Journal of Pediatric Ophthalmology & Strabismus最新文献

This interventional case report documents the underlying genetic mutation, secondary muscle changes, and the result of surgical intervention in a patient presenting with synergistic convergence and esotropia. A 16-year-old patient underwent full ophthalmic examination, radiological imaging, and genetic testing. Diagnosis of horizontal gaze palsy with progressive scoliosis was confirmed, suggesting central miswiring as a cause of the synergistic convergence. Whole exome sequencing gene test revealed homozygous ROBO3 gene mutation (p.Leu888Arg) at a mutational hot spot with a GERP score of 4.88. Several computational analyses predicted the variant to be damaging. Bilateral medial rectus recessions of 7 and 8 mm were performed. Both medial rectus muscles were found tight, but not atrophic. Orthotropia and temporary resolution of synergistic convergence were documented. This case study reports a new mutation in the ROBO3 gene, and it is one of the few cases of central synergistic convergence that underwent surgical intervention and documenting secondary muscle changes.

Purpose: To evaluate the relationship between sociodemographic characteristics and type of retinal hemorrhages in patients with non-accidental trauma.

Methods: Medical charts of patients with International Statistical Classification of Diseases and Related Health Problems codes corresponding to non-accidental trauma and retinal hemorrhage at one institution in Washington, DC, from 2010 to 2022 were retrospectively reviewed. Demographic information including race and ethnicity, age, sex, and insurance coverage were recorded. Retinal hemorrhage characteristics (including the layer depth and the extension of hemorrhage), and follow-up visual acuity data were collected.

Results: The study found that patients with deep or sub-retinal hemorrhages were more likely to have Medicaid insurance than those with preretinal hemorrhages (P = .049). Patients with hemorrhages extending to the periphery and ora serrata were younger than those with hemorrhages concentrated around the disc (P = .018). The duration of time before the first follow-up visit was significantly longer for Hispanic/Latino/Spanish patients, and the duration of time to the second follow-up visit was significantly longer for patients who had Medicaid.

Conclusions: To the authors' knowledge, there have been no previous studies discerning correlative factors for pediatric patients with non-accidental trauma who have severe retinal hemorrhage. The significant associations between Medicaid insurance and young age with more severe retinal hemorrhages may provide insight to help establish priorities for interventions to reduce non-accidental trauma events in these demographic groups.

Purpose: To evaluate retinal parameters and choroidal structural changes in children with isolated growth hormone deficiency (IGHD) and compare them with healthy children, and to find out whether these parameters are affected by growth hormone replacement therapy.

Methods: A total of 56 patients diagnosed as having IGHD were included in the study. The control group consisted of 46 healthy children, carefully matched for age and sex, with no systemic or ocular problems. All patients and controls underwent enhanced depth imaging optical coherence tomography to measure the central macular thickness (CMT), retinal nerve fiber layer (RNFL) thickness, subfoveal choroidal thickness (SFCT), choroidal luminal area, stromal area, and the total area. Choroidal vascular index (CVI) was calculated as the ratio of luminal area to total choroidal area.

Results: No statistically significant difference was observed between the groups in terms of age, gender, axial length, best corrected visual acuity, and intraocular pressure (P > .50). There were no significant differences in CMT and RNFL thickness between the study and control groups (P = .91 and .78, respectively). However, mean SFCT was significantly lower in the study group (333.7 ± 37.9 µm) than in the control group (351.2 ± 34.3 µm) (P = .01). Similarly, luminal area, total choroidal area, and CVI were significantly lower in the study group than in the control group (P < .05). Although no significant change was observed in CMT and RNFL thickness 12 months after growth hormone replacement therapy in the study group (P > .05), a significant increase was noted in SFCT, luminal area, total choroidal area, and CVI (P < .05).

Conclusions: This study shows that patients with IGHD have lower SCT and CVI values compared to healthy children. Growth hormone treatment appears to be associated with choroidal development.

Purpose: To establish a dose-response reference for surgical planning in type III acute acquired concomitant esotropia (AACE).

Methods: This study included consecutive patients who underwent unilateral or bilateral medial rectus recession for type III AACE or common forms of esotropia correction from January 2019 to August 2023. All patients with a minimum follow-up of 3 months were analyzed.

Results: A total of 269 participants were included in the study, with 170 having type III AACE and 99 having esotropia. The mean age of the participants was 20.93 ± 12.83 years, including 166 males and 103 females, with preoperative angles of deviation measuring 35.37 ±13.18 degrees. It was found that preoperative horizontal deviation had a significant impact on the total surgical amount required by the patients. When predicting the total surgical amount for patients with type III AACE, the recommended regression equation is Y = 3.259 + 0.174 × preoperative horizontal deviation. Additionally, for patients with type III AACE who had preoperative horizontal deviation less than 40 degrees, the quantified reference formula for the total surgical amount was Y = 1.746 + 0.236 × preoperative horizontal deviation. For patients with type III AACE who had preoperative horizontal deviation of 40 degrees or greater, the quantified reference formula for the total surgical amount was Y = 4.600 + 0.143 × preoperative horizontal deviation.

Conclusions: This study conducted a detailed quantitative analysis of the impact of preoperative horizontal deviation levels on the total surgical amount for patients with type III AACE and established specific quantitative reference formulas to inform surgeons' surgical planning.

Purpose: To assess the incidence and risk factors of retinopathy of prematurity (ROP) in Cyprus and evaluate the validity of United Kingdom-based screening criteria on the population. The findings aimed to optimize ROP screening guidelines for improved neonatal care.

Methods: This was a retrospective study of 183 children undergoing ROP screening from January to December 2023 in the only tertiary neonatal intensive care unit in Cyprus.

Results: A total of 33 infants developed ROP (18%) and 11 of these had vision-threatening ROP. Nine infants received treatment and two died prior to treatment. The youngest infant with ROP was born at 24 weeks of gestation and the oldest was born at 32 weeks. Gestational age, birth weight, sepsis, and long oxygen duration have a strong association with ROP, whereas race, multiple births, blood transfusion, and other operations in the neonatal age are not associated with ROP. Every week of increase in gestational age is correlated with reduction in ROP incidence. The severe prematurity group born at 24 to 28 weeks had the highest risk of vision-threatening disease.

Conclusions: Based on the analysis of a cohort of 183 preterm infants who underwent ROP screening over 1 year in the only tertiary-level neonatal intensive care unit in Cyprus, the authors concluded that the 2008 United Kingdom ROP screening criteria are appropriate and valid for this population because no cases of treatment-requiring ROP were missed. The findings indicate that the severity of prematurity is the primary determinant of ROP risk, whereas other independent risk factors appear to have a comparatively lesser impact on the development of ROP. Importantly, this represents the first epidemiological study of ROP in Cyprus, providing a nationally representative assessment of ROP incidence and screening effectiveness.

Purpose: To determine normative corneal epithelial thickness (CET) profiles in healthy Turkish children using anterior segment optical coherence tomography (AS-OCT), and to explore regional variations and associations with demographic and refractive parameters.

Methods: This cross-sectional observational study was conducted at a tertiary eye hospital and included 86 healthy children aged 7 to 18 years. One eye per participant was randomly selected. All participants underwent complete ophthalmic examination, cycloplegic autore-fraction, and AS-OCT imaging. CET measurements were obtained from central (2-mm), paracentral (5-mm), and midperipheral (6-mm) zones across eight radial sectors. Statistical analyses included sex-based comparisons, quadrant-based thickness differences, and correlation analyses with age and refractive parameters.

Results: Mean central CET was 53.7 ± 4.6 µm. Epithelial thickness (ET) decreased toward the periphery, with inferior and inferonasal sectors being thickest and superior sectors thinnest. Males exhibited significantly greater CET in several paracentral and midperipheral sectors (P < .05). Quadrant-based comparisons revealed consistent asymmetry: ET was greater in inferior and nasal sectors compared to superior and temporal regions, whereas corneal thickness was lower in the inferior and temporal quadrants relative to superior and nasal counterparts (P < .001). Central CET showed no correlation with age or refractive error, whereas paracentral nasal and temporal sectors exhibited weak age-related thinning (P < .05).

Conclusions: This study provides normative pediatric CET data, highlighting characteristic spatial variations and subtle sex-based differences. These findings support the clinical utility of epithelial mapping in early keratoconus detection and its integration into artificial intelligence-based diagnostic systems.

Purpose: To further explore the specific cognitive and behavioral challenges that may be associated with visual difficulties by examining demographic, health, and behavioral data from the 2022 National Health Interview Survey (NHIS).

Methods: Pediatric data from the 2022 NHIS were analyzed using the JMP Pro 16 software. Univariate and multivariate analyses were performed to identify associations among variables including visual difficulties, demographics, overall health, life satisfaction, learning disabilities, and behavioral subscale scores as assessed by caregivers.

Results: Children between 2 and 17 years of age with difficulty seeing according to their caretakers were less satisfied with life and had a higher prevalence of attention-deficit/hyperactivity disorder, intellectual disability, autism, developmental delay, and learning disabilities. Controlling for these conditions, children with visual difficulties received higher scores on all behavioral subscales, suggesting an association with more behavioral challenges, as perceived by caregivers. These subscales included peer problems, hyperactivity, conduct problems, and emotional problems.

Conclusions: There was a correlation between difficulty seeing and emotional, cognitive, and behavioral challenges as reported by caregivers. Although these findings must be interpreted with caution due to their reliance on caregiver perception, pediatricians may consider ophthalmologic evaluation as part of a comprehensive assessment for children presenting with mental health or behavioral concerns, given the observed associations between visual difficulties and behavioral challenges.

Purpose: To evaluate how permitting parents to be present during their infant's retinopathy of prematurity (ROP) staging examination affects their levels of anxiety, depression, and hopelessness.

Methods: This prospective cross-sectional study was conducted at two ROP centers, each following its routine parental attendance protocol. In the parent group, parents were permitted to accompany their infants during screenings, whereas in the no parent group, they were not. Parents completed the Beck Anxiety Inventory, Beck Depression Inventory, and Beck Hopelessness Scale immediately following their infant's first ROP examination.

Results: A total of 123 parents participated, with 65 in the parent group and 58 in the no parent group. There were no significant differences between the groups regarding demographic and clinical variables, except for the proportion of mothers (P = .030). Anxiety, depression, and hopelessness did not significantly differ between the groups. Mothers exhibited higher depression scores than fathers in both groups (P = .011 for the parent group; P = .036 for the no parent group) and higher anxiety scores in the parent group (P = .029). Neonatal intensive care unit (NICU) duration positively correlated with anxiety (r = 0.33, P < .001) and depression (r = 0.25, P = .006). Gestational age and birth weight showed weak negative correlations with anxiety (r = -0.29, P = .001; r = -0.25, P = .006, respectively).

Conclusions: Witnessing ROP examinations did not significantly affect parental psychological outcomes. Notably, mothers experienced higher emotional distress than fathers, possibly due to extended NICU stays. Considering parents' opinions before including them in ROP examinations is essential for empathetic and ethical practice.

Purpose: To explore whether earlier exposure to the pediatric ophthalmology subspecialty could help foster interest and enhance recruitment efforts among medical students to more effectively develop and connect with potential, future pediatric ophthalmologists.

Methods: A 22-question survey was administered via Qualtrics to medical students at 13 different accredited medical schools.

Results: The survey garnered 392 complete responses. Demographically, respondents included 34% men and 66% women, with the largest participant category being MS-2 level (44%) in the survey. Three-quarters of students expressed potential interest in working with children as practicing physicians. Notably, only 8% of students had encountered pediatric ophthalmology rotations during their training, and 40% were uninformed about the training necessary to pursue a pediatric ophthalmology fellowship. The following associations with higher awareness of pediatric ophthalmology were found to be statistically significant: female gender identity, individuals with a family member or friend who is an ophthalmologist, and students with a personal medical history involving an ophthalmologist.

Conclusions: This study highlights the significant deficiency in medical student exposure and education concerning pediatric ophthalmology. By recognizing this knowledge gap, this study underscores the necessity of enhancing pediatric ophthalmology exposure for medical students as a viable and rewarding career option.