Journal of Aapos最新文献

Keratoconus is a progressive condition marked by corneal thinning, caused by alterations of the structure and organization of corneal collagen. It is often diagnosed during the teen years, when collagen remodeling occurs at an increased rate. In contrast, Graves' disease most commonly presents during adulthood. When it does manifest in pediatric cases, patients typically exhibit mild eyelid retraction and proptosis without vision loss. We present the case of a 16-year-old boy with vision loss due to progressive keratoconus changes secondary to Graves' ophthalmopathy. To our knowledge, concurrent keratoconus and thyroid eye disease (TED) in a child has not been reported in the literature. Nor are there reports of rapid development of keratoconus following proptosis from TED.

A 68-year-old woman was referred to the emergency room for globe trauma of the left eye. Initial examination demonstrated absent adduction and infraduction. During preliminary repair, total transection of the medial and inferior rectus muscle bellies was noted, but the retracted proximal muscle segments could not be immediately retrieved. On re-exploration 36 hours later, both retracted muscle segments were recovered by tracing Tenon's capsule and reconnected to the distal portions of the muscles. At her postoperative month 1 visit she was orthotropic in primary gaze, with residual infraduction and adduction defects.

We report 3 cases of esotropia following scleral buckling surgery for retinal detachment, a relatively undocumented complication. All patients exhibited alterations at the site of the rectus muscle insertions. In all cases, the distance from the limbus to the functional muscle insertion was increased, highlighting the importance of considering the functional muscle insertion in strabismus surgery after scleral buckling.

Gonioscopy-assisted transluminal trabeculotomy (GATT), especially suture-GATT, has been gaining acceptance widely among pediatric glaucoma surgeons because of its ability to lower intraocular pressure while treating the whole of the trabecular meshwork in a single session and its cost-effectiveness. To date, its use in congenital glaucoma patients has been discussed less in the literature, with some studies based on heterogenous populations. We report our preliminary results of suture-GATT performed in 40 eyes of a homogenous cohort of 25 primary congenital glaucoma patients.

Carotid-cavernous fistulas (CCFs) occur rarely in children. We present the second known case of a pediatric CCF complicated by contralateral cranial nerve palsies. A 9-year-old boy developed a left CCF after falling onto a plastic stick. He underwent stenting of the internal carotid artery and transvenous coil embolization of the left superior ophthalmic vein and left sides of the cavernous and circular sinuses. Six weeks after repair, he demonstrated right periorbital edema, proptosis, and engorged conjunctival vessels, a right abducens nerve palsy, and a right relative afferent pupillary defect. Repeat angiogram showed shunting from the left CCF across the circular sinus and into the right superior ophthalmic vein. The patient underwent coil embolization of the circular sinus and right superior ophthalmic vein and cavernous sinus. This case underscores the importance of monitoring both eyes for signs of orbital congestion and cranial nerve palsies in patients with CCFs.

We present a case, with a 2-year follow-up, of the use of topical insulin in managing neurotrophic keratopathy in a 3-year-old boy diagnosed with congenital insensitivity to pain with anhidrosis (CIPA). Initially, the patient had a corneal perforation in the right eye, for which he underwent tectonic amniotic membrane transplantation. On examination, a central corneal ulcer with stromal infiltration was identified in the left eye, accompanied by a complete absence of corneal sensation in both eyes. Systemic features consistent with CIPA, such as the absence of a normal response to pain stimuli, anhidrosis, and self-injurious behavior, were also observed. Topical insulin, along with preservative-free lubricants (PF-L) and prophylactic antibiotics, was prescribed for both eyes. Within 2 weeks, the left corneal ulcer had healed, and treatment with topical insulin and PF-L was continued. After a 2-year follow-up, the left cornea exhibited a stable small paracentral nebula, whereas the right cornea showed a central non-adherent leucoma. No recurrence of corneal ulceration occurred.

The etiology of myopia is multifactorial, and various methods have been employed to control its progression. Low-dose atropine without bifocals has recently gained acceptance as a treatment option. We report a patient who developed acquired esotropia due to escalating atropine concentrations for myopia control, as a presumed result of atropine-induced accommodative duress and excessive convergence. We have found no previous accounts of this complication.

Congenital retinal folds (CRFs) are a rare entity, with an incompletely understood pathogenesis. They are often associated with ocular conditions such as familial exudative vitreoretinopathy (FEVR). We present a series of 5 patients with unilateral CRFs who underwent genetic testing. Mutations were identified in 4 patients: FZD4 and TSPAN12, both associated with FEVR, and IMPDH1 and PEX1, whose roles in CRF are unclear. Four patients presented with strabismus, all of whom underwent surgical intervention. Two patients developed tractional retinal detachments that necessitated vitrectomy. Visual outcomes were generally poor, with final visual acuity ranging from 20/600 to no light perception. This series underscores the importance of genetic testing in CRF cases, particularly for assessing familial risk, although the genetic basis remains inconclusive. Patients should be closely monitored for complications such as retinal detachment.