Journal of Aapos最新文献

Plus disease was first defined in the original International Classification of retinopathy of prematurity (ICROP) publication in 1984. Over time, the definition of plus disease has evolved, and each ensuing ICROP publication has included example plus disease images. Because plus disease is often present when treatment is indicated, it is important to evaluate whether the retinal vascular characteristics (ie, dilation and tortuosity) depicted in these example images have remained the same or changed over time. Using a semiautomated computer program to trace and quantitatively analyze the retinal vessels in all example plus disease images published in three iterations of ICROP over time, the most recent ICROP publication (ICROP3) consistently exhibited the lowest amount of vascular dilation and tortuosity. This suggests a potential shift towards less tortuous and dilated retinal vessels in example plus disease images published in ICROP3, possibly indicating a lowering of the threshold for diagnosing plus disease and treatment of retinopathy of prematurity.

Ocular torticollis is traditionally attributed to eye misalignment, nystagmus, ptosis, or refractive error. We present 3 pediatric cases of acquired torticollis caused by a foreign body beneath the upper eyelid. The head posturing presumably developed to minimize contact of the foreign body with the corneal surface and mitigate ocular discomfort. Torticollis resolved in all cases after removal of the foreign bodies. These cases demonstrate that acquired torticollis in a child can be a clinical sign of an ocular surface foreign body.

A man in his 60s developed an intermittent, variable left hypotropia with symptomatic diplopia following nasal pterygium surgery in the left eye. No tropia was present for most of the day, but a variable left hypotropia of 25^Δ could be provoked with downgaze. There was no history of radiation or other trauma. Magnetic resonance imaging of the brain and orbits with gadolinium was unremarkable. The patient was diagnosed with suspected ocular neuromyotonia secondary to the peribulbar block and temporarily managed with Fresnel prism. A trial of oral carbamazepine partially improved symptoms. He ultimately underwent a left inferior rectus recession with near complete resolution of his symptoms.

The FDXR-related disorder is caused by pathogenic variants in the FDXR gene. Including our case, a total of 47 patients have been reported. The most common genotypes are the homozygous c.1174C>T (p.R392W) variant and homozygous c.916C>T (p.R306C) variant. Optic atrophy is the most common feature (89%), but many other ocular manifestations have not previously been characterized. Our review of the existing literature reveals other common ocular findings of myopia, nystagmus, strabismus, retinal dystrophy, attenuation of retinal vessels, and cataracts. Common neurological symptoms include movement disorder, sensorineural hearing loss, developmental delay/regression, and hypotonia.

The association of low birth weight and development of retinopathy of prematurity (ROP) is well established for singletons; however, the association of birth weight and ROP in twins of discordant weight is understudied. Using an ROP registry, we investigated whether smaller twins were at greater risk for developing any stage ROP (stage 1 or greater in either eye) compared with their larger siblings, after adjusting for birth weight and gestational age. Discordance was defined as a birth weight difference of >25%. In a cohort of 2,083 infants (2006-2021), 36 discordant twin pairs were identified. The smaller twin had an increased odds of developing any ROP (OR = 2.7; 95% CI, 1.3-5.9; P = 0.01) compared with the larger sibling. This relationship was no longer significant following adjustment for gestational age and birth weight (adjusted OR = 0.92; CI, 0.11-7.43; P = 0.94). The results suggest that although the smaller twins in discordant pairs are at an increased risk of any stage ROP, this risk is driven by low birth weight conditional on gestational age.

A 3-year-old girl treated with intravenous chemotherapy for bilateral retinoblastoma (RB) and a standard technique of intravitreal topotecan for vitreous seeds in the left eye developed a conjunctival nodule at the injection site. Ultrasound biomicroscopy showed normal underlying sclera and ciliary body. Fundus examination of the left eye showed partly calcified vitreous seeds. Suspecting extraocular RB extension, we performed extended enucleation. Histopathology revealed partially regressed intraocular RB, and the conjunctival nodule showed subepithelial cystic degeneration with fibroblastic proliferation, a rare complication hitherto not reported with intravitreal or subconjunctival topotecan injections.

We present a rare case of optic neuropathy due to anaplastic lymphoma kinase-positive (ALK+) anaplastic large cell lymphoma (ALCL) with optic nerve infiltration in a 12-year-old girl who presented with acute unilateral vision loss, diplopia, and headache after two prior hospitalizations at an outside facility for disk edema. She had a presumptive diagnosis of neurosarcoidosis and empiric treatment had been initiated with high-dose corticosteroids. Ongoing worsening of vision prompted presentation at our facility. Histopathological examination from a cervical lymph node biopsy revealed ALK+ ALCL with central nervous system involvement. The patient's vision returned after initiation of chemotherapy. This case highlights the importance of considering malignancy in the differential for optic neuritis.

Endoscopic brow lift (EBL) surgery, performed for cosmetic purposes, carries a small risk for postoperative superior oblique paresis leading to diplopia. We report 2 cases of diplopia after EBL. In the first, a 54-year-old woman was diagnosed with right eye superior oblique paresis, which was confirmed on magnetic resonance imaging (MRI), which revealed trochlear region enhancement. In the second case, magnetic resonance imaging revealed trochlear edema in a 24-year-old woman with similar superior oblique paresis symptoms. In the context of limited orbital imaging, superior oblique paresis after EBL likely results from trochlear displacement due to periosteal dissection. Notable is the spontaneous resolution of symptoms in both cases within 3 months, attributed to reduction of edema. This complication is linked to subperiosteal fluid accumulation or inflammatory processes near the trochlea rather than direct trochlear damage. These cases suggest that EBL-related superior oblique paresis may be self-correcting as edema subsides.

A 13-month-old boy presented to the pediatric ophthalmology clinic at BC Children's Hospital for strabismus assessment. On examination he had a right facial hemangioma, left ptosis, and left exotropia and hypotropia. Magnetic resonance imaging and magnetic resonance angiography of his head demonstrated posterior cerebral artery tortuosity producing mild mass effect on the left oculomotor nerve. Oculomotor nerve palsies are a rare manifestation of PHACES syndrome, with multiple possible mechanisms, including cerebellar hypoplasia or vascular anomalies.

Synergistic divergence, sometimes identified as type IV Duane syndrome, belongs to a group of congenital disorders characterized by aberrant extraocular muscle innervation. In synergistic divergence, there is paradoxical abduction of both eyes on attempted gaze to one side. There is no consensus on surgical management of this rare disorder. We present the case of a 23-year-old man who underwent strabismus surgery for a large right exotropia and compensatory left head turn, which he had adopted to maintain single binocular vision from at least 4 months of age, when he first presented with strabismus. The left head turn was corrected with a 14 mm right lateral rectus recession and a 10 mm right medial rectus resection. Although surgical correction by means of lateral rectus periosteal fixation or extirpation has been reported previously, this case supports large recession and resection as an alternative for surgical treatment of synergistic divergence.