Journal of Pediatric Ophthalmology & Strabismus最新文献

Purpose: To investigate the short-term effect of atropine to better understand its mechanism of action in myopia prevention. The current study investigates whether atropine's effect on the axial length arises from an increase in choroidal thickness using swept-source optical coherence tomography angiography (OCTA).

Methods: Twenty-five myopic children (25 eyes) (9 boys and 16 girls; mean age: 11.8 years, range: 7 to 15 years) were enrolled following documented myopia progression and axial length increase in the preceding 6 months. Using swept-source OCTA, choroidal thickness and choroidal stromal volume (CSV) were measured at baseline and after 1 month of daily atropine 0.1% use. Axial length measurements were taken on the same days.

Results: Following 1 month of daily atropine 0.1% instillation, choroidal thickness increased from 284.24 ± 65.05 to 308.04 ± 70.65 µm (Δ 22.41 ± 4.20 µm, P < .01), CSV increased from 11.88 ± 5.20 to 12.96 ± 5.86 mm³ (Δ 1.08 ± 1.02 mm³, P < .01), and axial length decreased from 25.37 ± 1.21 to 25.33 ± 1.21 mm (Δ 0.044 ± 0.016 mm, P < .05). The CSV and choroidal thickness increase show a negative correlation with the axial length decrease of -0.462 and -0.374, respectively, demonstrating a weak to moderate correlation.

Conclusions: One month of daily atropine 0.1% eye drop administration results in an acute decrease in axial length concurrent with an increase in choroidal thickness and CSV. A direct cause-and-effect relationship between these two parameters is plausible. [J Pediatr Ophthalmol Strabismus. 2025;62(4):265-270.].

Retinoblastoma, a potentially fatal pediatric intraocular malignancy, is now curable with intravenous and intra-arterial (IAC) chemotherapy. In this report, the authors describe globe volume asymmetry, a lesser-known sequela of IAC, as well as the hemodynamics of a tumor-laden eye, pattern of eyeball growth following IAC, and potential mechanisms of amblyopia in retinoblastoma survivors. [J Pediatr Ophthalmol Strabismus. 2025;62(4):e46-e50.].

Purpose: To compare 0.01% and 0.05% atropine eye drops with every other day treatment for slowing myopia progression in children.

Methods: Children aged 5 to 15 years who had myopia of -1.00 to 8.00 diopters (D), astigmatism less than -2.50 D, and myopic progression of at least 1.00 D in the past year were included in the retrospective study. The 0.01% and 0.05% atropine eye drops were applied every other day. At each visit, all patients underwent complete ophthalmic examination including cycloplegic refraction, axial length (AL), and photopic-mesopic pupil sizes. Spherical equivalent (SE), AL, and photopicmesopic pupil sizes were evaluated.

Results: In total, 92 eyes of 46 patients were included in the study (22 in the 0.01% atropine group and 24 in the 0.05% atropine group). At the end of the 12-month follow-up period, the mean SE changes were -0.41 ± 0.28 and -0.19 ± 0.22 D in the 0.01% and 0.05% atropine groups, respectively (P < .001). The AL changes were 0.19 ± 0.16 and 0.16 ± 024 mm in the 0.01% and 0.05% atropine groups, respectively (P = .52). Side effects such as photophobia and blurred near vision were not observed in the 0.01% atropine group, but in the 0.05% atropine group, photophobia was observed in 3(12.5%) cases and blurred near vision was observed in 8 (33%) cases.

Conclusions: The 0.01% and 0.05% atropine eye drops significantly slowed the progression of myopia with every other day use. The 0.01% atropine was better tolerated than 0.05% atropine. [J Pediatr Ophthalmol Strabismus. 2025;62(4):297-302.].

Purpose: To observe and analyze the effects of orthokeratology in patients with convergence insufficiency, exophoria, and myopia.

Methods: Thirty patients (60 eyes) between 8 and 15 years old with myopia and convergence insufficiency exophoria treated with orthokeratology at the First Affiliated Hospital of the Baotou Medical College from December 2022 to December 2023 were prospectively enrolled. General information was gathered and examinations were performed at baseline and at 2 weeks and 1, 3, and 6 months after switching to orthokeratology lenses. Examinations included assessments of distance/near visual acuity, near point of convergence, distance and near horizontal phoria, near positive fusional vergence, and monocular amplitude of accommodation.

Results: The median age of the participants was 10 years (range: 8 to 15 years), and 40% were female. The baseline refractive error was -2.00 diopters (D) (range: -4.00 and -1.00 D). After 6 months of treatment, we found statistically significant differences in near point of convergence (95% confidence interval: -13.99 to -8.67), positive fusional vergence (95% confidence interval: 15.32 to 11.42), and monocular amplitude of accommodation (95% confidence interval: 6.62 to 4.51) compared with baseline. In addition, the mean pretreatment near horizontal phoria decreased from 6.83 ± 1.44 to -4.90 ± 1.29 prism diopters after the 6 months of treatment (95% confidence interval: -2.92 to -0.94).

Conclusions: This study showed that the use of orthokeratology lenses with an increased compression factor of 1.75 D may improve near point of convergence, positive fusional vergence, and monocular amplitude of accommodation for the treatment of convergence insufficiency with myopia. [J Pediatr Ophthalmol Strabismus. 2025;62(4):252-257.].

Purpose: To retrospectively analyze the clinical characteristics and therapeutic outcomes of congenital fibrovascular pupillary membrane (CFPM).

Methods: Twelve children (13 eyes) diagnosed as having CFPM between November 2017 and January 2024 in Qingdao Eye Hospital were retrospectively reviewed. Basic information and ophthalmic examination results were analyzed. Different treatment outcomes were monitored. Pathological analysis was performed using hematoxylin-eosin staining.

Results: Three eyes (25%) received conservative treatment, whereas 10 eyes (83.3%) underwent membranectomy. Compared to fellow eyes, the affected eyes exhibited increased central corneal and lens thickness, with decreased central anterior chamber depth (all P < .05). No significant difference was observed in mean preoperative intraocular pressure between the affected and fellow eyes, both within normal range. The median best corrected visual acuity (BCVA) for non-surgical cases was 0.9 llogarithm of the minimum angle of resolution (og-MAR) (Snellen equivalent of 0.125) with miosis. Surgical treatment improved the natural pupil size and median BCVA to 0.4 logMAR (Snellen equivalent of 0.4). Postoperative amblyopia was 100% and 33.3% in patients who underwent surgery after age 3 years and at or before 3 years, respectively (P = .035). No surgery-induced cataracts or recurrence in cases of unilateral involvement was noted. Histopathological analysis revealed that the excised tissue consisted of proliferative fibrous and vascular tissues with infiltrated inflammatory cells.

Conclusions: Affected eyes in CFPM exhibit a thickened cornea and lens with a shallow anterior chamber, typically without glaucoma. Surgery is a safe and effective treatment with low recurrence and fewer complications compared to limited conservative treatment. Performing surgery before age 3 years reduces amblyopia risk. CFPM may be linked to chronic inflammation from incomplete degeneration of fetal eye vasculature. [J Pediatr Ophthalmol Strabismus. 2025;62(4):286-296.].

This report presents a pediatric case of bilateral fovea plana and right solar retinopathy, using optical coherence tomography and optical coherence tomography angiography findings to evaluate the effects of these conditions on retinal structure and vasculature. The findings underscore the diagnostic utility of these imaging modalities in assessing concurrent retinal disorders and demonstrate that, despite the involvement of the outer retinal layers in solar retinopathy, the retinal and choroidal vascular structures were unaffected. [J Pediatr Ophthalmol Strabismus. 2025;62(4):e42-e45.].

Purpose: To assess the efficacy of botulinum toxin type A injection as a re-treatment procedure in patients with consecutive exotropia.

Methods: The medical records of 34 patients who underwent botulinum toxin type A injection for consecutive exotropia were retrospectively reviewed. Five units of botulinum toxin type A was applied to the unilateral lateral rectus muscle, and the injection was administered under electromyography guidance. Successful motor alignment was defined as a far deviation within 10 prism diopters (PD).

Results: A total of 34 patients were included in the study. Twenty-six patients (76.5%) had acquired esotropia and 8 patients (23.5%) had infantile esotropia. The average age of the patients was 169 ± 88.9 months. The mean time elapsed between the last surgery and botulinum toxin injection was 67.8 ± 78 months. The mean before botulinum toxin type A injection deviation was 20.03 ± 8.42 PD at near and 21.41 ± 8.87 PD at distance. The deviation after botulinum toxin type A injection was 9.65 ± 7.42 PD at near and 10.82 ± 7.33 PD at distance. All patients were followed up for 19.8 ± 20 months. The average number of injections was 1.6 ± 1.1. The final success rate was 73.5%. The first month's near deviation was significantly associated with treatment success (P = .012). Post-injection fusion potential had a weak association with the 6-month and overall treatment success (P = .073 and .057, respectively).

Conclusions: The results of this study demonstrate that botulinum toxin type A injection can be an effective, safe treatment option in consecutive exotropia. [J Pediatr Ophthalmol Strabismus. 2025;62(4):258-264.].

Purpose: To evaluate the efficacy of a single dose of botulinum toxin A injection into the medial rectus muscle to treat acute acquired concomitant esotropia (AACE).

Methods: This observational case series study included patients diagnosed as having AACE from January 2021 to December 2023 at a tertiary eye care center in South India willing to undergo botulinum toxin injections as the first treatment who experienced sudden-onset esotropia with diplopia. Their demographics, duration of symptoms, and visual acuity were recorded. Orthoptic evaluations, including measurement of esodeviation (prism cover test) for distance and near fixation, assessment of binocularity (Worth 4-dot test), anterior and posterior segment evaluations, and cycloplegic refraction, were conducted for all cases. Neurological examinations and relevant imaging studies were performed. All participants received a predetermined botulinum toxin A dose injected into the medial rectus muscle. Evaluations were conducted at 1 week, 1, 3, and 6 months, and 1 year after injection. Main outcome measures were ocular deviation and restoration of binocularity after botulinum toxin A injection. Motor success after injection was defined as angle of deviation less than 8 prism diopters of esotropia and sensory success as absence of diplopia .

Results: A total of 72 patients were included in the study. Their mean age was 10.39 ± 5.73 years (range: 2 to 24 years) and 49 (68.1%) were male and 23 (31.9%) were female. Forty-nine (63.88%) had emmetropia, 7 (9.7%) had myopia, and 19 (26.38%) had hyperopia. After injection, the percentage of patients experiencing diplopia reduced from 79.2% at presentation (n = 57) to 18.6% at 1 week after injection (n = 13), 4.9% at 1 month after injection (n = 3), 2.2% at 3 months after injection (n = 1), and none at 6 months and 1 year after injection. Forty-two (58.3%) patients for distance and 41 (56.9%) for near attained motor and sensory success as early as 1 week after injection. Of the 28 patients who attended follow-up visits more than 1 year after injection, 85.7% maintained both motor and sensory success.

Conclusions: Botulinum toxin A is an effective first-line treatment for patients with AACE. It provides sustainable motor and sensory restoration, faster rehabilitation, and reduced need for invasive surgery in at least two-thirds of patients. [J Pediatr Ophthalmol Strabismus. 2025;62(4):237-244.].

Purpose: To examine the prevalence of corneal changes and refractive amblyopia risk factors (ARFs) associated with blepharokeratoconjunctivitis (BKC) to evaluate the safety of remote pediatric chalazion management.

Methods: The authors retrospectively reviewed 381 in-person patients with chalazia 0 to younger than 18 years. The prevalence of corneal changes associated with BKC in all patients with chalazion 0 to younger than 18 years was compared with the population prevalence. Patient-reported symptoms were compared in patients with chalazion with and without corneal findings associated with BKC. The 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) ARF and visually significant refractive error failure level definitions were used to compare population prevalence of refractive ARFs to prevalence in patients with chalazia younger than 9 years.

Results: Ten of 381 patients with a chalazion (2.62%) had simultaneous active corneal changes associated with BKC, with a relative risk compared to the population of 444.9739 (P < .0001); 90% reported eye pain, eye redness, photophobia, or blurred vision. The prevalence of patients with a chalazion who concurrently met the 2021 AAPOS ARF and visually significant refractive error failure level definitions was 9.89% in 71 patients younger than 48 months and 21.79% in 78 patients 48 months to younger than 9 years. The relative risk of refractive ARFs was 1.7871 (P = .1397) in patients with chalazion younger than 48 months and 1.8014 (P = .0261) in those 48 months to younger than 9 years compared to the general population.

Conclusions: The elevated risk of corneal changes associated with BKC in patients with chalazia 0 to younger than 18 years and refractive ARFs in patients with chalazia 48 months to younger than 9 years should prompt screening for these conditions in association with teleophthalmology encounters. [J Pediatr Ophthalmol Strabismus. 2025;62(4):278-285.].

Purpose: To identify changes in Medicaid reimbursement rates for new patient and follow-up visit billing codes for pediatric ophthalmologists between the years 2022 and 2024.

Methods: Individual state Medicaid sites and state ophthalmology associations were used to determine Medicaid reimbursement rates for new patient and follow-up billing codes. The percentage change between 2022 and 2024 for these billing codes was calculated and comparisons were made for each individual state.

Results: Forty-six states, including the District of Columbia, were used to make comparisons between 2022 and 2024 Medicaid reimbursement rates for new patient and follow-up visits. The average change between 2022 and 2024 was +3.81% for the new patient visit and +4.98% for the follow-up visit. Twenty-one states had increases in reimbursement rates from 2022 to 2024, and eight had decreased rates. Pennsylvania, Illinois, Indiana, Hawaii, and New Mexico demonstrated the greatest increases in new patient visit reimbursement rates. Alaska, Pennsylvania, Illinois, Indiana, and Hawaii had the greatest increases for follow-up visit reimbursement rates.

Conclusions: Raising Medicaid reimbursement rates can alleviate the economic and workplace issues pediatric ophthalmologists face. State level advocacy is important in increasing Medicaid reimbursement rates effectively. [J Pediatr Ophthalmol Strabismus. 2025;62(3):160-165.].