Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To evaluate the short-term effects of inferior oblique myectomy on the retinal neurovasculature, choroidal thickness, and choroidal vascularity index at the macula.

Methods: Patients older than 5 years who were candidates for inferior oblique muscle myectomy surgery participated in the study. Patients with any systemic or ocular disease that could affect the macular neurovasculature were not included in the study. After recording demographic data, including age and gender, and conducting a complete ophthalmic examination, macular optical coherence tomography (OCT), enhanced depth imaging OCT, and OCT angiography imaging (AngioVue software (V.2017.1.0.151; Optovue, Inc) were performed before (1 day to 1 week) and in the specific time intervals (1 week, 1 month, and 3 months) after the surgery for all participants.

Results: Eighteen patients (13 male and 5 female) who underwent inferior oblique muscle myectomy, with a mean ± standard deviation age of 24.22 ± 18.14 years, were included in this study. The baseline mean ± standard deviation of subfoveal choroidal luminal area and subfoveal total choroidal area were 0.390 ± 0.03 and 0.539 ± 0.04 mm², respectively. The changing pattern of the subfoveal choroidal vascularity index and subfoveal choroidal luminal area was statistically significant (P = .013 and .035, respectively).

Conclusions: Inferior oblique myectomy can lead to changes in choroid hemodynamics in the short term. However, these changes seem to be temporary. [J Pediatr Ophthalmol Strabismus. 2024;61(4):235-244.].

Purpose: To describe and report the results of a zip-up modification for loop myopexy for facilitating a muscle union procedure in heavy eye syndrome.

Methods: A retrospective chart review was conducted on patients with heavy eye syndrome in whom the modified surgical technique was performed. Superior and lateral rectus muscle bellies were approximated using a suture 4 to 5 mm from the muscle insertion. Muscles were then zipped together by 5-0 polyester sutures placed in an anteroposterior direction using a hand-over-hand technique. Details of the surgical technique were reported. Ductions, versions, and angles of strabismus were evaluated before and after surgery. Complications were reported.

Results: A total of 8 patients were identified (mean age: 60.8 ± 7 years). Mean axial length was 33.2 ± 1.2 mm. Mean preoperative horizontal and vertical angles of deviation were 78 ± 20 prism diopters (PD) (range: 50 to 120 PD) and 34 ± 4 PD (range: 30 to 40 PD), respectively. Preoperative limitation of abduction and elevation was -4 to -5 in all patients. An average of seven to eight sutures were used. No intraoperative complications were reported. In 7 patients, both vertical and horizontal angles of deviation were reduced to within 8 PD from orthophoria and limitation of ductions was reduced to null or -1 after surgery. Undercorrection occurred in 1 patient with bilateral heavy eye syndrome who had unilateral surgery. No recurrences developed over a median of 6 months of follow-up.

Conclusions: A zip-up modification for loop myopexy can facilitate the surgical procedure to achieve a satisfactory outcome in heavy eye syndrome. [J Pediatr Ophthalmol Strabismus. 2024;61(4):279-286.].

Purpose: To compare the surgical outcomes in patients who had a failed botulinum toxin A injection before surgery versus those who had surgery as primary treatment (primary surgery) for infantile esotropia.

Methods: The files of patients who had strabismus surgery in the Strabismus Unit of Beyoglu Eye Training and Research Hospital between January 2012 and March 2022 were reviewed. This study included 104 eyes of 52 patients with infantile esotropia. The angle of deviation before and 1, 3, and 6 months after botulinum toxin A injection or surgery, complications, pattern deviations, family history, abnormal head position, history of prematurity, intensive care unit admission, and consanguineous marriage were noted. A successful outcome was defined as ocular alignment of 10 prism diopters (PD) or less.

Results: The study population consisted of 52 patients: 27 (52%) boys and 25 (48%) girls. In the botulinum toxin A group (n = 26), the mean age at admission was 14.0 ± 6.8 months, whereas the mean preoperative near and far angle of deviation were 41.92 ± 12.2 and 41.3 ± 13.0 PD, respectively. The mean age at the time of surgery was 40.6 ± 18.1 months. In the primary surgery group (n = 26), the mean age at admission was 34.0 ± 15.9 months. The mean preoperative near and far angle of deviation were 37.3 ± 8.0 and 35.3 ± 10.5 PD, respectively. The mean age at the time of surgery was 48.1 ± 18.5 months. The success rates 6 months after treatment in the botulinum toxin A group and the primary surgery group were 76.9% and 88.5% in near (P > .05) and 80.8% and 88.5% in far (P > .05), respectively. Three patients had transient ptosis and one had consecutive exotropia after botulinum toxin A injection.

Conclusions: In infantile esotropia treatment, strabismus surgery after failed botulinum toxin A injection compared to primary surgery has statistically comparable surgical success rates. [J Pediatr Ophthalmol Strabismus. 2024;61(4):245-251.].

Purpose: To better understand the patient journey and challenges in the diagnosis and treatment of patients with vernal keratoconjunctivitis (VKC).

Methods: This qualitative study assessed the experience of caregivers of children with VKC (n = 7) and of clinicians who treat VKC (n = 16) in the United States. The structured interviews were conducted to identify key "pain points", obstacles, and trends on the path to diagnosis.

Results: Like an earlier study conducted in the United Kingdom, this study found low awareness of the nature and severity of VKC among U.S. caregivers and non-specialist providers, and a tendency among young patients and their caregivers to downplay initial symptoms. Medical intervention was delayed as caregivers treated symptoms with over-the-counter medications; 88% (14 of 16) of specialists reported frequent misdiagnosis and mistreatment by pediatricians and primary care providers who were initial points of care. Time to appropriate referral ranged from 1 to 2 weeks to 3 months, in part due to convoluted referral pathways that were universal points of frustration for caregivers and specialists.

Conclusions: Limited awareness of VKC remains a barrier to timely identification and management of this rare but disruptive ocular surface disease. Caregivers underestimate symptom severity, pediatricians and primary care providers often misdiagnose VKC as allergy or infection, and referrals to appropriate specialists are delayed until symptoms are severe. Early identification is essential to improving the diagnostic journey and treatment of VKC. [J Pediatr Ophthalmol Strabismus. 2024;61(4):252-256.].

Purpose: To compare a single surgeon's surgical outcomes for treating intermittent exotropia using bilateral lateral rectus recession (BLR), unilateral lateral rectus recession and medial rectus resection (RR), and unilateral lateral rectus recession and medial rectus plication (RP).

Methods: A retrospective review of all surgeries for basic intermittent exotropia between 2015 and 2023 was performed. Only patients with initial correction using BLR, RR, or RP were included. Exclusion criteria included age older than 18 years, vertical deviation, any nonrefractive ocular diagnoses, prior ocular surgery, and inadequate follow-up.

Results: There were 460 patients identified; 123 met inclusion criteria with 54 in the BLR group, 41 in the RR group, and 28 in the RP group. The average pre-operative distance alignment (and standard error) values for the BLR, RR, and RP groups were 25.07 (7.35), 22.44 (5.95), and 23.84 (6.42) prism diopters (PD), respectively. At 1 year, the postoperative distance alignment values for the BLR, RR, and RP groups were 8.72 (7.89), 7.46 (6.31), and 12.83 (6.82) PD, respectively (P = .03). A subanalysis found a significant difference between the BLR and RP (P = .02) and RR and RP (P = .02) groups. There was no difference between the BLR and RR groups (P = .57).

Conclusions: This study of three surgical approaches for intermittent exotropia found RP had a significantly larger angle of exodeviation compared to BLR and RR at 1 year of follow-up. Both BLR and RR were equally effective approaches for treating intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 2024;61(4):287-290.].

Congenital corneal staphyloma is a rare congenital malformation with guarded visual potential. The cornea is opaque, markedly ectatic, and lined by uveal tissue with a variety of associated anterior segment abnormalities. In this case report, the detailed histopathology of this condition is highlighted with an unusual finding of the malformed lens. [J Pediatr Ophthalmol Strabismus. 2024;61(3):e28-e32.].

The authors report a case of a 5-month-old full-term infant with chronic conjunctival redness and elevated intraocular pressure in the right eye. Magnetic resonance imaging ruled out leptomeningeal angiomatosis. Despite lacking a typical port-wine mark, the diagnosis of Sturge-Weber syndrome was established based on specific observations in the right eye that involved unilateral vascular glaucoma. These findings included Haab striae, a larger axial length measurement, an increased number of episcleral vessels with blood in Schlemm canal, and a thicker choroid in the macular region. This is the first reported pediatric case with these specific ocular manifestations in the absence of facial angioma, highlighting the need for awareness among clinicians to avoid misdiagnosis and facilitate proper management. [J Pediatr Ophthalmol Strabismus. 2024;61(3):e19-e22.].

Purpose: To describe the clinical characteristics and outcomes of a pediatric cohort surgically treated for primary or secondary pediatric glaucoma (PPG/SPG).

Methods: A retrospective chart review was conducted of all patients with pediatric glaucoma who had surgery between 2013 and 2021. Relevant demographic and clinical data were cumulated and analyzed.

Results: Forty-two eyes of 29 patients (18 girls and 11 boys) were included: 22 (52.4%) primary congenital glaucoma (PCG), 7 (16.7%) juvenile open-angle glaucoma, and 13 (30.9%) SPG. Mean ages at presentation were 2.57 ± 2.87, 131.96 ± 27.71, and 62.09 ± 65.12 months, respectively. In this study, eyes with PCG presented the earliest, with the highest intraocular pressure (IOP) and thickest central corneal thickness (CCT). The mean number of glaucoma surgeries was 1.48 ± 0.71, with 38.1% of the eyes needing two or more glaucoma surgeries; trabeculectomy was the most frequent glaucoma surgery in this cohort. After surgical intervention, the overall mean IOP dropped from 32.25 ± 12.97 to 18.10 ± 9.23 mm Hg (P < .001). Moreover, the percentage using antiglaucoma medications decreased from 100% to 35.7% at the final visit, as did the number of medications prescribed per eye (2.69 ± 0.92 vs 1.05 ± 1.46, P ≤ .001). Mean best corrected visual acuity (BCVA), in patients who could have their BCVA measured, improved from 0.61 ± 0.61 to 0.53 ± 0.51 logMAR at final follow-up.

Conclusions: Surgical intervention was shown to provide a well-controlled IOP, decrease dependance on glaucoma medications, and improve BCVA in both PPG and SPG. Multiple surgical interventions may be necessary in the treatment of some pediatric patients with glaucoma. Prognostically, thicker CCT was significantly associated with worse IOP control, more glaucoma surgeries, and more antiglaucoma medications at the final visit. Initial BCVA correlated significantly with BCVA at the final visit. [J Pediatr Ophthalmol Strabismus. 2024;61(3):188-197.].