Journal of Aapos最新文献

Purpose: To report both the incidence of pediatric keratoconus (PKC) in a population-based cohort and the risk for undergoing corneal surgery over a 20-year period at a single institution.

Methods: The medical records of all patients <19 years of age diagnosed with keratoconus while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 2019, were retrospectively reviewed. The records of patients <19 years with keratoconus examined at our institution from January 1, 2001, through December 31, 2020, were also reviewed.

Results: The incidence of PKC in this population over the 45-year study period was 2.48 cases per 100,000 people per year (95% CI, 1.67-3.29). The mean age at diagnosis was 15.25 years (range, 7-18) years, and 28 (77.8%) were male. During a mean follow-up of 2.8 years (range, 0-17.3 years), 33 of 71 patients managed at our institution (46%) underwent at least one corneal procedure. In this cohort, the Kaplan-Meier risk of requiring a procedure by 10 years following diagnosis was 60%.

Conclusions: The incidence of PKC in Olmsted County, Minnesota, over a 45-year period was 2.48 cases per 100,000 people per year. Nearly half of the patients managed at our institution over the past 20 years required a procedure during follow-up.

Purpose: To compare ocular and anesthesia-related complications in a cohort of patients having undergone either delayed sequential bilateral cataract surgery (DSBCS) or immediate sequential bilateral cataract surgery (ISBCS).

Methods: The medical records of children who underwent bilateral cataract surgery at our institution between 2012 and 2021were reviewed retrospectively. Included patients were 0-24 months of age, aphakic, and followed for at least 1 year after surgery.

Results: A total of 56 children were included: 23 underwent ISBCS; 33, DSBCS. Mean age at surgery was 2.6 ± 2.5 months for ISBCS patients and 2.8 ± 3.0 months for DSBCS patients (P = 0.752). Association with systemic diseases was more common in the ISBCS group. The mean anesthesia time per child was shorter in the ISBCS group (P < 0.001), although the mean total procedure time was similar in both groups. The rate of intraoperative anesthesia-related complications and intraocular complications was similar in both groups. There were no cases of endophthalmitis. The mean number of additional surgical interventions per child and the mean number of follow-up visits within 1 year were similar between groups. Children in the ISBCS group required fewer nights of hospital admission (P < 0.001).

Conclusions: ISBCS in children in this series did not lead to an increased incidence of ocular or anesthesia-related complications compared with DSBCS. ISBCS avoids repeated anesthesia and shortens the total time that the child is under anesthesia.

Background: We developed and tested a dichoptic treatment designed for younger children that can be viewed freely and involves a dichoptic manipulation of a popular animation series that enables contrast-rebalancing without disrupting fusion. Our aim was to assess whether this novel amblyopia treatment is superior to patching in children aged 3-5 years.

Methods: A total of 34 children with amblyopia were randomly assigned to contrast-rebalanced dichoptic cartoons (4 hours/week) or patching (14 hours/week) for 2 weeks. Children in the cartoon group continued watching cartoons for an additional 2 weeks. Designed to target the youngest and most treatable children, the dichoptic cartoons presented the entire scene to the amblyopic eye at 100% contrast, while the fellow eye view was presented at reduced contrast with the main character omitted. Best-corrected visual acuity (BCVA), stereoacuity, suppression, and manual dexterity were measured at each visit.

Results: After 2 weeks, improvement in amblyopic eye BCVA was greater for dichoptic treatment than for patching, with a mean improvement of 0.11 ± 0.08 versus 0.06 ± 0.09 logMAR, respectively (P = 0.04). Stereoacuity, suppression, and manual dexterity did not improve significantly more in the dichoptic group than the patching group at 2 weeks. After 4 weeks of dichoptic cartoon treatment, mean visual acuity improvement in the dichoptic group was 0.16 logMAR (95% CI, 0.10-0.21).

Conclusions: In our study cohort, a contrast-rebalanced dichoptic cartoon was more effective than patching in treating childhood amblyopia after 2 weeks. Dichoptic cartoons that rebalance contrast to overcome suppression provide an additional treatment option for amblyopia in young children.

We report the case of an 8-month-old infant born at 33 weeks' gestation referred to our institution for evaluation of left eye abduction deficit and microcephaly. Ophthalmic examination revealed a left eye abduction deficit with palpebral fissure narrowing on adduction along with palpebral fissure widening on abduction, consistent with Duane syndrome. Genetic testing revealed a pathogenic EP300 mutation confirming Rubinstein-Taybi syndrome type II. The cooccurrence of Duane syndrome and Rubinstein-Taybi syndrome is rare, with only 3 cases in the literature, 2 with genetic confirmation. Potential involvement of the cranial nerves in Rubinstein-Taybi syndrome may explain its cooccurrence with Duane syndrome, which is seemingly more common in EP300-mediated disease.

Molluscum contagiosum (MC) is a benign cutaneous viral infection commonly affecting children, sexually active adults, immunocompromised individuals, and patients on immunosuppressive therapy. Giant periorbital MC lesions with preseptal cellulitis are rare. We present 2 such pediatric cases. Case 1 was a 9-month-old boy with an enlarging left upper eyelid mass and preseptal cellulitis. MC was confirmed on histopathology, and surgical excision was curative. Case 2 was an 18-month-old girl with a right lower eyelid ulcerating mass and preseptal cellulitis. She was managed with antibiotics and surgical excision.

Scleritis is a rare complication of strabismus surgery. We present the case of an 11-year-old girl with Down syndrome who underwent strabismus surgery and developed bilateral symmetric nodular scleritis 3 weeks after surgery. Anterior segment optical coherence tomography revealed localized hyporeflective thickening of the sclera at the primary site of muscle insertion in both eyes. Treatment with topical and oral corticosteroids led to resolution of her condition.

A 13-month-old boy presented with bilateral periorbital swelling accompanied by rhinorrhea and fever. Nasal endoscopy revealed middle meatus edema and purulent discharge. He was diagnosed with bilateral preseptal cellulitis and treated with intravenous antibiotics. Continuous fever and new-onset proptosis with extraocular muscle restriction the next day prompted imaging, which revealed sinusitis with bilateral subperiosteal abscesses. He underwent endoscopic sinus surgery with bilateral abscess drainage and recovered uneventfully. Bilateral orbital complications of acute sinusitis are exceedingly rare occurrences and nearly always require surgical treatment.