Journal of Pediatric Ophthalmology & Strabismus最新文献

The authors describe a Chinese boy presenting with recurrent retinoblastoma in combination with anterior chamber and vitreous seeding. After two cycles of intra-arterial chemotherapy combined with intracameral and intravitreal melphalan injections, the retinal tumor regressed. The seeds in the anterior chamber and vitreous body were invisible. After 12 months of follow-up, extraocular metastasis was not demonstrated and the retinal tumor was stable. The visual acuity of this patient remained 20/30.

Purpose: To perform a systematic review and meta-analysis comparing the efficacy of botulinum toxin A (BTX-A) and bilateral medial rectus recession (BMR) surgery for partially accommodative esotropia (PAET).

Methods: PubMed, EMBASE, and the Cochrane database were searched on May 29, 2024 for studies comparing BTX-A and BMR in patients with PAET, reporting at least one outcome of interest. The odds ratio (OR) and 95% CI were used for binary outcomes. Heterogeneity was assessed using I² statistics. The analysis was performed using R software version 4.3.2. The Risk of Bias Summary for Non-randomized Studies tool was used to assess the risk of bias.

Results: Four observational studies comprising 521 patients were eligible for inclusion. BTX-A and BMR groups had comparable motor success rates (OR: 1.14; 95% CI: 0.27 to 4.81; P = .861; I2 = 88%). However, consecutive exotropia was reported exclusively after BMR only (OR: 0.08; 95% CI: 0.01 to 0.46; P = .004; I² = 0%). All studies accounted for heterogeneity in the leave-one-out sensitivity analysis. Two studies were judged as moderate risk of bias and two as serious. Assessment of Grading of Recommendations Assessment Development and Evaluation resulted in moderate certainty in the outcome of motor success rates.

Conclusions: BTX-A might be a good alternative to BMR in patients with PAET. Randomized controlled trials with larger sample sizes and longer duration of follow-up are needed. Studies should also focus on sensory outcomes in addition to motor outcomes.

Herpes simplex virus (HSV) can affect both the central nervous system and the eye, most notably as herpes simplex encephalitis and the less common but vision-threatening acute retinal necrosis (ARN). The authors report a 13-year-old boy who developed ARN shortly after confirmed herpes simplex encephalitis despite appropriate systemic antiviral therapy. He presented with light perception vision, vitritis, retinal necrosis, and retinal detachment in the left eye, with HSV-1 detected by polymerase chain reaction from vitreous fluid. Intravitreal antiviral therapy was promptly administered, followed by early pars plana vitrectomy with silicone oil tamponade and 360-degree peripheral retinal laser, resulting in retinal reattachment and improvement of visual acuity to 20/200. After subsequent cataract extraction and silicone oil removal, visual acuity further improved to 20/80. This case emphasizes the importance of close ophthalmic monitoring in patients recovering from herpes simplex encephalitis, because ocular disease may develop rapidly even under systemic antivirals. It also underscores that early combined medical and surgical intervention can preserve meaningful vision in pediatric ARN complicated by retinal detachment. Such reports contribute to the limited literature linking herpes simplex encephalitis and ARN in children and highlight the potential for favorable outcomes with timely management.

Purpose: To examine the success rate and the dose-response ratio of three-muscle compared to two-muscle surgery for the treatment of medium- and large-angle (20 to 45 prism diopters [PD]) intermittent exotropia.

Methods: Medical records of patients who underwent strabismus surgery for treatment of intermittent exotropia were reviewed. Patients with exodeviation of 20 to 45 PD who underwent either bilateral lateral rectus recession (BLRc; two-muscle group) or BLR recession and unilateral medial rectus resection (BLRc+UMR; three-muscle group) were selected. Preoperative and postoperative deviation and amount of recessed and resected muscles were assessed. Successful surgery was defined as postoperative deviation of 10 PD or less of orthophoria at the last visit. Dose-response ratio was analyzed.

Results: Forty-four patients were included. The mean age of patients at surgery was 11.85 ± 10.82 years (range: 4 to 54 years) and was comparable in both groups. The mean far preoperative deviation was lower for the two-muscle than the three-muscle group, and measured 29.7 ± 5.9 and 34.4 ± 7.1 PD, respectively (P = .019). At the last follow-up, successful motor outcomes for both distance and near were achieved in 70.5% and 84.6% in the two-muscle and three-muscle group, respectively. At the last follow-up, mean dose-response ratio was significantly higher for the three-muscle group (1.82 ± 0.58 and 2.72 ± 0.72 PD/mm for the two-muscle and three-muscle group, respectively; P < .0001). Overcorrections were similar in both groups.

Conclusions: Primary repair surgery of intermittent exotropia with three-muscle surgery is an effective method of resolving 20 to 45 PD with excellent outcomes and a low risk of overcorrection.

Purpose: To examine the effects of accompanying systemic diseases on surgery preparation and follow-up in congenital and infantile cataract cases.

Methods: The files of patients aged 0 to 12 months presenting to one clinic between January 2010 and January 2024 and scheduled for cataract surgery were retrospectively scanned. The patients' demographic data, gestational age, age at admission and surgery, accompanying systemic diseases, and systemic complications that developed before, during, and after surgery were recorded.

Results: A total of 142 patients (75 girls, 67 boys) were included in the study. The average follow-up period was 30.6 ± 33.9 months (range: 2 to 159 months). Unilateral cataract surgery was performed in 45 (31.7%) patients and bilateral cataract surgery was performed in 97 (68.3%) patients. The average number of gestational age was 37.2 ± 3.4 week (range: 23 to 41 weeks). The average age at presentation was 4.22 ± 3.20 months (range: 1 to 12 months). Systemic pathology was present before surgery in 40 patients (28.2%). Neuromuscular system diseases were the most common accompanying systemic pathology (15 patients), followed by genetic diseases (13 patients). Eleven (7.7%) patients had facial anomalies, and 21 (14.8%) were at risk of malignant hyperthermia during anesthesia. Eighteen (12.7%) were defined as having difficult intubation, and 46 patients (32.4%) required postoperative pediatric intensive care. One patient died due to pneumonia during surgery preparations, and 4 patients died due to systemic complications unrelated to the surgery during the follow-up period.

Conclusions: Congenital cataract cases require a multi-disciplinary approach to surgical planning that considers systemic comorbidities, anesthesia management, and postoperative follow-up.

Purpose: To analyze current trends in pediatric ophthalmology and strabismus (PO&S) fellowship match and the current workforce issues that affect pediatric ophthalmology.

Methods: PO&S fellowship match data for 2016 to 2024 fellowship match cycles were obtained via the Association of University Professors of Ophthalmology and the San Francisco Match. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) was used to obtain total pediatric ophthalmology membership to estimate the number of practicing pediatric ophthalmologists within the United States from 2016 to 2024.

Results: The number of applicants who matched into PO&S fellowships was significantly lower compared to other specialties such as retina, cornea, and glaucoma. The increase in fellowship spots in PO&S (+10.2%) was also significantly lower than the increases seen in retina and glaucoma. The PO&S match rate remained lower than the other subspecialities every year from 2016 to 2024. The number of international medical graduates matching into PO&S fellowships increased compared to U.S. medical graduates from 2016 to 2024. A similar trend was seen within AAPOS membership, where the U.S. membership has remained steady and international membership has significantly grown (+47.1%) since 2016.

Conclusions: Workforce trends within pediatric ophthalmology show a continued decline in interest among U.S. medical graduates to pursue PO&S fellowships. As experienced pediatric ophthalmologists retire and interest remains lower, the provider gap widens and decreases accessibility to pediatric eye care. Efforts in addressing the disparity between the demand for pediatric ophthalmologists and the limited supply for PO&S-trained fellows need to be at the forefront.