was 17 weeks (range: 2.86 to 591 weeks). Male-to-female infant ratio was 1.34:1. Fifty (45.4%) infants had bilateral stage 5 ROP, 17 (15.4%) had stage 5 in one eye and stage 4B in the other eye, 15 (13.6%) had bilateral stage 4B and 23 (20.9%) had stage 4B in one eye and stage 4A/stage 3 in the other eye. Five (4.5%) had stage 5 in one eye and vitreous hemorrhage/stage 4A in the other eye. Among those with bilateral stage 5 ROP, 90% were from neighboring districts/states. Fifty-two (47.27%) infants underwent vitreoretinal surgery. Of 110 infants, 28 (25.45%) were self-referred (late presentation due to family-related issues), 80 (72.73%) were referred by ophthalmologists either after a few sessions of late screening or for further management, 1 (0.91%) was referred through telescreening, and 1 was referred from pediatricians directly to the hospital.

Conclusions: This study highlights the importance of awareness of the disease and screening of premature infants. Lack of these two factors leads to late presentation of these infants with advanced stages and serious implications. [J Pediatr Ophthalmol Strabismus. 2024;61(5):339-343.].

Purpose: To report long-term ocular alignment and sensory outcomes after medial rectus recession for high accommodative convergence/accommodation (AC/A) ratio esotropia.

Methods: The medical records of consecutive patients who had undergone unilateral or bilateral medial rectus recession for high AC/A ratio esotropia and were observed postoperatively for a minimum of 5 years were reviewed retrospectively.

Results: A total of 34 patients were included. Twenty-three patients (68%) used bifocals preoperatively. The mean age at surgery was 11.5 ± 4.4 years (range: 2.5 to 19.0 years). The mean postoperative follow-up was 7.5 ± 2.3 years (range: 5.0 to 15.25 years). Overall, 21 patients (62%) had surgical success at their last follow-up visit. Age at surgery, preoperative angle of distance and near deviation, distance-near disparity, and preoperative bifocal wear did not predict motor outcome after surgery. Preoperative presence of peripheral binocular single vision was a significant favorable factor for surgical success. At the last follow-up visit, 21% of patients had a recurrence of high AC/A ratio esotropia and 9% each had consecutive exotropia (intermittent [3%] and constant [6%]) and basic esotropia. Peripheral binocular single vision was achieved in 64% of patients and stereopsis in 28%. Bifocal segment was eliminated postoperatively in 70% of patients.

Conclusions: Nearly two-thirds of patients with high AC/A ratio esotropia achieved a successful long-term motor outcome and peripheral binocular single vision, and nearly one-fourth achieved stereopsis. Recurrence of high AC/A ratio esotropia occurred in some patients, and consecutive exotropia and basic esotropia in a few. Bifocal segment was eliminated postoperatively in 70% of patients. [J Pediatr Ophthalmol Strabismus. 2024;61(5):344-350.].

Purpose: To observe postoperative histological changes in the anterior part of the posterior fixation suture after a Faden operation in an animal model.

Methods: A posterior fixation suture was placed at two points 6 mm posterior to the insertion of the extraocular muscle on the superior rectus muscle of the right eye in eight rabbits. The superior rectus muscle of the left eye was used as a control. The eyes were enucleated and the anterior portion of the posterior fixation suture, including the myoscleral junction, was extracted 4 weeks after surgery. Postoperative adhesion was graded from 0 to 4 based on histologic findings (hematoxylin-eosin and Masson's trichrome staining).

Results: Histological evaluation revealed diffuse fibrosis at the myoscleral junction and the anterior part of the posterior fixation suture after the Faden operation. The graded scores for fibrosis, acute inflammation, chronic inflammation, and foreign body reactions in the Faden operation group were significantly higher than those in the control group (P < .05). Postoperative diffuse fibrosis of the myoscleral junction and anterior-to-posterior fixation sutures were observed in an animal model.

Conclusions: Histologic changes may affect ocular alignment and motility, making reoperation unpredictable after the Faden procedure. [J Pediatr Ophthalmol Strabismus. 2024;61(5):371-375.].

Oculomotor synkinesis is an unusual phenomenon that encompasses various presentations with few associations reported in the literature. It can occur with or without a previous setting of oculomotor nerve injury. The authors present the first reported case of bilateral congenital trochlear-oculomotor synkinesis in a 5-month-old infant. [J Pediatr Ophthalmol Strabismus. 2024;61(5):e50-e53.].