Journal of Aapos最新文献

A congenital external lacrimal fistula appears as a small aperture inferonasal to the inner canthus, exuding clear fluid. It is thought to arise from an accessory duct connected to the lacrimal sac. Various operations have been described for ablation of congenital lacrimal fistula, but no prior study has documented spontaneous closure. We describe a child whose congenital lacrimal fistula resolved after 5 years of observation, obviating the need for a surgical procedure.

Group A Streptococcus (GAS) is a rare cause of endogenous endophthalmitis among both children and adults, with only a handful of cases described in the current literature. We report the case of a previously healthy 3-year-old girl who was diagnosed with unilateral endogenous GAS endophthalmitis with severe anterior involvement, after presenting with unilateral eye pain and injection, polyarthralgia, and skin changes thought to be inflammatory in nature. This case highlights the atypical manifestations of GAS bacteremia that can masquerade as a systemic autoimmune process.

Purpose: To investigate the association between the severity and distribution of retinal findings, systemic morbidity, and socioeconomic factors with mortality risk in pediatric patients with abusive head trauma (AHT) and retinal hemorrhages.

Methods: This retrospective study analyzed data from children diagnosed with AHT who underwent RetCam fundus photography over a 10-year period at Arkansas Children's Hospital. Retinal hemorrhages were graded based on extent (region 1 or 2), spread (A-C), and morphology (intraretinal or extraretinal). Based on these three factors, the overall retinal involvement was classified into three grades (1-3). Logistic regression analyzed associations between retinal findings and mortality risk, adjusting for age, sex, race/ethnicity, socioeconomic measures (as determined by the Childhood Opportunity Index), and clinical variables.

Results: A total of 182 eyes of 91 children were included. Eighteen children (20%) died. A higher grade of retinal hemorrhages was significantly associated with increased mortality risk (P = 0.0004), with mortality rates of 7% in grade 1, 18% in grade 2, and 53% in grade 3. Greater hemorrhage spread also correlated with a markedly increased mortality risk (odds ratio for grade C = 17.43). Additionally, hypoxic-ischemic injury was a strong predictor of mortality (odds ratio = 115.4). Hemorrhage morphology and demographic and socioeconomic factors were not significantly associated with mortality risk.

Conclusions: In pediatric AHT, the grade and extent of retinal hemorrhages serve as strong predictors of mortality. These findings highlight the prognostic value of detailed retinal examinations in assessing survival outcomes in this population.

Purpose: To describe the scleral adjustment (SA) method, a double-pass, knot-free adjustable suture technique for strabismus surgery, and evaluate its clinical outcomes.

Methods: The medical records of 14 consecutive patients treated with the SA method between December 2024 and May 2025 with ≥3-month follow-up were reviewed retrospectively. Suspension sutures from each muscle end were passed twice through the sclera near the original insertion. After initial surgery, patients returned to the operating room for binocular adjustment in an upright position.

Results: Mean patient age was 60 ± 19 years, with mean number of adjustments performed per case of 1.4. Postoperative alignment was within 10^Δ in all patients and remained stable. The SA method enabled precise microadjustments and facilitated simplified adjustments. No intraoperative or postoperative complications were observed.

Conclusions: The SA method is technically simple, avoids knot manipulation during adjustment, and enables precise microadjustments with secure fixation. Favorable outcomes in our small cohort suggest that it is a reliable alternative to sliding knot and bowtie techniques, with potential for mainstream application.

A 16-year-old girl with major depressive disorder suffered from a recurrent polymicrobial conjunctivitis, culture-positive for Escherichia coli, that persisted over several months despite evaluation by multiple specialists and appropriate antibiotic treatment. Ultimately, a brown malodorous mass, concerning for possible fecal matter, was noted in the inferior fornix of the left eye and sent for pathology review. Pathology results of the mass revealed degenerated vegetable matter debris with associated bacterial colonies consistent with fecal matter. Discussions were held with the patient, her parents, and her primary care provider. The decision was made to involve psychiatry to ensure the self-harm behavior did not continue and further place the patient at risk of vision loss. This report emphasizes that ophthalmic issues can sometimes be manifestations of an underlying psychiatric condition, highlighting the importance of a multidisciplinary treatment approach.

Pulled-in-two syndrome (PITS) is a rare but serious complication of strabismus surgery, with a reported incidence of once every decade among strabismus surgeons. It occurs more commonly in patients of advanced age and those with cranial nerve palsies or who have undergone prior surgeries. We present a case of PITS in a young female, diagnosed following surgery with a hereditary myosin myopathy.