To determine the frequency of amblyopia in preschoolers and school-age children with alternating esotropia.
Methods
This retrospective, cross-sectional, single-center study analyzed the preoperative medical records of patients 3-10 years of age with confirmed alternating esotropia evaluated between 2012 and January 2024. Patients with motor or cognitive disabilities, ocular pathologies, or craniofacial anomalies were excluded, as were those with prior ocular surgeries or vertical deviations. Comprehensive ophthalmic examinations assessed refractive error, visual acuity, angle of deviation, and density of amblyopia.
Results
A total of 767 subjects (mean age, 6.9 ± 1.8 years; 41.4% female) with alternating esotropia were included. Of these, 151 (19.7%) were diagnosed with varying degrees of amblyopia: mild in 87 patients (57.6%), moderate in 60 (39.8%), and severe in 4 (2.7%). Thirty-seven of the amblyopic patients (24.5%) showed evidence of anisometropia; specifically, 32 (21.2%) had anisohyperopia, 4 (2.7%) had anisomyopia, and 1 (0.7%) had anisoastigmatism. Of the 616 nonamblyopic participants, 36 individuals (5.8%) had anisometropia.
Conclusions
The alternating nature of esotropia does not necessarily ensure the absence of amblyopia in children who are candidates for strabismus surgery. The high prevalence of amblyopia highlights the importance of thorough assessment and careful attention to the detection of amblyopia in this patient population.
{"title":"Amblyopia prevalence in patients with alternating esotropia","authors":"Masoud Khorrami-Nejad PhD , Mohamad Reza Akbari MD , Babak Masoomian MD , Yasir Adil Shakor PhD , Foroozan Narooie-Noori PhD","doi":"10.1016/j.jaapos.2025.104700","DOIUrl":"10.1016/j.jaapos.2025.104700","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the frequency of amblyopia in preschoolers and school-age children with alternating esotropia.</div></div><div><h3>Methods</h3><div>This retrospective, cross-sectional, single-center study analyzed the preoperative medical records of patients 3-10 years of age with confirmed alternating esotropia evaluated between 2012 and January 2024. Patients with motor or cognitive disabilities, ocular pathologies, or craniofacial anomalies were excluded, as were those with prior ocular surgeries or vertical deviations. Comprehensive ophthalmic examinations assessed refractive error, visual acuity, angle of deviation, and density of amblyopia.</div></div><div><h3>Results</h3><div>A total of 767 subjects (mean age, 6.9 ± 1.8 years; 41.4% female) with alternating esotropia were included. Of these, 151 (19.7%) were diagnosed with varying degrees of amblyopia: mild in 87 patients (57.6%), moderate in 60 (39.8%), and severe in 4 (2.7%). Thirty-seven of the amblyopic patients (24.5%) showed evidence of anisometropia; specifically, 32 (21.2%) had anisohyperopia, 4 (2.7%) had anisomyopia, and 1 (0.7%) had anisoastigmatism. Of the 616 nonamblyopic participants, 36 individuals (5.8%) had anisometropia.</div></div><div><h3>Conclusions</h3><div>The alternating nature of esotropia does not necessarily ensure the absence of amblyopia in children who are candidates for strabismus surgery. The high prevalence of amblyopia highlights the importance of thorough assessment and careful attention to the detection of amblyopia in this patient population.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104700"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaapos.2025.104681
Maya Ganeshan BA, MS , Andrew Chung MD , Evan Silverstein MD
KidsVisionCheck (KVC), a free photoscreening mobile application for iOS and Android released in 2022, aims to detect amblyopia risk factors (ARFs) in children. We evaluated its performance in a convenience sample of 120 pediatric ophthalmology clinic patients 12 months to 12 years of age. Patients were screened without optical correction using the application on an iPhone 14 Pro Max running iOS. Screening was followed by a dilated fundus examination with cycloplegic refraction. The 2021 AAPOS Vision Screening guidelines were used to assess for ARFs and visually significant refractive errors. The sensitivity of the application was 69.7%; the specificity, 58.7%. The positive predictive value in this patient population enriched for ophthalmic pathology was 52.4%, and the negative predictive value was 75.7%. KidsVisionCheck performed worse on these metrics than FDA-approved commercial instrument-based vision screeners.
KidsVisionCheck （KVC）是一款于2022年发布的iOS和Android免费的光筛查移动应用程序，旨在检测儿童弱视风险因素（arf）。我们在120名12个月至12岁的儿童眼科门诊患者的方便样本中评估了其性能。患者在没有光学校正的情况下使用运行iOS系统的iPhone 14 Pro Max上的应用程序进行筛查。筛检后进行扩张性眼底检查伴睫状体麻痹性屈光。2021年AAPOS视力筛查指南用于评估arf和视觉显著屈光不正。应用的灵敏度为69.7%；特异性为58.7%。在眼科病理丰富的人群中，阳性预测值为52.4%，阴性预测值为75.7%。KidsVisionCheck在这些指标上的表现比fda批准的商用仪器视力筛检器更差。
{"title":"Effectiveness of the KidsVisionCheck mobile application in screening for amblyopia risk factors and visually significant refractive error","authors":"Maya Ganeshan BA, MS , Andrew Chung MD , Evan Silverstein MD","doi":"10.1016/j.jaapos.2025.104681","DOIUrl":"10.1016/j.jaapos.2025.104681","url":null,"abstract":"<div><div>KidsVisionCheck (KVC), a free photoscreening mobile application for iOS and Android released in 2022, aims to detect amblyopia risk factors (ARFs) in children. We evaluated its performance in a convenience sample of 120 pediatric ophthalmology clinic patients 12 months to 12 years of age. Patients were screened without optical correction using the application on an iPhone 14 Pro Max running iOS. Screening was followed by a dilated fundus examination with cycloplegic refraction. The 2021 AAPOS Vision Screening guidelines were used to assess for ARFs and visually significant refractive errors. The sensitivity of the application was 69.7%; the specificity, 58.7%. The positive predictive value in this patient population enriched for ophthalmic pathology was 52.4%, and the negative predictive value was 75.7%. KidsVisionCheck performed worse on these metrics than FDA-approved commercial instrument-based vision screeners.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104681"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaapos.2025.104678
Nancy Arias-González MD , Lauren Kiryakoza MD , Lesly Sahagun-Anguiano MD , Davina A. Malek MD , Hong-Uyen Hua MD , Zenia Aguilera MD , Catherin I. Negron MBA , Audina M. Berrocal MD
Post–strabismus surgery endophthalmitis (PSSE) is a rare but significant complication, which is most commonly associated with medial rectus recession. We report a case of PSSE in a child who had completed chemotherapy 1 year prior to surgery. Despite vaccination, Haemophilus influenzae was cultured from the vitreous. Although infrequent, scleral perforation during surgery can occur without immediate detection. PSSE is typically caused by Staphylococcus aureus, Streptococcus pneumoniae, and H. influenzae, common pathogens found in the respiratory tract of children.
{"title":"Post-strabismus surgery endophthalmitis without evident scleral perforation due to Haemophilus influenzae in a pediatric patient with neurofibromatosis type 1","authors":"Nancy Arias-González MD , Lauren Kiryakoza MD , Lesly Sahagun-Anguiano MD , Davina A. Malek MD , Hong-Uyen Hua MD , Zenia Aguilera MD , Catherin I. Negron MBA , Audina M. Berrocal MD","doi":"10.1016/j.jaapos.2025.104678","DOIUrl":"10.1016/j.jaapos.2025.104678","url":null,"abstract":"<div><div>Post–strabismus surgery endophthalmitis (PSSE) is a rare but significant complication, which is most commonly associated with medial rectus recession. We report a case of PSSE in a child who had completed chemotherapy 1 year prior to surgery. Despite vaccination, <em>Haemophilus influenzae</em> was cultured from the vitreous. Although infrequent, scleral perforation during surgery can occur without immediate detection. PSSE is typically caused by <em>Staphylococcus aureus</em>, <em>Streptococcus pneumoniae</em>, and <em>H. influenzae</em>, common pathogens found in the respiratory tract of children.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104678"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 4-year-old boy presented with poor vision following an episode of febrile illness with abdominal distension, seizures, and respiratory distress with metabolic acidosis. He had bilateral partial optic atrophy. Neuroimaging revealed bilateral symmetric post-contrast enhancement of the optic nerves, diffuse white matter T2-hyperintensities, and a lactate peak on magnetic resonance spectroscopy. Serology for aquaporin-4 and myelin-oligodendrocyte antibodies were negative. Whole exome sequencing showed a homozygous pathogenic variant in the LYRM7 gene (c.2T>C) known to cause mitochondrial complex III deficiency. Following initiation of mitochondrial cocktail therapy, his visual behavior improved.
{"title":"Sudden bilateral vision loss in a child with LYRM7-related leukoencephalopathy","authors":"Lubhavni Dewan MD, FICO , Vyshnavika Mupparapu MSc , Ramesh Kekunnaya MD, FRCS , Goura Chattannavar DNB","doi":"10.1016/j.jaapos.2025.104658","DOIUrl":"10.1016/j.jaapos.2025.104658","url":null,"abstract":"<div><div>A 4-year-old boy presented with poor vision following an episode of febrile illness with abdominal distension, seizures, and respiratory distress with metabolic acidosis. He had bilateral partial optic atrophy. Neuroimaging revealed bilateral symmetric post-contrast enhancement of the optic nerves, diffuse white matter T2-hyperintensities, and a lactate peak on magnetic resonance spectroscopy. Serology for aquaporin-4 and myelin-oligodendrocyte antibodies were negative. Whole exome sequencing showed a homozygous pathogenic variant in the <em>LYRM7</em> gene (c.2T>C) known to cause mitochondrial complex III deficiency. Following initiation of mitochondrial cocktail therapy, his visual behavior improved.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104658"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaapos.2025.104698
Reed M. Jost MS , Kartik Kumar MD , Lori M. Dao MD , Becky Luu OD , Anastasia A. Alex MD , Brooke A. Koritala BS, BA , Krista R. Kelly PhD , Yi-Zhong Wang PhD , Eileen E. Birch PhD
Background
Surgical and nonsurgical treatments of childhood intermittent exotropia (IXT) often have unsatisfactory results due to poor sensory status. Dichoptic 3D movies may offer a novel treatment designed to reduce suppression, encourage fusion, and engage stereoacuity. Our aim was to assess whether 3D movies are superior to 2D sham movies treatment in treating children with IXT.
Methods
In this masked, pilot randomized clinical trial, 41 children aged 3-13 years with spontaneously manifested IXT (triple office distance control score ≥3.00; mean, 3.64 ± 0.72) were assigned to watch dichoptic 3D animated movies or 2D sham movies (3 movies/week, ∼5 hours) for 4 weeks. After completing their treatment assignment, children returned to the masked pediatric eye specialist to reassess IXT control and ocular alignment, with change in triple office distance control score as the primary outcome. Distance and near stereoacuity were also assessed.
Results
After 4 weeks of treatment, the 3D movie group showed a significant improvement in mean triple office distance control score (1.39 ± 1.00; P = 0.0002; n = 14); the 2D sham movie group did not (0.62 ± 1.36; P = 0.11; n = 14). The 3D movie group had significantly more improvement in distance control than the sham group (P = 0.049), but near control, ocular alignment, and stereoacuity did not change for either group.
Conclusions
In our study cohort, at-home dichoptic 3D animated movie treatment significantly improved IXT triple office distance control scores after 4 weeks, indicating that it might provide an alternative nonsurgical treatment for childhood intermittent exotropia.
{"title":"A pilot, randomized clinical trial of dichoptic 3D movies versus dichoptic 2D movies for treatment of childhood intermittent exotropia","authors":"Reed M. Jost MS , Kartik Kumar MD , Lori M. Dao MD , Becky Luu OD , Anastasia A. Alex MD , Brooke A. Koritala BS, BA , Krista R. Kelly PhD , Yi-Zhong Wang PhD , Eileen E. Birch PhD","doi":"10.1016/j.jaapos.2025.104698","DOIUrl":"10.1016/j.jaapos.2025.104698","url":null,"abstract":"<div><h3>Background</h3><div>Surgical and nonsurgical treatments of childhood intermittent exotropia (IXT) often have unsatisfactory results due to poor sensory status. Dichoptic 3D movies may offer a novel treatment designed to reduce suppression, encourage fusion, and engage stereoacuity. Our aim was to assess whether 3D movies are superior to 2D sham movies treatment in treating children with IXT.</div></div><div><h3>Methods</h3><div>In this masked, pilot randomized clinical trial, 41 children aged 3-13 years with spontaneously manifested IXT (triple office distance control score ≥3.00; mean, 3.64 ± 0.72) were assigned to watch dichoptic 3D animated movies or 2D sham movies (3 movies/week, ∼5 hours) for 4 weeks. After completing their treatment assignment, children returned to the masked pediatric eye specialist to reassess IXT control and ocular alignment, with change in triple office distance control score as the primary outcome. Distance and near stereoacuity were also assessed.</div></div><div><h3>Results</h3><div>After 4 weeks of treatment, the 3D movie group showed a significant improvement in mean triple office distance control score (1.39 ± 1.00; <em>P</em> = 0.0002; n = 14); the 2D sham movie group did not (0.62 ± 1.36; <em>P</em> = 0.11; n = 14). The 3D movie group had significantly more improvement in distance control than the sham group (<em>P</em> = 0.049), but near control, ocular alignment, and stereoacuity did not change for either group.</div></div><div><h3>Conclusions</h3><div>In our study cohort, at-home dichoptic 3D animated movie treatment significantly improved IXT triple office distance control scores after 4 weeks, indicating that it might provide an alternative nonsurgical treatment for childhood intermittent exotropia.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104698"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaapos.2025.104688
Islam Y. Swaify MD, Rania A. El Essawy MD, Rana A. Abdelfattah MD, Sameh H. Abdelbaky MD
Purpose
To compare the surgical outcomes of one-stage and two-stage correction of blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) in children <3 years of age.
Methods
This retrospective comparative study included children <3 years with BPES who underwent surgical correction at Cairo University. Medial canthoplasty was performed using the Y-V, C-U, or five-flap technique, while ptosis was corrected by frontalis suspension using polytetrafluoroethylene sling. Patients were divided into one-stage and two-stage groups. Surgical outcomes were assessed based on horizontal palpebral fissure length (HPFL), interpalpebral fissure height (IPFH), inner intercanthal distance (IICD) and IICD/HPFL ratio.
Results
Twenty-four patients were included: 11 in the one-stage group and 13 in the two-stage group. Both groups showed significant postoperative improvements in HPFL, IPFH, IICD and IICD/HPFL (P < 0.005), with no statistically significant difference between them. The two-stage group had a higher proportion of patients with good blepharophimosis outcome (46% vs 27%), whereas the one-stage group showed a higher proportion of good ptosis outcomes (64% vs 46%); however, these differences were not statistically significant. Complications were minimal and comparable between both groups.
Conclusions
Outcomes of one- and two-stage approaches were comparable in our cohort. One-stage correction may be preferable in patients with severe ptosis, although two-stage repair may better address severe blepharophimosis.
{"title":"One-stage versus two-stage surgical correction of blepharophimosis-ptosis-epicanthus inversus syndrome: a retrospective comparative study","authors":"Islam Y. Swaify MD, Rania A. El Essawy MD, Rana A. Abdelfattah MD, Sameh H. Abdelbaky MD","doi":"10.1016/j.jaapos.2025.104688","DOIUrl":"10.1016/j.jaapos.2025.104688","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the surgical outcomes of one-stage and two-stage correction of blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) in children <3 years of age.</div></div><div><h3>Methods</h3><div>This retrospective comparative study included children <3 years with BPES who underwent surgical correction at Cairo University. Medial canthoplasty was performed using the Y-V, C-U, or five-flap technique, while ptosis was corrected by frontalis suspension using polytetrafluoroethylene sling. Patients were divided into one-stage and two-stage groups. Surgical outcomes were assessed based on horizontal palpebral fissure length (HPFL), interpalpebral fissure height (IPFH), inner intercanthal distance (IICD) and IICD/HPFL ratio.</div></div><div><h3>Results</h3><div>Twenty-four patients were included: 11 in the one-stage group and 13 in the two-stage group. Both groups showed significant postoperative improvements in HPFL, IPFH, IICD and IICD/HPFL (<em>P</em> < 0.005), with no statistically significant difference between them. The two-stage group had a higher proportion of patients with good blepharophimosis outcome (46% vs 27%), whereas the one-stage group showed a higher proportion of good ptosis outcomes (64% vs 46%); however, these differences were not statistically significant. Complications were minimal and comparable between both groups.</div></div><div><h3>Conclusions</h3><div>Outcomes of one- and two-stage approaches were comparable in our cohort. One-stage correction may be preferable in patients with severe ptosis, although two-stage repair may better address severe blepharophimosis.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104688"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaapos.2025.104682
Sidratul Rahman MD , Vincent Sun MD , Christine Saint-Martin MD , Daniela Toffoli MD
We report 4 patients with Coffin-Siris syndrome (CSS), all exhibiting midline brain abnormalities and all showing either optic nerve hypoplasia or dysplasia. Each of the patients has a unique pathogenic variant in CSS-related genes, including SMARCA4, SMARCB1, SMARCE1, and ARID2, all of which encode components of the BRG1/BRM-associated factor chromatin remodeling complex. The diversity of mutations highlights the molecular heterogeneity of CSS and its potential link to shared developmental pathways affecting the optic nerve.
{"title":"Optic nerve hypoplasia/dysplasia in Coffin-Siris syndrome: a case series","authors":"Sidratul Rahman MD , Vincent Sun MD , Christine Saint-Martin MD , Daniela Toffoli MD","doi":"10.1016/j.jaapos.2025.104682","DOIUrl":"10.1016/j.jaapos.2025.104682","url":null,"abstract":"<div><div>We report 4 patients with Coffin-Siris syndrome (CSS), all exhibiting midline brain abnormalities and all showing either optic nerve hypoplasia or dysplasia. Each of the patients has a unique pathogenic variant in CSS-related genes, including <em>SMARCA4, SMARCB1, SMARCE1</em>, and <em>ARID2</em>, all of which encode components of the BRG1/BRM-associated factor chromatin remodeling complex. The diversity of mutations highlights the molecular heterogeneity of CSS and its potential link to shared developmental pathways affecting the optic nerve.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104682"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jaapos.2025.104695
Hala ElHilali MD, Ahmed Awadein MD, Rokaya Radwan MD, Jylan Gouda MD, Heba M. Fouad MD
Purpose
To identify the incidence of and risk factors for development of spontaneous consecutive exotropia during management of fully accommodative esotropia with optical correction.
Methods
The medical records of patients who presented with an initial diagnosis of fully accommodative esotropia and converted to exotropia during their management were reviewed retrospectively. Patients with a minimum of 3 years’ follow-up were included. The following data were extracted from the record: age of onset, refractive error, glasses prescription, angles of deviation, visual acuity, and stereoacuity.
Results
A total of 178 children with fully accommodative esotropia were identified. Mean age of esotropia onset was 2.3 ±1.4 years; of initial glasses prescription, 2.9 ± 1.5 years. We calculated the mean spherical equivalent by averaging the values of both eyes for each patient. Mean spherical equivalent of both eyes was +4.3 ± 1.8 D. The mean follow-up was 6.9 ± 3.7 years. Consecutive exotropia developed in 31 children (17.4%) at a mean of 3.5 ± 3.6 years after prescription of spectacles. Children who developed consecutive exotropia had a higher initial spherical error (P = 0.02), higher initial cylindrical error (P = 0.01), and higher prevalence of neurological problems (P = 0.01) on multivariable analysis. Higher prevalence of amblyopia (P < 0.001) and vertical deviation (P < 0.001) were detected in the spontaneous exodeviation group on univariate analysis only. There was no statistically significant difference between spontaneous exotropia following accommodative esotropia and accommodative esotropia groups as a whole in terms of age of onset, the age of initiation of spectacles, angles of deviation, stereoacuity, or the time of initiation of reduction of hyperopic prescription.
Conclusions
High hyperopia (≥5 D), high astigmatic errors (≥1.5 D), and presence of neurological problems are risk factors for development of spontaneous exotropia among accommodative esotropia patients. Long-term follow-up is recommended for patients who have identifiable risk factors.
{"title":"Predictors of nonsurgical consecutive exotropia following accommodative esotropia","authors":"Hala ElHilali MD, Ahmed Awadein MD, Rokaya Radwan MD, Jylan Gouda MD, Heba M. Fouad MD","doi":"10.1016/j.jaapos.2025.104695","DOIUrl":"10.1016/j.jaapos.2025.104695","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify the incidence of and risk factors for development of spontaneous consecutive exotropia during management of fully accommodative esotropia with optical correction.</div></div><div><h3>Methods</h3><div>The medical records of patients who presented with an initial diagnosis of fully accommodative esotropia and converted to exotropia during their management were reviewed retrospectively. Patients with a minimum of 3 years’ follow-up were included. The following data were extracted from the record: age of onset, refractive error, glasses prescription, angles of deviation, visual acuity, and stereoacuity.</div></div><div><h3>Results</h3><div>A total of 178 children with fully accommodative esotropia were identified. Mean age of esotropia onset was 2.3 ±1.4 years; of initial glasses prescription, 2.9 ± 1.5 years. We calculated the mean spherical equivalent by averaging the values of both eyes for each patient. Mean spherical equivalent of both eyes was +4.3 ± 1.8 D. The mean follow-up was 6.9 ± 3.7 years. Consecutive exotropia developed in 31 children (17.4%) at a mean of 3.5 ± 3.6 years after prescription of spectacles. Children who developed consecutive exotropia had a higher initial spherical error (<em>P</em> = 0.02), higher initial cylindrical error (<em>P</em> = 0.01), and higher prevalence of neurological problems (<em>P</em> = 0.01) on multivariable analysis. Higher prevalence of amblyopia (<em>P</em> < 0.001) and vertical deviation (<em>P</em> < 0.001) were detected in the spontaneous exodeviation group on univariate analysis only. There was no statistically significant difference between spontaneous exotropia following accommodative esotropia and accommodative esotropia groups as a whole in terms of age of onset, the age of initiation of spectacles, angles of deviation, stereoacuity, or the time of initiation of reduction of hyperopic prescription.</div></div><div><h3>Conclusions</h3><div>High hyperopia (≥5 D), high astigmatic errors (≥1.5 D), and presence of neurological problems are risk factors for development of spontaneous exotropia among accommodative esotropia patients. Long-term follow-up is recommended for patients who have identifiable risk factors.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104695"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To examine the clinical characteristics and surgical outcomes of patients with Down syndrome (DS) presenting with primary epiphora.
Methods
The medical records of children with DS referred to a tertiary academic children’s hospital between 2013 and 2023 were reviewed, and 63 patients with primary epiphora were included in our analysis. Clinical characteristics, diagnostic findings, and surgical intervention outcomes were analyzed.
Results
Forty-two patients (67%) had epiphora since birth, and 12 patients (19%) developed symptoms after the first year of life. Of the 40 patients who underwent lacrimal syringing, 28 (70%) showed passage, and 12 showed obstruction. Surgical intervention was performed in 18 patients. Either office-based probing under local anesthesia or endoluminal lacrimal duct recanalization (ELDR) with stent intubation under general anesthesia was performed. In the 18 patients who underwent surgery, surgical outcomes were as follows: complete resolution of symptoms in 7 patients, partial resolution in 10 patients, and failure in 1 patient. Dacryoendoscopy revealed dense white fibrous tissue obstructing the mucosal surface of the nasolacrimal duct in several cases, indicating chronic inflammatory changes.
Conclusions
Dacryoendoscopic findings revealed not only stenotic lacrimal passages due to developmental anomalies of the lacrimal drainage system but also fibrous obstruction secondary to chronic inflammation. Surgical intervention limited to probing or ELDR resulted in only partial symptom improvement in two-thirds of patients, without achieving complete resolution.
{"title":"Endoscopic and surgical evaluation of epiphora in children with Down syndrome","authors":"Jutaro Nakamura MD, PhD , Mizuki Asano MD , Tomoko Ohno MD, PhD , Satoshi Goto MD, PhD , Nobuhisa Mizuki MD, PhD , Nozomi Matsumura MD, PhD","doi":"10.1016/j.jaapos.2025.104687","DOIUrl":"10.1016/j.jaapos.2025.104687","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the clinical characteristics and surgical outcomes of patients with Down syndrome (DS) presenting with primary epiphora.</div></div><div><h3>Methods</h3><div>The medical records of children with DS referred to a tertiary academic children’s hospital between 2013 and 2023 were reviewed, and 63 patients with primary epiphora were included in our analysis. Clinical characteristics, diagnostic findings, and surgical intervention outcomes were analyzed.</div></div><div><h3>Results</h3><div>Forty-two patients (67%) had epiphora since birth, and 12 patients (19%) developed symptoms after the first year of life. Of the 40 patients who underwent lacrimal syringing, 28 (70%) showed passage, and 12 showed obstruction. Surgical intervention was performed in 18 patients. Either office-based probing under local anesthesia or endoluminal lacrimal duct recanalization (ELDR) with stent intubation under general anesthesia was performed. In the 18 patients who underwent surgery, surgical outcomes were as follows: complete resolution of symptoms in 7 patients, partial resolution in 10 patients, and failure in 1 patient. Dacryoendoscopy revealed dense white fibrous tissue obstructing the mucosal surface of the nasolacrimal duct in several cases, indicating chronic inflammatory changes.</div></div><div><h3>Conclusions</h3><div>Dacryoendoscopic findings revealed not only stenotic lacrimal passages due to developmental anomalies of the lacrimal drainage system but also fibrous obstruction secondary to chronic inflammation. Surgical intervention limited to probing or ELDR resulted in only partial symptom improvement in two-thirds of patients, without achieving complete resolution.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104687"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Optic pathway gliomas (OPGs) are among the most frequent central nervous system tumors in children with neurofibromatosis type 1 (NF1), yet their prevalence has not been systematically synthesized. Pooled prevalence estimates are important to inform clinical surveillance practices, particularly given the critical role of early symptom detection in preserving vision and the debate regarding magnetic resonance imaging (MRI) surveillance in asymptomatic patients. The purpose of this study was to investigate the prevalence of OPG in children (<18 years) with NF1 based on pooled data in the literature and describe its variability.
Methods
The databases of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched without language or date restrictions. Eligible studies reported OPG prevalence in patients with NF1 <18 years of age. Two reviewers independently screened studies, extracted data, and assessed quality. Studies meeting minimum methodological quality were included in our meta-analysis, and subgroup and meta-regression analyses were performed.
Results
A total of 38 studies encompassing 6,314 patients were included in the qualitative synthesis; 27 studies (5,485 patients) were subject to meta-analysis. The pooled prevalence of optic pathway gliomas was 17% (95% CI, 14%-20%), with low certainty according to GRADE. Subgroup analysis found no significant association in reported rates across MRI surveillance strategies, and a focused meta-regression directly comparing routine and symptom-based approaches showed similar results. Analyses by continent, sample size, and quality score revealed no significant differences.
Conclusions
Our results provide the first pooled evidence prevalence estimate of OPG in children and adolescents with NF1 and highlight the importance of close monitoring, reinforcing guidelines that favor a symptom-based MRI approach and suggesting no clear advantage of routine imaging.
背景：视神经胶质瘤（OPGs）是1型神经纤维瘤病（NF1）患儿中最常见的中枢神经系统肿瘤之一，但其患病率尚未系统综合。综合患病率估计对于临床监测实践非常重要，特别是考虑到早期症状检测在保护视力方面的关键作用以及关于无症状患者的磁共振成像（MRI）监测的争论。本研究的目的是调查儿童OPG的患病率(方法：检索PubMed、Embase、Scopus、Web of Science和Cochrane CENTRAL数据库，无语言和日期限制。合格的研究报告了NF1患者的OPG患病率。结果：定性综合纳入了38项研究，包括6314名患者；27项研究（5485例患者）纳入meta分析。视神经胶质瘤的总患病率为17% (95% CI, 14%-20%)，根据GRADE，确定性较低。亚组分析发现，MRI监测策略中报告的发病率没有显著关联，直接比较常规方法和基于症状的方法的集中meta回归显示了相似的结果。大陆、样本量和质量评分的分析显示没有显著差异。结论：我们的研究结果首次提供了NF1儿童和青少年OPG患病率的综合证据估计，强调了密切监测的重要性，强化了基于症状的MRI方法的指南，并表明常规成像没有明显的优势。
{"title":"Prevalence of optic pathway glioma in NF1: a systematic review and meta-analysis focused on MRI surveillance","authors":"Michail Angelos Gkikas MD, MSc , Anna Nikolaidou MD, MSc , Athanasia Sandali MD , Konstantinos Benekos MD, MSc , Ioannis Tsinopoulos MD, PhD , Lampros Lamprogiannis MD, PhD","doi":"10.1016/j.jaapos.2025.104701","DOIUrl":"10.1016/j.jaapos.2025.104701","url":null,"abstract":"<div><h3>Background</h3><div>Optic pathway gliomas (OPGs) are among the most frequent central nervous system tumors in children with neurofibromatosis type 1 (NF1), yet their prevalence has not been systematically synthesized. Pooled prevalence estimates are important to inform clinical surveillance practices, particularly given the critical role of early symptom detection in preserving vision and the debate regarding magnetic resonance imaging (MRI) surveillance in asymptomatic patients. The purpose of this study was to investigate the prevalence of OPG in children (<18 years) with NF1 based on pooled data in the literature and describe its variability.</div></div><div><h3>Methods</h3><div>The databases of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched without language or date restrictions. Eligible studies reported OPG prevalence in patients with NF1 <18 years of age. Two reviewers independently screened studies, extracted data, and assessed quality. Studies meeting minimum methodological quality were included in our meta-analysis, and subgroup and meta-regression analyses were performed.</div></div><div><h3>Results</h3><div>A total of 38 studies encompassing 6,314 patients were included in the qualitative synthesis; 27 studies (5,485 patients) were subject to meta-analysis. The pooled prevalence of optic pathway gliomas was 17% (95% CI, 14%-20%), with low certainty according to GRADE. Subgroup analysis found no significant association in reported rates across MRI surveillance strategies, and a focused meta-regression directly comparing routine and symptom-based approaches showed similar results. Analyses by continent, sample size, and quality score revealed no significant differences.</div></div><div><h3>Conclusions</h3><div>Our results provide the first pooled evidence prevalence estimate of OPG in children and adolescents with NF1 and highlight the importance of close monitoring, reinforcing guidelines that favor a symptom-based MRI approach and suggesting no clear advantage of routine imaging.</div></div>","PeriodicalId":50261,"journal":{"name":"Journal of Aapos","volume":"29 6","pages":"Article 104701"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号