Journal of Aapos最新文献

Congenital cranial dysinnervation disorders involve abberant connections between cranial nerves, often resulting in synkinetic activation of target muscles. Marcus-Gunn jaw winking ptosis and Duane retraction syndrome are some of the more well-known examples of this phenomenon. We present serial video of a child with congenital trigemino-abducens synkinesis, a lesser known congenital cranial dysinnervation disorder, to demonstrate the characteristics of this likely under-diagnosed presentation.

Yearly vision screenings, often performed in a primary care setting, are an important part of child health for detection of ocular disorders, but there are discrepancies in referral guidelines. Whereas guidelines provide consistent failure and referral criteria for 3- and 4-year-olds, criteria for older children disagree. To investigate the effect of having discordant guidelines, we retrospectively applied each guideline threshold to a cohort of 5- to 6-year-olds who underwent visual acuity screening during a well-child encounter and compared the results to the real-life referral rates. We found a 2.7-fold difference in the proportion of 5- to 6-year-olds children failing a vision screening and a difference in referral rate of 18%. Our results demonstrate that the existence of even mildly conflicting pediatric vision screening guidelines can lead to uncertainty among primary care providers who perform vision screening in children. We hope that this study will shed light on the problem and stimulate efforts to harmonize referral criteria.

Background: The American Academy of Pediatrics recommends pediatric vision screening to detect and refer vision disorders during the critical early years when intervention yields the greatest benefits. We determined the rate of vision screening for US children 3-5 years of age with commercial insurance and compared rates among those living in rural versus urban areas. Children in rural compared with urban areas were expected to have lower rates of vision screening.

Methods: A cross-sectional study using commercial claims for 3- to 5-year-olds derived from the Merative MarketScan Database (IBM, Armonk, NY), 2011-2020, was conducted. Primary outcome was the proportion of children with a claim for vision screening. Adjusted incident rate ratios (aIRR) of vision screening with 95% confidence intervals were computed for children living in rural compared with urban areas of the United States.

Results: Claims for 2,299,631 children were included. Most children (1,724,923 [75.0%]) were enrolled in preferred provider organization plans and lived in urban areas (2,031,473 [88.3%]). A total of 662,619 (28.8%) had a claim for a vision screening. Children living in rural versus urban areas had a lower adjusted incident rate of vision screening (15.1 vs 30.6%, aIRR 0.57; 95% CI, 0.53- 0.61) after adjusting for sex, age, region, and insurance type.

Conclusions: For preschool age children with commercial insurance, vision screening is low, especially in rural compared with urban areas.

The purpose of this case series is to consider whether preterm infants having gestational age (GA) ≥32 weeks and birth weight (BW) ≥1500 g exposed to unblended oxygen should be screened earlier than the current guidelines adopted from Kenya for the third epidemic of retinopathy of prematurity (ROP). Cases of such infants with severe, treatment-requiring ROP at St Francis Hospital Nsambya, Kampala, Uganda, were reviewed for severe ROP requiring treatment prior to 30 days of life. Since 2022, 3 infants required treatment prior to 30 days of life. All infants received unblended oxygen for 5-10 days after birth and were on room air at the time of treatment. GA ranged from 32 to 34 weeks, and all had BW >1500 g. All infants had chronological age of 2 weeks at treatment. Preterm babies who are born at GA ≥32 weeks and exposed to unblended oxygen may be at risk of developing severe, treatment-requiring ROP earlier than the adopted guidelines from other countries have suggested.

Retinal arteriovenous malformations (AVMs) are rare congenital, nonhereditary vascular anomalies of the retina. We report the case of a 6-year-old child presenting with recurrent frontal headaches. Funduscopy examination revealed an AVM in the right eye, inferior to the optic nerve head. Optical coherence tomography and retinal imaging confirmed the presence of an AVM measuring 3 disk diameters. Magnetic resonance imaging of the head revealed a cavernous malformation in the right frontal subcortical region.

In cases of recurrent exotropia, medial rectus resection after bilateral lateral rectus recession is often considered for reoperations. The surgical amount of medial rectus resection is typically determined according to the standard surgical dose table; however, postoperative variability has been noted in the surgical outcomes. In the current study, medial rectus tendon width (MRTW) was measured intraoperatively, and surgical dose-response was calculated as the ratio between amount of correction and resected medial rectus. The MRTW exhibited a positive correlation with age at time of surgery and surgical dose-response. MRTW could thus merit further study as a potential intraoperative predictor of surgical dose-response when considering medial rectus resection in patients with recurrent exotropia.