Journal of Aapos最新文献

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.

Background: There are no clinical parameters that predict response to intra-arterial chemotherapy (IAC), which is a first-line treatment for primary and recurrent unilateral retinoblastoma. We evaluated the utility of ophthalmic ultrasound with color Doppler imaging to predict retinoblastoma response to IAC treatment.

Methods: The medical records of 14 retinoblastoma patients (20 eyes) treated with IAC were reviewed retrospectively. Baseline clinical information and ultrasound metrics were obtained from the medical record, including tumor volume, resistive index (RI) and pulsatility index (PI) of both the central retinal artery (CRA) and tumor feeding vessel (FV). Tumor volume was recorded [from repeat assessment 3-6 weeks after initial IAC.

Results: Median baseline tumor volume was 0.40 cm³ (range, 0.01-2.3); median percent change in volume after initial IAC was 71% (range, 50%-81%). Tumors with baseline volume of <1 cm³ were associated with increased CRA RI (median, 0.73) and PI (median, 1.36) compared with larger tumors (median, CRA RI 0.60 [P = 0.04]; median, CRA PI, 1.03 [P = 0.03]) as well as higher FV RI (median, 0.72) and PI (median, 1.40) than larger tumors (median FV RI, 0.63 [P = 0.02]; median FV PI, 1.01 [P = 0.001]). None of the included Doppler parameters were significantly associated with change in tumor volume following IAC.

Conclusions: In this pilot study, we found that retinoblastoma tumor volume is correlated with various Doppler characteristics of the CRA and feeder artery. Further studies are required to elucidate potential ocular blood flow patterns that may predict response to IAC.

In this retrospective study of asymmetric retinopathy of prematurity (ROP) cases treated with unilateral intravitreal bevacizumab (IVB), half of the treated patients did not require further IVB, whereas the other half required sequential IVB at a mean of 12 days after initial treatment.

Purpose: To compare the Spot Vision Screener (SPOT) to the GoCheck Kids mobile application (GCK) in the evaluation of amblyopia risk factors (ARFs), according to updated 2021 AAPOS guidelines for instrument-based pediatric vision screening.

Methods: SPOT, GCK using horizontal and vertical images (two-photo mode), and a complete eye examination (CEE) were performed on children ages ≥1 to <7 years referred to a pediatric ophthalmologist from October 2020 to December 2022 for a failed vision screen based on manufacturer guidelines. The primary outcomes were sensitivity, specificity, and positive predictive value (PPV) for each photoscreener.

Results: Of 267 subjects included, 42% had one or more 2021 guideline ARFs after CEE. Overall, for SPOT and GCK, respectively, the sensitivity was 0.765 and 0.748, specificity was 0.769 and 0.755, and PPV was 0.728 and 0.712 (P > 0.05 for all). In participants ≥4 years old, SPOT had higher ARF sensitivity than GCK (0.900 and 0.750, resp.; P = 0.005), while among participants <4 years old, SPOT had lower sensitivity than GCK (0.487 and 0.744 respectively; P = 0.004). There were no statistically significant differences between SPOT and GCK in specificity among the younger (0.750 and 0.676 resp.) or older (0.785 and 0.823, resp.) cohorts, or in strabismus detection. The performance of the SPOT and GCK was evaluated using receiver operating characteristics (ROC) curves. Area under the curve (AUC) ranged from 0.857 to 0.980 for SPOT and 0.809 to 0.931 for GCK.

Conclusions: Overall, SPOT, and GCK had similar values for sensitivity, specificity, and PPV to identify patients with ARFs using the 2021 AAPOS guidelines.

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.

Strabismus following other intraocular surgery has several well-described etiologies. Vitreoretinal surgeries are the most likely to require retrobulbar anesthesia and exoplants, two commonly associated risk factors for postoperative strabismus. A reliable assessment of the incidence of strabismus secondary to other ocular surgery has not been established. We report a large cohort of vitreoretinal surgery cases performed in the same multispecialty practice with the area's only adult strabismus surgeon. We specifically examined strabismus surgery as the inclusion criteria, because nonsurgical management of postoperative strabismus typically indicates more benign and less-complex presentations. We found 7 cases of strabismus surgery following 4,176 retina surgeries (0.17%), one of which had a prior history of strabismus surgery. Of the 6 others, 2 had a scleral buckle placed, and a further 2 had a course consistent with a typical block infiltration strabismus.

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.