Journal of Aapos最新文献

英文中文

Telemedicine for initial postoperative appointments following strabismus surgery 斜视手术后初次预约的远程医疗。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104645

Majida Gaffar MD , Elias Mullane MD

Purpose

To compare the results of telemedicine versus in-person initial postoperative evaluations of patients who underwent strabismus surgery.

Methods

We conducted a retrospective chart review of patients who underwent strabismus surgery at a single institution by a single surgeon between June 2020 and December 2022. Initial postoperative visits were consistently conducted via telemedicine. Collected data included the percentage of visits completed successfully, average time to complete visits, technical difficulties, no-show rates, and average numbers of complications. This data was compared with the same measures from in-person initial postoperative visits for the period January 2018 to March 2020. Statistical analysis was conducted to determine significant differences in the two data sets.

Results

A total of 276 charts were reviewed, 109 of which were from in-person postoperative visits and 167 were from telemedicine visits. Telemedicine was found to significantly reduce the length of the initial postoperative visit compared with in-person visits (P < 0.001), with no significant differences noted in visit attendance rates (P = 0.12). Additionally, there were no significant differences in complications or adverse outcomes of strabismus surgery between telemedicine and in-office visits (P = 0.50).

Conclusions

In our single-center study cohort, telemedicine proved a viable option for initial postoperative visits following strabismus surgery, with reduction in duration of visits and no significant difference in completion rates and adverse outcomes compared with in-person visits.

目的：比较远程医疗与面对面的斜视手术患者术后初步评估的结果。方法：我们对2020年6月至2022年12月在同一家机构由同一名外科医生进行斜视手术的患者进行了回顾性图表回顾。术后首次就诊均通过远程医疗进行。收集的数据包括成功完成访问的百分比、完成访问的平均时间、技术困难、缺勤率和并发症的平均数量。将这些数据与2018年1月至2020年3月期间首次亲自术后就诊的相同数据进行比较。对两组数据进行统计学分析，确定两组数据存在显著差异。结果：共回顾了276份病历，其中109份来自术后现场就诊，167份来自远程医疗就诊。与现场就诊相比，远程医疗显著减少了术后初次就诊的时间（P < 0.001），而就诊出勤率无显著差异（P = 0.12）。此外，远程医疗斜视手术的并发症或不良结局与办公室就诊无显著差异（P = 0.50）。结论：在我们的单中心研究队列中，远程医疗被证明是斜视手术后初次就诊的可行选择，与现场就诊相比，远程医疗可以减少就诊时间，在完成率和不良后果方面没有显著差异。

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引用次数: 0

Incidence and clinical characteristics of pediatric traumatic hyphema from 2000 to 2009 in a population-based cohort 2000 - 2009年儿童创伤性前房积血的发病率和临床特征

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104642

Grayson B. Ashby MD , Matthew R. Claxton MD , Brian G. Mohney MD

Purpose

To provide updated epidemiologic data on pediatric traumatic hyphema.

Methods

This multicenter retrospective, population-based cohort study included all patients <19 years of age diagnosed with a closed-globe traumatic hyphema from January 1, 2000, through December 31, 2009, in a single United States county.

Results

During the 10-year study period, 70 patients (52 males [74%]) sustained a traumatic hyphema, yielding an incidence of 19 per 100,000 patients. Mean age at diagnosis was 13 years (range, 4.8-18.6). The most common injury mechanisms were sports (43%) and projectiles (23%). Mean logMAR visual acuity at presentation was 0.218 (range, 0.0 to light perception), and 14 patients (20%) had ocular hypertension during the first month post-injury. Microhyphema was present in 27 patients (44%), and 2 (3%) had a grade III hyphema or worse. Mean final logMAR visual acuity was 0.03 (range, –0.1 to 0.54). No patient had persistently elevated or asymmetric intraocular pressure. Long-term sequelae occurred in 29 patients (41%), most commonly angle abnormalities, but 27 (39%) did not undergo gonioscopy during the follow-up period.

Conclusions

The population-based incidence of traumatic hyphema is similar to that reported five decades ago. Expected visual recovery is good, although long-term sequelae are relatively common. The risk of ocular hypertension or glaucoma following traumatic hyphema is low through young adulthood, but one-third of patients did not receive gonioscopy following injury.

目的：为小儿外伤性前房积血提供最新的流行病学资料。方法：这项多中心回顾性、基于人群的队列研究纳入了所有患者。结果：在10年的研究期间，70例患者（52例男性[74%]）出现外伤性前房积血，发病率为19 / 10万。平均诊断年龄为13岁（范围4.8-18.6岁）。最常见的损伤机制是运动（43%）和弹丸（23%）。患者就诊时的平均logMAR视力为0.218（范围从0.0到光感），14例患者（20%）在伤后第一个月内出现高眼压。27例（44%）患者存在小前房积血，2例（3%）患者有III级或更严重的前房积血。平均最终logMAR视力为0.03（范围为-0.1至0.54）。无患者眼压持续升高或不对称。29例（41%）患者出现长期后遗症，最常见的是角度异常，但27例（39%）患者在随访期间未行阴道镜检查。结论：创伤性前房积血的人群发生率与50年前的报道相似。预期视力恢复良好，尽管长期后遗症相对常见。创伤性前房积血后发生高眼压或青光眼的风险在成年早期较低，但三分之一的患者在受伤后未接受阴道镜检查。

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引用次数: 0

Pedigree analysis of an unusual low penetrance retinoblastoma mutation resulting in multiple silent carriers and a discordant effect on monozygotic twins 一个不寻常的低外显率视网膜母细胞瘤突变导致多个沉默携带者和对同卵双胞胎的不一致影响的家系分析。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104647

John J. McDermott IV MD , Ramitha R. Nyalakonda MD , Amy C. Schefler MD

There are few investigations into low-penetrance heritable retinoblastoma (RB) mutations and sparse reports of identical twins with RB. To our knowledge, this is the first report of monozygotic twins with molecularly proven discordant RB and the largest pedigree published describing a low-penetrance RB1 mutation with multiple successive generations of silent carriers.

关于低外显率遗传性视网膜母细胞瘤（RB）突变的研究很少，同卵双胞胎患有RB的报道也很少。据我们所知，这是首次报道分子证明RB1不一致的同卵双胞胎，也是描述低外显率RB1突变与连续多代沉默携带者的最大家谱。

引用次数: 0

Fibrotic bands in thyroid eye disease: a contributing factor to persistent postoperative restriction 甲状腺眼病的纤维化带：术后持续限制的一个因素。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104653

Veronika Yehezkeli MD, Stacy L. Pineles MD, MS, Federico G. Velez MD

Accessory extraocular fibrous bands are orbital structures that are typically symptomatic in patients with congenital cranial dysinnervation disorders. However, orbital imaging studies have documented asymptomatic accessory extraocular fibrous in individuals without strabismus. The role of preexisting symptomatic fibrotic bands in causing persistent restrictive strabismus in patients with acquired strabismus and the possibility that inflammatory conditions affecting the extraocular muscles could also affect those bands is rarely discussed. We present 2 cases of thyroid eye disease (TED) in which asymptomatic bands likely became clinically significant with progression of TED. Both patients developed restrictive strabismus and underwent strabismus surgery. Both showed persistent positive forced duction tests (FDT) despite muscle disinsertion. Intraoperative identification and excision of fibrotic bands led to normalization of the FDT and improved surgical outcomes. These bands may contribute to atypical motility patterns in TED.

副眼外纤维带是眼眶结构，是先天性颅神经支配障碍患者的典型症状。然而，眼窝影像学研究证实无斜视的人有无症状的副眼外纤维。在获得性斜视患者中，先前存在的症状性纤维化带在引起持续性限制性斜视中的作用，以及影响眼外肌的炎症条件也可能影响这些带的可能性，很少被讨论。我们报告了2例甲状腺眼病（TED），其中无症状带可能随着TED的进展而变得具有临床意义。两例患者均出现限制性斜视并接受斜视手术。尽管肌肉拔出，但两例患者的强迫诱导试验（FDT）均持续呈阳性。术中识别和切除纤维化带可使FDT正常化并改善手术效果。这些束带可能导致TED的非典型运动模式。

引用次数: 0

Agreement between the Spot Vision Screener and cycloplegic retinoscopy for toddlers with astigmatism 斑点视力筛检和独眼性视网膜镜检查对散光幼儿的影响。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104656

J. Daniel Twelker OD, PhD , Andrew W. Arthur MD , Rita Bhakta OD , Amy L. Davis OD , Leslie K. Dennis MS, PhD , Siomara G. Enriquez EDS , Kimberly D. Gerhart MD , Chiu-Hsieh Hsu PhD , M. Sandra González Marshall RN, PhD , Jenifer Martin BS , Eileen R. McGrath PhD , Joseph M. Miller MD, MPH , Divya Ramesh MSc , Erin M. Harvey PhD

Background

We investigated the agreement between the Spot Vision Screener (Welch Allyn) and gold standard cycloplegic retinoscopy in infants and toddlers, with special attention to astigmatism.

Methods

Participants were children 12-35 months of age who failed a routine photoscreening using the Spot conducted at a recent well-child visit and who subsequently received a cycloplegic eye examination through the Spectacle Prescribing in Early Childhood Study (SPECS).

Results

The final sample included 410 children, with an average age of 20.24 months. The Spot mean spherical equivalent value (M) was significantly less hyperopic than cycloplegic retinoscopy M (+0.35 D vs +0.80 D, t[409] < 0.001), and mean Spot Vision Screener cylinder (CYL) was significantly higher than cycloplegic retinoscopy CYL (1.84 D. vs 1.58 D, t[409] < 0.001).

Conclusions

Cycloplegic retinoscopy found more hyperopic, or conversely, less myopic sphere power, in 60% of participants at the clinically significant level of >0.50 D. When using the Spot, this could result in under-referral to an eye care professional for moderate to high hyperopia. About 1 in 4 subjects showed higher clinically significant cylinder (>1.00 D) using the Spot compared with cycloplegic retinoscopy, which could result in over-referral for astigmatism when using the 2013 criteria for astigmatism.

背景：我们调查了斑点视力筛检（Welch Allyn）和金标准的婴幼儿单眼瘫痪视网膜镜检查之间的一致性，特别注意散光。方法：参与者是12-35个月大的儿童，他们在最近的一次健康儿童访问中使用Spot进行了常规光筛查，随后通过早期儿童眼镜处方研究（SPECS）接受了单眼麻痹检查。结果：最终样本包括410名儿童，平均年龄20.24个月。Spot平均球面等效值(M)明显低于单眼视网膜镜M (+0.35 D vs +0.80 D, t[409] < 0.001)，平均Spot视力筛检筒（CYL）明显高于单眼视网膜镜CYL （1.84 D vs 1.58 D, t[409] < 0.001）。结论：睫状体麻痹性视网膜镜检查发现，60%的受试者在临床显著水平>.50 d时远视较多，或者相反，近视眼度数较低。当使用Spot时，这可能导致中度至高度远视未及时转诊至眼科专业人员。与睫状体瘫痪性视网膜镜检查相比，约1 / 4的受试者使用Spot显示出更高的临床意义柱面（bbb1.00 D），这可能导致在使用2013年散光标准时过度转诊散光。

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引用次数: 0

Surgical management and long-term follow-up of a traumatic intrastromal epithelial cyst 外伤性间质上皮囊肿的外科治疗及长期随访。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-08-01 DOI: 10.1016/j.jaapos.2025.104268

Andrew J. Catomeris MD , Michael E. Zegans MD , Jonathan D. Marotti MD , Erin M. Salcone MD

We report the case of a 5-year-old boy who presented with an enlarging intrastromal cyst at the site of a previous corneal laceration. The cyst was monitored biannually for 2 years, during which time it continued to enlarge and encroach on the visual axis, prompting surgical drainage. Subsequent recurrences necessitated repeating drainage twice, followed by prolonged stability. This case demonstrates successful long-term management of an intrastromal epithelial cyst with curettage and balanced salt solution irrigation.

我们报告的情况下，一个5岁的男孩谁提出了一个扩大的间质内囊肿的地方，以前的角膜撕裂。囊肿每半年监测2年，在此期间，囊肿继续扩大并侵犯视轴，促使手术引流。随后的复发需要重复引流两次，然后是长时间的稳定。本病例通过刮除和平衡盐溶液冲洗成功地长期治疗了一个间质上皮囊肿。

引用次数: 0

Surgical management of hypotropia and exotropia in high myopia: a case report 高度近视低斜视和外斜视的手术治疗1例。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-08-01 DOI: 10.1016/j.jaapos.2025.104264

Rita Teixeira-Martins MD, Inês Coelho-Costa MD, Renato Santos Silva MD, Augusto Magalhães MD

Myopic strabismus, also known as heavy eye syndrome, is a rare ocular motility disorder, typically presenting with bilateral esotropia and hypotropia. We present the case of a 42-year-old man who presented with progressive hypotropia and exotropia rather than esotropia. Orbital imaging revealed a superonasal staphyloma with pathological changes in the extraocular muscles. Surgical correction involved loop myopexy between the superior rectus and medial rectus muscles combined with lateral rectus recession.

近视斜视，又称重眼综合征，是一种罕见的眼运动障碍，典型表现为双侧内斜视和低视。我们提出的情况下，42岁的男子谁提出进行性低视和外斜视，而不是内斜视。眼眶影像显示一鼻上葡萄肿伴眼外肌病变。手术矫正包括上直肌和内直肌之间的环形肌固定术，并伴有外直肌收缩。

引用次数: 0

Anterior segment structure after angle-based surgery in childhood glaucoma: descriptive findings using overhead-mounted optical coherence tomography 儿童青光眼角度手术后的前段结构：使用头顶光学相干断层成像的描述性结果。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-08-01 DOI: 10.1016/j.jaapos.2025.104265

Bo Wang MD, PhD , Zara Saleem MD , Rohini R. Sigireddi MD , Rizul Naithani DO , Samuel Alvarez MD , Alden P. Gregston MD , Sharon F. Freedman MD

Despite the importance of the iridocorneal angle in childhood glaucoma, relatively few studies have been published on the outflow system in children and how surgery affects the iridocorneal angle. Using overhead-mounted optical coherence tomography, we investigated the iridocorneal angle of patients with childhood glaucoma after angle surgery to describe the appearance of the angle and how it may be associated with intraocular pressure (IOP) control. No eyes showed closed angle or peripheral anterior synechiae. Almost all imaged eyes (89%) had a visible open cleft, but many had inadequately controlled IOP. The presence of a cleft, residual trabecular meshwork or remnant of tissue, and open collector channels were not associated with IOP at the time of imaging, although our analysis did not control for other treatment variables that may have masked associations of IOP with anatomical features.

尽管虹膜角膜角在儿童青光眼中的重要性，但关于儿童流出系统以及手术如何影响虹膜角膜角的研究相对较少。使用头顶光学相干断层扫描，我们研究了儿童青光眼患者在角度手术后的虹膜角膜角度，以描述角度的外观及其与眼内压（IOP）控制的关系。无闭眼角及周围前粘连。几乎所有成像的眼睛（89%）都有可见的开放裂隙，但许多人的IOP控制不充分。在成像时，裂口、残余小梁网或残余组织以及开放的收集器通道的存在与IOP无关，尽管我们的分析没有控制其他治疗变量，这些变量可能掩盖了IOP与解剖特征的关联。

引用次数: 0

Risk factors for capsular phimosis following congenital cataract extraction 先天性白内障摘出后囊包下垂的危险因素。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-08-01 DOI: 10.1016/j.jaapos.2025.104279

Amal M. Al-Lozi MD , James McFadyen MBBCh , Ann Shue MD , Scott R. Lambert MD

Background

Visual axis opacities are one of the most common complications following infantile cataract surgery. To date, most studies have focused on lens reproliferation and pupillary membranes rather than capsular phimosis. We evaluated risk factors for capsular phimosis after lensectomies in infants.

Methods

A retrospective chart and video review of patients seen at a single institution over a period of 4 years was performed. Exclusion criteria were follow-up of <7 months and poor video quality. Two independent examiners, masked to patient outcomes, calculated capsulotomy diameters from video stills. To analyze risk factors for capsular phimosis, the χ² test was used for categorical variables; the independent t test for continuous variables. For bilateral cases, one eye was randomly included in capsulotomy analysis.

Results

A total of 20 eyes of 12 patients, aged 1.7 months (IQR, 1.25; range, 0.6-3.2) at time of surgery, were reviewed. Median follow-up was 1.7 years (IQR, 2.39; range, 0.5-3.9). Capsular phimosis developed in 7 eyes (35%) and required surgical intervention in 5 eyes (25%) a median of 2.3 months (IQR 1.49; range, 1.2-5.1) after primary surgery. Male sex (P = 0.03) and smaller anterior horizontal (4.31 vs 5.78 mm [P = 0.0039]), anterior vertical (4.67 vs 5.59 [P = 0.0131]), and posterior vertical (4.10 vs 5.08 mm [P = 0.00074]) capsulotomy diameters increased risk of phimosis.

Conclusions

In our study cohort, capsular phimosis was a common complication following a lensectomy in infants. Smaller anterior and posterior capsulotomy diameters increase risk of capsular phimosis.

背景：视轴混浊是婴儿白内障手术后最常见的并发症之一。迄今为止，大多数研究都集中在晶状体再生和瞳孔膜，而不是荚膜包茎。我们评估了婴儿晶状体切除术后荚膜包茎的危险因素。方法：回顾性图表和视频回顾在一个机构看到的病人超过4年。排除标准为随访2次，分类变量采用检验；连续变量的独立t检验。对于双侧病例，随机纳入一只眼进行囊膜切开分析。结果：12例患者共20只眼，年龄1.7个月(IQR, 1.25；手术时的范围为0.6-3.2)。中位随访时间为1.7年(IQR, 2.39；范围内,0.5 - -3.9)。7只眼（35%）出现囊包茎，5只眼（25%）需要手术干预，中位时间为2.3个月(IQR 1.49；范围，1.2-5.1)。男性（P = 0.03）和较小的前水平（4.31 vs 5.78 mm [P = 0.0039]）、前垂直（4.67 vs 5.59 [P = 0.0131]）和后垂直（4.10 vs 5.08 mm [P = 0.00074]）囊切开术直径增加了包茎的风险。结论：在我们的研究队列中，包囊包茎是婴儿晶状体切除术后常见的并发症。较小的前后囊切开术直径增加囊包茎的风险。

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引用次数: 0

Combined strabismus and cataract surgery in adults with longstanding horizontal strabismus and coexisting senile cataract 长期水平斜视合并老年性白内障的成人斜视及白内障联合手术治疗。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-08-01 DOI: 10.1016/j.jaapos.2025.104274

Ankita Bisani DNB (Ophthalmology), FICO, Akila Chandrasekaran MBBS, MS (Ophthalmology), Saranya Settu DNB (Ophthalmology), FICO, Rohan Arora MBBS

Purpose

To evaluate the factors affecting postoperative outcomes in a cohort of patients who underwent combined surgery for horizontal strabismus and visually significant senile cataract.

Methods

We retrospectively reviewed the records of adults who underwent combined strabismus and cataract surgery for horizontal strabismus and senile cataracts at a single institution between January 2022 and January 2024. Best-corrected visual acuity, astigmatism, and angle of deviation were analyzed preoperatively, on postoperative day 14, and at last follow-up.

Results

A total of 40 eyes of 34 patients (21 females), 58.5 ± 7.1 years of age were included. Mean follow-up was 5.2 months (range, 1-26). All eyes achieved visual success, defined as visual acuity of ≤0.3 logMAR, 30 patients (88%) achieved motor success, and 4 (12%) had residual misalignment at final follow-up. None of the preoperative variables assessed significantly predicted postoperative motor outcome. There were no intra- or postoperative complications in any patients.

Conclusions

In our study cohort, cataract surgery was effective in all patients, strabismus surgery outcomes were comparable to standard horizontal strabismus surgeries, and no complications were noted. The outcomes of neither procedure were compromised by being performed in combination.

目的：评价影响水平斜视合并明显老年性白内障联合手术患者术后预后的因素。方法：我们回顾性回顾了2022年1月至2024年1月在同一机构接受水平斜视和老年性白内障联合斜视和白内障手术的成年人的记录。术前、术后第14天及最后随访分析最佳矫正视力、散光、偏差角。结果：共纳入34例患者40眼（女性21例），年龄58.5±7.1岁。平均随访5.2个月（1-26个月）。所有眼视力均成功，定义为视力≤0.3 logMAR， 30例（88%）患者运动成功，4例（12%）患者在最终随访时存在残留不对准。术前评估的变量均不能显著预测术后运动预后。所有患者均无术中或术后并发症。结论：在我们的研究队列中，白内障手术对所有患者都有效，斜视手术结果与标准水平斜视手术相当，无并发症发生。两种手术的结果均未因联合进行而受到损害。

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